HIV healthcare looks totally different today than it did 20 or even 10 years ago.
Rebecca Dillingham, MD, who works in the UVA Ryan White HIV Clinic, caught us up on what has – and hasn’t – changed.
HIV Infection Rates
The bad news: HIV/AIDS infection rates mean it’s still an epidemic in the U.S. In 2011, 1.2 million people were living with HIV; about 50,000 people get infected every year.
The good news: The past few years have seen a moderate reduction in the numbers of new cases in some populations. Between 2005 and 2014, the number of new HIV diagnoses among women declined 40 percent.
The troubling news: HIV rates are actually growing in certain subsets of the population — and the social factors at play are not much different than the issues seen when the AIDS crisis first took center stage.
The populations at highest risk, who need “desperate attention,” include the entire region of the Southeast.
Why? Contributing factors could possibly include:
- Lower access to healthcare
- A persistent stigma against sexual minorities
Less access to quality healthcare means less testing, less treatment and higher rates of transmission.
The populations at the highest risk for HIV — gay and bisexual males — tend to either avoid seeking healthcare and, when they do, interact with providers whose bias and ignorance prevents them from offering appropriate care.
The other group at risk — an “emergency,” Dillingham says is found in gay men of color. A 2016 Center for Disease Control study estimates that 1 in 2 gay African-American men are expected to become HIV positive in their lifetime, if current trends continue. These are, Dillingham says, without drama, “terrifying numbers.” From 2008 to 2010, HIV infections among young black gay and bisexual men increased 20 percent.
Again, Dillingham points to familiar culprits. “While bias continues everywhere, the stigma against sexual minorities in the African-American community seems bigger. And the healthcare inequalities for racial minorities are dramatic.”
According to the CDC, an increased poverty rate among African Americans means a lack of:
- High-quality healthcare
- HIV prevention education
- HIV care/treatment
“Stigma, fear, discrimination, homophobia, and negative perceptions about HIV testing may also place many African Americans at higher risk and discourage testing,” the CDC report says.
What is Your Risk?
View your statistical risk of getting HIV.
AIDS Prevention: PrEP
What is PrEP?
PrEP, which stands for pre-exposure prophylaxis, is a daily pill that Dillingham says is:
- Very effective
- Responsible for a 75 percent reduction in transmission of HIV
- Medically safe
- Relatively easy to monitor
“I think that for young gay men, PrEP is a critical and responsible decision they can make to protect themselves. Condoms are still the best protection against HIV and sexually transmitted diseases. But this is a really exciting prevention tool.”
Of course, PrEP has received criticism, specifically that taking it will encourage promiscuity.
Dillingham’s response? “This is what people used to say about women taking birth control. But young men shouldn’t be belittled or criticized for it. It’s a responsible choice.”
The challenge, Dillingham says, is raising awareness about PrEP in a society where stigmas against same-sex loving relationships can make it hard for people to understand and accept this option.
“In order to get it to the people who need it, we need to develop more awareness and comfort among our providers to talk to people about PrEP and to make it available to them if that is a choice they want to make — an additional piece of protection they’d like to employ.”
Dillingham sees her work as a physician directly linked to the attitudes of the whole community.
“We need to help adolescents and young adults to develop and engage in healthy and safe relationships no matter who they love. Whether we’re talking about heterosexual or gay teens and young adults, we need to think, as a community, about how we can help youth make good choices. That may sound like a tall order, but I think it’s potentially life-saving, both in reference to HIV healthcare and in terms of helping young people navigate what is a complicated time in human development.”
Dillingham notes one example of UVA’s leadership in this area as the opening of the Transgender Health Clinic for youth. “Identifying more safe spaces within medical care, within our own health system, is really important. And having great organizations like Rosmy that serve sexual minorities and bring together all young people to talk about healthy and safe relationships — that’s one of the most important things we can do for the next generations.”
Facts About PrEP
- Daily PrEP use can lower the risk of getting HIV from sex by more than 90 percent and from injection drug use by more than 70 percent.
- You must take an HIV test before beginning PrEP and every 3 months while you’re taking it to be sure you don’t have HIV.
- PrEP is recommended for people who are HIV-negative and can help to protect the HIV-negative person from getting HIV from a sexual or injection-drug-using partner who’s positive.
See more facts.
HIV Healthcare & Testing
Nearly 1 in 5 people with HIV don’t know they’re infected, which means they can unknowingly pass the virus on.
Which is why Dillingham is glad that HIV testing has changed dramatically in the last ten years, making it easier and faster for people to get results.
For one thing, clinics like the UVA Ryan White HIV Clinic offer rapid antibody screening tests, which provide results in 30 minutes or less. Not only can you get your results quickly, but the results are more accurate than ever before, even early on in an infection.
Perhaps even more revolutionary is the availability of home test kits. There are two main types of home tests:
- Home Access HIV-1 Test System
- Blood test
- Send in by mail; call for results by next day
- OraQuick In-Home HIV Test
- Oral swab test
- Results in 20 minutes
- Not as accurate as blood home tests or lab tests
While Dillingham emphasizes how critical testing is, and that everyone should be tested “no matter how you do it,” she does have concerns with home testing.
“My greatest concern about home testing is that people will not link to the HIV healthcare services they need afterwards.”
Her recommendation: “Identify what you’re going to do with the result.” If your home test gives you a positive result, be prepared to call the local health department or UVA right away.
Know Your HIV Status
Get tested at the Ryan White HIV Clinic.
Dillingham’s concern is rooted in some scary statistics: Only 4 in 10 people living with HIV are in medical care.
Getting HIV healthcare early on in an infection can make a huge difference in your lifespan and overall well-being. And while in medical care, you have a 76 percent chance of achieving viral suppression — which improves your own health and dramatically reduces the possibility that you will infect anyone else.
Learn more about increased lifespans with HIV healthcare in our next post.