HIV Infections in US Disproportionately Impact Communities of Color and the Poor
HIV Specialists Meet to Identify, Help Those Who Are Falling Through the Cracks
WASHINGTON, DC (May 31, 2012) - With mounting evidence that many Americans remain the invisible people
with HIV/AIDS who live in poverty, have limited health literacy, are diagnosed late in the course of their disease, and therefore,
are the most likely to die of AIDS, leading members of the HIV/AIDS community called for a new mobilization to find, test and
treat those people with HIV who are falling through the cracks of the healthcare system.
Meeting in San Francisco at a conference convened by the Forum for Collaborative HIV Research, HIV experts and advocates
mapped a pathway to reduce disparities in HIV/AIDS, applying the lessons learned from the Bay Area where disparities exist
across the spectrum of care. In San Francisco alone, it is estimated that as many as a third (33%) of the African
American men who have sex with men (MSM) live with HIV. Moreover, across the Bay Area, almost a third (32%) of
those infected with HIV and especially low-income African Americans and Hispanics, older residents, and
immigrants are "late testers" who develop AIDS within a year of diagnosis and enter the healthcare
system when treatment outcomes are poor.
"If there was ever a time when we need to confront disparities in HIV/AIDS, it is now," said Veronica Miller, Ph.D., Director of
the Forum. "We now know that effective interventions are changing the standard of care for populations at risk in the Bay Area. Now,
the goal is to apply these lessons learned so more communities will have the tools to address disparities in HIV that are keeping
too many vulnerable people from receiving quality care at all points in the process -- from screenings and diagnosis to access
to state-of-the-art therapies and ongoing treatment."
With the Bay Area as a model for how communities are responding to reduce HIV transmission and better support people living with
HIV, the conference attendees agreed that confronting disparities in HIV requires a multi-level approach where state and
community-supported programs combine proven HIV prevention methods - such as condom availability, HIV testing, and
antiretroviral therapy for diagnosed positives and high risk negatives - with novel interventions that deal
directly with the root causes of HIV disparities. The most significant factors contributing to disparities
in HIV infection are race/ethnicity, poverty and neighborhood conditions, STD prevalence, incarceration,
homelessness, and access to quality healthcare services.
Disparities: The Real HIV/AIDS Epidemic
Providing the most up-to-date information on the extent of HIV/AIDS in the U.S., Grant Colfax, MD, President Obama's new Director of
the Office of National AIDS Policy, termed growing disparities in HIV infection rates the "real" HIV/AIDS epidemic today. Of the
estimated 50,000 new cases of HIV that occur each year in the U.S., infection rates in Latinos are nearly three times as high
as for whites and seven-fold the rate in African Americans as in whites. Of added significance, black women are especially
hard-hit by the HIV/AIDS epidemic, accounting for 30% of the estimated new HIV infections among all blacks in 2009.
Dr. Colfax also called attention to the many Americans with HIV who remain undiagnosed - an estimated 200,000 people - where
stigma, discrimination and distrust of the healthcare system are significant factors contributing to the unequal burden of
HIV/AIDS among communities of color, sexual minorities and the poor. Noting that discrimination still occurs within
today's medical setting and affects the personal attitudes and perceptions of some healthcare providers, the
Director of the Office of National AIDS Policy said one of the ongoing challenges is educating clinicians
about HIV prevention and treatment, especially at a time when there are not enough qualified providers
to increase HIV testing and ensure availability of quality medical care. The National AIDS Policy
Director further called for an increased focus on educating minority populations to dispel the
expectation of inadequate care that has kept many underserved people with undiagnosed HIV
from getting tested and linked to care.
Assessing the Impact of Same-Sex Marriage and the Affordable Care Act
Although disparities in HIV are now at epidemic levels, two Administration policies have significant potential to improve disease
outcomes - President Obama's support for same-sex marriage and the changes in healthcare coverage that either have or will be
taking place under the Affordable Care Act (ACA). Among the "meaningful" changes now taking place under ACA, Dr. Colfax
pointed to an additional 54 million Americans who are now eligible for preventive care. And by 2014 when ACA is fully
implemented, Dr. Colfax said that as many as 30% of the HIV/AIDS population now without health insurance will be
enrolled in the Medicaid program and have access to the package of Essential Health Benefits (EHB) all the
state health exchanges must offer their beneficiaries. Among the benefits available under EHB are
preventive and wellness services, chronic disease management, laboratory services and prescription drug coverage.
Despite this great promise, implementing the Affordable Care Act will not be easy, and not just because of lingering questions about
whether the Supreme Court will uphold the law, strike it down entirely or overturn the individual mandate that citizens must carry
health insurance. Using California as an example of how states are transitioning HIV care to new systems, Anne Donnelly, Director
of Public Policy for Project Inform, one of the most influential community-based HIV treatment information and advocacy
organizations, reported that a range of immediate challenges face the public health community, including:
Moving state Medicaid programs to managed care models
Providing care to immigrants and especially undocumented individuals who will not be eligible for coverage under Medicaid and the health
Communicating the many new changes in low income health programs, eligibility requirements and new provider rates to healthcare
professionals and individuals
But of greatest concern to the HIV community, stressed Ms. Donnelly, are addressing two important needs of those individuals with HIV who
are at highest risk for HIV disparities - providing a safe transition to new systems of care for vulnerable populations and ensuring that
the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act continues to fill the gaps between what is covered by the Essential
Health Benefits package and what is needed to keep people with HIV in treatment. Accordingly, Ms. Donnelly urged HIV advocates to
press for continued Ryan White funding so people with HIV will have ongoing access to such needed services as case management,
nutrition counseling, help with transportation to clinical care settings and peer support services.
"Implementing the Affordable Care Act requires tremendous systems change, which always involves unintended consequences, "said Ms. Donnelly.
"It's clear that there will be a critical ongoing need for Ryan White services that support health but are not completely medical in nature,
such as dental care and social support programs."
Lives Cut Short in the Bay Area; What Is Working to Reduce Disparities in HIV
While documenting the extent of and causes of persistent disparities in HIV nationally, the conference focused specifically on the real-life impact
of disparities in poor neighborhoods of San Francisco, Oakland and San Jose where new data from the Health Equity Institute reveal major differences in
life expectancy between more affluent and poorer communities. Specifically, the Institute compared the life spans of people residing in the
prosperous areas of Russian Hill in San Francisco and the Oakland Hills in Alameda County with those living in the underserved communities
of Bayview/Hunter's Point in San Francisco an in West Oakland, finding that residents of the poorer neighborhoods died an average of 14
Calculating the cost of poverty in the Bay Area alone, the Health Equity Institute estimates that every additional $12,500 in
household income buys an extra year of life expectancy. Reinforcing these findings, Wendy Leyden, a researcher with Kaiser
Permanente Northern California, presented the results of a study of 10,518 HIV-infected adults followed between 1996 and
2006, which found no differences in mortality between white and minority individuals with HIV when they are insured and
have equal access to care.
Using these findings as a call-to-action, the conference emphasized the role of community- based organizations in confronting
the barriers that prevent vulnerable populations from receiving quality care, highlighting a range of innovative programs that
are working to increase HIV testing and treatment adherence among high-risk youth, HIV-positive women, injecting drug users
and crack smokers, those with mental illness, and men and women with HIV who are over age 50. Among the programs featured were:
Cultural Odyssey Troupe in San Francisco - that developed The Medea Project: Theater for Incarcerated Women in conjunction with the Women's HIV Program (WHP) at University of California, San Francisco to encourage HIV-positive women to write out their personal stories and make known their HIV status in a public theatrical performance called Dancing with the Clown of Love
The Downtown Youth Clinic at the East Bay AIDS Center in Oakland - which conducts a social network HIV testing program where high-risk African American and Latino youth ages 13-24 refer acquaintances for testing
Glide Foundation in San Francisco - where a research team distributes crack pipes and materials on safer smoking techniques to crack smokers in the Tenderloin District, creating the opportunity to educate this underserved population about th
Positive Care Center at UCSF - that developed the Urban Telemedicine Program as a new way to provide nutrition counseling, pharmacy advice and other HIV management services to underserved people with HIV via real-time, secure broadband video connections in urban settings
Health Equity Institute, San Francisco State University - that is studying Peer Navigation as a strategy for overcoming distrust and stigma in African American men so they can be tested for HIV and linked to care.
Held in association with the University of California, San Francisco Center for AIDS Research and San Francisco Department of
Public Health, the conference - Overcoming Health Disparities in the Bay Area: Using HIV/AIDS as a Model - took place May 23-24
and drew nearly 150 scientists, clinicians, public health leaders and advocates, including many from the Bay Area.
About the Forum for Collaborative HIV Research
Part of the University of California (UC), Berkeley School of Public Health and based in Washington, DC, the Forum was founded in
1997 as the outgrowth of a White House initiative. Representing government, industry, patient advocates, healthcare providers,
foundations and academia, the Forum is a public/private partnership that organizes roundtables and issues reports on a range
of global HIV/AIDS issues. Forum recommendations have changed the ways that clinical trials are conducted, accelerated the
delivery of new classes of drugs, heightened awareness of TB/HIV co-infection, and helped to spur national momentum
toward universal testing for HIV. http:// www.hivforum.org.
Source: Forum for Collaborative HIV Research