As far as HIV prevention and treatment are concerned, no other time in history has been as good as the current moment. Theoretically, the virus should be is as good as eradicated, as medications like pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) have come onto the scene. Essentially the birth control and Plan B of HIV, PrEP and PEP have made the virus 100 percent preventable.
If HIV is contracted, scientists have another fortuitous front: antiretrovirals. When prescribed early on, antiretrovirals have successfully halted viral reproduction, with patients achieving viral suppression to the point that it’s no longer detectable or transmittable.
The attitudes toward HIV have shifted, too. People are more sex positive, embracing sexual expression and emphasizing safe and consensual sex. They aren’t as homophobic, either; gay and queer sex has become more normalized and talked about.
That’s why the numbers don’t add up. The CDC reported in May that one in 11 white men who have sex with men (MSM) will contract HIV, following current trends. That statistic gets exponentially scarier for black MSM, who’ll have a 50-50 chance of contracting HIV, and who, in 2015, made up a third of all HIV diagnoses.
“It is one thing to hear these stats, but it’s another thing to see it,” shared Jessica Sherman, nurse practitioner for Equitas Health, one of the nation’s largest HIV/AIDS, LGBTQ healthcare organizations.
Sherman entered the medical field 17 years ago, beginning at age 18 as a volunteer in emergency rooms located locally and globally. In 2005, she became a nurse and worked in Washington, D.C. for the following six years, running the ER’s rapid HIV testing program.
Daily, Sherman witnessed the impact HIV has on people’s lives as she diagnosed patients or managed the effects of the virus going untreated. She wanted to get closer to her patients, keep them in treatment and on track to viral suppression, so she became a nurse practitioner.
During her time working in HIV treatment and prevention, she’s seen the same barriers to HIV eradication as have existed for decades: stigma, miseducation, and lack of access to care.
The stigma comes from everywhere, from peers, from family members, even from top policy leaders, who decide where resources are allocated. While discussing methods of curtailing new HIV infections, Betty Price, a Republican lawmaker from Georgia, wondered openly about quarantining HIV patients and recalled a time when those suffering with the viral infection “died more readily.” Georgia was recently ranked fifth in the country for new HIV diagnoses.
Mikayla Robinson, a local advocate for HIV awareness, sees attitudes like Price’s as outdated and uneducated.
“Yes, HIV comes from sexual transmission, but people look at it like it’s the dirtiest thing,” said Robinson, who’s HIV positive, “when really it’s just like if you get diabetes and you take stuff for your sugar. If you get it stable, you can live a good life. People don’t want to accept that news. People don’t want to accept that growth that has come.”
Robinson said the first step to overcoming this miseducation is talking about it.
Several local groups have assembled to do the job. Encouraging empowerment through knowledge, Project INK (Imagine Not Knowing), Your Voice, and the Greater Columbus Mpowerment Center (GCMC) provide testing and linkage to health services, and they all do outreach through different educational and social events, usually handing out goodie bags with condoms, lube, and informational packets.
Breaking through that initial awkwardness of discussing HIV with a perfect stranger does take some tact, but Your Voice prevention coordinator Cole Still said it doesn’t always require getting personal with someone.
“When I am out in public and we’re doing outreach events, I try to meet them where they’re at,” he said. “So a lot of the times, we don’t try to have an entire conversation, but just get them materials and get them safe sex packets, and try to make it as comfortable as possible.”
Randle Moore, who works at GCMC, said it goes beyond that initial discomfort for black MSM and for the African-American population in general. Typically, those groups just don’t trust healthcare providers or the medical system at large.
“We just don’t feel comfortable going to the doctor a lot of times unless something is wrong,” Moore said. “Very seldom do we go just to get a checkup. And I think a lot of it is also generational. My parents felt the same way, my grandparents felt the same way, my great grandparents. So, it’s just a learned behavior, a learned thought and idea.”
This learned idea is grounded in some harsh facts, too. A study out of Harvard Medical School from earlier this year revealed that racism and implicit bias within the medical field has persisted since racial health disparities were first “officially” noted in the 1980s, resulting in “more illness, worse outcomes, and premature death” for minority populations compared with whites. HIV diagnosis or treatment isn’t the only time this occurs, either (read: infant mortality).
GCMC, which targets the black MSM community, has sought to normalize the task of going to the doctor and getting tested. Moore started a social media campaign telling people to snap photos of themselves at the doctor’s office and “Let your social media friends, family and friends — let them know that, ‘Hey, I’m at the doctor today, and I’m okay,’” Moore said.
As part of outreach, Moore and Still stress the importance of patient control, informing their clients of what they may experience at the clinic, what to expect of their doctor, and the questions they should be asking.
“We have come so far as a community, with education and the social strides that we’ve made. I love that we’re able to dance in the street at Pride, or be who we want, or walk down the street holding hands with our partners,” Still said, “but I want to get out in the community and empower people and educate people that there’s still change that needs to happen, that people can get involved and can be a part of this fight.”
“If you think about it it’s kind of frustrating,” Sherman said. “We have the tools in our pockets to eradicate HIV. We have the medicine to prevent it. It’s virtually impossible to spread the virus. So, we have the tools. The problem is, it’s challenging, and we have to overcome this barrier of getting people in care.”