Let’s use the lessons of COVID to end HIV

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Much has been written and will continue to be written about the victories and failures of America’s battle against COVID-19. There is already a large consensus that the pandemic has taught our healthcare system a lot about tackling a deadly highly contagious virus, and we hope it will. better prepare for the next threat of infectious disease. But as medical providers working in HIV prevention, we say that we should not wait to put these lessons into practice; We need to apply some of the urgency and innovation we put into tackling the raging hell of the COVID pandemic to smother the smoldering embers of the still deadly HIV / AIDS epidemic.

The HIV / AIDS community has achieved heroic and vital victories, with drugs that make HIV a survivable chronic disease. When taken correctly, these treatments can make the infection non-communicable. When pre-exposure prophylaxis (PrEP) is taken as prescribed by HIV-negative people, it provides almost perfect protection against contracting the virus.

HIV infections and AIDS deaths have declined steadily, and this deserves to be celebrated. Nonetheless, there are new infections every day here in the United States and around the world. Despite treatment and PrEP, there are still so many people who lack access and education around HIV and its prevention. Here has Nurx, when we order home HIV tests and prescribe PrEP, we need to inform a newly infected patient of their status at least twice a week, or about 100 times a year. It’s never an easy call to make.

We often hear people asking if HIV still exists, which makes us angry, not at the person asking the question, but at public health authorities and the media silence around HIV. In the United States, there are approximately 1.2 million people living with HIV and 14 percent of these do not know they have it. The lack of testing and the persistence of stigma keep this population in the shadows.

In 2018, the approximately 36,400 new HIV infections in the United States were mainly found in the southern states and were not evenly distributed across the population. Indeed, testing, prevention and treatment are not reaching those who need it most: men who have sex with men, black and Latin Americans, and transgender people. That being said, education needs to be shared with all groups because statistics don’t matter when you are the one affected, and we often fail women when we exclude them from the discussion. Whenever we have to tell a cisgender woman that she is HIV positive, she is completely shocked and often never thought that was even a possibility. These are women like a student at a prestigious university who was so ill that she had full blown AIDS when she was diagnosed, but none of the (many) doctors she had seen about her illness. hadn’t thought of testing her for HIV. Or the divorced grandmother in her 60s who contracted HIV from a single sexual encounter at her college reunion.

After what we saw last year, it’s hard not to see the persistence of HIV in the United States as a failure of willpower. COVID has shown that our healthcare system can quickly reorganize itself to create drive-thru testing centers in sports stadiums, a high-speed vaccination effort and public education efforts that got everyone talking about it. antibodies, antigens and viral load just as easily as them. I mentioned the weather once. We can certainly make the much less disruptive effort required to end HIV. Here’s how:

  • Test, test, test. With COVID, we have seen that frequent testing, including that of asymptomatic people and especially those working or living in high-risk environments, was essential to contain the virus until a vaccine arrived. Healthcare providers should assume that patients need an HIV test, unless they know otherwise. Healthcare providers often do not offer HIV testing to patients they suspect are not at risk, and patients do not know how to ask for it. Going forward, we should think more like the University of Chicago Medical Center, which set up a combined HIV / COVID testing site for the public during the pandemic.
  • Destigmatize. Healthcare providers haven’t judged or humiliated people for the COVID infection, whether they caught him doing essential work or attending a high-risk social gathering out of human need of interpersonal connection. Likewise, we should de-stigmatize HIV and the ways people get it. Health care providers may be uncomfortable talking about sex, and when their schedules are only 15 minutes per patient, there may be “no time” to have the crucial conversations about. the sex life of a patient. The combination of these two things can leave the patient without the care they should be receiving, in a system that does not standardize and prioritize sexual health as an essential part of comprehensive care. All people should be asked about their sexual health so that they can be tested for HIV at the frequency that is convenient for them, and be prescribed PrEP if their sex life puts them at risk of contracting HIV.
  • Meet the people where they are. During COVID, we brought tests and vaccines to stadiums, schools, supermarkets and more. So let’s make it easier to prevent and treat HIV by doing testing and prevention outside of the clinic and meeting people where they are. Patients who need HIV testing and prevention face too many barriers to getting care. The first hoop is finding a supplier they can trust. Imagine living in a small town where everyone knows you and your family, or where the lab technician or pharmacist is also a member of your religious community. The shame and fear associated with sex prevent many people from seeking face-to-face care.

Telehealth is an essential means of providing people with informed, non-judgmental HIV prevention. Telehealth allows them to contact a care provider anytime, day or night, from their ubiquitous smartphone to request an HIV test or a prescription for PrEP. Telehealth allows a patient who thinks they need an HIV test, or is interested in PrEP, to make that request as soon as they think about it and feel empowered to do so – no research. ” a clinic, waiting for an appointment, taking time off work for it, or letting shame or stigma lead them to cancel the appointment. Home HIV tests and PrEP drugs can then be shipped to the patient’s door in discreet packaging, and communications with medical providers can take place from the comfort and convenience of the patient’s home.

But to harness the potential of telehealth to make HIV prevention accessible, we need policy changes. One is to change laws that prohibit telehealth providers from providing care across state lines. Recognizing that medical providers can effectively provide preventive care to patients across state borders or time zones will improve access to the best HIV care (often concentrated in cities) to those who need it most (those in the cities). poor rural areas). During the pandemic, these requirements were lifted, dramatically reducing the burden on clinics and keeping patients at home when it was the safest place.

Another way to make this vital and cost-effective care more accessible is to improve reimbursements for telehealth. State laws that require that care begin at the clinic, or that a patient has a prior relationship with a health care provider before telehealth can be provided or reimbursed, create an often insurmountable barrier to access. for populations who need it most, face stigma and, in many cases, are at higher risk of contracting HIV.

The city of San Francisco has seen particularly low COVID rates compared to other dense cities, which has been attributed to a public health infrastructure that has learned hard lessons from the AIDS epidemic and was ready to ring the alarm early, to test and contract the trace when a new virus has appeared. 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 in all communities across the country.

This is an opinion and analysis article; the opinions expressed by the author or authors are not necessarily those of American scientist.

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