By Sarah Varney, Kaiser Health News

Wednesday, April 21, 2021 (Kaiser News) – Facing siege throughout the year CoronavirusIn the second rescue, the old wars are wobbling.

For the last two decades, HIV/ AIDS has been organized in the Gulf by powerful antiviral drugs, aggressive testing, and inventive public education campaigns. But COVID-19 Universal epidemic There has been profound disintegration on almost every aspect of that fight, grounding outreach teams, rapidly curating tests and shifting critical staff away from laboratories and medical centers.

The exact impact of one epidemic on the other is still coming to mind, but preliminary evidence is troubling to experts who have celebrated huge progress HIV treatment. While the change in priorities is nationwide, delays in testing and treatment pose a particularly serious risk in southern states, which are now the epicenter of the country’s HIV crisis.

“This is a major offending,” Dr. Said Carlos Del Rio, professor of medicine at Emory University in Atlanta and head of Emory AIDS International Training and Research Program. “There will be loss. The question is how much?”

In clinics individual visits and stalled routines are limited HIV screening In doctors’ offices and emergency rooms, with physicians relying instead on video calls with patients, a pointless option for homeless or afraid family members will be to discover their status. Rapid-testing vans that once parked outside nightclubs and bars and condoms are thrown out are mothballed. And, in state capitals and county seats, government expertise is focused on the deck COVID response with all hands.

Solid signs of impact on HIV surveillance: a large commercial laboratory reported nearly 700,000 fewer HIV screening Trials across the country – a 45% decline – and 5,000 fewer diagnoses between March and September 2020 compared to the same period of the year before. Tips of To presentAccording to new research presented at a conference last month, a preexposure prophylaxis, which can prevent HIV infection, has also fallen sharply. The state’s public health departments have reported a similar drop in testing.

This decrease in new data gives rise to an uncertain, unintentional moment: for the first time in decades, the country’s acclaimed HIV surveillance system is blind to the virus’s movement.


The lack of data will be felt far more deeply in the South: the region accounts for 51% of all new infections, eight of the 10 states have the highest rates of new diagnoses, and half of all HIV-related deaths. The most recent data available from the Centers for Disease Control and Prevention.

Even before the COVID epidemic, Georgia had the highest rate of new HIV diagnoses of any state, although lower than in Washington, D.C. The Georgia Department of Public Health reported a 70% drop in testing last spring compared to spring 2019 .

The principal investigator of the AIDS Research Consortium of Atlanta, Drs. Melanie Thompson said the slowdown in HIV patient services “can be felt for years.”

“Each new HIV infection ends the epidemic and will likely be passed on to one or more people in the coming months if people are not diagnosed and offered HIV treatment,” he said.

Coronavirus test HIV /AIDS test, Straining further monitoring efforts. Polymerase chain reaction – or PCR – machines used to detect and quantify genetic material in human immunodeficiency virus are the same machines that run the COVID test round the clock.

For decades, as HIV migrated inland from coastal cities such as San Francisco, Los Angeles, and New York, it took root in the South, where poverty is endemic, lack of health coverage is common, and HIV stigma prevails.

“There is stigma that is real. Legacy is racism,” Dr. Thomas Giordano, medical director of Thomas Street Health Center in Houston, is one of the largest HIV clinics in the US. State political leaders said, “Look at HIV as a disease of the poor. Blacks, Latino and homosexuals. It is not just mainstream at the state level.”

Black people represent 13% of the US population but approximately 40% of HIV cases – and deaths. In many southern states, there are disparities: in Alabama, black residents make up 27% of the population and 70% are newly diagnosed; In Georgia, black people account for 33% of residents and 69% of people living with HIV.


HIV clinics serving low-income patients also face limitations using video and phone appointments. Clinic directors say that poor patients often lack data plans and many homeless patients simply do not have phones. They will also have to contest elections out of fear. Del Rio of Emory University said, “If a friend has given you room to sleep and your friend finds out that you have HIV, you can lose that place to sleep.”

Texting can also be difficult. The Chief Executive Officer of PRISM Health Care North Texas in Dallas, Drs. “We have to be vigilant about text messages,” said John Carlo. “If someone looks at their phone, it can be disastrous.”

In Mississippi, HIV contact tracing – which was used as a model for some local efforts to track coronoviruses – COVID-related travel restrictions are meant to “protect both employees and customers,” the Melverta Bender The director said. class/ HIV Office at Mississippi State Department of Health.

Of all areas of the US, the South has the weakest health safety nets. And southern states have far fewer resources than states such as California and New York. “Our public health infrastructure has been undervalued and underestimated over the past few decades,” said Thompson, a Atlanta researcher. “So we stand to do worse by multiple matrices.”

Georgia’s high HIV infection rate and state’s slow rate of COVID Vaccination “Not unrelated,” Thompson said.

The porous safety net extends to health insurance, which is an important requirement for those living with HIV. Nearly half of Americans without health coverage live in the South, where many states have not expanded Medicaid under the Affordable Care Act. This leaves many people with HIV to rely on federal Ryan White HIV / AIDS programs and state-run AIDS drug assistance programs, known as ADAPs, that provide limited coverage.

“As a matter of equity, insurance is important for people living with HIV to thrive and thrive,” said Tim Horn, director of Health Care Access at NASTAD, the National Alliance of State and Territorial AIDS Directors. Ryan White and ADAPs “are not equipped to provide that complete sweep of comprehensive care,” he said.


South Carolina’s ADAP Program Manager Roshan McDaniel says 60% of South Carolina’s enrolled in ADAP will be eligible if their state expands Medicaid. “The first few years we thought about it,” McDaniel said. “We don’t even think about it nowadays.”

Enrollment in the Ryan White program skyrocketed during the early months of the epidemic when state economies froze and Americans traveled down the middle of an epidemic. Statistics from the state’s health department indicate an increased need. In Texas, enrollment in the state’s AIDS medicine program increased 34% from March to December 2020. In Georgia, enrollment increased by 10%.

State health officials attribute the increase in job losses related to the epidemic, especially to states that did not extend Medicaid. Antiretroviral treatment, established regimen that suppresses the amount of virus in the body and prevents AIDS, costs up to $ 36,000 per year, and drug blockage can lead to viral mutations and drug resistance. But qualifying for state aid is difficult: Approval can take up to two months, and cancellation of paperwork can lead to cancellation of coverage.

Federal health experts say southern states have generally lagged behind getting patients into medical care and suppressing their viral load, and people with HIV infection do not go there for longer than in other regions. For example, in Georgia, about 1 in 4 people learned that they were infected with AIDS within a year, indicating that their infections had gone undiagnosed for a long time.

As vaccination becomes widely available and restrictions ease, directors of the HIV clinic are scouring their patient lists to determine who to see them first. “We are seeing how many people have not seen us in a year. We think it is over several hundred. Did they leave? Did they move providers? Said Carlo, a doctor and health care CEO in Dallas. “We don’t know what the long-term consequences are going to be.”

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