Much has been written about the victories and failures of the American fight against COVID-19 and will make us better prepared for the next infectious disease threat. But as medical providers involved in HIV prevention, we say we shouldn’t wait to put these lessons into practice. We must apply some of the urgency and innovation we are using to fight the raging inferno of the COVID pandemic to stifle the smoldering embers of the still deadly HIV / AIDS epidemic.
The HIV / AIDS community has achieved heroic, life-saving victories with drugs that make HIV a viable chronic disease. When taken properly, these treatments can make the infection non-communicable. If pre-exposure prophylaxis (PrEP) is taken as prescribed by HIV-negative people, this offers almost perfect protection against infection with the virus.
Both HIV infections and AIDS deaths have steadily declined, and this is to be celebrated. Even so, there are new infections every day here in the US and around the world. Despite treatments and PrEP, there is still a lack of access and education about HIV and its prevention. Here, at Nurx, where we order home HIV tests and prescribe PrEP, we have to inform a newly infected HIV patient about their status at least twice a week, about 100 times a year. This is never an easy phone call.
We often hear people asking if HIV still exists, which makes us angry – not at the person asking, but at health officials and the media’s silence about HIV. There are about 1.2 million people living with HIV in the United States, and 14 percent of them don’t know they have it. A lack of testing and persistent stigma keep this population in the shadows.
In 2018, the roughly 36,400 new HIV infections in the US were predominantly in southern states and not evenly distributed across the population. This is because testing, prevention, and treatment don’t get to those who need it most: men who have sex with men, Black and Latin American Americans, and transgender people. That being said, education needs to be shared with all groups as statistics don’t matter if you are concerned and we women often fail when we take them out of the discussion. Whenever we have to tell a cisgender woman that she is HIV positive, she is completely shocked and often has not thought that this is even possible. These are women like a student at a prestigious university who was so sick that she had AIDS at the time of diagnosis, but none of the (many) doctors she had consulted about her illness had thought of checking her out for HIV to test. Or the divorced grandmother in her 60s who contracted HIV in a single sexual encounter at their college get-together.
From what we have seen over the past year, it is hard not to see the persistence of HIV in the US as a failure of will. COVID has shown our health system can quickly reorganize to create drive-through testing centers in sports stadiums, a warp-speed vaccine effort, and public awareness campaigns with everyone talking about antibodies, antigens, and viral loads as easily as they do. d chatted once about the weather. We can certainly put in the much less disruptive efforts necessary to end HIV. Here’s how:
- Test, test, test. With COVID, we’ve seen that frequent testing, including that of asymptomatic people, and especially those who work or live in high-risk environments, was essential to contain the virus until a vaccine hit the market. Healthcare professionals should assume that patients will need an HIV test unless they know otherwise. Medical providers often do not offer HIV testing to patients who they believe are not at risk, and patients do not know what to ask. Going forward, we should think more like the University of Chicago Medical Center, which opened a combined HIV / COVID testing site for the public during the pandemic.
- Destigmatize. Healthcare providers did not judge or shame people for COVID infection – whether they caught them doing important work or attending a high-risk social gathering out of a human need for interpersonal connection. Likewise, we should de-stigmatize HIV and the way people get infected with it. Healthcare providers can be uncomfortable talking about sex, and if their schedule is only 15 minutes per patient, there may be “no time” to have the crucial conversations about a patient’s sex life. The combination of the two things can result in the patient being left without the care they should receive within a system that does not normalize sexual health and is an integral part of comprehensive care. All People should be asked about their sexual health so they can get tested for HIV at the frequency that is right for them and have PrEP prescribed if their sex life is at risk for HIV.
- Meet people where they are. During COVID, we’ve brought tests and vaccines to stadiums, schools, supermarkets, and more. So let’s make HIV prevention and treatment that easy by doing testing and prevention outside of the clinic and meeting people where they are. Patients in need of HIV testing and prevention face too many hurdles to receive care. The first step is to find a provider they can trust. Imagine you live in a small town where everyone knows you and your family or where the laboratory technician or pharmacist is also a member of your parish. The shame and fear associated with sex prevent many from seeking personal help.
Telemedicine is an essential way of giving people informed, non-judgmental HIV prevention. Telemedicine enables them to use their ubiquitous smartphone to contact a doctor at any time, day or night, to request an HIV test or a prescription for PrEP. Telemedicine enables a patient who thinks they need an HIV test or who is interested in PrEP to submit this application as soon as they think about it and feel empowered – no searching for a clinic, waiting for an appointment, Taking away from work or being tempted to cancel the appointment out of shame or stigmatization. Home HIV testing and PrEP medication can then be sent to the patient’s door in discreet packaging, and communication with health care providers can be conveniently and conveniently from home.
But in order to exploit the potential of telemedicine to make HIV prevention accessible, we need political changes. One is to change laws that prohibit telemedicine providers from providing nationwide care. Recognition that healthcare providers can provide effective preventive care to patients across state or time zones will improve access to the best HIV treatment (often urban-centered) for those who need it most (those in poor, rural areas) . These requirements were waived during the pandemic, which drastically reduced the burden on clinics and kept patients at home when it was the safest place.
Another way to make this life-saving and cost-saving care more accessible is to improve reimbursements for telemedicine. State laws requiring that care begin at the clinic or that a patient have a prior relationship with a medical provider before telemedicine can be provided or reimbursed create an often insurmountable barrier to access for populations who need it most face stigma and, in many cases, have a higher risk of HIV.
The city of San Francisco had particularly low rates of COVID compared to other densely populated cities, which was attributed to a public health infrastructure that learned hard lessons from the AIDS epidemic and was ready to raise the alarm, test the tracking, and shut down early instruct when a new virus has surfaced. Now let’s turn that around and take what the health system as a whole has learned from COVID and apply it to accelerate the end of HIV all Parishes across the country.
This is an opinion and analysis article; the views of the views Author or authors are not necessarily those of Scientific American.