Strides Against HIV/AIDS Falter During Pandemic

By Sarah Varney, Kaiser Health News

Wednesday April 21, 2021 (Kaiser News) – Faced with a year-long siege from the coronavirus, the defenses of another older war are faltering.

Over the past two decades, HIV / AIDS has been kept at bay by powerful antiviral drugs, aggressive testing and inventive public education campaigns. But the COVID-19 pandemic has caused profound disruption in almost every aspect of that battle, entrenching outreach teams, drastically cutting testing and diverting critical staff from labs and medical centers.

The exact impact of one pandemic on another is still unclear, but preliminary evidence is troubling experts who have celebrated the huge advances in HIV treatment. While the shift in priorities affects the whole country, delays in testing and treatment carry particularly serious risks in southern states, now the epicenter of the country’s HIV crisis.

“This is a major derailment,” said Dr. Carlos del Rio, professor of medicine at Emory University in Atlanta and head of the international Emory AIDS training and research program. “There will be damage. The question is how much? “

Clinics have limited in-person visits and have discontinued routine HIV testing in doctor’s offices and emergency rooms, with doctors relying instead on video calls with patients, a futile alternative for those who are homeless or who fear that their family members will find out about their status. Rapid test vans that once parked outside nightclubs and bars and handed out condoms are being put on standby. And, in state capitals and county seats, government expertise has focused solely on the practical COVID response.

Concrete signs of the impact on HIV surveillance abound: a large commercial laboratory reported nearly 700,000 fewer HIV tests across the country – a 45% drop – and 5,000 fewer diagnoses between March and September 2020, compared to the same period the previous year. Prescriptions for PrEP, a pre-exposure prophylaxis that can prevent HIV infection, have also dropped sharply, according to a new study presented at a conference last month. State health departments have seen similarly sharp declines in testing.

This dearth of new data has led to a precarious and unknowable moment: For the first time in decades, the country’s rented HIV surveillance system is blind to the movement of the virus.

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Nowhere will the lack of data be felt more profoundly than in the South: the region accounts for 51% of all new infections, eight of the 10 states with the highest rates of new diagnoses, and half of all deaths related to the disease. HIV, according to the most recent data available from the Centers for Disease Control and Prevention.

Even before the COVID pandemic, Georgia had the highest rate of new HIV diagnoses of any state, although it was lower than Washington, DC The Georgia Department of Public Health recorded a drop in 70% of tests last spring compared to spring 2019.

The slowdown in services to HIV patients “could linger for years,” said Dr. Melanie Thompson, principal investigator with the Atlanta AIDS Research Consortium.

She added: “Each new HIV infection perpetuates the epidemic and will likely be passed on to one or more people in the months to come if people go undiagnosed and do not receive HIV treatment.”

Coronavirus testing requisitioned machines previously used for HIV / AIDS testing, further straining surveillance efforts. The polymerase chain reaction – or PCR – machines used to detect and measure the genetic material of the human immunodeficiency virus are the same machines that run COVID tests around the clock.

Over the decades, as HIV has migrated inland from coastal cities like San Francisco, Los Angeles and New York, it has taken root in the south, where poverty is rampant, lack of health coverage. is common and HIV stigma is pervasive.

“There is the stigma that is real. There is a racist legacy, ”said Dr Thomas Giordano, medical director of Thomas Street Health Center in Houston, one of the largest HIV clinics in the United States. Blacks, Latinos and gays. This is just not common at the state level. “

Blacks make up 13% of the American population but about 40% of HIV cases – and deaths. In many southern states, the disparities are striking: in Alabama, black residents account for 27% of the population and 70% of new diagnoses; in Georgia, blacks represent 33% of residents and 69% of people living with HIV.

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HIV clinics that serve low-income patients also face limitations in using video and telephone appointments. Clinic directors say poor patients often lack data plans and many homeless patients simply don’t have phones. They also have to fight against fear. “If a friend gives you a room to sleep in and your friend finds out that you are HIV positive, you may lose that place to sleep,” said del Rio of Emory University.

Sending text messages can also be tricky. “We have to be careful with text messages,” said Dr. John Carlo, general manager of PRISM Health Care North Texas in Dallas. “If someone sees their phone it can be devastating.”

In Mississippi, HIV contact tracing – which has been used as a model for some local efforts to track the coronavirus – has been limited by COVID-related travel restrictions intended to “protect both staff and the customer.” said Melverta Bender, director of the STD / Office of HIV at the Mississippi State Department of Health.

Of any region in the United States, the South has the weakest safety nets. And southern states have far fewer resources than states like California and New York. “Our public health infrastructure has been chronically underfunded and undermined over the decades,” said Thompson, the Atlanta researcher. “So we are doing worse according to many indicators.”

Georgia’s high rate of HIV infection and the slow pace of state COVID vaccinations “are not unrelated,” Thompson said.

The porous safety net extends to health insurance, a vital need for people living with HIV. Nearly half of Americans without health coverage live in the south, where many states have not extended Medicaid under the Affordable Care Act. This leaves many HIV-positive people dependent on the federal Ryan White HIV / AIDS program and state-run AIDS drug assistance programs, known as ADAP, which offer limited coverage.

“For the sake of fairness, insurance is essential for people to live and thrive with HIV,” said Tim Horn, director of access to health care at NASTAD, the National Alliance of Health Managers. State and local authorities in the fight against AIDS. Ryan White and ADAPs “are not equipped to provide this full range of comprehensive care,” he said.

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Roshan McDaniel, head of the ADAP program in South Carolina, says 60% of South Carolinians enrolled in ADAP would be eligible if his state developed Medicaid. “The first few years we thought about it,” McDaniel said. “We don’t even think about it these days.”

Enrollment in the Ryan White program jumped in the early months of the pandemic as state economies froze and Americans crouched down in the midst of a gruesome pandemic. State health service data reflects the increased need. In Texas, enrollments in the state’s AIDS program increased 34% from March to December 2020. In Georgia, enrollments jumped 10%.

State health officials attribute the increase in enrollments to job losses linked to the pandemic, especially in states that have not developed Medicaid. Antiretroviral therapy, the established regimen that removes the amount of virus in the body and prevents AIDS, costs up to $ 36,000 per year, and treatment interruptions can lead to viral mutations and drug resistance. But it’s hard to qualify for state aid: approval can take up to two months, and missing documents can result in cancellation of coverage.

Federal health experts say southern states have generally fallen behind in getting patients to receive medical care and suppress their viral loads, and people with HIV tend not to be diagnosed longer than in other regions. In Georgia, for example, nearly one in four people who found out they were infected developed AIDS within a year, indicating that their infections have been undiagnosed for a long time.

As vaccinations become widely available and restrictions ease, managers of HIV clinics go through their patient lists to determine who to see first. “We’re looking at the number of people who haven’t seen us for over a year. We think it’s over several hundred. Have they moved? Have they moved suppliers? Said Carlo, the doctor and CEO of healthcare in Dallas. “We don’t know what the long term consequences will be.”

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Along with policy analysis and surveys, KHN is one of the three main operational programs of the KFF (Kaiser Family Foundation). KFF is a non-profit organization with information on health issues across the nation.

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