Showing posts with label people living with HIV/AIDS. Show all posts
Showing posts with label people living with HIV/AIDS. Show all posts

Thursday, June 11, 2026

HIV Advocacy: Why Stories Change More Than Hearts

By: Michelle Anderson, MA, Grassroots Advocacy & Patient Storytelling Consultant, ADAP Advocacy

**First-Person Perspectives**

I have been in advocacy for more than 20 years, and for years, I have sat in rooms where decisions were being made for people like me without including people like me in the conversation. I have listened to presentations filled with statistics, charts, and research findings that spoke completely over my head. I have listened to reports that described the disparities affecting Black women living with HIV, but those reports were not always an accurate depiction because they did not provide a complete narrative of Black women's experiences when faced with the systemic pressures that create risk for HIV beyond behavior. Although the data is important and research matters, something is still missing.


We are proud to announce that ADAP Advocacy has selected Narrative Power Institute own, Michelle Anderson, M.A. as a strategic partner in its renewed fight to protect access to HIV treatment.
Photo Source: Narrative Power Institute

I often say that stories are more than personal experiences. They are a form of knowledge that speaks beyond what data cannot convey. They help us understand how policies, systems, and institutions impact real lives. They reveal the human reality behind data and create opportunities for change that numbers alone often cannot achieve because they connect the numbers to human impact.


For instance, when a Black woman living with HIV shares her experiences, it brings context to the conversation. It helps people understand that HIV is not a single issue. It is often connected to issues like poverty, trauma, housing insecurity, gender-based violence, lack of healthcare access, and systemic racism. These are realities that cannot be fully captured in a report because statistics only tell the story of the disproportionate impact of HIV.


Storytelling makes systems visible. It helps us move away from stigmatizing rhetoric that blames individuals and toward examining the conditions that shape people's realities. Instead of asking why someone did not make a different choice, storytelling helps us understand why the decision was made, given the options available to them and the conditions that shaped those options.


I have seen firsthand how stories can change a room. I have watched policymakers lean in when they hear someone describe the choice between paying rent and paying for healthcare. I have seen healthcare providers reconsider their assumptions after listening to a patient who may have fallen out of care due to transportation barriers. I have watched community members connect with issues they previously viewed as distant or unrelated to their own lived experiences. Stories create understanding, empathy, accountability, and, most importantly, they create movement.


ADAP Saves Lives: End the Wait
Photo Source: ADAP Advocacy

That same principle is at the heart of the work currently underway through the "ADAP Saves Lives: End the Wait" campaign, which was launched in response to the reemergence of ADAP waiting lists and restrictions in some parts of the country. For those of us who have been in this fight nearly 20 years ago, the thought of people once again waiting for access to life-saving HIV medication is deeply concerning. Storytelling is an essential advocacy tool because behind every policy decision is a person whose health may be affected. By elevating the voices of persons living with HIV, storytelling helps policymakers and communities understand what is truly at stake when access to care is threatened.


Meaningful Involvement of People Living with HIV/AIDS (MIPA) recognizes that people living with HIV should be involved, utilizing our lived expertise as leaders, decision makers, and partners in shaping the policies and programs that impact our lives. When people share their experiences in legislative hearings, advisory boards, advocacy campaigns, and community discussions, they provide evidence-informed solutions grounded in real-time experiences. This is when narrative begins to build power.


Narrative power is the ability to shape how people understand an issue. It is the ability to influence systems by challenging stigma, exposing data gaps, and moving conversations beyond awareness to impact. By shifting the narrative, our stories change perspectives, influence policy, and become the power that shapes how systems operate and whose voices are valued within them.


Group of HIV advocates
Photo Source: ADAP Advocacy

I believe that the people closest to the issues are often closest to the solutions. Lived experiences belong at decision-making tables because stories are more than personal testimonies. They are tools for leadership, advocacy, and systems change. Stories do change hearts, but they also change how people understand issues, how policies are shaped, and how systems respond to the communities they serve.


Stories do change hearts, but the power does not stop there. They help people understand, in real time, the realities behind data and the impact systems have on people’s lives. When we share our stories, we are challenging stigma, educating communities, informing policy, and creating opportunities for change. We move beyond awareness and into action. We transform our lived experiences into narrative power. This month marks the beginning of ADAP Advocacy’s narrative power to combat the resurgence of those dreading AIDS Drug Assistance Program waiting lists. Patient’s lives depend on it!


Disclaimer: All funders of the ADAP Advocacy Association are publicly listed on our website


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

Thursday, September 7, 2023

Cardiovascular Disease and Living with HIV...and the Benefit of Statins

By: Ranier Simons, ADAP Blog Guest Contributor

The evolution of HIV treatment has turned HIV into a manageable chronic disease. As such, people living with HIV/AIDS (PLWHA) live longer lives with an expectation of lifespans comparable to those without HIV.[1] PLWHA are now more likely to die from ailments other than HIV. One of those ailments is cardiovascular disease. PLWHA have twice the risk of atherosclerotic cardiovascular disease than the general populace.[2,3] Specifically, the higher risks include heart attack, stroke, heart failure, and pulmonary hypertension.[4] Unfortunately, the reasons for the increased risks are not readily understood. 

X-ray image of the body with cardiovascular system highlighted in red
Photo Source: AIDSmap

Traditional risk factors for heart disease, such as high blood pressure and smoking, are the same for PLWHA and the general population. However, ongoing research indicates cardiovascular disease risk factors unique to PLWHA, such as the effects of antiretroviral therapy and biological mechanisms of HIV itself, such as chronic inflammation.[4] Lack of a thorough understanding of the increased risk for cardiovascular disease among PLWHA means there is no established way to battle the issue to improve outcomes. Clinical trials are being conducted to investigate means to treat the problem. One such trial conducted is the REPRIEVE trial.

REPRIEVE stands for ‘Randomized Trial to Prevent Vascular Events in HIV.’ The purpose of the phase 3 trial was to investigate the efficacy of statins in reducing the risk of cardiovascular disease in PLWHA. The idea is to use statins as a primary prevention tool for major adverse cardiovascular events (MACE) in HIV. Statin use was chosen as an intervention because research shows statins lower LDL cholesterol, a significant factor in cardiovascular disease. Additionally, statins positively affect vascular inflammation and immune system activation in PLWHA.[3]

The multinational phase 3 randomized REPRIEVE trial, which included the United States, contained 7769 subjects. Assigned to two groups through computer randomization, the subjects received either oral pitavastatin calcium (at a dose of 4 mg per day) or a placebo. Pitavastatin was chosen because it does not interact with antiretroviral medications. The subjects' inclusion criteria included being 40 to 75 years old, living with HIV, on stable antiretroviral therapy, having no previously known cardiovascular disease, and having no history of statin use in the previous 90 days of entering the study. Another important criterion is that all “had a low-to-moderate risk of atherosclerotic cardiovascular disease, as determined by the score on the American Heart Association and American College of Cardiology 2013 Pooled Cohort Equation risk calculator.”[3]

When studies are done, researchers define a primary outcome. The primary outcome is the most essential occurrence to be examined as a result of applying the intervention in question. For the REPRIEVE, the primary outcome was the occurrence of a MACE. The MACE for this study was not just one issue but considered a composite of the existence of many issues: cardiovascular death; myocardial infarction; hospitalization for unstable angina; stroke; transient ischemic attack (TIA); peripheral arterial ischemia; revascularization of a coronary, carotid, or peripheral artery; or death from an undetermined cause, as measured in a time-to-event analysis.[3]

Pitavastatin
Photo Source: New England Journal of Medicine

In the pitavastatin group, the incidence of MACE was 4.81 per 1000 person-years and 7.32 per 1000-person-years in the placebo group. That equates to a 35% lower MACE incidence in the pitavistatin group.[5] Non-cardiovascular outcomes included muscle and diabetes issues. Myalgia and myopathy occurred in 2.3% of the pitavastatin group and 1.4% of the placebo group. Regarding diabetes, there was a 1.13 incidence rate (5.3%) in the pitavastatin group and a 0.84 incidence rate (4.0%) in the placebo group.[3] This was not surprising since previous research shows that statin use is associated with increased diabetes mellitus as it can increase blood sugar by preventing the body’s proper utilization of insulin.

Additionally, results showed that adverse event rates increased with increasing subgroup risk categories for atherosclerotic cardiovascular disease. However, the number needed to treat (NTT) decreased with rising risk category.[3] This means there is a possible greater benefit of statin use among those who started the study with more baseline cardiovascular risk. NTT is a statistical description indicating how many people need to be treated before a positive outcome is seen. Theoretically, the perfect NTT is 1, meaning that every person treated has a positive outcome. Since the NTT decreased with increasing risk category, more positive outcomes occurred among those with higher levels of diagnosis.

Trials like the REPRIEVE study open the door to investigating the use of other possible statins. Moreover, additional research is imperative since there is currently no established therapeutic or diagnostic paradigm for addressing the increased risk of cardiovascular disease in PLWHA. Without identifying the specific mechanisms contributing to atherosclerotic cardiovascular disease pathology among PLWHA, it is impossible to find or create medical interventions against it.

[1] Hayes, R. (2023, July). Life expectancy for people living with HIV. Retrieved from https://www.aidsmap.com/about-hiv/life-expectancy-people-living-hiv#:~:text=Many%20people%20living%20with%20HIV,adhere%20to%20their%20HIV%20treatment

[2] Boccara, F., Cohen, A. (2016) HIV and heart disease: What cardiologists should know. Revista Espanola De Cardiologia, 69(12), 1126-1130. DOI: 10.1016/j.rec.2016.05.032

[3] Grinspoon, S. K., Fitch, K. V., Zanni, M. V., Fichtenbaum, C. J., Umbleja, T., Aberg, J. A., … Douglas, P. S. (2023). Pitavastatin to Prevent Cardiovascular Disease in HIV Infection. New England Journal of Medicine, 389(8), 687–699. doi:10.1056/NEJMoa2304146

[4] Feinstein, M. J. (09 2022). HIV, Subclinical Cardiovascular Disease, and Clinical Progression: Insights From Immunologic Heterogeneity. JAMA, 328(10), 931–932. doi:10.1001/jama.2022.15226

[5] Susman, E. (2023, July 24). Statin reduced risk of heart disease in people with HIV. Retrieved from https://www.medpagetoday.com/meetingcoverage/ias/105613

[6] Lerner, A. M., Eisinger, R. W., & Fauci, A. S. (2020). Comorbidities in Persons With HIV: The Lingering Challenge. JAMA, 323(1), 19–20. https://doi.org/10.1001/jama.2019.19775

[7] Mulcahy, L. (2023, July 27). Menopause may start earlier for aging women with HIV. Retrieved from https://www.webmd.com/hiv-aids/news/20230627/menopause-may-start-earlier-aging-women-hiv

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.   

Wednesday, June 28, 2023

Walmart’s Expanded HIV Services Promise Increased Access

By: Marcus J. Hopkins, ADAP Blog Guest Contributor, and Founder & Executive Director of the Appalachian Learning Initiative (APPLI)

Editor's Note: The Blogger platform classifies any use of the word "p(h)armacy" as being a sales promotion. As a result of this erroneous classification, the word and its derivations will be typed using that format in order to avoid being flagged as a sales promotion.

In December 2022, Walmart announced that it would be expanding its Special P(h)armacies of the Community (SPOCs) to support communities with high rates of HIV to include stores in North Brunswick and North Bergen, NJ, Monticello, NY, and Hartford, CT. Those locations joined the initial three locations opened as part of their pilot program.

Since then, Walmart has opened an additional 70 locations, totaling 77 SPOCs located in Colorado, Connecticut, Florida, Georgia, New Jersey, New York, North Carolina, Texas, and Virginia. By the end of 2023, Walmart has promised more than 80 locations across eleven states.

According to their initial press release, Walmart claims that these SPOCs:

will help with all aspects of care, including industry-leading clinical programs, p(h)armacy services provided by HIV-trained p(h)armacists, enhanced care coordination, healthy lifestyle recommendations, and finding emotional support services from our Community Health Workers.

Walmart's SPOCs are located inside of individual p(h)armacies within the stores, ostensibly making the locations convenient to patients and those seeking HIV preventative care.

There are, it should be said, significant benefits to Walmart beyond just the good press.  Walmart has enormous opportunities to earn profits by accessing the 340B Drug Pricing Program’s inclusion of HIV medications. According to a 2019 report by Drug Channels, an estimated 25,000 p(h)armacies acted as contract p(h)armacies for hospitals and other covered entities that participate in the 340B program, and six large retail chains—Walgreens, CVS, Walmart, Rite Aid, Kroger, and Albertsons—account for two-thirds of 340B contract p(h)armacy locations.

In recent years, 340B program profits have soared with little to no oversight or enforcement, and we would be remiss if we didn't mention that Walmart stands to earn significant profits from serving as the contract p(h)armacy for People Living with HIV/AIDS (PLWHA), particularly in the markets they've chosen.

Which brings me to the next point:

As Walmart pointed out in its December 2022 statement, roughly 90% of the U.S. population lives within 10 miles of a Walmart location. They also state that these SPOCs provide “…an opportunity to reach people who might not otherwise have access to or seek out HIV care.”

And yet…the locations of these SPOCs are in areas of the country that already receive the bulk of federal funding for HIV testing, services, and treatment. Almost every location is in an urban or suburban population center—areas that often already have p(h)armacies specializing in HIV treatment and care.

It is obvious that these locations were chosen in accordance with the Ending the HIV Epidemic's (EHE) Phase 1 jurisdictions, which resulted in federal HIV funds being directed to the counties and cities where HIV incidence is highest. This methodology is all well and good, but it misses the larger scope of the HIV epidemic and fails to fill the gaps left by this federal funding "plan".

It is curious, then, that Walmart argues that these locations will "…reach people who might not otherwise have access to or seek out HIV care," when those areas are already glutted with services compared to other areas of the country. Looking at Orlando alone, there are 25 providers of care, and four dedicated p(h)macies dedicated to providing services to PLWHA.

If the purpose is to expand access, Walmart would be better suited to open SPOCs in farther-flung areas of those states, where patients are already required to travel more than 30 minutes to access HIV services. Opening a SPOC in Florida’s rural counties, such as Okeechobee, Hardee, DeSoto, Highlands, or Glades, would provide patients living outside of urban areas better access to care and services.

Beyond just the nine current and two potential states where Walmart's SPOCs have or will be opened, there are significant gaps in care and p(h)armacy services in states like Alabama, Kentucky, Mississippi, Tennessee, central and western Virginia, and West Virginia—areas that are largely rural, but have either significant existing populations of PLWHA or face increased risks of HIV transmission either through sexual contact or through Injection Drug Use.

To be clear, I am not being critical of Walmart for expanding services to be inclusive of PLWHA and those seeking preventative services. I am absolutely in favor of a "Yes, And" approach to HIV services provision. The addition of more providers has the potential to provide patients with more choices of where to receive care, and additional opportunities and points of care may allow patients to access services in places that are convenient to them. Additionally, increasing the number of providers has the potential to break HIV care outside of the longstanding monopolistic service provision models that exist both locally and nationally, where patients have been essentially forced to access care, treatment, and supportive services from providers because there hasn’t been anywhere else to go, even if those providers have treated them poorly, engaged in unethical practices, or provided services that aren't culturally competent or sufficient to meet the needs of their patient populations.

That said, Walmart, CVS, and Walgreens haven't really managed to make their locations places where patients—particularly those attempting to access sexual or reproductive healthcare services—feel safe accessing those services or openly discussing concerns with staff p(h)armacists. There’s a distinct lack of personal connection in highly corporate locations, and when you're dealing with fraught issues such as those presented with HIV care and treatment (or other chronic conditions), the last place you want to be if you're having a tough time dealing with issues is in the middle of a large shopping center surrounded by random people trying to find the potato chip aisle.

Overall, however, the expansion of Walmart's SPOC locations seems like a good thing, even if the locations they've chosen don’t really provide services that are novel to those areas. Time will tell whether or not they have any real impact.

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.  

Thursday, January 11, 2018

NASTAD Releases Updated 2017 ADAP Formulary Database

By: Brandon M. Macsata, CEO, ADAP Advocacy Association

Allowing people living with HIV/AIDS ("PLWHAs") to make informed decisions about their own healthcare has been a cornerstone of the ADAP Advocacy Association's mission since the organization launched in 2007. All too often, local service providers and advocacy organizations take a paternal approach to PLWHAs, evidenced by the complaints expressed directly by the people themselves. One organization should be commended for their efforts to put important treatment-related information directly at the fingertips of PLWHAs, specifically as it relates to drug formularies under the AIDS Drug Assistance Program ("ADAP").

Two pill capsules, one with the word "rejected" and one with the word "accepted" on them
Photo Source: lookfordiagnosis.com

The National Alliance of State & Territorial AIDS Directors ("NASTAD") announced late last year that it had updated its Online AIDS Drug Assistance Program (ADAP) Formulary Database (2017 version). According to NASTAD, its database provides "an online, searchable, publicly available resource detailing state-by-state ADAP coverage of medications both individually and by drug class including HIV antiretroviral ("ARV") treatments, A1 Opportunistic Infections ("A1 OI") medications, treatments for hepatitis B and C, mental health and substance use treatment medications, and various vaccines and laboratory tests."[1]

The database offers the following:[2]

  • General Information
  • Antiretroviral medications
  • ARV Generic Equivalents
  • “A 1” opportunistic infection medications
  • Hepatitis B treatments
  • Hepatitis C treatments
  • Substance use treatment medications
  • Mental health treatment medications
  • Other medication categories
  • Vaccines
  • HIV & STD diagnostics
  • Hepatitis C diagnostics

NASTAD's 2017 Online AIDS Drug Assistance Program Formulary Database is available online at https://www.nastad.org/adap-formulary-database.

Making such a valuable resource available directly to PLWHAs (and others) cannot be under-estimated in its importance. Access to timely, appropriate care and treatment is essential to achieving improved medication adherence, greater peace-of-mind, and better health for people living with any chronic health condition. Yet we know one of the most stressful things for PLWHAs are their medications. More efforts like NASTAD's database should be implemented across the treatment cascade.

In fact, that is the very reason why we launched our ADAP Directory. It offers PLWHAs (and others) a one-stop online resource center for the latest ADAP information for better decision-making for HIV/AIDS care; improved quality of HIV/AIDS information; and assistance for advocates and medical staff. It also includes an ADAP Eligibility Calculator. The ADAP Directory is available online at http://adap.directory.

Yes, that was a shameless plug for our flagship program. Now back to NASTAD's efforts...

NASTAD's database is very comprehensive. Some key findings from the updated 2017 ADAP Formulary Database include:[3]
  • 12 ADAPs have “open formularies” in which all FDA-approved medications are included, excluding designated exceptions
  • 39 ADAPs cover one or more hepatitis B treatment medication
  • 40 ADAPs cover one or more hepatitis C ("HCV") treatment medication
  • 34 ADAPs cover one or more of the curative direct acting antiviral ("DAA") HCV treatment medications
  • 46 ADAPs cover one or more of the most frequently prescribed mental health treatment medications
  • 27 ADAPs cover one or more substance use treatment medication
Any questions about NASTAD's database should be directed to Amanda Boyles at abowes@NASTAD.org. Kudos, NASTAD! Kudos!

NASTAD logo

__________

[1] Penner, Murray (2017, November 29); NASTAD Releases Updated 2017 ADAP Formulary Database; National Alliance of State & Territorial AIDS Directors (NASTAD). 
[2] National Alliance of State & Territorial AIDS Directors (2017, November 29); 2017 ADAP Formulary Database; National Alliance of State & Territorial AIDS Directors (NASTAD); page 4. 
[3] Penner, Murray (2017, November 29); NASTAD Releases Updated 2017 ADAP Formulary Database; National Alliance of State & Territorial AIDS Directors (NASTAD).