Changing the Conversation Around HIV in 2016: Who’s Being Left Out?
World AIDS Day 2015 has passed, but as we enter a new year, we need to ensure that the conversation around HIV focuses on the issues that are most critical. Mitigating the stigma of HIV and encouraging support for expanded access to HIV prevention and treatment, particularly for those who are still disproportionately affected, are essential to increase viral suppression and reduce the rate of new infections. Two groups that are severely affected by HIV are still too often left out of the dialogue: young men of color who have sex with men (MSM) and transgender individuals. If we are going to end the HIV/AIDS epidemic in the U.S. and throughout the world, we should confront the issues that are causing these disparities.
According to the U.S. Centers for Disease Control and Prevention (CDC), MSM account for more than half of the approximately 1.2 million people living with HIV in the United States (60 percent, or an estimated 732,200 persons) and approximately two-thirds of all new HIV infections each year (66 percent, or an estimated 31,400 infections). MSM of color face a particularly high risk of contracting HIV. Black men accounted for 39 percent of all MSM diagnosed with HIV in 2013. Young MSM (ages 18 to 25) are most at risk, and young black MSM are twice as likely to be infected with HIV as young MSM of any other ethnic group. Young black MSM now account for more new infections in the U.S. than any other group.
Latinos are one of the groups most seriously affected, accounting for nearly 25 percent of new HIV infections in the U.S. from 2008-13, with a 16 percent increase among Latino MSM during the same time period.
The transgender community is experiencing an HIV epidemic. According to the CDC, the highest percentage of newly identified HIV infections in 2010 (the most recent year for which data is available) was among transgender individuals, with trans women being most at risk. A recent global study found that trans women are 49 times more likely to be living with HIV than the general population.
Both MSM of color and transgender communities face obstacles that prevent them from being tested for HIV and linked to treatment and care. Stigma and discrimination, often stemming from intolerance in many groups, creates significant barriers, generating a culture of silence around HIV, and, in the case of the transgender community, gender identity. This often prevents people in these communities from understanding the risks they face, knowing their HIV status, and seeking crucial treatment. According to the Human Rights Commission, many transgender individuals have been refused medical care because of their gender identity or have been harassed in a doctor’s office; as a result, they are often unable to access health care that meets their specific needs.
These obstacles are also linked to social disparities, including lack of access to health insurance, secure housing, and employment opportunities, making it even more challenging to receive and sustain treatment. New York State Governor Andrew Cuomo recently issued regulations that prohibit harassment of and discrimination against transgender people—the first U.S. state to do so. This should become a model for the rest of the nation.
When the HIV epidemic began, stigma and discrimination were heavily directed toward gay white men, which delayed a federal response to the HIV crisis. Now, in the 2000s, stigma and discrimination are having a serious impact on people of color, namely African Americans and Latinos living with HIV. We couldn’t tolerate this then, and we can’t tolerate it now.
The cost in human lives is too high for us to remain silent and do nothing. We can end the AIDS epidemic; it is now within our reach. But it won’t happen unless we pay attention to people in communities at greater risk of infection. We should engage and inform them, help them overcome stigma and discrimination, provide culturally competent health services, and ensure that they are tested for HIV and linked to treatment and care if they test positive. People who test negative but may be at high risk of infection may be candidates for pre-exposure prophylaxis (PrEP), which involves the use of anti-retroviral medication to prevent HIV infection and has been shown to be over 90 percent effective. New York State has a Blueprint to End the AIDS Epidemic by 2020, which if fully funded, can become a blueprint for all 50 states and Puerto Rico.
At Amida Care, the largest Medicaid special-needs health plan (SNP) in New York State, we have demonstrated the power of providing holistic, accessible HIV and AIDS treatment and care to these underserved and often overlooked communities. With a diverse membership—62 percent African American, 34 percent Latino, and 7 percent transgender—over 90 percent of our members are receiving ongoing, sustained medical care, and we have achieved a viral suppression rate approaching 75 percent among our HIV-positive members. Successes like these save lives and produce much-needed long-term health care savings.
The cost in human lives is too high for us to remain silent and do nothing. It is time for all of us to recognize and break down the barriers that are preventing these vulnerable populations from accessing preventive services, starting treatment, and receiving regular, high-quality health care. By including MSM of color and the transgender community in the conversation, we open the door to equitable health care and life-saving treatment for the people who need it most, which will create a healthier nation and world for all of us.