Why is National HIV testing awareness day important?
We have the tools to end the HIV epidemic and HIV-related stigma and make new infections a thing of the past. But, according to the CDC, one in seven people living with HIV is unaware of their status, which is why encouraging everyone to get tested is so important. If an individual tests positive, HIV is very manageable. HIV treatment is highly effective and your provider can prescribe you medications to help you reach a place where the HIV virus is undetectable (also known as viral suppression). This means you will remain healthy but also achieves a place of “Undetectable = Untransmittable,” meaning that a person living with HIV who has an undetectable viral load and is durably virally suppressed (for at least six months and on an ongoing basis) does not transmit HIV. The sooner you know your status, the sooner you can be linked to care and live a long, healthy life. And if you test negative, you can talk with your provider and decide if you need additional forms of prevention, like PrEP, to help you remain HIV-negative.
You just came back from a session where you informed Congress about PrEP —how did that go? On Monday, June 25, a resolution (H.Res.960) on the importance of PrEP education was introduced by Congresswoman Watson Coleman. The resolution focuses on barriers to PrEP access and asks the government to assess ways to best address these barriers. The HIV community has done a great deal of education on PrEP with Congress, showing that it is an important tool in the prevention toolbox to prevent new infections. While there has not been any PrEP-specific legislation, it has been included in other pieces of legislation as part of sexual health services and a critical tool necessary for ending the HIV epidemic.
At the state level, we’ve seen a number of encouraging policies helping access to PrEP. Illinois just passed state legislation defining PrEP as a preventive service that should be covered by public health care payers, including Medicaid, Medicare and CHIP, at no cost to the patient.
In Florida, the state’s Surgeon General mandated that local health departments make PrEP available to their patients and the health department is making the medication available through their clinics for uninsured patients. New York State’s Insurance Commissioner issued a reminder to health plans calling on them to cover PrEP and avoid placing any barriers to its access. And Many states like Iowa and Washington State are allowing pharmacists to provide a number of preventive clinical services, including prescribing PrEP and ordering labs in collaboration with a licensed clinician. These flexibilities can help us expand the number of PrEP prescribers across the country, which is especially important in rural areas.
Do you think the massive PrEP ad campaign they've launched will penetrate the American psyche? Disseminating information about PrEP remains critical. We’ve seen greater awareness among gay and bisexual men. I think more is needed to convey the message that PrEP is available to all individuals who are at high risk of HIV infection, including women of color and people who inject drugs. Having campaigns that reach everyone, that speak to everyone in a way that helps take the stigma away from HIV and PrEP is definitely a move in the right direction, but changing behaviors and increasing awareness isn’t necessarily as easy as one advertising campaign. We need strong political will behind this strategy as well and the resources to support people in obtaining PrEP and the associated clinical services.
In regards to the HIV epidemic among Black men in the south what was your first and subsequent reactions/actions? I have always known that Black men have been historically marginalized and disproportionately impacted by the HIV epidemic in this country — that sense of urgency that we need to do far more has never escaped me. While our society often attributes this disparity to health behaviors among Black men, especially young men who have sex with men (YBMSM), the problem extends far beyond the individual. When the CDC reported that Black gay men have a one in two lifetime risk of being diagnosed with HIV, my colleagues and I at NASTAD understood that there were underlying systemic issues contributing to this epidemic. We must address the legacy of institutional racism, the effects of medical mistrust on the Black community, and interconnected social determinants of health such as unemployment, low educational attainment and healthcare access, homelessness, domestic violence, homophobia, and stigma. These factors both directly and indirectly make Black men, including YBMSM, more vulnerable to becoming HIV positive. As a result, we have incorporated a holistic and intersectional approach to our work at NASTAD.
In 2016, NASTAD founded the Center for Engaging Black MSM Across the Care Continuum, which is an online resource created in partnership with the Health Resources Services Administration’s HIV/AIDS Bureau. Our website, His Health, provides healthcare providers, public health professionals and students the opportunity to become well-versed in the health needs of Black men who have sex with men (MSM) through a wide range of tools including accredited continuing education courses, models of care and trainings. These resources were developed and led by social workers, and infectious disease and primary care physicians who have centered this patient population in their work. We are continuing to develop innovative, intersectional, and effective strategies that our healthcare community can incorporate into their practices or into their organizations to advance health equity for Black MSM.
Do you think we need a PEPFAR (The U.S.President's Emergency Plan for AIDS Relief) for the US? We do in a way have a domestic PEPFAR, the National HIV Strategy, that prioritizes the domestic response. What we need, similar to PEPFAR, is a coordinated effort across federal agencies to be held accountable with achieving national goals. And the Strategy should be updated once it expires in 2020 to incorporate new tools and strategies, including PrEP and helping all people living with HIV achieve an undetectable viral load, another proven prevention modality known as “Undetectable = Untransmittable,” or U=U.
Terrance Moore is the deputy executive director of NASTAD. He manages member technical assistance activities and policy development, oversees the organization’s domestic programs portfolio, including health care access, HIV prevention, hepatitis and health equity. Prior to his current role, Terrance was the driving force behind the expansion of NASTAD’s gay men’s portfolio as the director of the Policy and Health Equity teams. Terrance also worked for the National Prison Project of the American Civil Liberties Union and served as a legislative aide for Senators Charles Schumer (D-NY) and Christopher Dodd (D-CT). Terrance is a graduate of Howard University.