UNAIDS: HIV care helps other conditions

Tending to HIV health care helps countries to address other conditions as well, says a report from UNAIDS and Friends of the Global Fight Against AIDS, Tuberculosis and Malaria.

For example, “In Colombia, a model of care specifically developed for HIV is now being used for the provision of comprehensive, coordinated care for other chronic diseases, including diabetes, cancer and cardiovascular diseases.” Laboratory developments in Cote d’Ivoire that resulted from HIV funding now help improve outcomes for maternal and child health, tuberculosis, viral hepatitis and COVID-19.

The 24-page report, released in April, also reviews findings from Jamaica, South Africa, Thailand and Uganda.

According to Expanding the HIV Response to Drive Broad-Based Health Gains: Six Country Case Studies, evidence shows that the world can end AIDS as a public health threat by 2030 and that “clear pathways exist to reach this goal.” In fact, the advancements made to reach that goal stand out as a “beacon of hope” while other health targets haven’t done as well.

The report ends with six recommendations. In brief:

  • “National HIV program planners and donors should be more purposeful in leveraging HIV platforms to achieve broad-based benefits.
  • “The HIV response must make the case for the broad health value of
  • HIV investments.
  • “HIV investments should be further strengthened and sustained.
  • “Particular action is needed to maintain and further strengthen investments in strong, sustainable community networks of people living with HIV and key populations, including networks led by women and young people.
  • “Health must be elevated as a priority for investments.
  • “The principles and values of the HIV response should be mainstreamed across health systems.”

GO TO bit.ly/3xJ0JiN.

STI Awareness

STI Awareness Week this year was April 14–20, highlighting “the stigma, fear and discrimination associated with STIs,” reported HIV.gov.

Ask. Test. Treat. Repeat., an education campaign, promotes routine screening, testing and treatment of STIs among people with HIV or who are vulnerable to it.

Another campaign, Prepare Before You’re There, “encourages [all] people to learn more about what puts them at risk for STIs and to have a game plan regarding safer sex and STI prevention before ‘the heat of the moment.’”

Yet another campaign encourages people, regardless of HIV status, to talk with their partners—Talk. Test. Treat.

GYT (Get Yourself Tested) specifically addresses young people, encouraging them to protect themselves and their partners.

HIV.gov noted that many times STIs go unnoticed because they often have no symptoms.

“Testing is the only way to know for sure. If untreated, STIs can increase your chances of transmitting or getting HIV,” the government website noted. “An untreated STI can also lead to health problems, such as long-term pelvic or abdominal pain, difficulty getting pregnant and other pregnancy complications that can lead to serious health conditions for your baby.”

The website noted statistics from the CDC 2022 STI Surveillance Report (the latest edition available):

  • The highest number of syphilis cases seen since the 1950s (207,255—an 80% increase since 2018)
  • More than 3,700 cases of congenital syphilis among newborns
  • No increase in chlamydia cases
  • Cases of gonorrhea actually fell for the first time in a decade
  • More than 2.5 million cases of chlamydia, gonorrhea and syphilis in the U.S.

“We encourage individuals, healthcare providers, federal and non-federal agencies and others to learn more about the campaigns, plan activities and help spread the word about prevention, testing and treatment during STI Awareness Week and throughout the year,” HIV.gov concluded.

GO TO bit.ly/4aBGXUM.

Young woman tells her story through TikTok

“At the tender age of 10, my world was turned upside down when I discovered I was living positively with HIV,” writes Adelaide Hamese. Now 23, she revisits her adolescent years of coming to terms with her status, including getting through denial, and the ups and downs of dealing with teen realities, including sexual attraction.

“To anyone grappling with the weight of HIV stigma, please know that you’re not alone,” said Hamese in a piece for Thought Catalog, an online magazine devoted to young voices. “Reach out for support, speak your truth and never allow shame to silence your voice. Together we can rewrite the narrative surrounding HIV, fostering a future filled with empathy, understanding and love.”

Hamese’s TikTok handle is @HivtalkswithAdele.

READ the Thought Catalog piece at bit.ly/3U3bwM4.

PrEP inequities in England

There are medications to prevent HIV, but the inequities in accessing them seem to be neverending. Simply referred to as PrEP (for pre-exposure prophylaxis), these medications are considered essential to ending the epidemic.

In a detailed article from Great Britain’s aidsmap.com, Krishen Samuel summarizes the findings of a study looking at what happened when England made PrEP available for free.

“Contrary to what researchers expected to see with more accessible PrEP, the equity gap for these two groups [Black African women and white men] increased between the periods [that were looked at], and substantially,” Samuel writes.

There were other groups of people with a gap between their PrEP use and the number of new HIV cases. They included Black Caribbeans, people who are older and individuals living outside of London.

TO READ Samuel’s article, GO TO bit.ly/3Q774uC.

The study’s lead author, Flavian Coukan, of the Imperial College London, and colleagues noted in their conclusion that using a combination of prevention methods, including HIV testing, can help the country achieve its goal of ending new HIV transmissions by 2030. Equity, not equality, will help ease barriers to PrEP, they wrote. Meaning that PrEP availability is not divided equally, but rather is provided where needed most.

The study, Impact of national commissioning of pre-exposure prophylaxis (PrEP) on equity of access in England: A PrEP-to-need ratio investigation, was published online March 20 in the medical journal Sexually Transmitted Infections, an official journal of the British Association of Sexual Health and HIV (BASHH). The article is available free online. GO TO bit.ly/446QwsD.

MISTR adds doxy-PEP to its PrEP offerings

The former gay dating app now serves as a telemedicine provider of HIV prevention in the form of PrEP and now adds doxy-PEP for the prevention of STIs. MISTR provides free doctor consults and helps people apply for patient assistance programs and other services to lower the cost of medication

Doxycycline is an antibiotic that is used to prevent gonorrhea, chlamydia and syphilis. Unlike PrEP (pre-exposure prophylaxis), PEP (post-exposure prophylaxis) is used after a possible exposure to an STI.

MISTR announced in April that it was adding doxy-PEP. “Gay-owned and -operated, MISTR has brought together a network of the best doctors, pharmacists and problem solvers to make PrEP, doxy-PEP and long-term HIV care available to all who need it. No doctor’s office, no paperwork and free delivery,” MISTR declared.

GO TO heymistr.com.

Meth, stigma and HIV in Latino men

The National Institute on Drug Abuse (NIDA) has awarded a five-year, $950,000 research grant for examining the connection between stigma and vulnerability to HIV by Latinos who use crystal methamphetamine.

University of Connecticut assistant professor of human development and family sciences Raymond L. Moody, PhD, was awarded the K01 Mentored Career Development Award in April.

“Methamphetamine use is one of the most significant predictors of HIV vulnerability among sexual minority men,” Moody was quoted by the university’s news service. “As many as one in three new HIV infections [among sexual and gender minorities] are among people who use methamphetamine.”

A clinical psychologist, Moody is passionate about examining the role of internalized stigma, which he said are “these negative beliefs [people have] about themselves related to characteristics around their sexuality or around their drug-using status, and the consequences of internalizing those beliefs.”

TO READ more, GO TO bit.ly/3w8Yl4a.

KFF: Discrimination against LGBTQ+ community

The Kaiser Family Foundation (KFF) released data showing that LGBTQ+ adults experience more discrimination than other people their age. The latest report from the KFF 2023 Survey of Racism, Discrimination and Health was released in April. An earlier release covered the survey’s findings on racism and discrimination in health care.

Key findings include:

  • “LGBT adults face higher rates of discrimination and unfair treatment in their daily lives compared to non-LGBT adults, including in health care settings.
  • “LGBT adults are more likely than non-LGBT adults to report adverse consequences due to negative experiences with health care providers and to say they take steps to mitigate or prepare for unfair treatment when receiving care.
  • “Among LGBT adults, those who have lower income, are younger or are women are more likely to face challenges with discrimination or unfair treatment in their daily life and while receiving health care."

KFF is an independent non-profit reporting on health policy research and polling. TO READ the report, GO TO bit.ly/3w1vm2n.

Continuum of care in the European Union

The European version of the U.S. CDC released a report on its latest statistics (2023) for the HIV continuum of care—from living with HIV, to being diagnosed, to starting treatment and achieving undetectable viral load. According to the report, for the 45 countries reporting all four steps:

  • 83% of all people living with HIV were diagnosed
  • 84% of people diagnosed were on HIV treatment
  • 93% of people on treatment had an undetectable viral load (which improves their health and prevents transmission)

An estimated 35% of all people living with HIV (PLWH) did not have undetectable HIV, however. According to the report, of the individuals living with “transmissible levels of virus” in 2023, it was estimated that:

  • 48% were undiagnosed
  • 37% were diagnosed but not treated
  • 15% were on treatment but had “an unsuppressed viral load”

“This suggests that a rapid and sustained scale-up of treatment and care to reduce the number of [PLWH] with transmissible levels of virus could have as much of an impact as current efforts to reduce the undiagnosed population through testing,” the report noted.

The European Centre for Disease Prevention and Control (ECDC) estimated that 7% of individuals treated did not reach a suppressed HIV viral load. The report was released in April. GO TO bit.ly/3U4uHVN.

The U.S. Department of Health and Human Services (HHS), which produces HIV treatment guidelines, uses a different continuum of care which includes testing and staying in medical care.

European Union: PrEP

What about preventing HIV with the use of medications in the first place? The European Centre for Disease Prevention and Control (ECDC) produced another report in April, looking specifically at PrEP. The ECDC noted that greater PrEP uptake is needed to meet the UNAIDS goal of ending the global AIDS epidemic by 2030.

“By 2023, 30 countries in Europe and Central Asia had developed and implemented national PrEP guidelines, and PrEP was available free through the public healthcare systems of 15 countries. However, even within these countries, PrEP is not always available everywhere and some countries have restrictions on who is eligible for it,” the report stated in its conclusion. “In particular, PrEP remains inaccessible for certain key populations, including prisoners and undocumented migrants. While progress has been made on increasing PrEP accessibility in Europe and Central Asia, countries reported several barriers which may be encountered when attempting to access the treatment, including stigma, discrimination and distance to clinics.”

The report listed five action steps, which include talking with people who have newly acquired HIV to “understand and address the barriers individuals face while attempting to access PrEP.”

Another action step states that, “To reach a wider population, countries are encouraged to remove restrictions on who can access PrEP and review and expand the settings in which PrEP is available. For example, they are encouraged to explore how PrEP could be provided in more non-medical settings such as through community-based organizations.”

GO TO bit.ly/3xE2a1Y.

Youth activists call on Congress

The day before April 10’s National Youth HIV & AIDS Awareness Day (NYHAAD), activists from Advocates for Youth met on Capitol Hill with congressional lawmakers and staff from the office of Rep. Barbara Lee (California, 12th Dist.) for a briefing on what Congress can do to support young people living with HIV. While Congress saved HIV funding from Republican-proposed cuts, the activists called on lawmakers to ensure that those dollars are allocated to the most-needed programs.

“Through my work as a peer support advocate for people living with HIV, I know firsthand how hard it is for young people like me to access care and navigate the medical system,” said DáRon Davis Henderson, NYHAAD youth ambassador from North Carolina. “We need government funding for HIV-inclusive sex education to make sure everyone understands how to prevent and treat HIV.”

The activists and Advocates for Youth asked Congress to co-sponsor the Real Education & Access for Healthy Youth Act (REAHYA). Co-sponsored by Reps. Lee, Pramilia Jayapal (Washington, 7th) and Alma Adams (North Carolina, 12th), and Senators Mazie Hirono (Hawaii) and Cory Booker (New Jersey), the measure would provide the first federal grants for comprehensive sex education in the U.S. and end abstinence-only education. It would also increase funding for HIV prevention, treatment and care for young people. 

“When health classes don’t address HIV treatment and prevention, students leave with misconceptions that continue the cycle of stigma and discrimination against people living with HIV,” said Amaka Agwu, NYHAAD youth ambassador from Maryland. “There needs to be a more standardized, comprehensive sexual health curriculum taught by educators with the relevant and accurate knowledge to help young people practice safer sex habits, know the ways in which we are at risk and reduce stigma.”

In addition to REAHYA, Advocates for Youth is urging Congress to support a number of other appropriations for fiscal year 2025. Among them:

  • $395 million for the Ending the HIV Epidemic plan, including $100 million to create a National PrEP Program to support equitable access to HIV prevention medications
  • $3.082 billion for the Ryan White HIV/AIDS Program
  • $150 million for the Minority HIV/AIDS Fund and $610 million for other programs of the Minority HIV/AIDS Initiative
  • $150 million for a teen HIV prevention program from the Office of Adolescent Health, under the Department of Health and Human Services
  • $100 million for the Centers for Disease Control and Prevention’s Division of Adolescent and School Health

“Young people face unique barriers to accessing health care. Many of us don’t have parental support, medical insurance, reliable transportation or even flexible schedules that allow us to make appointments,” said Peggy Owusu-Ansah, NYHAAD youth ambassador from Tennessee and the District of Columbia. “These barriers are even harsher for Black youth, who are more likely to contract HIV but often encounter misinformation, stigma and medical mistrust. Young people’s needs have to be taken into account when we consider creating inclusive care for all people.”

—Rick Guasco

LGBTQ+ documentary examining trauma and resilience of gay men premieres at L.A. film festival

A new documentary explores traumas experienced by men who are part of the LGBTQ+ community.

Speaking Out features three racially diverse and openly proud gay men and their journey toward healing. It plays out like a movie with actors performing scenes, in addition to hearing from the men. As they reveal the mental and physical abuse they endured and the strengths they’ve gained, mental health experts join in to provide insights on both the trauma and the recovery. The film makes its premiere at the Los Angeles Latino International Film Festival.

“I created Speaking Out from a vision of vulnerability and love with the ultimate hope that it can heal people from the inside out,” director John Solis says. “As a Latino filmmaker, I’m honored and awestruck that Speaking Out will premiere at LALIFF, giving us the opportunity to begin our journey of sharing this important message of healing with the world.”

José Ramos is one of the men featured. In 2009 he founded Impulse Group, a non-profit organization dedicated to building healthy communities for gay men around the world. Impulse Group produced the documentary in association with the AIDS Healthcare Foundation.

As a team predominantly composed of Latinos, being selected to showcase our work at LALIFF holds deep significance for us,” Ramos says. “It represents not only a validation of our creative endeavors but is also an affirmation of the importance of representation in the film industry.”

Co-executive producer Miguel Angel Caballero says, “I believe Speaking Out serves as both a mirror and a megaphone for the LGBTQ+ community, especially for gay men who have endured trauma and sexual assault. In a world where stigma still looms large, Speaking Out stands as a beacon of hope, reminding every gay man that their voice matters, their pain is valid, and they are not alone in their journey towards healing and resilience.”

The team believes the film “showcases the power of storytelling to drive social impact and promote inclusivity.” The documentary is helping to end the silence and shame surrounding trauma experienced by the gay community. Estamos hablando. We are talking.

LALIFF runs May 29–June 2. Speaking Out was produced by BrightBulb Studio and Cabaldana Alchemy.

GO TO impulsegrp.org.

Activists urge Congress to make HIV a funding and policy priority

More than 400 advocates from 35 states came to Capitol Hill in mid-March to urge members of Congress to support funding for HIV-related programs and legislation to address racism and inequity.

Organized by AIDS United, the annual AIDSWatch lobbying campaign was held March 17–19 with a series of activist workshops and training sessions that culminated in a day of meetings in about 120 congressional offices with staffers as well as senators and members of Congress.

Positive Women’s Network-USA, the largest national organization of women living with HIV, was among the groups that sent members to the Hill.

“A large part of our advocacy centered around appropriations [federal spending authorization],” said Tana Pradia, one of the 51 PWN-USA members who took part. “We need Congress to ensure people have access to HIV prevention, like the PrEP Access and Coverage Act (HR-4392/S-2188). Congress should protect Medicaid from cuts and go further by ensuring universal healthcare access for everyone.”

Katie Willingham, a transgender activist living with HIV, also came to D.C. “I attended a workshop about transgender health and safety in the southern states, and the need for comprehensive sex education,” she said. “These issues are important to me and my state.”

She added, “My state brought the second largest delegation to AIDSWatch, with 19 people from Alabama—seven of whom are living with HIV. We all visited the offices of our senators, Tommy Tuberville and Katie Britt.”

PWN-USA member Susan Mull highlighted some of the priorities and tactics. “Sometimes the metrics are the only thing that legislators understand,” she said. “Out of 1.2 million people living with HIV in the United States, at least 100,000 are unhoused. We used that statistic as we spoke to staffers in the Senate and the House of Representatives. Folks told their own stories of being unhoused, and patiently explained that one cannot remain adherent to life-saving medication if one does not have stable housing. Housing is healthcare!”

This year, 56% of AIDSWatch attendees self-identified as living with HIV.

—Rick Guasco