National Gay Men's HIV/AIDS Awareness Day: Remembering the Other Pandemic

2020, otherwise known as the year of the pandemic, has unhinged most of the world into a tailspin of concern as coronavirus cases top more than seven million in the U.S. alone. Yet the global HIV epidemic, with origins dating as far back as 1959, has killed approximately 33 million people. September 27, National Gay Men's HIV/Awareness Day (#NGMHAAD), focuses on the disproportionate impact of HIV on gay and bisexual men in the United States – and what we can do in response.

What the Numbers Tell Us
Of the estimated 36,400 new HIV infections in the United States in 2018, 67% (24,400) were among gay and bisexual men. Among these men, racial and ethnic differences exist, with the highest disparity among Black and Latino gay and bisexual men.

In 2018, 39% (9,400) of new HIV infections were among Black gay and bisexual men; 33% (8,000) among Latino gay and bisexual men; 23% (5,700) among white gay and bisexual men; and 68% (16,600) among gay and bisexual men under the age of 35. Compared to 2014, in 2018, new HIV infections were down 20% among white gay and bisexual men and remained stable among Black and Latino gay and bisexual men.

Just the like data gathered for coronavirus, we continue to see racial disparity among HIV infection rates.

In a recently published article in Morbidity and Mortality Weekly Report, researchers from the Centers for Disease Control and Prevention (CDC) reported results from an analysis of HIV diagnosis, linkage to care, and viral suppression data from the National HIV Surveillance System, 2014–2018.

Results showed that in addition to being disproportionately diagnosed with HIV, Black, Hispanic/Latino, and younger men who have sex with men (MSM) are less likely to be linked to care or achieve viral suppression (have low levels of virus in the body). Increased linkage to care promotes viral suppression, which helps people with HIV stay healthy.

A person with a suppressed or undetectable viral load also has effectively no risk of sexually transmitting HIV to partners. However, only 67.2% of all MSM included in the analysis achieved viral suppression within six months of diagnosis. During 2018, proportionally fewer Black MSM were linked to care and achieved viral suppression than MSM of other racial/ethnic groups.

Although this analysis did not explore reasons for the results, limited health care access, housing instability, poverty, homophobia, and systemic racism commonly act as barriers to linkage to care and viral suppression. Additionally, in some cases, healthcare providers' implicit racial biases (thoughts and feelings that providers are not consciously aware of) toward Blacks and Hispanics/Latinos can influence provider behavior and negatively affect treatment choices. This may lead to treatment nonadherence (not taking medication as prescribed), reducing the likelihood of viral suppression.

Researchers concluded that interventions that address systemic racism and racial biases within healthcare systems could be beneficial. Interventions that address the social determinants of health associated with high risk for HIV infection among MSM might help prevent HIV infection and eliminate racial/ethnic disparities in HIV infection among gay and bisexual men.

Where You Live Makes a Difference
HIV tends to disproportionately impact those living in the South. Events and policy choices must be closely monitored in these areas. With several legislation areas to keep track of, here are a few notable potential policy changes impacting Georgia and Mississippi, as reported by AIDS United.

Georgia
Georgia requested from the Centers for Medicare and Medicaid Services a waiver that would make multiple changes to the Affordable Care Act Applicability in the state that are of concern to the HIV community. As a result of this waiver, Georgia would no longer use the federal health care exchange, healthcare.gov, to distribute health insurance plans. Instead, the state would move to a privatized marketplace that would operate through private web brokers or health plans. This would be called the "Georgia Access Model."

The tax credits used in the ACA would now be used to purchase substandard plans, which, while cheaper, provide limited coverage. It would eliminate the ACA's premium tax credit and enable Georgia to establish a financial-aid program for people in need. However, this program would come with a cap in the number of people who can receive assistance. This translates into a situation where people who are currently receiving subsidies for their insurance could be left unable to access insurance.

Mississippi
Mississippi advocates have been revisiting the expansion of Medicaid in the state through ballot initiative. Mississippi is one of the states that has not expanded Medicaid under the ACA. It is also one of the country's poorest, with a full 25% of the population relying on Medicaid. Expanding access would allow many people who do not qualify for traditional Medicaid and do not have private insurance to access Medicaid coverage. Projected figures state that there would be a 57% reduction in the state's uninsured, offsetting financial losses for health care providers, especially safety-net hospitals.

Medicaid expansions substantially help people living with HIV. In 2018, there were at least 9,466 people living with HIV in the state, and nationwide, those of us living with HIV are more likely to rely on Medicaid, at a rate of 42%, compared to 13% of the total U.S. population. Medicaid expansions significantly help people of color, who are also more likely to rely on Medicaid and at greater risks of contracting HIV.

Be the Change
As part of the Ending the HIV Epidemic (EHE) initiative that aims to reduce HIV infection in the United States by 90% by 2030, CDC's Let's Stop HIV Together campaign aims to empower communities, partners on the ground, and healthcare providers to reduce HIV stigma among all Americans, prevent HIV among the hardest-hit populations such as Black and Hispanic/Latino MSM, and help people with HIV stay healthy.