The U.S. was on a roll to ending the HIV epidemic, but then the country was hit with the coronavirus. Now, the timeline to end HIV may not be as certain as it once was. That's because HIV and STI services have been stripped of its fundamental priorities.
For example, King County, where Seattle is located, has HIV mostly under control. 85 percent of the diagnoses are virally suppressed because of getting care for the disease.
The remaining 15 percent do not have adequate care or resources.
The EHE strategy (Ending the HIV Epidemic: A Plan for America) is to lower the percentage rate of HIV infections by 75 percent by 2025, and by 2030, a 90 percent decline in infections.
The various Department of Health and Human Services agencies came up with a plan that focused on the early diagnosis and treatment of HIV-infected individuals. This included the attainment of a viral suppression that prevents new HIV transmissions using proven methods such as PrEP and the containment of HIV outbreaks.
However, the priorities moved from HIV diagnoses, treatment and prevention to COVID-19, and the money allocated to the 2021 budget did not see the increase necessary to expand the program.
The National Alliance of State and Territorial AIDS Directors said nearly all health departments have their staff dedicated to the COVID-19 pandemic and not their actual activities. On top of that, community organizations work with HIV-positive people who have a hard time taking care of themselves under the COVID-19-causing recession.
Some of the organizations are in danger of closing because of the loss in federal and state funding. According to the University of Pennsylvania Associate Professor of Clinical Medicine Dr. Helen C. Koenig, budgets have been cut, people are being laid off, and programs are being shut down temporarily.
Research studies for new drugs and other clinical trials and important behavior intervention studies were also halted since people are unable to meet in person.
The COVID-19 pandemic has consumed a plethora of attention as well as time and effort. This includes the emotional effort on health care providers to deal with other chronic health issues. Other problems in dealing with HIV is the hesitation some people have about getting tested or treated for the disease due to COVID-19.
According to Dr. Rachel Bender Ignacio at the University of Washington in Seattle, there is an increase in the risk of dying from diabetes, heart attacks, cancer, Alzheimer's and stroke because of the fear of catching the coronavirus.
Avoiding care may also be the reason new PrEP prescriptions have decreased. STI screenings are also down, which means STIs are not being caught, and people who could benefit from PrEP are not getting it.
Substance abuse programs are also not operating well, which can increase the chances of HIV transmission. Since people have had to social distance, group therapy is limited in the number of people who can participate. This could lead to relapses in substance abuse, raising the chance for HIV transmissions.
Dr. Bender Ignacio said the 57 "end the epidemic" places where HIV is so prevalent are also COVID-19 hot spots. Another problem is that the jurisdictions have ostracized individuals, so COVID-19 makes it even harder for humanitarians to help those most at risk. Since it's difficult to get PrEP to these individuals due to the high cost, many of them must apply through a PrEP drug assistance program (very few insurance companies cover it).
This means a lot of paperwork and signatures. Although some restrictions have been lifted due to the coronavirus, and processes can be done electronically, the paperwork still presents a challenge. On top of that, many of those non-marginalized individuals are having to deal with paperwork because of a loss in health insurance due to unemployment.
Although there is a lot of problems fighting HIV during a global pandemic, there are some benefits. Two states have agreed to expand their Medicaid, which means just 12 states do not offer Medicaid to certain individuals.
Also, $90 million of the Coronavirus Aid, Relief and Economic Security Act was transferred into the Ryan White HIV/AIDS Program for safer transportation options, cellphones and telehealth infrastructure.
Dr. Ann Wooley, the Brigham and Women's Hospital Transplant Infectious Disease associate clinical director, said it would be reasonable to assume the COVID-19 pandemic will hinder the EHE timeline. This is especially true since there is yet no vaccine and a lack of effective treatment options.
Written by Mark Riegel, MD
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