Lab Test

Featuring Our Faculty: Here’s Why HIV Rates aren’t Going Down for People of Color

Once considered ground zero for the HIV/AIDS epidemic in the United States, San Francisco in recent years has been lauded as a success story for reducing transmission rates of the disease. But in both the Bay Area and the rest of the nation, people of color continue to be disproportionately infected with HIV—which makes some health advocates wonder why San Francisco’s approach to reducing infection rates isn’t being focused on the black and Latino communities.

According to Dr. Darpun Sachdev, a clinical prevention specialist at the San Francisco Department of Public Health and director of the city’s Linkage, Integration, Navigation, and Comprehensive Services program, which helps connect patients with treatment, a lack of access to PrEP—which stands for “pre-exposure prophylaxis” and is an anti-HIV medication—and health care in general are major obstacles to lowering infection rates among people of color.

“At least 6,000 people in San Francisco are on PrEP. But African Americans only make up 10 percent of those prescribed,” Sachdev told TakePart. “We need to increase the access of PrEP particularly among African American and Latino MSM”—shorthand for “men who have sex with men.”

Data from the Centers for Disease Control and Prevention show that 44 percent of estimated new HIV diagnoses in the United States were among black people, who are only 12 percent of the U.S. population. Latinos accounted for almost one-quarter of all estimated new diagnoses, despite representing about 17 percent of the total population. Even more alarming, fewer than half of Latinos with HIV are receiving medicines to treat their infection, and as of 2012, only 37 percent of black people with the disease were receiving treatment.

Meanwhile San Francisco, which is home to the first dedicated AIDS ward and was the testing ground of the first antiretroviral drug, has distributed clean needles to drug addicts since 1992 and actively promotes preventive treatment for those at risk of acquiring HIV. PrEP, found commercially as the pill Truvada, is distributed at clinics at no charge to the uninsured.

Along with boosting resources for getting residents tested, in 2013 San Francisco created the Rapid Antiretroviral Program Initiative for New Diagnoses, which guarantees a quick doctor’s visit even if the patient cannot afford it. RAPID also helps with obtaining insurance, a primary care physician, and transportation to appointments. Experts have supported the San Francisco model of funding programs that enable people to be tested and treated immediately following diagnosis and that eliminate the stigma associated with the disease. World Health Organization guidelines for treating HIV released in 2015 mirror this model but are not yet implemented widely.

Now San Francisco has launched “Getting to Zero,” an ambitious campaign that unites city health agencies, NGOs, businesses, and research institutions. The campaign has a goal of cutting HIV transmissions and related deaths by 90 percent by 2020. Even though the city has cut new diagnoses from 2,332 in 1992 to 302 in 2014, infection rates are declining much more slowly among minority groups.

Reaching into communities of color—especially teens and young adults—and ensuring that all the practical issues that may make it harder to be on PrEP are addressed is essential, Sachdev said.

“I think we’re trying to become more aware of the challenges that are leading to the racial disparities and head-on address them,” Sachdev said. “We’re hoping to do a PrEP demonstration project among youth in the next couple of years, in order to make sure that you are able to access PrEP and have a way of getting to PrEP quickly without jumping through a bunch of hoops.”

A lack of access to health insurance and cultural prejudices that associate HIV infection with drug use or being gay can also make seeking a diagnosis or treatment tough for people of color, according to Patrick Sullivan, a professor at Emory University whose work focuses on HIV prevention in minority communities.

“Black gay men in Atlanta, for example, have a higher risk of acquiring HIV than white gay men. One of the factors that really explains that disparity is lack of health insurance,” Sullivan said. “HIV testing should be part of routine medical care, but if folks don’t have health insurance and aren’t getting routine checkups, that’s a missed opportunity for early diagnosis. All the way down the line, lack of access to health insurance is a critical issue.”

For the MAC AIDS Fund, a charitable organization funded by lipstick sales, cultural barriers are the biggest obstacle to expanding outreach.

“The issue is if you can put this institutional ego aside and really engage nonprofit partners in an ego-free way,” Nancy Mahon, director of the MAC AIDS Fund, said. “San Francisco has an incredible history of tolerance and not judging people about either sex or drug use.”

Mahon said that this attitude is essential for governments that work with organizations such as MAC AIDS Fund. The approach will be key to “getting to zero” in all groups, including those in San Francisco whom progress has so far left behind, Sachdev said.

“We’re trying to deal with the structural issues as we get closer to zero, and that’s very challenging,” Sachdev said. “We really understand that addressing racial disparities are essential to the getting-to-zero mission.”

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