Since the first cases of AIDS were reported more than three decades ago, the medical community has made significant progress in prevention and treatment of the disease, and the human immunodeficiency virus (HIV) that causes it. Medical advances now make it possible to prevent HIV transmission and effectively treat HIV infection, if it is detected early.
However, we face this World AIDS Day knowing that HIV and AIDS still disproportionately affects African Americans, particularly with respect to high rates of new HIV infections and AIDS diagnoses. For instance, African Americans accounted for 44% of all new HIV infections among adults and adolescents aged 13 years or older in 2010.
Obviously, HIV and AIDS are public health issues, but they are also civil rights issues. Discrimination and stigma contribute to the additional barriers that Black Americans and other communities of color face in access to testing and treatment, as well as knowledge of prevention options.
We at National Black Leadership Commission on AIDS, Inc. (NBLCA) are dedicated to empowering Black community leaders and organizations to address these inequities. Too few people within the Black community and other disproportionately affected groups have access to or even know about the options that are available, such as pre-exposure prophylaxis (PrEP) to prevent infection or antiretroviral therapy (ART) to treat it. Many who know about these options don’t trust them, due to a historic distrust of the healthcare system among African Americans.
Furthermore, medical providers may be less willing to inform African Americans of all the prevention strategies that are available. According to a study published last year in the February 2014 edition of AIDS and Behavior, medical students taking an online survey judged a Black patient who was a man having sex with men (MSM) to be more likely to engage in PrEP-associated sexual risk compensation — in other words, participate in more unprotected anal intercourse after starting PrEP initiation — compared to a white MSM patient. “This judgment was associated with reduced willingness to prescribe PrEP in a hypothetical primary care scenario,” said the study’s authors.
This is one of the reasons why I am presenting the keynote address, “HIV/AIDS: A Civil Rights Issue,” to members of the Student National Medical Association and LGBTQ Medical Association attending the World AIDS Day Dinner at the University at Buffalo. It’s important to reach our future medical providers early and educate them about testing, treatment and the role implicit bias can play in their health care providing decisions if they are not careful.
Getting more healthcare providers to offer HIV testing on a routine basis is another challenge, and I will speak to the students about this, as well. In New York State, HIV testing must be offered to all persons between the ages of 13 and 64 receiving hospital or primary care services, with limited exceptions (We at NBCLA advocate raising the age limit because many people do not stop having sex at age 64). However, too often medical providers are not offering testing based on superficial characteristics such as race, income or gender.
As a member of New York State’s Ending the Epidemic Task Force, NBLCA is following Governor Andrew Cuomo’s blueprint to reduce new HIV infections down to 750 per year by 2020, compared to over 3,000 annually today. The three-point plan for reaching that goal apply well beyond the borders of our state:
· Identify people with HIV who remain undiagnosed and link them to health care.
· Link and retain people diagnosed with HIV in health care to maximize virus suppression so they remain healthy and further transmission is prevented
· Facilitate access to PrEP for high-risk individuals to keep them HIV-negative.
I encourage everyone to take a moment on this World AIDS Day to educate themselves about HIV/AIDS and the latest options available to prevent the virus, get tested, and get treated if you have it. More information is available at CDC.gov, Health.NY.gov, and NBLCA.org.
C. Virginia Fields, MSW is the President and CEO of the National Black Leadership Commission on AIDS, Inc. and a member of New York State’s Ending the Epidemic Task Force.