Wednesday, April 21, 2021 (Kaiser News) – Facing a one-year siege since coronavirus, the defenses in another older war are faltering.
For the past two decades, HIV/ AIDS has been kept at bay thanks to powerful antiviral drugs, aggressive testing and inventive public education campaigns. But the COVID-19 pandemic it has caused profound disruptions in almost every aspect of this battle, putting outreach equipment on the ground, drastically reducing testing and diverting critical staff from laboratories and medical centers.
The exact impact of one pandemic on another is still coming into focus, but preliminary evidence worries experts who have celebrated the huge advances HIV treatment. Although the change in priorities is taking place across the country, delays in testing and treatment pose particularly serious risks in the southern states, now the epicenter of the nation’s HIV crisis.
“This is a major derailment,” Dr. Carlos del Rio, professor of medicine at Emory University in Atlanta and head of the emory AIDS International Training and Research Program. “It simply came to our notice then. The question is: how much? ”
Clinics have limited face-to-face visits and have stopped the routine HIV detection to medical consultations and emergencies, with doctors relying on video calls with patients, a useless alternative for the homeless or who fear relatives will find out about their condition. Vans that do quick tests that once parked outside nightclubs and bars and handed out condoms stay sick. And, in state capitals and county headquarters, government experience has focused individually on the practical response of COVID.
These are specific signs of the impact on HIV surveillance: a large commercial laboratory reported nearly 700,000 fewer HIV detection nationwide testing (a 45% drop) and 5,000 fewer diagnoses between March and September 2020, compared to the same period last year. Prescriptions of PrEP, a pre-exposure prophylaxis that can prevent HIV infection, has also fallen sharply, according to new research presented at a conference last month. State public health departments have recorded similar declines in testing.
This lack of new data has led to a precarious and unrecognizable moment: for the first time in decades, the nation’s lauded HIV surveillance system is blind to the virus’s movement.
Nowhere will the lack of data be noticed more deeply than in the south: the region accounts for 51% of new infections, eight of the ten states with the highest rates of new diagnoses and half of HIV-related deaths. the latest data available at the Centers for Disease Control and Prevention.
Even before the COVID pandemic, Georgia had the highest rate of new HIV diagnoses in any state, though lower than in Washington, DC. The Georgia Department of Public Health saw a 70% drop in tests last spring compared to the spring of 2019.
The slowdown in services for HIV patients “could be felt for years,” said Dr. Melanie Thompson, a principal investigator with the Atlanta AIDS Research Consortium.
He added: “Each new HIV infection perpetuates the epidemic and will likely be transmitted to one or more people in the coming months if they are not diagnosed and offered HIV treatment.”
Coronavirus tests has ordered the machines previously used for HIV /AIDS tests, further straining surveillance efforts. The polymerase chain reaction (PCR) machines used to detect and measure the genetic material of the human immunodeficiency virus are the same machines that perform COVID testing 24 hours a day.
Over the decades, as HIV migrated inland from coastal cities such as San Francisco, Los Angeles and New York, it took root in the south, where poverty is endemic, lack of health coverage is common. and HIV stigma is widespread.
“It simply came to our notice then. There is inherited racism, “said Dr. Thomas Giordano, medical director of the Thomas Street Health Center in Houston, one of the largest HIV clinics in the U.S.” The state’s political leaders said they believe HIV is “a disease of the poor, blacks, Latinos and gays. It’s just not a general statewide trend. “
Blacks make up 13% of the American population, but about 40% of HIV cases and deaths. In many southern states, disparities are strong: in Alabama, black residents make up 27% of the population and 70% of new diagnoses; in Georgia, blacks make up 33% of residents and 69% of people with HIV.
HIV clinics that care for low-income patients also have limitations through video and phone appointments. Clinic directors say poor patients often don’t have data plans and many homeless patients simply don’t have phones. They must also fight with fear. “If a friend gave you a room to sleep and your friend finds out you have HIV, you may lose that place to sleep,” he said of Emory University’s Rio.
Text messaging can also be tricky. “We have to be careful about text messages,” Dr. John Carlo, CEO of PRISM Health Care North Texas in Dallas. “If someone sees their phone, it can be devastating.”
In Mississippi, HIV contact screening – which was used as a model for some local coronavirus screening efforts – has been limited by COVID-related travel restrictions designed to “protect both staff and clients.” “said Melverta Bender, director of the ARE YOU/ HIV Office at the Mississippi State Department of Health.
Of all the regions in the US, the south has the weakest health 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’re going to get worse by a lot of metrics.”
Georgia’s high HIV infection rate and the state’s slow rate of COVID vaccines “They have no relationship,” Thompson said.
The porous safety net extends to health insurance, a vital necessity for people living with HIV. Nearly half of Americans without health coverage live in the south, where many states have not expanded Medicaid under the Affordable Care Act. This causes many people with HIV to rely on the federal Ryan White HIV / AIDS program and state AIDS drug assistance programs, known as ADAP, which offer limited coverage.
“As a matter of fairness, insurance is critical for people to live and thrive on HIV,” said Tim Horn, director of access to health care at NASTAD, the national alliance of territorial directors. of AIDS. Ryan White and the ADAP “are not equipped to offer comprehensive comprehensive care,” he said.
Roshan McDaniel, manager of South Carolina’s ADAP program, says 60% of South Carolinians enrolled in ADAP would qualify if their state expanded Medicaid. “In the early years, we thought about it,” McDaniel said. “We don’t even think about it.”
Enrollment in the Ryan White program jumped during the early months of the pandemic, when state economies froze and Americans fell in the midst of a pandemic grind. Data from state health departments reflect the growing need. In Texas, enrollment in the state AIDS drug program increased 34% from March to December 2020. In Georgia, enrollment increased 10%.
State health officials attribute the increase in enrollment to the loss of pandemic-related jobs, especially in states that do not expand Medicaid. Antiretroviral treatment, the established regimen that suppresses the amount of virus in the body and prevents AIDS, costs up to $ 36,000 a year and drug interruptions can lead to viral mutations and drug resistance. But qualifying for state aid is difficult: approval can take up to two months and lack of paperwork can lead to cancellation of coverage.
Federal health experts say southern states have generally lagged behind getting medical care for patients and suppressing their viral loads, and people with HIV infections tend not to be diagnosed longer than in other regions. . In Georgia, for example, nearly 1 in 4 people who knew they were infected developed AIDS within a year, indicating that their infections had not been diagnosed.
As vaccines become available and restrictions are reduced, directors of HIV clinics go through patient lists to determine who to see first. “We are seeing how many people have not seen us in more than a year. We believe they are over several hundred. Did they move? Did they move suppliers? said Carlo, the Dallas physician and director general of health. “We don’t know what the long-term consequences will be.”
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