HIV, COVID-19 and the importance of public health

HIV, COVID-19 and the importance of public health
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As COVID-19 cases continue to rise — it is a sobering moment to recognize and take stock of another epidemic that we have been battling for nearly four decades. The first HIV Testing Day was 25 years ago and emphasized the opportunity for individuals to take control of their health by getting tested for HIV. It has become an annual reminder that the HIV epidemic is still with us. This year the SARS-CoV-2 pandemic threatens the ability of those with undiagnosed HIV and those with other serious conditions to take control of their health. 

As an infectious disease physician specializing in HIV, I worry about the many individuals who do not have easy access to HIV testing now because testing venues have been shut down by the pandemic. Already too many of my patients do not discover they have HIV until they are ill with advanced disease or AIDS. In Georgia, the state with the highest rate of new cases in the U.S., nearly one-quarter of patients are diagnosed with AIDS within one year of being diagnosed with HIV. 

This means they have been living, undiagnosed, with the virus for up to 10 years and have been unable to benefit from the HIV treatment that could have kept them healthy and prevented transmission to others. This is tragic given that a strong public health system with widespread testing could prevent death. 

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If this sounds familiar, it should. Today media attention is focused on the challenge of performing widespread testing for COVID-19. The pandemic has laid bare a strained public health system depleted by chronic underfunding and has highlighted a long-overdue recognition of the importance of investing in public health. 

A strong public health system led by the Centers for Disease Control and Prevention is needed to catalyze the widespread testing that must occur to combat COVID-19 and HIV and will be needed to launch effective vaccination campaigns for these twin scourges — hopefully in the near term for COVID-19.

While COVID-19 may fade from the public consciousness in the years to come, HIV will still be with us. Nationwide, even with efforts to make HIV screening a routine part of medical care, 1 in 7 people living with HIV do not know it. Like COVID-19, HIV disproportionately affects minority populations with the majority of new infections in Black/African American (42 percent) and Latinx (27 percent) populations. These disparities are fueled by poor access to the healthcare system worsened by stigma and systemic racism.

Yet the COVID-19 pandemic has taught us innovative ways to enhance healthcare delivery — innovations that could be harnessed to respond to the HIV epidemic. Telehealth services, utilizing technology as common as the smartphone, can bring care into a patient’s own living room, enhancing access.

Widespread prescription delivery can minimize the need for transportation to pharmacies. Home delivery of HIV testing kits with access to supportive counseling could vastly enhance HIV testing with an immediate connection to care for those testing positive. Those with negative tests could begin pre-exposure prophylaxis or PrEP to prevent future infection. These innovations would once again put control of healthcare in the hands of the individual but must be supported by public and private health insurers' plans as well as public health outreach and education campaigns. 

In this way, the COVID-19 pandemic has given us hope, by forcing us to think of new strategies. With the federal initiative to End the HIV Epidemic launched last year coupled with a sustained commitment to public health we can make progress rather than see setbacks in efforts to end HIV as an epidemic in the United States. We must be nimble in adopting innovations in prevention and care delivery to stay in control and must not let progress on ending the HIV epidemic be a victim of the pandemic.

Wendy Armstrong, M.D. is a professor of Medicine at Emory University School of Medicine where she is the vice-chair of Education and Integration for the Department of Medicine, the medical director of the Infectious Disease Program at Grady Health System, and the ID Fellowship Program Director. She is a member of the HIV Medicine Association Board of Directors.