Wednesday, April 21, 2021 (Kaiser News)-Facing a year-long siege coronavirusIn another older war, the defenses faltered.
In the past two decades, AIDS virusAIDS was blocked through effective antiviral drugs, aggressive testing and creative public education campaigns. But COVID-19 Pandemic In almost all aspects of this battle, it caused far-reaching damage, grounded outreach teams, drastically reduced testing, and evacuated key personnel from laboratories and medical centers.
The exact impact of one epidemic on another is still the focus of attention, but preliminary evidence has disrupted experts celebrating the great progress of the pandemic. AIDS treatment. Although the focus of work across the country has shifted, in the southern states (now at the center of the state’s HIV crisis), delays in testing and treatment pose a particularly serious risk.
“This is a major derailment,” said Dr. Carlos Del Rio, a professor of medicine at Emory University in Atlanta and the head of Emory University. AIDS International training and research programs. “There will be damage. The question is, how much?”
The number of face-to-face visits at the clinic is limited and daily activities have ceased HIV screening In the doctor’s office and emergency room, doctors relying on video calls with patients are a futile choice for the homeless or those who are worried that family members will find out about their condition. The quick test van that once parked outside nightclubs and bars and distributed condoms was sealed. Moreover, in state capitals and counties, the government’s expertise has been focused on COVID response measures on deck.
Concrete signs of impact on HIV surveillance abound: A large commercial laboratory reported a reduction of nearly 700,000 HIV screening From March 2020 to September 2020, compared with the same period last year, the number of tests nationwide fell by 45%, and the number of diagnoses fell by 5,000.prescription EPAccording to a new study presented at a conference last month, pre-exposure prophylaxis that can prevent HIV infection has also fallen sharply. The state public health department also recorded a similar sharp drop in testing.
The lack of new data has led to a turbulent, unknown moment: For decades, the country’s acclaimed HIV surveillance system has turned a blind eye to the spread of the virus.
Nowhere in the southern region will the lack of data be felt more deeply than ever: this region accounts for 51% of all new infections, and 8 of the 10 states with the highest new diagnosis rates account for all HIV-related deaths half. The latest data provided by the Centers for Disease Control and Prevention.
Even before the COVID pandemic, Georgia had the highest rate of new HIV diagnoses, albeit lower than Washington, DC. The Georgia Department of Public Health’s test results last spring were down 70% compared to the spring of 2019.
Dr. Melanie Thompson, principal investigator of the Atlanta AIDS Research Association, said, “The decline in the rate of services for AIDS patients may continue for several years.”
She added: “Every new HIV infection will perpetuate this epidemic. If people are not diagnosed and treated for HIV, they are likely to be infected to one or more people in the next few months.”
Coronavirus test Captured previously used for HIV/AIDS test, Further increase the burden of surveillance work. The polymerase chain reaction (or PCR) machine used to detect and measure the genetic material in the human immunodeficiency virus is the same machine that runs the COVID test around the clock.
For decades, as HIV has moved inland from coastal cities such as San Francisco, Los Angeles, and New York, it has taken root in the south, where poverty is an endemic disease, lack of medical services is common, and the stigma of HIV is widespread.
“This is a real stigma. “This is traditional racism. “Thomas Giordano, medical director of the Thomas Street Health Center in Houston, said that he is one of the largest HIV clinics in the United States. Political leaders in the state believe that HIV is “a disease of the poor, black, Latin Descent and homosexuality. At the state level, it is not yet mainstream. “
Blacks make up 13% of the U.S. population, but 40% of HIV cases and deaths. In many southern states, the gap between the rich and the poor is clear: In Alabama, black residents make up 27% of the population and 70% of newly diagnosed people. In Georgia, blacks make up 33% of residents and 69% of people living with HIV.
AIDS clinics that provide services to low-income patients also face the limitations of using video and telephone appointments. The director of the clinic said that poor patients often lack a data plan, and many homeless patients do not have a phone at all. They must also face fear. “If a friend gives you a room to sleep in, and your friend discovers that you have AIDS, you may lose that place to sleep,” said Del Rio of Emory University.
Texting can also be tricky. “We must be cautious about text messages,” said Dr. John Carlo, North Texas CEO of PRISM Health Care in Dallas. “If someone sees their phone, it will be devastating.”
In Mississippi, HIV contact tracing (which was once used as a model for local coronavirus tracking work) is restricted by COVID-related travel restrictions, which means “protecting both staff and customers”, the department’s responsibility Melverta Bender said. Venereal diseaseThe HIV/AIDS Office of the Mississippi Department of Health.
Of all regions in the United States, the health safety net in the South is the weakest. The southern states have far fewer resources than California and New York. Atlanta researcher Thompson said: “For decades, our public health infrastructure has been underfunded and destroyed for a long time.” “So, in many ways, we will do worse.”
Georgia has a high rate of HIV infection, while the pace of COVID in the state is slow Vaccination Thompson said: “It’s not unrelated.”
The porous safety net extends to health insurance, which is an urgent need for people living with HIV. Americans with almost no health insurance live in the South, and many states have not expanded Medicaid under the Affordable Care Act. This leaves many people living with HIV relying on the federal Ryan White’s HIV/AIDS program and state-run AIDS drug assistance programs (called ADAPs) to provide limited services.
“From a fair point of view, insurance is essential for people’s survival and growth in AIDS,” said Tim Horn, director of health care at NASTAD, the National and Regional AIDS Alliance. He said that Ryan White and ADAP “are not capable of providing comprehensive and comprehensive care.”
Roshan McDaniel, manager of the South Carolina ADAP program, said that if the state of South Carolina expands the Medicaid program, 60% of the people in South Carolina who participate in the program will be eligible. “In the first few years, we thought about it,” McDaniel said. “Now we don’t even think about it.”
In the first few months of the pandemic, enrollment in the Ryan White program surged, when states’ economies were at a deadlock, and Americans withdrew from the pandemic. Data from the state health department reflects an increase in demand. In Texas, from March 2020 to December 2020, enrollment in the state’s AIDS drug program increased by 34%. In Georgia, the enrollment jumped 10%.
State health officials attribute the increase in enrollment to pandemic-related job losses, especially in states without expanded Medicaid programs. Antiretroviral therapy is an established therapy that can suppress the amount of virus in the body and prevent AIDS. The annual cost is as high as 36,000 US dollars. The interruption of drug treatment may lead to virus mutation and drug resistance. But eligibility for state aid is difficult: approval may take up to two months, and lack of written documentation may result in cancellation of coverage.
Federal health experts say that southern states generally lag behind getting patients to receive medical services and curbing their viral load, and that people living with HIV tend to be misdiagnosed longer than in other regions. For example, in Georgia, among the four people who knew they were infected, nearly one had developed AIDS within a year, indicating that their infection had already been diagnosed.
With the spread of vaccines and the relaxation of restrictions, the heads of HIV clinics are searching the list of patients to determine who they need to see first. “We are studying people who haven’t seen us for more than a year. We think there are more than a few hundred. Did they move? Did they move?” said Carlos, a Dallas-based doctor and health care chief executive officer. . “We don’t know what the long-term consequences will be.”
KHN (Kaiser Health News) is a national newsroom that publishes in-depth news on health issues. Together with policy analysis and polling, KHN is one of the three main operational plans of KFF (Kaiser Family Foundation). KFF is a donated non-profit organization that provides information about health issues to the country.