HIV POLICY UPDATE

What HIV Incidence Looks Like in the Three Hardest-Hit States

On July 27 , the Republican-led Senate was ardently touting the “HEALS Act,” their $1 trillion funding package designed to address the devastation caused by COVID-19.  However, before the week was out, the White House flip-flopped on their support of the Act’s “liability shields,” which protected businesses from being sued by exposing employees and customers to COVID-19.  With the Republican in-fighting, what happens next to the HEALS Act is anyone’s guess.

While Congress continues to debate, the rest of the country is suffering economic and medical hardships.  As we look at how the pandemic is stealthily spreading throughout the country, many of the regions that are now feeling the effects of COVID-19 overlap with some of the hardest hit HIV areas, so-called “hot spots” which were identified in the President’s 2019 “Ending the HIV Epidemic” initiative.  Unfortunately, with both COVID-19 and HIV, these areas continue to struggle due to government’s inability to provide a cohesive, inclusive and scientifically-based strategy for combatting these viruses.

We watched COVID-19 strike our country first in large urban areas, primary in the west and northeast sections of the US.  The pandemic has now engulfed the southern states and is permeating into the more rural areas of the country.  These are the same regions fighting the bulk of HIV infections.  In fact, nearly half (47%) of all HIV related deaths in the US happen in the south.  The highest HIV rates of anywhere in the country occur in Florida, Georgia and Louisiana, according to the CDC. These are also three states with some of the highest numbers of new COVID-19 cases and cases per capita.

It seems with many of these states, politics has bested science.  For instance, Miami’s rate of new HIV infections is four times that of the national average.  This was driven by the state’s recent period of shocking neglect of HIV services, as described in a previous column exposing the previous Governor’s decision to starve its HIV services.  Likewise, current Governor DeSantis’s handing of COVID-19 can be characterized as irresponsible at best, if not egregiously dangerous.  As of Aug. 4th, Miami-Dade County has 124,759 confirmed COVID-19 cases and 1,724 deaths.

Knowing virus status is a key factor to consider with both HIV and COVID-19.  In 2019, the Miami Herald reports that, “More than 115,000 people in Florida live with HIV, about 12.5 percent of all cases in the United States.  But about 15 percent of those individuals, or roughly 19,200 people are not aware of their status and therefore not receiving care.”

This is eerily similar to the challenges with COVID-19, which is being spread at a rapid pace in significant part because many people don’t know if they are positive and may remain asymptomatic or mostly asymptomatic.

By contrast, Louisiana’s HIV incidence in 2018 was at its lowest rate in a decade.  The state’s incidence numbers dropped from 1,124 in 2016 to 989 to 2018 – the first time since 2005 that the state has come below an incidence rate of fewer than 1,000 people.  Dr. Alexander Billioux of the state’s health department attributes this to outreach, education and their “increase in the number of people who are being linked to medical care within 30 days.”

Achieving “viral suppression for those who are living with HIV, and increases in routine screening of HIV throughout the state” have also yielded good results, he added.

The same can be said for Louisiana’s COVID-19 strategy.  The state was hit hard early in the epidemic, but has been able to slow the spread gradually due to increased testing and state mandates for masks and social distancing.  Just this week, Governor John Bel Edwards announced the state will push back their phase three reopening until the end of August.

With over 197,000 cases of COVID-19, Georgia also leads the way with the largest incidence rates for both the novel coronavirus and HIV.  In 2018, 2,501 people were newly diagnosed with HIV, bringing a total of 54,600 Georgians HIV positive in the state.  Even more alarming is the fact that about 25% are living with advanced disease by the time they test positive.

Statistically, most of them are Black men, and Carlos del Rio, co-director of the Emory Center for AIDS Research (CFAR), reports their studies show that these men “don’t have more partners or indulge in riskier sexual behaviors than their white counterparts.  But they are poor, often lacking insurance, transportation, and other necessities for accessing care.”

The health disparities of COVID-19 mirror these risk factors, showcasing the need to systemically address racism in our healthcare system – something HIV care providers have been pointing to for years.

Unfortunately, with all the partisanship and in-fighting, it’s proving difficult to successfully combat either COVID-19 or HIV.

As Carlos from CFAR cleverly points out, “In light of Senate’s feuding with the White House over trillions of dollars, it brings to mind the Kenyan proverb that ‘when the elephants fight, it’s the grass that suffers.’”