Update on the Epidemic

2016 marks the 35th anniversary of the first detection of what has come to be known as human immunodeficiency virus (HIV). In the early years of the epidemic, it was hard to picture an AIDS free generation. We now have the knowledge and tools to end the HIV epidemic in Ohio. We can successfully treat those living with HIV, prolong their lives, and stop new infections. We must commit to working together to create and champion sound public policies. Ending the HIV epidemic in Ohio will require creative solutions, engaging partnerships, and strong leadership.

 

The Ohio Department of Health’s HIV Surveillance Program reports that in 2014 there were 950 new diagnoses of HIV infection (a number that does not reflect the 18.3% of Ohioans who are HIV positive but do not know their status) and approximately 22,000 Ohioans currently living with a HIV diagnosis. The groups most disproportionally affected by the epidemic include persons of color, men who have sex with men, those who struggle with substance abuse, people who inject drugs, those living in poverty, and transgender individuals.

 

Opportunities

We now have the tools we need to effectively end the HIV epidemic in Ohio. Some of our most promising tools are as follows.

Treatment as Prevention (TasP)

Two groundbreaking studies that forced us to completely rethink our notions of HIV prevention were recently published. In 2011 HPTN 052 demonstrated that when antiretroviral medications are taken regularly as prescribed and the amount of HIV in the body is reduced to undetectable levels, that individual becomes up to 96% less likely to transmit the virus. The PARTNER study published in 2014 also shows similar results. Over the five year course of that study there were no HIV transmissions when the HIV+ partner was virally suppressed. These two studies provide us the knowledge that treatment for HIV is HIV prevention.

Pre-exposure Prophylaxis (PrEP)

Pre-exposure prophylaxis (PrEP) is a once-daily pill that HIV negative people take to reduce their risk of getting HIV. Studies have shown when taken as prescribed, PrEP is 92-99% effective in preventing HIV infection. PrEP is even more effective when combined with condoms and other prevention tools. Missed doses can reduce its effectiveness. Most insurance and Medicaid plans cover PrEP and there is additional financial assistance available to those who qualify.

Health Reform

The Affordable Care Act (ACA) and Medicaid Expansion significantly improved pathways to health care and medications for people living with HIV. Provisions in the ACA require insurers to cover a minimum set of benefits and protect people living with HIV from discriminatory practices, such as denial based on pre-existing conditions, closed formularies, and small provider networks.

Halting the HIV Epidemic in Ohio

There are many great yet unconnected ideas on how to address the HIV epidemic. In 2016 the Ohio AIDS Coalition released a series of recommendations as a plan to end the HIV epidemic in Ohio. This proposal considers how those ideas structurally and operationally might fit together and produce synergy in a post-ACA world to decrease the rate of new infections. This strategy involves identifying the undiagnosed, linking to and engaging people living with HIV in care, education, decriminalization, and introducing new mechanisms to assist with viral suppression rates.

 

Challenges

Although we have had many scientific breakthroughs and political reforms in the last 35 years that puts ending the HIV epidemic within our grasp, a number of challenges still stands in our way.

Gaps in Care and Treatment

Although the ACA and Medicaid expansion addressed some gaps in terms of HIV care and treatment, there is still much work to be done. Many health insurers still engage in practices that are blatantly discriminatory towards those living with HIV. Medications may be nearly impossible to attain due to restrictive formularies and high costs. Provider networks may be limited. Stronger anti-discrimination protections and their enforcement are needed.

Stigma

HIV-related stigma still runs rampant today. Stigma is spread by fear, lack of education, and misinformation. Complete and medically accurate HIV education is not disseminated in secondary schools. In Ohio, we criminalize potential HIV exposure regardless of intent or actual transmission. Stigma deters people from getting tested, getting into care, and maintaining an undetectable viral load. Stigma perpetuates Ohio’s HIV epidemic.

Intersections

HIV is intrinsically linked to other deep-rooted and complex social inequalities that also tend to affect racial, ethnic, and sexual minorities. These disparities include poverty, racism, homelessness, homophobia/transphobia, and injection drug use. We know that if an individual does not have basic needs met—such as safety, food, and shelter that they are much harder to engage and retain in care. We must continue to champion interventions such as stable housing, employment opportunities, access to behavioral health, transportation, and child care, and effective education to make it possible for those living with HIV to maintain undetectable viral loads.

 

We are currently at a public health cross-road. We have all the tools and knowledge at our disposal to not just put a dent in, but to end, the HIV epidemic in Ohio. In order to achieve such success we need a coordinated and effective response from our leaders. It is imperative that we work together to ensure adequate investment, cooperation, and action is taken. We call on you today to help make HIV in Ohio a thing of the past.