Victory for COVID … What about HIV?

Author: Lunthita M. Duthely EdD MSc MS,  Public Voices Fellow of The OpEd Project, Faculty with the University of Miami School of Medicine and Visiting Professor, UCSF.

During June, the US commemorates HIV Long-Term Survivors Day to honor people who acquired HIV prior to the advent of anti-retroviral treatments (1996). The drugs changed the trajectory for those with HIV—meaning, these survivors beat the odds and have lived with HIV over 25 years. That has not been the fate for all. In fact, even in the era of the most advanced therapy, when HIV deaths are preventable, 15,000+ people with HIV die annually in the US and of those, 1 in 3 died of HIV-related causes (not car accidents, for example). So it is still relevant to prevent transmission of HIV, since 36,000 new infections occur in the US annually

Early diagnosis is key. Not only does early diagnosis of the virus reduce the spread of HIV, it also averts new infections for babies exposed to the virus by their mother and bad health outcomes, like cancers and even death, that result from advanced disease. Massive effort on the part of the US government got free home test kits into American homes for COVID/SARS-CoV-2. This is a victory for COVID-19. Why can there not be a similar victory for HIV?

Despite initial delays in developing and distributing a US test for SARS-CoV-2, within six months of US lockdowns the first home test became available for about $30. By January of 2022, two years after the first US cases were detected, the Biden Administration mailed, en masse, kits for free. As of May 2022, the third round of tests are being made available, and approximately 350 million free tests have been distributed.  (See chart  here ). What about HIV?

Using the most conservative inputs into a complex statistical model, it was estimated that without widespread rapid testing of SARS-CoV-2, the US would have faced 11.5 million infections, 119,000 deaths, $10.1 billion dollars of costs—inpatient care and productivity loss, during a 60-day period.

HIV providers anticipated disruptions in care for an already-marginalized group of people, subsequent to nation-wide shutdowns of non-essential medical care and health departments. This was of particular concern in the global context, where weak infrastructures, low supplies and a dependence on resources across borders were a bigger issue. Lockdowns and redirection of resources to combat COVID-19 left a big gap in the fight against HIV.

We now know that the pandemic created setbacks in the fight against HIV, TB and Malaria in low-to-middle-income countries. The World Health Organization estimates that people who normally would have had access to condoms and clean needles and syringes dropped by 11% and testing for HIV fell by 22%, introducing delays in treatment and further spread of the HIV virus.

To be sure, in the US, free test kits are available. In Miami-Dade County, where I live, if you are referred for testing by health care provider or a case manager, fill in an online form and agree to an interview with the Health Department, you may qualify for a free HIV home test kit. If can you afford it, for $35 you could go here have one test delivered to your home within a few days. You could also go here, share your desire to have one test kit on hand with 160 people and get one about $10; however, you might not quite be ready to go public with your intentions.

Of note, only one company is authorized by the FDA to provide HIV self-testing. The company’s monopoly on HIV self-testing kits.

What is needed is a policy change for the widespread dissemination of extremely low cost/free HIV testing. Research, has shown that advocacy and targeted campaigns to raise awareness about HIV and testing makes a difference in increasing the rate of HIV  testing and the willingness to be tested.

However, HIV is a stigmatizing condition and people assume that “drug addicts”, “gays/homosexuals”, people whose partners are drug addicts or gay/homosexual are at-risk. However, nearly one-quarter (23%) of new infections occur among people who identify heterosexual, and the majority of new infections among people who are heterosexual are women.

The CDC has several recommendations and tool kits for physicians help stop the spread of HIV; however, these are based on the assumption that individuals seek regular medical care. Due to the disruption of HIV-related services, in 2020 the CDC even launched a campaign to distribute HIV self-test kits, but focused on gay/bi-sexual men. In the US, $28 billion annually is spent fighting HIV/AIDS, including research to develop a vaccine. Perhaps ,if a higher portion of that money went towards wide-spread distribution of HIV home test kits, we could avert the spread of HIV and reduce HIV-related health care costs.

About Dr. Duthely

Lunthita M. Duthely, EdD, MSc, MS, is a Research Assistant Professor in Public Health Sciences, and Obstetrics, Gynecology & Reproductive Sciences at the University of Miami, Miller School of Medicine and a Public Voices Fellow of The OpEd Project. Dr. Duthely has more than 35 years of HIV/AIDS research experience including collaborations and published works focused on treatment adherence and mental health among pregnant and post-natal women living with HIV; anogenital dysplasia screening; HIV, substance use and mental health conditions; and the structural-level barriers and public health/environmental concerns for vulnerable populations.