Given a year-long siege by the corona virus, the defenses in another, older war are stalling.
For the past two decades, HIV / AIDS has been kept in check through effective antiviral drugs, aggressive testing, and inventive public awareness campaigns. But the COVID-19 pandemic has caused profound disruption in almost every aspect of this struggle, grounding emergency teams, severely restricting testing, and diverting critical personnel away from laboratories and medical centers.
The exact effects of one pandemic on another are still under focus, but preliminary evidence is bothering experts who have hailed tremendous advances in HIV treatment. While the shift in priorities is nationwide, delays in testing and treatment are particularly risky in the southern states, which are now the epicenter of the country’s HIV crisis.
“This is a major derailment,” says Dr. Carlos del Rio, professor of medicine at Emory University in Atlanta and head of the Emory AIDS International Training and Research Program. “There will be damage. The question is how much? “
Clinics have limited personal visits and doctor’s offices as well Emergency rooms have stopped routine HIV screening, with doctors relying instead on video calls with patients, a pointless alternative for the homeless who fear family members will discover their status. Rapid test vehicles that were once parked in front of nightclubs and bars distributing condoms are being mothballed. In the state’s capitals and county cities, government expertise has focused solely on the COVID-19 response on deck.
Specific signs of the effects on HIV surveillance abound: A large commercial laboratory In the United States, nearly 700,000 fewer HIV screening tests were reported – a 45% decrease – and 5,000 fewer diagnoses than in the same period last year. The prescriptions for PrEP, a pre-exposure prophylaxis that can prevent HIV infection, are loud new research presented at a conference last month. State health departments saw similarly sharp decreases in tests.
This lack of new data has led to a precarious, unrecognizable moment: for the first time in decades, the country’s lauded HIV surveillance system is blind to the virus’ movement.
Nowhere will the lack of data be more palpable than in the south: the region is responsible for 51% of new infections, 8 of the 10 states with the highest rate of new diagnoses and half of all HIV-related deaths latest available data from the Centers for Disease Control and Prevention.
Even before the COVID-19 pandemic Georgia had the highest rate of new HIV diagnoses The Georgia Department of Health last spring saw a 70% decrease in tests compared to spring 2019.
The slowdown in HIV patient services “was felt for years,” says Dr. Melanie Thompson, principal researcher at the AIDS Research Consortium in Atlanta.
She adds, “Any new HIV infection continues the epidemic and is likely to be passed on to one or more people in the coming months if people are not diagnosed and offered HIV treatment.”
Coronavirus testing has commanded the machines previously used for HIV testing and has further weighed on surveillance efforts. The polymerase chain reaction or PCR machines that are used to detect and measure the genetic material in human immunodeficiency virus are the same machines that run coronavirus tests around the clock.
Over the decades as HIV migrated inland from coastal cities like San Francisco, Los Angeles, and New York, it took root in the south, where poverty is endemic, poor health insurance is common, and HIV stigma is rampant.
“There is the stigma that is real. There is legacy racism, “says Dr. Thomas Giordano, medical director of the Thomas Street Health Center in Houston, one of the largest HIV clinics in the United States. The state’s political leaders, he says, view HIV as “a disease of the poor, black, Latino and gay. It’s just not mainstream at the state level. “
Blacks make up 13% of the US population, but about 40% of HIV cases – and deaths. In many southern states, the differences are large: In Alabama, the black people are responsible 27% of the population and 72% of the new diagnoses;; In Georgia, the blacks are making amends 33% of the population and 69% of people living with HIV.
HIV clinics that care for low-income patients also face restrictions on the use of video and phone appointments. Clinic directors say poor patients often lack data plans and that many homeless patients simply do not have phones. You also have to struggle with fear. “If a friend gives you a room to sleep in and your friend finds out you have HIV, you may lose that place to sleep,” says Del Rio of Emory University.
Texting can also be difficult. “We have to be careful with text messages,” says Dr. John Carlo, CEO of Prism Health North Texas in Dallas. “When someone sees their phone, it can be devastating.”
In Mississippi, HIV exposure tracing, which has been used as a model for some local coronavirus tracking efforts, has been limited by coronavirus-related travel restrictions that are “designed to protect both staff and customers,” said Melverta Bender, director the STD / HIV office at the Mississippi Department of Health.
Of all regions in the United States, the south has the weakest health protection networks. And southern states have far fewer resources than states like California and New York. “Our public health infrastructures have been chronically underfunded and undermined over the decades,” said Thompson, the Atlanta researcher. “So we will deteriorate by many key figures.”
The high rate of HIV infection in Georgia and the slow pace of COVID-19 vaccinations in the state are “not independent of each other,” Thompson said.
The porous safety net extends to health insurance, a vital need for people living with HIV. Almost half of Americans have no health insurance live in the southwhere many states have not expanded Medicaid under the Affordable Care Act. As a result, many people living with HIV can rely on the Ryan White Federal HIV / AIDS Program and Government AIDS Drug Assistance Programs (ADAPs), which have limited coverage.
“For the sake of equity, insurance is vital to the lives and thriving of people living with HIV,” said Tim Horn, director of health care access for NASTAD, the National Alliance of State and Territorial AIDS Directors. Ryan White and ADAPs “are unable to provide this comprehensive coverage,” he says.
Roshan McDaniel, ADAP program manager in South Carolina, says 60% of South Carolinians enrolled in ADAP would qualify if their state expanded Medicaid. “We thought about it for the first few years,” says McDaniel. “We don’t even think about it these days.”
Admission to the Ryan White program skyrocketed in the early months of the pandemic as state economies froze and Americans huddled amid a severe pandemic. Data from state health authorities reflect the increased demand. 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 increased enrollment to pandemic-related job losses, particularly in states where Medicaid has not been expanded. 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 virus mutations and drug resistance.
However, qualifying for government assistance is difficult: approval can take up to two months, and lack of documentation can result in coverage being canceled.
Southern states have generally lagged behind when it comes to getting patients to health care and suppressing their viral loads, and people with HIV infection tend to go undiagnosed there longer than elsewhere, according to federal health experts. In Georgia, for example almost 1 in 4 people Those who learned they were infected developed AIDS within a year, indicating that their infections had not been diagnosed for a long time.
As COVID-19 vaccinations become widespread and restrictions wear off, the directors of the HIV clinic search their patient lists to determine who to see first. “We look at how many people haven’t seen us in over a year. We think it’s over several hundred. They moved? Have you moved providers? “Says Carlo, the doctor and CEO of Healthcare in Dallas. “We don’t know what the long-term consequences will be.”
Kaiser Health News produces extensive journalism on health policy topics. In addition to policy analysis and surveys, KHN is one of the three main programs of the Kaiser Family Foundation, a non-profit foundation, and not affiliated with Kaiser Permanente.
