Report Cites Addressing Health Disparities to End HIV Epidemic

Researchers, advocates, and other stakeholders are urging for care to be expanded to overcome barriers in high-risk populations to address the HIV epidemic, as part of a series published in The Lancet HIV in the USA Series.

The series features literature reviews, commentaries, and data analyses outlining recommendations to overcome barriers to implementing HIV services, such as counseling, testing, treatment, pre-exposure prophylaxis (PrEP), and syringe services programs. These services are critical to preventing new HIV transmissions and helping people living with HIV achieve and maintain a “durably undetectable” viral load, or the amount of HIV in the blood.

Maintaining an undetectable viral load both preserves individual health and eliminates the risk of sexually transmitting the virus to others, or Undetectable = Untransmittable (U=U). Leveraging these services and addressing structural barriers make the Ending the HIV Epidemic: A Plan for America (EHE) goals attainable and important, even with the challenges and health disparities of coronavirus disease 2019 (COVID-19), according to the study authors.

“Scientific advances have transformed the course of HIV in individuals. To transform the course of the epidemic, we need to expand care and prevention strategically to those who need it most,” said National Institute on Drug Abuse Director Nora D. Volkow, MD, in a press release. “That means taking a hard look at who has been excluded from services and take immediate steps to overcome systemic barriers like stigma, structural racism, and other forms of discrimination to connect hardly reached people, such as individuals with substance use disorders, with HIV testing, prevention, and treatment.”

The study authors recommend allocating resources to the areas and populations most hard-hit by the HIV epidemic, especially in the Southern United States, where 52% of new HIV transmissions occurred in 2018 despite being home to only 37% of the US population. This recommendation imitates a key EHE strategy to prioritize the 57 countries, US territories, and states in which more than half of US HIV transmissions occurred in 2016 and 2017 for targeted interventions, according to the press release.

“To end the HIV epidemic, we must continue to develop and deploy novel HIV treatment and prevention strategies suited to the different needs and preferences of diverse populations disproportionately affected by HIV,” said National Institute of Allergy and Infectious Diseases Director Anthony S. Fauci, MD, in a press release. “It is also essential that HIV health services continue during the COVID-19 pandemic.”

The study authors explained the disparities in HIV outcomes also exist between certain age, racial, and ethnic groups, as well as between sexual and gender identities. Although HIV diagnoses decreased overall and among white men who have sex with men between 2009 and 2018, new cases remained stable among Black/African American men who have sex with men and increased among young people, between 25 and 34 years of age, and Latino men who have sex with men.

Although Blacks/African Americans comprised only approximately 13% of the US population, they accounted for 43% of HIV-related deaths in 2018. The researchers suggested that culturally appropriate, tailored interventions may help communities respond to the unique needs of people in, or at the intersections of, these groups.

“We have incredible tools to prevent and treat HIV, but people may not fully utilize them if they are facing personal or structural issues that pose more immediate hardship like substance use and mental health disorders,” said lead study author Chris Beyrer, MD, MPH, investigator at the Johns Hopkins Bloomberg School of Public Health, Baltimore, in a press release. “You may struggle to take a daily medication if you are facing food insecurity or cannot find affordable treatment for your substance use disorder.”

The study authors detailed additional economic barriers to accessing HIV health services in the United States, including unequal access to Medicaid, on which 40% of people living with HIV depend on, based on one’s state of residence. Additionally, they recommend implementing universal health care coverage and expanding safety net programs for the uninsured, on which 82% of uninsured people living with HIV rely for medical care.

Major barriers to care identified by the authors include stigma, discrimination, and bias, which disproportionately affected marginalized racial groups, people who use drugs, and sexual and gender minorities. Health care professionals may help address these concerns by cultivating informed, supportive care practices that integrate mental health care, and substance counseling, according to the study.

Internalized HIV stigma can also negatively affect a person’s mental health and adherence to medication, so the authors recommend promoting awareness of U=U through a national campaign.

The study authors highlighted opportunities for additional research that could help end the HIV epidemic, including the need for studies around the transgender population and females in all stages of clinical research. A continued investment in efforts to develop a preventive HIV vaccine and HIV cure were also supported by the study authors.

REFERENCE

To end HIV epidemic, we must address health disparities. NIH. https://www.nih.gov/news-events/news-releases/end-hiv-epidemic-we-must-address-health-disparities. Published February 19, 2021. Accessed February 19, 2021.