Living with HIV: Lessons Learned from COVID-19

By: Marcus J. Hopkins, Founder & Executive Director, Appalachian Learning Initiative

The Health Resources and Services Administration (HRSA) has released the first Ryan White HIV/AIDS Program COVID-19 Data Report covering activities conducted from January 20, 2020, through September 30, 2021 (HRSA, 2022b). These activities were funded by the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) of 2020, are the data contained therein were gathered using the COVID-19 Data Report (CDR) system developed by HRSA to receive monthly, aggregate-level reporting from providers were accepted and utilized funds provided by the CARES Act.

Before we get started on the data analyses contained within that report, however, it is vital to put this report into what I believe to be the proper context: that of the patient.

How the COVID-19 Pandemic Impacted People Living with HIV

The very first point that must be made is that, despite the title of this blog, the novel Coronavirus—SARS-COV-2 (COVID-19)—is not behind us.

Since March 2020, roughly 1 million Americans have lost their lives to COVID-19 (Stein, 2022), including one of my mentors in the fight against HIV/AIDS, former Long Beach AIDS Foundation Director, Garry Bowie, who died in April 2020. His was the first, but not the last, loss I experienced due to COVID and truly set the stage for the years to come. Garry is survived by his husband, Jeff Wacha, who continues to work in the non-profit sector.

For those of us living with HIV and those of us old enough to remember the early years of the HIV/AIDS epidemic, many memories were stirred in those first days. For me, it was the nervous sense of dread, just waiting to receive the next piece of news on Facebook that another friend had died. Every cough carried with it the threat of being intubated or having to sit alone in your car in the parking lot waiting to receive what seemed like the inevitable “bad news.”

But this time, it was somehow worse because we couldn’t even get together for a viewing, a wake, a funeral, a celebration of life…all of these opportunities to grieve with, seek comfort from, or provide solace to our friends and loved ones were all but eliminated for fear that, by gathering, we would be the next one on a rapidly growing epitaph. For those Americans who were concerned about the virus, we watched in horror as morgues reached their capacities, overspilled into hallways, and then flooded into refrigerated storage units.

In addition to our worries about COVID-19, those of us living with HIV and countless others living with chronic conditions that require somewhat regular healthcare services provision were met with the stark reality that those services were going to have to be put on hold. Medical appointments were canceled with no replacement dates offered, treatments and surgeries were indefinitely postponed, and clinics, hospitals, and other providers all but locked down to try to prevent the spread of COVID-19 outside of its walls. The uncertainty of not knowing when you’d see your doctor or provider, again, and the fears of not being able to renew your prescriptions or address co-morbid conditions were palpable in chronic illness communities. For those who were newly diagnosed, these postponements meant delaying the initiation of treatment—a topic that has not yet received significant research to determine the consequences.

Further complicating these concerns about treatment were losses or risks of losing employment, housing, food, and utilities. The majority of PLWH in the United States fall at the lower end of the socioeconomic ladder (Denning & DiNenno, 2019), meaning that were likelier to have worked in employment sectors that bore the greatest brunt of pandemic-related shutdowns (e.g., food service, entertainment, travel, and other service sector industries). These crises increased reliance upon social services programs and other programs created in the CARES Act to ensure that housing, nutrition assistance, and unemployment insurance needs were met during the first year of the pandemic. Surprisingly, enrollment in the Ryan White HIV/AIDS Program actually decreased in 2020, though no specific reasons are given (HRSA, 2021).

Beyond just those of us already living with HIV, the pandemic effectively halted HIV and Viral Hepatitis testing campaigns in their tracks, particularly in highly vulnerable communities including those experiencing homelessness and People Who Inject Drugs (PWID) populations through which HIV and Viral Hepatitis were rapidly spreading. The COVID-19 pandemic led to lower rates of HIV testing (Moitra, et al, 2022) and Hepatitis C (HCV) testing and treatment initiation (Kaufman, et al, 2021). The full impacts of these drops in testing and treatment initiations have yet to be fully measured, and it is likely that it will take years before we begin to see a relatively massive uptick in the number of new HIV and HCV diagnoses.

With these considerations in mind, let us delve into the finding of the latest HRSA report.

Background About the Ryan White HIV/AIDS Program and CARES Act Funding

For those unfamiliar with the various parts of the Ryan White HIV/AIDS Program (RWHAP), here is a quick breakdown:

Table 1. Ryan White HIV/AIDS Program Parts, Eligible Grant Recipients, and Funding Purposes

(CLICK IMAGE TO ENLARGE)

Source: HRSA, 2022a

Now that we’ve got a better understanding of the various parts of the RWHAP program, let’s look at how the activities presented in this HRSA report were funded:

On March 27, 2020, the Fiscal Year 2020 (FY 2020) Coronavirus Aid, Relief, and Economic Security (CARES) Act was signed into law. The FY 2020 CARES Act appropriated $90 million to the Health Resources and Services Administration’s (HRSA) Ryan White HIV/AIDS Program (RWHAP) to prevent, prepare for, and respond to the coronavirus disease 2019 (COVID-19) pandemic. This funding supported 581 existing RWHAP Parts A, B, C, and D recipients for the prevention and treatment of COVID-19 for RWHAP-eligible clients and their immediate household members. FY 2020 CARES Act funding also was awarded to the RWHAP Part F AIDS Education and Training Center (AETC) Program; AETC Program recipients used these funds for a variety of activities, such as developing webinar training series on methods for continued provision of high-quality HIV care during a pandemic, increasing telehealth capacity, and shifting to distance-based training programs. (HRSA, 2022b)

The initial funding period lasted from January 20th, 2020, through March 31st, 2021. Those programs who were unable to expend the entirety of those funds were eligible to apply for no=cost extensions (NCEs) to continue using the funds beyond the initial budget period. 

Findings

One of the primary findings of this report concerns the provision of telehealth services—the distribution of health-related services and information via electronic information and telecommunication technologies. According to the report, RWHAP providers increased their capacity to provide services via telehealth rapidly at the beginning of the pandemic, nearly doubling the number of providers offering telehealth services from 375 providers able to provide telehealth services in the period from January 20th – March 31st, 2020, to 684 in the month of April 2020—an 82.4% increase in just one month (Figure 1a). This trend continued for nearly an entire year, seeing a gradual decline in the number of providers reporting telehealth capacity in the early months of 2021. 

Figure 1a. Telehealth capacity among RWHAP FY2020 CARES Act-funded service providers, by reporting period, January 20, 2020, through March 31, 2021

(CLICK IMAGE TO ENLARGE)

Source: HRSA, 2022b

For those providers who applied for and received an NCE, the number of providers with telehealth capacity continued to decrease to the end of the reporting period in September 2021 to just 183 providers with CARES Act funding (Figure 1b).

Figure 1b. Telehealth capacity among RWHAP FY 2020 Cares Act-funded service providers with an NCE, by reporting period, April 1, 2021, through September 30, 2021

(CLICK IMAGE TO ENLARGE)

Source: HRSA, 2022b

These data actually say a lot about the way we’ve been receiving treatment, as HIV patients. For much of the time I’ve spent living with HIV, I have lived in rural parts of the country, traveling sixty miles, round trip, to access HIV treatment and care. For patients living in even more remote parts of the country, these trips can require entire days. What the pandemic taught us is that, for the most part, a good percentage of HIV-related services can actually be delivered via telehealth services, rather than in-person visits. This has the potential to decrease transportation barriers significantly…assuming that federal and state funding for telehealth services (and the subscriptions those services require) continues. 

In addition to telehealth services provision, CARES Act funding also funded COVID-19 testing. At its peak, 48.5% of funded service providers delivered COVID-19 testing services, averaging 10,500 tests per month over the initial funding period (Figure 2a). More concerning, however, is that number of tests conducted for NCE recipients decreased precipitously (Figure 2b).

Figure 2a. RWHAP FY 2020 CARES Act-funded service providers conducting COVID-19 testing and number of people tested, by reporting period, January 20, 2020, through March 31, 2021

(CLICK IMAGE TO ENLARGE)

Source: HRSA, 2022b

Figure 2b. RWHAP FY 2020 CARES Act-funded service providers with an NCE conducting COVID-19 testing and number of people tested, by reporting period, April 1, 2021, through September 30, 2021

(CLICK IMAGE TO ENLARGE)

Source: HRSA, 2022b

While the development and public dissemination of the various COVID-19 vaccines began in late-December 2020, the rapid decline in the number of COVID-19 from January through March indicates that there was a decided shift in focus from providing testing opportunities to providing vaccination opportunities. This is of particular concern given what we knew then and know now about breakthrough infections—they occur and with the emergence of new variants and subvariants, occur more frequently, particularly in immunocompromised people (Sun, et al, 2022).

In addition to service delivery, the HRSA report indicates that CARES Act-funded service providers addressed issues such as COVID-19 vaccine hesitancy, the inclusion of PLWH in vaccine trials, COVID-19 education, and the promotion of HIV care and treatment at vaccination clinics. 

Unfortunately, this report does not detail the provision of HIV-related services during the COVID-19 pandemic, as those activities were not specifically funded by the CARES Act. As a result, we are unsure of what struggles RWHAP providers faced during the pandemic in terms of reaching existing clients, enrollment and eligibility verification checks, or the provision of case management services. In fact, there has been little real reporting on these issues, as those types of qualitative data haven’t been the primary foci of HRSA.

But, again—as with the revelation that telehealth was actually possible, one of the valuable lessons we learned was that most of these eligibility and verification checks can be done electronically, rather than in-person (Texas, I’m looking at you). But then, certain states use in-person enrollment and verification as a means of cost control, as potential clients are more likely to skip in-person appointments than they are to fail to submit documents digitally. That, however, is a topic for another blog.

References:

• Denning, P. D. & DiNenno, E. (2019, December 11). Communities in Crisis: Is There a Generalized HIV Epidemic in Impoverished Urban Areas of the United States? Atlanta, GA: United States Department of Health and Human Services: Centers for Disease Control and Prevention: National Center for HIV, Viral Hepatitis, STD, and TB Prevention: Division of HIV Prevention: HIV by Group: Economically Disadvantaged. https://www.cdc.gov/hiv/group/poverty.html
• Health Resources and Services Administration. (2021, December). Ryan White HIV/AIDS Program Annual Client-Level Data Report 2020. Rockville, MD: United States Department of Health and Human Services: Health Resources and Services Administration: HIV/AIDS Bureau: Ryan White HIV/AIDS Program: Data: Data Reports and Slide Decks. https://ryanwhite.hrsa.gov/sites/default/files/ryanwhite/data/rwhap-annual-client-level-data-report-2020.pdf
• Health Resources and Services Administration. (2022a, February). Program Parts & Initiatives. Rockville, MD: United States Department of Health and Human Services: Health Resources and Services Administration: HIV/AIDS Bureau: Ryan White HIV/AIDS Program: About the Program. https://ryanwhite.hrsa.gov/about/parts-and-initiatives
• Health Resources and Services Administration. (2022b, April). Ryan White HIV/AIDS Program COVID-19 Data Report—January 20, 2020, through September 30, 2021. Rockville, MD: United States Department of Health and Human Services: Health Resources and Services Administration: HIV/AIDS Bureau: Ryan White HIV/AIDS Program: Data: Data Reports and Slide Decks. https://ryanwhite.hrsa.gov/sites/default/files/ryanwhite/data/2021-hrsa-covid-19-data-report.pdf
• Kaufman, H. W., Bull-Otterson, L., Meyer, W. A., 3rd, Huang, X., Doshani, M., Thompson, W. W., Osinubi, A., Khan, M. A., Harris, A. M., Gupta, N., Van Handel, M., Wester, C., Mermin, J., & Nelson, N. P. (2021). Decreases in Hepatitis C Testing and Treatment During the COVID-19 Pandemic. American journal of preventive medicine, 61(3), 369–376. https://doi.org/10.1016/j.amepre.2021.03.011
• Moitra, E., Tao, J., Olsen, J., Shearer, R. D., Wood, B. R., Busch, A. M., LaPlante, A., Baker, J. V., & Chan, P. A. (2022, March). Impact of the COVID-19 pandemic on HIV testing rates across four geographically diverse urban centres in the United States: An observational study. The Lancet Regional Health – Americas, 7(100159). https://doi.org/10.1016/j.lana.2021.100159
• Stein, R. (2022, May 14). Almost 1 million Americans have died from COVID-19. Washington, DC: National Public Radio: Health: Weekend Edition Saturday. https://www.npr.org/2022/05/14/1098942933/almost-1-million-americans-have-died-from-covid-19
• Sun J, Zheng Q, Madhira V, et al. Association Between Immune Dysfunction and COVID-19 Breakthrough Infection After SARS-CoV-2 Vaccination in the US. JAMA Intern Med. 182(2),153–162. https://doi.org/10.1001/jamainternmed.2021.7024

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.

HIV Disproportionately Affects African-American Women

By: Ranier Simons, ADAP Blog Guest Contributor

African-Americans are disproportionately burdened with HIV in comparison to other racial and ethnic groups. In 2019, African-Americans were 13% of the population but represented 42% of the new HIV diagnoses in the United States.[1] As a population group, African-Americans have higher rates of HIV in their communities, which increases the risk of infection by sexual contact or intravenous drug use.[2] Compared with other racial/ ethnic groups, there is no significant difference in the frequency of unprotected sex or practice of having multiple sex partners. The increased prevalence is positively correlated with the concentration of the number of infected people.

Men who have sex with men (MSM) of all ethnicities are the most affected subgroup of the national population in regards to HIV-infection. However, African-American women are significantly more impacted by HIV than women of other racial/ethnic groups. The rate of new infections in 2019 among black women was 11 times that of white women and four times that of Latina women.[2] Additionally, most of the transmission of HIV among black women occurs in heterosexual relationships.[3]

Disparities in various social determinants of health directly influence the disproportionate burden of HIV on the African-American community. Uniquely, African-American women sit at the intersection of many of those issues. Improving the HIV status quo among African-American women can not be viewed through individual discrete lenses of inequity. Intersectionality is what makes dealing with HIV among black women a challenge. 

Photo Source: CDC

African-American women are a gender minority, racial/ethnic minority, and sexual minority (those who are non-heterosexual). They simultaneously hold a heightened awareness of wearing many social and familial hats such as mother, sister, community leader, healer, friend, minister, etc. Race, class, and gender interact with social systems and power dynamics that work against African-American women.

Race and ethnicity have sociologically identified stigma that negatively affects African-American women's mental and physical health. They already deal with discrimination in terms of employment, microaggressions within and outside of the workplace, and even inequalities of treatment within the healthcare system. This negative self-view view regarding things external is further exacerbated by other devaluated identities such as sexual orientation, history of incarceration, or substance abuse.[4]

Layers of stigma and external societal infrastructure decrease the likelihood of HIV-positive African-American women coming forward to take care of themselves for the betterment of themselves and their communities. They not only hide their HIV-positive status from their friends and family but from themselves. Simultaneous devalued identities keep many African-American women on the sidelines and at home instead of seeking out and engaging in the services they need along the HIV care continuum.[4]

History of discrimination and mistrust of the healthcare system are established causes for disparities in healthcare utilization among African-Americans.[5] Culturally, African-American women are further affected by how sexually repressive African-American norms are regarding women and sexuality. Seeking out testing for sexually transmitted diseases (STD) or in-person resources regarding sexual health requires an open discussion about sexual behavior that many view as unacceptable. Moreover, culturally many African-American women feel it is unnecessary to think about STD testing and sexual health when they are in monogamous relationships with or without marriage. Additionally, studies have shown the widespread suspicion that most black women contract HIV from black men who secretly have sex with men is untrue.[6] 

Photo Source: The Root

The HIV problem in the African-American community cannot be solved externally or by the government. It requires efforts by members of the community. "The government can support research and training opportunities to prioritize women-centered prevention efforts led by African American or culturally competent women."[6] However, prevention and education initiatives need to be gender and culturally specific.

Reductions in stigma and increased social support have been correlated with viral suppression in African-American women.[6] Social support enables women to openly discuss their stresses with racism, relationships, health, and sexuality. Self-efficacy, empowerment, spirituality, and self-esteem enable African-American women to build resilience that allows them to reduce the effects of stigmas on their lives.[6]

Increased social support results in better self-efficacy, the belief that one is in control of their own life. Feeling in control of your life means you embody the self-value you need to make your health a priority. Empowerment can come in the form of racial pride, community pride, and economic empowerment.[6] Community empowerment results from creating spaces and networks to share skills, knowledge, and resources. Coupling HIV education with spirituality means soliciting faith-based organizations to develop relatable programs that create a safe space to discuss HIV and religion. Increased self-esteem leads to more robust mechanisms with which to handle and process stress and an increased likelihood of seeking out healthcare.[6]

One company that understands the need for focused intervention for black women and HIV is ViiV Healthcare. ViiV Healthcare has launched a program called 'Risk to Reasons'. The program's purpose is to refocus the dialogue from ‘risk’ to ‘reasons for HIV prevention’.[7] Over the next five years, ViiV will invest five million dollars to increase awareness and action around HIV prevention for black women. The funding is for grants to be utilized for programs and initiatives such as improving community-based initiatives that improve client/provider communication and collaboration with organizations outside of HIV-specific services that connect wholistically to women’s health and wellness. Requests for proposals can be submitted at https://viivhealthcare.fluxx.io/user_sessions/new.

[1] Centers for Disease Control and Prevention. (2022, February 4). HIV Diagnoses. Retrieved from https://www.cdc.gov/hiv/group/racialethnic/africanamericans/diagnoses.html
[2] HIV.gov. (2022, January 26). What Is the impact of HIV on racial and ethnic minorities in the U.S.? Retrieved from https://www.hiv.gov/hiv-basics/overview/data-and-trends/impact-on-racial-and-ethnic-minorities
[3] Mahon, C. (2019, May 10). Black women in the USA continue to be disproportionately affected by HIV, but there’s evidence that the gap may be slowly starting to close. Retrieved from https://www.avert.org/news/black-women-usa-continue-be-disproportionately-affected-hiv-there%E2%80%99s-evidence-gap-may-be-slowly
[4] VRao, D., Andrasik, M. P., & Lipira, L. (2018). HIV Stigma Among Black Women in the United States: Intersectionality, Support, Resilience. American journal of public health, 108(4), 446–448. https://doi.org/10.2105/AJPH.2018.304310
[5] Wyatt, G., Davis, C. (2020) Foreword: The paradigm shift–The impact of HIV/AIDS on black women and families: Speaking truth to power. Ethnicity and Disease. 30(2), 241-246. doi:10.18865/ed.30.2.241
[6] NPR.org. (2009, October 28th). Myth: HIV/AIDS rate among black women traced to 'down low' black men. Retrieved from https://www.npr.org/templates/story/story.php?storyId=114237523
[7] ViiV Healthcare. Risk to Reasons Initiative. https://viivhealthcare.com/content/dam/cf-viiv/viivhealthcare/en_US/pdf/2022-risk-to-reasons-pafw-rfp.pdf#:~:text=About%20Risk%20to%20Reasons%20ViiV%20Healthcare%20is%20expanding,HIV%2C%20with%20Black%20women%20bearing%20the%20greatest%20burden

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.  

What Happens When Homelessness, Politics, and HIV Collide?

By: Ranier Simons, ADAP Blog Guest Contributor

It is a futile waste of time and resources to try to improve the quality of life and standards of living for communities without examining social determinants of health. Social determinants of health (SDOH) are "individuals' personal circumstances that impact their health and well-being."[1] SDOH's five main domains are economic stability, education access and quality, healthcare access and quality, neighborhood and built environments, and social and community context.[2] The health and well-being of populations suffer greatly when SDOH are not adequately met. The devastating effects of the confluence of homelessness, drug addiction, and mental health issues currently is becoming increasingly visible all across the United States. Currently, West Virginia is confronting an avoidable community-level disaster.

Photo Source: Kaiser Family Foundation

Images of the plight of the impoverished living amidst urban sprawl are familiar. Unfortunately, there is also increasing amounts of suffering going under the radar in small cities and towns. One such town is Charleston, West Virginia. In Charleston, politics, homelessness, mental illness, and preventable infectious diseases, including HIV, swirl in a blender resulting in a smoothie of despair. People with grassroots first-hand knowledge of the plight of West Virginians are trying to shed light on their struggle. Marcus J. Hopkins, Founder & Executive Director of the Appalachian Learning Initiative (APPLI), is one such person. According to Mr. Hopkins, "The issues that plague West Virginia's population are not something that can be easily, efficiently, or quickly addressed."

"One of the unfortunate truths of life in West Virginia is that we are constantly trying not to correct, but to overcome—to survive—generations of economic decline, an education system that has been perennially underfunded and underperforming, a healthcare system that barely functions and only in a handful of cities in the state, a crumbling infrastructure, and communities that have been ravaged by nearly 30 years of prescription and illicit opioid use disorders in every part of the state. The state and federal governments have been virtually useless in addressing these issues, which results in grassroots organizations doing whatever they have to do in order to try to just keep people alive, only to have their actions criminalized by the very governments that are supposed to be helping."

Charleston has an unhoused population plagued by drug addiction, mental illness, and HIV. There is an abidance of evidence showing harm reduction is a proven solution to the poorly met SDOH of this population. However, politics have gotten in the way. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), "Harm reduction plays a significant role in preventing drug-related deaths and offering access to healthcare, social services, and treatment. This results in a reduction of overdose fatalities, acute life-threatening infections related to unsterile drug injection, and chronic diseases such as HIV/HCV."[3] 

The unhoused population in Charleston struggles with finding safe shelter, food, and even places to bathe or wash clothing. People have lived under bridges, uncovered on the streets ,and in unofficial tent camps in public spaces. Soup kitchens and places like the Manna Meal lunchroom are places where the unhoused and other poor citizens go to find sustenance. However, not having stable housing and food insecurity are exacerbated by drug addiction and HIV.[4]

Politics has shuttered places that used to be havens of clean needle exchanges for those addicted to intravenous drugs like heroin and other opioids. A nonprofit called SOAR ran a clean needle exchange on Charleston's west side until it was outlawed last summer.[4] Before that, the city of Charleston ended its own needle exchange in 2018. Without clean needle exchanges, people reuse and even share needles. This results in the spread of hepatitis, heart inflammation, and endocarditis (infection of the heart's inner lining). The U.S. Centers for Disease Control & Prevention (CDC) found that needle exchanges cut the rates of these diseases by half.[4] Treating hepatitis C in Charleston costs $25,0000 per person, while a new needle costs 50 cents.[4]

Sharing needles also contributes to the spread of HIV. The West Virginia public health bureau reports that since 2019 there have been 137 HIV cases diagnosed in Kanawha County, where Charleston is located,[4] and 76.6% of the cases in Kanawha County were directly related to injection drug use.[5] In 2020, 207 people died from overdoses in Kanawha County, which is one of the highest death rates in the state, while West Virginia, as a whole, has the highest overdose death rate in the United States.[4]

Photo Source: GETTY IMAGES

Politics also is a barrier to helping the homeless. There is political pressure to criminalize being homeless on the street. Police destroy the tents and shelters that many of the unhoused have built, in addition to disposing of their meager belongings. Recommendations for creating places like drop-in shelters for the homeless are usually met with opposition from business owners and other people who want the homeless to be swept out. They do not want to see them sleeping on park benches or the door stoops of their businesses. Other people do not want the visual reminder of the homeless’ existence and plight. 

People living with medical conditions, possibly mental illness, drug addiction, and no stable social network cannot be expected to thrive when trying to manage all of those things, in addition to being homeless. Proper harm reduction requires robust funding and programmatic infrastructure. It is necessary to help people get off of the streets and then help them maintain stability to stay off.

[1] Zia, S. (2021, April 28). What are social determinants of health? Retrieved from https://www.medicalnewstoday.com/articles/social-determinants-of-health
[2] U.S. Department of Health and Human Services.(2022). Social Determinants of Health. Retrieved from https://health.gov/healthypeople/priority-areas/social-determinants-health
[3] Substance Abuse and Mental Health Services Administration.(2022). Harm Reduction. Retrieved from https://www.samhsa.gov/find-help/harm-reduction#:~:text=Harm%20reduction%20plays%20a%20significant,diseases%20such%20as%20HIV%2FHCV
[4] Vergano, D. (2022, April 22). Here’s how homelessness and politics meet amid an HIV outbreak in one U.S .city. Retrieved from https://www.yahoo.com/entertainment/hiv-homelessness-politics-colliding-west-183301994.html?soc_src=social-sh&soc_trk=tw&tsrc=twtr
[5] Office of Epidemiology and Prevention Services. (2022, April 21). HIV Diagnoses by County, West Virginia, 2019-2022. Charleston, WV: West Virginia Department of Health and Human Resources: Office of Epidemiology and Prevention Services: HIV and AIDS. Retrieved from: https://oeps.wv.gov/hiv-aids/Documents/Data/WV_HIV_2019-2022.pdf

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.  

Historic Victory for HIV-Positive Military Service Members

By: Ranier Simons, ADAP Blog Guest Contributor

In the early years of the AIDS epidemic, fear and hysteria were founded on and fueled by paranoia of the unknown. Seroconversion predominately resulted in rapid onset of severe illnesses resulting in premature death. The lack of knowledge concerning modes of transmission, coupled with the stigma of what was then being labeled a predominantly ‘gay disease,’ resulted in multiple lanes of discrimination. Discrimination manifested in many forms of access denial, including housing, employment, and healthcare. In fact, HIV discrimination was specifically ‘codified’  in the military regulations. 

Photo Source: Advocate

The Pentagon began mandatory HIV screening for recruits in 1985.[2] Those with positive test results were turned away. Active-duty members who tested positive were allowed to continue to serve. However, the stigma around the assumption that they would get too sick to function productively meant demotion of duty and ostracism. HIV-positive service members were also prosecuted for sodomy and disobedience, and some were discharged without medical coverage.[2] Anecdotal evidence indicates some were segregated into separate barracks for HIV-positive troops.

Medical advancements in the treatment of HIV have drastically changed the trajectory of the disease since the 1980s. HIV is no longer a death sentence, and life-expectancy is almost on par with non-infected individuals.[2] Moreover, current antiviral medications reduce the viral load to undetectable levels where the possibility of transmission is effectively eliminated even through sexual contact, or has been termed 'undetectable equals untransmissible’ (U=U).[3]

Despite the current state of medical and scientific understanding of HIV, the military has yet to change its outdated policies. Employers are legally prohibited from discrimination against HIV-positive individuals on a federal level by the Americans with Disabilities Act of 1990.[4] There are other protections afforded under the Rehabilitation Act of 1973, as amended. Regardless, the military still maintains HIV discriminatory practices.

The Pentagon presently bans HIV-positive people from enlisting in armed services and prohibits HIV-positive people from being commissioned out of military academies. Additionally, the Pentagon had a policy of banning HIV-positive service members from deployment even with undetectable viral loads on active antiretroviral therapy. 

The wheels of justice, however, seem poised to pump the brakes on the military's discriminatory policies. A federal district judge recently struck down part of the Defense Department’s current policy.

On April 6, 2022, in response to two different lawsuits, U.S. District Judge Leonie Brinkema ruled that U.S. service members can no longer be discharged or barred from becoming officers solely based on their positive HIV status.[4] Ra v. Austin and Roe & Woe v. Austin are two separate cases that were tried together. [4] In Harrison v. Austin, Sergeant Nick Harrison, who joined the military in 2000, sued the Army and the U.S. Department of Defense for denying his application to become a military lawyer with the JAG Corps due to his HIV status. He tested positive in 2012 after a tour of duty in Kuwait.[4]

Sergeant Nick Harrison; Photo Source: Metro Weekly

In Roe & Voe v. Austin, the U.S Air Force attempted to discharge two active-duty airmen based on their HIV status. The discharge decision was based on a Trump-era policy of discharging service members who are undeployable for a period of 12 months. Since HIV-positive status barred the plaintiffs from deployment, they were subsequently undeployable for 12 months.[1]

Judge Brinkema’s ruling is a victory for the roughly two-thousand HIV-positive service members currently serving. This ruling also opens the door to future legal challenges involving the current policy preventing HIV-positive people from joining the military. Current military policy is not in line with current medical science and treatment innovation. Legal remedies to the detrimental results of outdated policy are sure to continue.

[1] Padgett, D. (2022, April 7). Landmark court victory: Military can’t boot people with HIV. Retrieved from https://www.hivplusmag.com/stigma/2022/4/07/landmark-court-victory-military-cant-boot-people-hiv
[2] Lalwani, N. (2021, July 22). The military's HIV policies are discriminatory and decades behind the times. Retrieved from https://www.washingtonpost.com/outlook/the-militarys-hiv-policies-are-discriminatory--and-decades-behind-the-times/2021/07/22/616fa480-e8c0-11eb-8950-d73b3e93ff7f_story.html
[3] RW Eisinger, CW Dieffenbach, AS Fauci. HIV viral load and transmissibility of HIV infection: undetectable equals untransmittable. Journal of the American Medical Association DOI: 10.1001/jama.2018.21167 (2019)
[4] Ryan, B. (2022, April 7). Judge strikes down military's limits on service members with HIV. Retrieved from https://www.nbcnews.com/nbc-out/out-news/judge-strikes-militarys-limits-service-members-hiv-rcna23513

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.