The face of HIV in the United States has long been white gay men, even though the epidemic has had a devastating and disproportionate impact on African-American communities.

This is especially true among women; 60 percent of newly diagnosed cases of HIV in women in 2017 were African-American. Yet, African-American women’s voices are notoriously absent from the national discourse on HIV.

Largely invisible to a fractured health care system, these women are often breadwinners and matriarchs whose families count on them for support and care.

Treatments to help people who are HIV-positive manage their illness and survive into older age have improved greatly, yet the unique health needs of African-American women living and aging with HIV—estimated at about 140,000—are often ignored.

While many are actively taking medication and receiving care, some do not know their HIV status. After diagnosis, many have difficulties managing their HIV, which can contribute to their other health challenges.

I have been working on collecting oral histories from many older HIV-positive women in the Washington, D.C., area, where I live and research. It is my hope that by focusing on the voices of African-American women themselves, we as a country are able to better understand the profound impact that HIV has had on black life.

HIV and African-Americans.

Many believe the HIV epidemic in the United States is nearing an end, in part because increased funding, targeted prevention efforts, and better treatment have resulted in drastic reductions in new HIV-positive cases. Even President Trump, in his recent State of the Union address, discussed his goal of ending HIV by 2030. I am an HIV researcher, and I can say this is totally unrealistic, especially for African-Americans.

Despite comprising only 12 percent of the overall U.S. population, African-Americans represent 43 percent of all persons with newly diagnosed HIV and 42 percent of all people living with HIV. African-Americans living with HIV are nearly 10 times more likely to be diagnosed with AIDS (now often called advance or late-stage HIV) and over six times more likely to die of complications of advanced HIV than their white counterparts.

African-Americans are also at a higher risk for other health conditions, which can make managing HIV infection more difficult. For instance, African-Americans are twice as likely to die from heart disease and 50 percent more likely to have high blood pressure than whites.

In Washington, D.C., a place filled with public health experts and policymakers, the HIV prevalence rate is the highest in the nation, exceeding the World Health Organization’s definition of a generalized epidemic. African-Americans represent a staggering 75 percent of all HIV cases in D.C.

HIV in Washington D.C. is a regional epidemic, and crosses the jurisdictional border into Prince George’s County, Maryland. The sprawling suburbs of Prince George’s County are well known for their ranking as one of the wealthiest African-American-majority counties in the nation, but with HIV rates that are four to 10 times higher than those of white adults.

The high rates of HIV in Washington D.C. and Prince George’s County reflect a growing public health crisis in the United States, where the disproportionate burden of HIV is increasingly concentrated in the U.S. South. Southern states, where 55 percent of African-Americans live, have the highest rates of new HIV-positive diagnoses, the highest percentage of people living with HIV, and the lowest rates of survival for those who are HIV-positive.

Government investment in the domestic response to HIV tops more than $26 billion per year, yet these health inequities in HIV for African-Americans continue to persist. These inequities are due in part to abstinence-only funding to schools with large minority populations and HIV-specific criminal laws, which undermine the health and well-being of African-Americans and perpetuate systems of inequity. Systemic racism in resource distribution, such as concentrated poverty and health care and funding disparities is also a significant driver of the epidemic within African-American communities.

Since the beginning of the epidemic in the 1980s, African-American women have carried a large burden of HIV, and more than 60,000 lost their lives. But not everyone died. My project of personal narratives of these women suggest that they live with multiple uncertainties brought on by HIV. Many worry about how their health, disability, and eventual death will impact their roles as mothers, grandmothers, daughters, sisters and wives.

Lives of suffering, strength and survival.

Shawnte’ Spriggs’s story is typical of many African-American women living with HIV whom I spoke to. Many suffered trauma and abuse as children. Like everyone, however, she has her own unique story.

“My family stories are not pretty,” said Spriggs, 45, who grew up in northeast Washington D.C., in a neighborhood with open-air drug markets, crime, and gang violence. “My mother had a very bad temper. If she had a bad day, or someone teed her off, or one of her boyfriends did something to her, I was abused pretty bad.”

Her father was around only intermittently. She later learned the reason for his disappearances: He was often in prison.

Looking for love and craving protection from her mother, she turned to her godbrother, a caring guardian whom she later married.

Three months into their marriage, beatings began. The first was in the middle of the night. She woke suddenly. Her ex-husband was still asleep but sat up as if he were awake and punched her in the face. They both laughed about it in the morning, as if it had been an accident.

The abuse continued.

Eventually Spriggs escaped the marriage. She moved to another state and created a rewarding life. She even found love again, and remarried. She changed careers. She also became an evangelist, traveling for religious conferences frequently.

In 2010, Spriggs accepted an invitation to speak at a women’s conference in Lynchburg, Va. The conference offered health screenings. Some of the women invited her to take an HIV test with them. Sure, why not? she thought, wanting to set an example for the young women attending.

The last thing she expected was to test positive.

Her initial reaction was that she was going to die. She researched to learn more about HIV and began to realize that many people in her life probably died of it even though it was being labeled as something else in the community. She was terrified, especially because she feared returning to the pain and trauma from her past.

“I was so afraid of going to a dark place, from my childhood. I know my triggers,” Spriggs said.

She took action, signing herself up for both inpatient and outpatient mental health care, which helped her with her healing process. She attended HIV support groups, where she was the only woman among gay men.

Spriggs counts herself fortunate. She knows that many others have fewer resources, more responsibilities, and a lack of accessible and culturally appropriate care.

The post How HIV Stigma Affects Black Women appeared first on MyMedicPlus.

In an interview with the Trinidad and Tobago Newsday in mid-December, 2019, Trinidad and Tobago Minister of Health Terrence Deyalsingh made a controversial statement, suggesting that even if the HIV-preventative drug known as PrEP (Pre-Exposure Prophylaxis) were readily available, it would encourage promiscuity.

Minister Deyalsingh had made similar remarks at the 2016 Joint United Nations Programme on HIV and AIDS signing ceremony, aimed at eliminating the spread of HIV by 2030, at which he made it clear that the government would not allow access to PrEP via the local public health care system.

Deyalsingh’s attitude toward HIV/AIDS prevention highlights Trinidad and Tobago’s ongoing struggle with HIV stigma and a lack of sex education.

While PrEP has been proven to reduce the chances of contracting the HIV virus, Deyalsingh maintained that the government will not subsidise the PrEP medication because the thrust of his ministry’s HIV/AIDS awareness campaign is post-exposure care, not prevention. If people want the drug, he said, it is available in the private health care sector.

While Deyalsingh offered exceptions to the rule, many citizens felt that his remarks exacerbate the heavy stigma of HIV/AIDS.

In the interview with Newsday, Deyalsingh explained that should a health care worker accidentally get stuck with a needle, for instance, or in cases of sexual assault, those involved would be given the treatment if there is a chance they might contract the virus. While the World Health Organisation classifies PrEP as an “essential medicine,” the minister rationalised his position this way:

PrEP is to give […] to people before exposure or with no exposure to HIV…It means that knowingly you are going to engage in some sort of behaviour that would cause you to be at a higher risk of getting HIV and you want to take a drug to prevent yourself from getting HIV. […]

That is not government policy […] It’s a simple as that.

His comment was met with a lot of criticism, especially from Trinidad and Tobago’s estimated 29,000 citizens living with the virus — a reduced number, thanks in part to the efforts of both government agencies and non-governmental organisations dedicated to education, prevention and stigma reduction on HIV/AIDS.

HIV stigma

HIV-positive patients often face discrimination because of their health status, and many cannot afford the required drugs through the private health care system.

The Family Planning Association of Trinidad and Tobago (FPATT) has insisted that the government must make the drug available, saying that citizens have the right to access medication in the public health sector.

Calling the minister’s statement “myopic,” executive director of FPATT, Donna Da Costa Martinez, chastised Deyalsingh for contributing to the narrative that the drug encourages promiscuity, rather than educating people about its actual purpose: being “a useful tool to prevent HIV”:

The statement is not only short-sighted but harmful, as the deciding factor then becomes grounded in a moral debate about human sexuality, an integral part of who we are and what we do.

A lack of sex education

The Family Planning Association, Minister of Sports and Youth Affairs, Shamfa Cudjoe, and Minister Deyalsingh, representing the health ministry, have all said that the country needs massive reforms in sex education, but little to nothing has been done by the Ministry of Education.

Deyalsingh is pro-sex education and admits that its absence contributes misinformation among young people:

Let’s not try to put our heads in the ground. Let’s just open our eyes, face the realities and make sure that we introduce sexual education adequate for the age of the students in schools.

Yet, several of the country’s religious bodies condemn the concept of sexual education, most notably the Trinidad and Tobago Council of Evangelical Churches.

Despite the state’s mandate to retain a secular view when it comes to laws and policies, government officials, often in the health and education ministries, often pander to the interests of the country’s diverse religious population, using religion as their rationale for not developing a well-rounded sex education curriculum.

As a result, successive governments have had a “hands-off” policy when it comes to sex education, with many schools opting for an abstinence-only approach, mainly due to the fact that a majority of the country’s schools have religious affiliations.

Currently, the ministry has a Primary Health and Family Life Education (HFLE) curriculum aimed at teaching children about sex, sexuality and STIs.  The programme, however, is not mandatory for teachers if they feel uncomfortable teaching it. Since the ministry does not have many specialised teachers to teach the subject, they rely “on the goodwill of the teachers”:

Connected with this lack of sex education are many unplanned pregnancies and a lack of knowledge about how sexually transmitted infections and be contracted and prevented.

Dr. Kale Ferguson, Chairman of the Tobago AIDS Coordinating Committee, said in a speech earlier this year that youth education is key to HIV prevention, as well as reducing stigma. Trinidad and Tobago’s “most at risk” group for HIV is females, aged 15-24.

‘Moral hypocrisy’

Meanwhile, Colin Robinson of the Coalition Advocating for Inclusion of Sexual Orientation (CAISO), which has been advocating the use of PrEP as a preventative measure, has accused Minister Deyalsingh of “moral hypocrisy.”

By refusing to implement a policy to allow access to PrEP, Robinson said, the ministry is standing in the way of protection. He explained that the decision to make the drug available in public health care facilities lies solely with the minister, but lamented the ministry’s stance, stating: “We are not really empowering communities to stop HIV.”

Other Caribbean territories, including Guyana, have already implemented the use of the drug in order to prevent HIV and save lives.

Thus far, Minister Deyalsingh has not responded to any of the outcry surrounding his statement.

The post Trinidad and Tobago continues to face HIV stigma and lack of sex education appeared first on MyMedicPlus.

Singapore had its first human immunodeficiency virus (HIV) case reported in 1985, and experts across Singapore are now aiming for the nation to see its last case no further beyond 2030.

Describing advances in medicine as providing the “most opportune time” to end HIV transmission and acquired immune deficiency syndrome (AIDS) in Singapore, a community blueprint unveiled by non-profit group Action for AIDS (AFA) Singapore on Saturday (Nov 23) said that there are more than half a million people at risk of acquiring HIV in Singapore.

Of the people most at risk, the majority are heterosexual males and men who have sex with other men, it said.

Covering areas such as prevention testing, treatment and outreach to reduce stigma, AFA said that 60 experts from 30 organisations had helped in the formulation of the blueprint, which aims to be a starting point for a national plan to end HIV in Singapore.

Stigma and discrimination need to be addressed

According to the blueprint, key areas in ending HIV include the tackling of HIV-related stigma and discrimination, and the normalisation and scaling of Pre-Exposure Prophylaxis (PrEP).

PrEP is a daily course of antiretroviral drugs taken by high-risk HIV persons to protect themselves from infection, according to Avert, a UK-based HIV charity. According to the US Centers for Disease Control and Prevention, PrEP reduces the risk of getting HIV from sex by about 99 per cent when taken daily. Among people who inject drugs, PrEP can reduce the risk by at least 74 per cent.

A 2018 study published in the US National Institutes of Health’s National Library of Medicine revealed that persons living with HIV who perceive high levels of HIV-related stigma are 2.4 times more likely to delay treatment until they are very ill.

In addition, the fear of stigma and discrimination has been shown to discourage HIV-infected persons from disclosing their status even to family.

In order to reduce stigma, the blueprint proposed a few measures such as the promotion of HIV testing as part of regular health screenings and the development of large-scale campaigns to raise awareness and drive acceptance of HIV-infected people among the general population.

In regards to the normalisation and scaling of PrEP, the document said that it can be a powerful tool for reducing HIV transmission rates.

However, there are limited PrEP options in Singapore as it is currently only available at the National University Hospital, Tan Tock Seng Hospital, DSC Clinic and some general practitioner (GP) clinics.

Another barrier to PrEP normalisation is its price, as Truvuda – a brand of PrEP medication – costs about S$15 per tablet in restructured hospitals, AFA said.

Thus, the blueprint proposed that the government make more efforts to engage private GPs in providing PrEP services, and to explore registration of generic PrEP medications in order to scale up the program.

Other areas include expanding the HIV community-based medical workforce and the monitoring and evaluation of HIV prevention programmes.

Another country with similar plans is Australia, where the Australian Federation of Aids Organisations announced a blueprint in 2017 that sought to end HIV by 2020.

More than 70 cities around the world have also signed the Paris Declaration as Fast-Track Cities with the target of eliminating all new HIV infections and AIDS-related deaths.

At the end of 2018, the Ministry of Health (MOH) said that there had so far been 8,295 HIV-infected Singapore residents, of whom 2,034 had passed away. In addition, there were 400 to 500 new HIV cases detected among Singapore residents each year from 2007 to 2017.

There is no known cure for the disease. But effective antiretroviral drugs can control the virus and help prevent transmission.

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