While HIV infections do not garner the media attention they did during the AIDS crisis of the 1980s, the disease is still at epidemic proportions in Louisiana.
In 2014, Louisiana ranked 2nd in the nation for estimated HIV case rates and 2nd in the nation for estimated AIDS case rates. Baton Rouge ranked 1st and New Orleans ranked 3rd for estimated HIV case rates among large American metropolitan areas. In 2015, 33 percent of HIV cases diagnosed in Louisiana were in New Orleans.
African Americans are only 12 percent of the population in the United States, but make up 45 percent of AIDS cases. For African-American men who engage in sex with other men, the risks are substantial. A 2016 study by the CDC found these men had a 50 percent chance of contracting HIV in their lifetimes.
Stacy Greene, MD, and the associate medical director of St. Thomas Community Health Center, said prevention is a crucial step towards reducing those numbers. Pre-exposure prophylaxis (PrEP) was approved by the FDA in 2012. The drug Truvada is aimed at adults who are at high-risk of recurring HIV exposure due to their sexual or injection behaviors. Examples include having a HIV-positive sexual partner, sharing injection equipment, having a high number of sex partners, among others.
Education is also a tool in prevention. But local schools do not teach sex ed, even though there is no state law prohibiting it. New Orleans City Councilwoman Latoya Cantrell said it’s not enough to teach it in schools. There should also be educational resources on HIV in local libraries.
Dr. Greene emphasized the importance of reaching millennials (ages 13-34), who comprised 55 percent of American HIV patients in 2015. Instead of using old-school methods like pamphlets and fliers, Dr. Greene advocated using the Internet and social media to reach millennials where they are. One such website is WePrepTogether.com, which educates the community about PrEP.
Diagnosis and treatment is also an important part of prevention. The CDC estimates that one in eight people infected with HIV are unaware they have it. A person who is unaware of his/her condition is more likely to engage in risky behaviors that could infect others. But if a person is diagnosed, then he/she can receive treatment. If properly treated, HIV patients can see their virus loads reduced to nearly non-existent levels.
The Journal of the American Medical Association published a study that found that HIV patients on suppressive therapy did not transmit the disease to their partners during sex (without a condom). While such sex may still not be 100 percent safe, the study indicates that patients whose virus load is drastically reduced are far less likely to spread the disease.
“If you can make people’s virus load undetectable, you’re going to stop the spread of HIV,” said Dorian-Gray Alexander, a local advocate for HIV service.
But many people still are reluctant to get tested because HIV still carries a stigma to it that a disease like breast cancer does not.
“The disease is so stigmatic, people don’t want to get into testing,” said Dr. Greene. “If we can get them into treatment, then we decrease the chance of them passing on the disease.”
Another hurdle is cost. While treatment is essential, it is expensive. Dr. Greene said on average, suppressive medications cost $3,000 a month. For PrEP medication, that number is $1,500. Either way, it’s costly for those without insurance. But in 2016, more Louisiana residents have access to insurance than ever before because of the Medicaid expansion signed into effect by Governor John Bel Edwards. The expanded coverage allows more HIV-infected Louisiana residents access to health care.
“Now we have the resources to make those medications readily available,” said Brandi Bowen, program director of the New Orleans Regional AIDS Planning Council.
But, there are fears that with a new Republican administration about to enter the White House it might not last for long.
“We’ve got to be aware that our votes have consequences,” said Department of Health and Hospitals Secretary Rebekah Gee, MD.
This article originally published in the December 5, 2016 print edition of The Louisiana Weekly newspaper.