A Rare Personal Appeal to My POZ Brothers & Sisters; Please Protect Yourself

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

For nearly 15 years, I've had the distinct honor of serving as the CEO of the ADAP Advocacy Association. The position has afforded me the opportunity to advocate for greater access to care and treatment for people living with HIV/AIDS, as well as to encourage patients to become stronger self-advocates, and also to mentor some new advocates along the way. And although it is a rare occurrence for me, today I'm making a personal appeal to my POZ brothers and sisters to protect themselves against Covid-19. Please get vaccinated, and boosted!

Over the weekend, and only after playing the "rona-dodge-ball" game for over two years, my luck finally ran out and I tested positive for Covid-19. Last year, I had received both series of the Pfizer–BioNTech Covid-19 vaccine, as well as the first booster shot. I did so to protect myself as an immunocompromised patient, but more importantly to protect my son, Sebastian, who is too young to be vaxx'd. In retrospect, it was the best thing that I could have done for both him and me. 

My ongoing recovery from Covid-19 has also been helped with a prescription for Merck's monoclonal antibody, called molnupiravir. That, and a lot of fluids and rest.

Although vaccines don't guarantee full protection against acquiring Covid-19, they most certainly do provide undeniable protection after testing positive. I have experienced 48-hours of severe Flu-like symptoms, but it could've been much worse if I had been unvaccinated.

Too many people living with HIV/AIDS remain unvaccinated, and it is concerning to me. We've witnessed enough needless suffering from this coronavirus, and far too many deaths. Please don't ignore the facts made available by the U.S. Centers for Disease Control & Prevention on the rates of Covid-19 cases, associated hospitalization, and deaths by vaccination status. The broader issue isn't about protecting you from SARS-CoV-2 infection, but rather what will happen if you do indeed get it. It is undeniable the full vaccine series and booster is very likely to keep you out of the hospital, and more importantly, out of the funeral home.

Photo Source: CDC

My personal appeal comes in response to recent troubling conversations about vaccination hesitancy; one was with an unvaccinated young, African-American male, and another with an unvaccinated middle-aged, white female. The former believed the Covid-19 vaccinations actually cause people to get the coronavirus, and not provide any protection. The latter argued the unvaccinated were actually faring better against Covid-19 than their vaccinated (and boosted) peers. Neither of these beliefs could be further from the truth, but they exist. Unfortunately, a lot of misinformation is fueled by certain cable news outlets, social media-fueled conspiracy theories, and ill-informed politicians with bad hair lusting over sound bites.

The intersection between the HIV/AIDS epidemic and the Covid-19 pandemic has become the new normal. A recent headline in Business Insider read, "Over the last four decades, HIV/AIDS has killed at least 700,000 Americans. COVID-19 has killed more in two years." We've previously been down this road, together. So let's learn from the past!

The science and technology behind the current vaccinations against Covid-19 are deeply rooted in the same life-saving therapies we rely on to keep us all healthy...and alive! Why not embrace the Covid-19 vaccination as an extension of your HIV-related care and treatment? Why not trust in the advent of the medical and treatment advances to keep you healthy? Why not take a leap of faith the same way we'd collectively do, if a cure for HIV is eventually discovered?

There could be numerous reasons why protecting yourself against Covid-19 is important. For me, especially as a single parent, it is my son. The mental health toll that this pandemic has placed on me cannot be understated with respect to him. I lay awake at night playing the what if game. If something happens to me, then who will care for him? If I test positive, then will I expose him to this terrible illness? If he gets sick, then will he end up in the pediatric intensive care unit? What I do know, getting that jab in my arm is my best line of defense.

In other words, our choices have consequences.

If you're HIV-positive and still unvaccinated, then please... please... please protect yourself by getting vaccinated against this potentially deadly virus. Talk to your physician. Talk to your pharmacist. Talk to your social worker. Talk to your clergy. Talk to your vaccinated peers. I invite you to email me and let's set-up a time to talk about why it is so important to protect yourself and the people important to you. You're important to me, and that's why I'm making this rare appeal.

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.

Effective Messaging Will Get More Vaccine Hesitant HIV-Positive People Vaccinated

By: Ranier Simons, ADAP Blog Guest Contributor

Navigating domestic and global public health is challenging. The difficulty lies in figuring out how to juggle the heterogeneous cultural, social, economic, political, and even physical attributes of groups of people. The ultimate goal is to establish best practices and have populations homogeneously and completely adopt those practices. Unfortunately, such an outcome is virtually impossible.

The world is not new to plagues and pandemics. The plague of Justinian killed 100 million people throughout Egypt and the Roman Empire between 541 and 543 AD. The Black Death, from 1347-1351 AD, killed roughly 200 million people or 30 percent of the European population. Those are just two of many. What they both have in common is the public health response. Just as with Covid-19, evidence showed the efficacy of enhanced sanitation, separation, and isolation.[1]

Photo Source: NCBI

In addition to enhanced sanitation, separation, and isolation, the constantly evolving tool of vaccination is a modern weapon against disease. Global vaccination efforts have eradicated diseases such as smallpox. However, the present state of the Covid-19 vaccination is a daunting conundrum. While there have been aggressive efforts to ensure supply of vaccines is available, availability is not enough. Widespread use and acceptance are key.

Scientific evidence has shown that Covid-19 vaccines are effective. There is also proof that while it’s not a perfect bulletproof panacea, full Covid-19 vaccination results in far better outcomes than being unvaccinated. Regardless, there has been a messaging issue due to many factors including deliberate and inadvertent misinformation, politicization, and lack of consistency.

Several groups at higher risk for seriously adverse outcomes from covid infection have elevated levels of vaccine hesitancy. One of those groups is people who are living with HIV/AIDS. The population of people who are HIV positive is not monolithic. Research shows that older individuals living with HIV for a long time are more likely to have had at least one vaccine dose and have much lower hesitancy among that population.[2] It also shows that African-American and younger people living with HIV were more likely to be unvaccinated.[2]

A study published in AIDS Patient Care and STD’s also showed a disparity in vaccine adoption in HIV-positive individuals based on gender and sexuality.[3] Surveys showed that among the unvaccinated, there was higher intent to get vaccinated among sexual and gender minority individuals (including but not limited to those identifying as LGBT) than non-sexual and gender minority individuals. Additionally, it showed that people with suppressed viral loads were more likely to be vaccinated.

Vaccine hesitation among HIV-positive people is based on many factors. Several major ones are pandemic fatigue, the success of vaccination, pregnancy concerns, and the constantly evolving science around Covid-19 virology and immunology.[3] Pandemic fatigue has resulted in many HIV-positive people mentally distancing themselves from thinking about it. Oddly, the success of getting large numbers of people vaccinated has caused complacency. It has caused some people living with HIV/AIDS to have a much lowered perceived risk of infection. Misinformation about fertility has made some HIV-positive women hesitant due to the belief it will cause sterility. Most importantly, constantly changing and sometimes conflicting information about the science of covid has caused hesitancy due to a lack of public confidence.

Photo Source: STAT News

Effective messaging for HIV-positive people means specific targeting of groups.[4] There needs to be population-sensitive messaging of African-Americans, of younger populations, of cisgendered straight men who don’t receive much messaging or access care as often for their HIV treatment, and women who have fertility and reproductive concerns.

As we advance, it is imperative that vaccine messaging come from trusted sources including antiretroviral therapy staff.[4] Emphasis should be placed on the safety and efficacy of the vaccines. Discussion should be centered on how vaccination can prevent severe disease, hospitalizations, and death. There should be reminders of how the personal choice to get vaccinated helps to protect other unvaccinated family members and fellow neighborhood residents. Most importantly, the motivations behind misinformation should be explained. Misinformation should be countered with responsibly factual and documented information to facilitate the social spread of correct knowledge. These messaging solutions can also translate into changing vaccination messaging for the seronegative vaccine-hesitant population, as well. 

[1] Piret, J., & Boivin, G. (2021). Pandemics Throughout History. Frontiers in microbiology, 11, 631736. https://doi.org/10.3389/fmicb.2020.631736
[2] People living with HIV need tailored COVID-19 vaccination information (2022, January 21). Retrieved from https://medicalxpress.com/news/2022-01-people-hiv-tailored-covid-vaccination.html
[3] Ekstrand, Heylen, E., Gandhi, M., Steward, W. T., Pereira, M., & Srinivasan, K. (2021). COVID-19 Vaccine Hesitancy Among PLWH in South India: Implications for Vaccination Campaigns. Journal of Acquired Immune Deficiency Syndromes (1999), 88(5), 421–425. https://doi.org/10.1097/QAI.0000000000002803
[4] Lila, J. et. al. (2021). Evidence-based strategies for clinical organizations to address COVID-19 vaccine hesitancy. Mayo Clinic Proceedings. 96(3). 699-707. https://doi.org/10.1016/j.mayocp.2020.12.024

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.

#YourVaccineIsWaiting Public Awareness Campaign Targets Marginalized Groups Living with HIV/AIDS

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

The ADAP Advocacy Association recently launched its public awareness campaign - 'Your Vaccine Is Waiting' - targeting marginalized groups living with HIV/AIDS on their need to get vaccinated against Covid-19. Designed to raise awareness, it came in response to learning that numerous segments of the HIV community were among those characterized as vaccine hesitant. The campaign includes four public service announcements, produced by Brandagement, LLC. 

According to the World Health Organization, HIV increases the risk for severe Covid-19 by six percent (6%) and the risk of dying of Covid-19 in the hospital by thirty percent (30%).[1] Yet, vaccine hesitancy among the HIV community remains a very real issue in the United States, as well as abroad in other countries.

#YourVaccineIsWaiting continues our organization's commitment to focusing on the intersection between these two ongoing epidemics. Earlier this year, we blogged about the importance of the immunocompromised getting vaccinated against Covid-19. Fast-forward to now, four amazing advocates living with HIV/AIDS were asked to share their personal perspectives on why getting the jab was important to them, but also for the marginalized groups they represent. 

Tez Anderson, a long-term survivor living with HIV, shares why he decided to get vaccinated against Covid-19. He resides in San Francisco, California. Tez’s message aims to help convince long-term survivors to get vaccinated and further protect themselves.

In urban cities with large LGBTQ communities, HIV and Covid-19 has presented dual challenges for older residents. Listen to his message to the long-term survivor community: https://www.youtube.com/watch?v=s9Z0qiwoe00. 

Jen Laws, a transgender community organizer living with HIV, shares why he decided to get vaccinated against Covid-19. He resides in Slidell, Louisiana. Jen’s message aims to help convince the transgender community to get vaccinated and further protect themselves. 

According to the Williams Institute, among transgender people 25.9% report being in poor health, 32.2% have not seen a medical provider in the last year due to cost, and 34.6% expressed their gender identity could result in denial of quality care. Listen to his message to the transgender community: https://www.youtube.com/watch?v=8W_ZmVDxO74&t=259s.

Michelle Anderson, a community activist and policy associate living with HIV, shares why she decided to get vaccinated against Covid-19. She lives in Waxahachie, Texas. Michelle’s message aims to help convince African Americans to get vaccinated and further protect themselves.

In states with large urban communities, Covid-19 has disproportionately impacted African Americans. Listen to her message to the African American community: https://www.youtube.com/watch?v=7AJ440_kE68&t=213s.

Jonathan J. Pena, MSW, licensed clinical social worker associate living with HIV, shares why he decided to get vaccinated against Covid-19. He lives in Morrisville, North Carolina.

There are over 250,000 Hispanic/Latino Americans living with HIV/AIDS in the United States. One in five new HIV diagnosis in the United States were among Hispanic/Latino men (22%). Listen to his message to the Hispanic/Latino community: https://www.youtube.com/watch?v=mPWXIonBtTI&t=233s.

Why is our ongoing public awareness campaign important? According to research conducted by Johns Hopkins Medicine, Pfizer/BioNTech's vaccine induces a robust immune response in people living with HIV.[2] 

“Previous research has suggested a suboptimal response to COVID-19 vaccines in people living with HIV; however, these studies did not fully characterize and define that response, both for cellular [where the immune system directly attacks infected cells] and humoral [where the immune system circulates virus-fighting antibodies] immunity,” says study senior author Joel Blankson, M.D., Ph.D., professor of medicine at the Johns Hopkins University School of Medicine. “What we found with the widely used Pfizer/BioNTech vaccine was just the opposite, as it induces robust immune responses in people living with HIV comparable to those seen in healthy people.”[3]

The HIV community has waited decades for the development of a vaccine to defend against acquiring the human immunodeficiency virus, and yet we have one available for the other ongoing epidemic. SARS-CoV-2 has already taken 659,813 souls (and counting) from us in the United States, alone. Our community must meet the challenges presented by Covid-19 with the same intensity and rigor that we've done in the fight against HIV/AIDS over the last forty years. That is why, #YourVaccineIsWaiting.

[1] World Health Organization (2021, July 15). WHO warns that HIV infection increases risk of severe and critical COVID-19. Retrieved online at https://www.who.int/news/item/15-07-2021-who-warns-that-hiv-infection-increases-risk-of-severe-and-critical-covid-19.
[2] Johns Hopkines Medicine (2021, August 11). COVID-19 NEWS: Johns Hopkins Medicine Study Shows Vaccine Likely Protects People with HIV. Retrieved online at https://www.hopkinsmedicine.org/news/newsroom/news-releases/covid-19-news-johns-hopkins-medicine-study-shows-vaccine-likely-protects-people-with-hiv.
[3] Johns Hopkines Medicine (2021, August 11). COVID-19 NEWS: Johns Hopkins Medicine Study Shows Vaccine Likely Protects People with HIV. Retrieved online at https://www.hopkinsmedicine.org/news/newsroom/news-releases/covid-19-news-johns-hopkins-medicine-study-shows-vaccine-likely-protects-people-with-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.

COVID-19 Vaccination Clinical Trials MUST Include PLWHAs

By: Sarah Hooper,  intern, ADAP Advocacy Association, and rising senior at East Carolina University

As the COVID-19 pandemic enters its ninth month, the world is still struggling to create a vaccination and find medication to treat the virus properly. President Trump has been saying for months that the vaccine trials and research are going well, and America should expect a vaccination by the end of the year. While this sentiment is hopeful (and considered by many to be driven by politics and not science), it does exclude the major process involved in vaccination trials: testing trials, which can take months to years. 

Photo Source: health management.com

Vaccination trials have begun around the world but are a slow process. One vital aspect of these trials is testing and planning for the immunocompromised population, who are often most affected by the diseases typically vaccinated for. In a vaccination trial for COVID-19 by Moderna Inc., the biotechnology company initially excluded people living with HIV from COVID-19 vaccine trials (Smart Brief).

After pressure and lobbying from HIV advocates, the biotech company expanded their vaccine trials to include HIV positive persons. 

“Moderna Inc. is committed to working with all communities who could benefit from our COVID-19 vaccine. While we had always planned to evaluate mRNA-1273 in people living with HIV (PLWH) in a separate study, as we are doing for other participant groups, we have heard the preference of the community to be included in the ongoing Phase 3 study in the U.S.,” Moderna Inc. shared on their Twitter account on Aug. 5. (Twitter).

Photo Source: Moderna

Those with underlying health conditions such as HIV and those above the age of 50 are at highest risk for COVID-19. According to the U.S. Centers for Disease Control & Prevention (CDC), nearly half of people in the United States who are diagnosed with HIV are 50 and older. (CDC)

As COVID-19 is a relatively new virus, the long-term effects of it are unknown on those with HIV. As of now, there is no evidence to suggest those with HIV have an increased risk of infection and severity of illness if they were to contract COVID-19, according to the Journal of the International AIDS Society. 

“It is thought that people living with HIV who have achieved viral suppression through antiretroviral treatment and do not have a low CD4 count will be affected by COVID-19 in a similar way to what a person not living with HIV would be, based on other coronavirus-caused disease outbreaks such as SARS (caused by SARS-CoV-1) and MERS (caused by MERS-CoV), where only a few cases of mild disease among people living with HIV were reported,” said JIAS. (JIAS) 

In an opinion article written for the website Devex in late May of this year, Mitchell Warren makes an excellent observation about the connection between the COVID-19 vaccination trials and what we can learn from previous experience with the HIV responses around the world. 

“As we know so well from over 40 years of experience in the HIV response, developing and delivering prevention and treatment options at scale is essential to containing an epidemic. But no durable and sustainable end to any epidemic is possible without a vaccine,” Warren said. (Devex)

Vaccine trials are expected to continue through the end of the year and into 2021, until a proper vaccination is discovered for COVID-19. Until then, the CDC recommends all those with underlying health conditions such as HIV take extra precautions while going out in public and conversing with others. It is equally important the PLWHA not be excluded from the clinical trials for any COVID-19 vaccination

References:

• Moderna. (2020, August 05). Today, we are sharing an important update about our protocol for the Phase 3 COVE Study of mRNA-1273, our vaccine candidate against COVID-19. pic.twitter.com/jigTXUi9v2. Retrieved August 26, 2020, from https://twitter.com/moderna_tx/status/1291056643464192001?ref_src=twsrc^tfw|twcamp^tweetembed|twterm^1291056643464192001|twgr^
• People with HIV to join Moderna COVID-19 vaccine trial. (2020, August 10). Retrieved August 26, 2020, from https://www.smartbrief.com/branded/D4C8EBAD-9C67-4D55-869C-CC2C8F893F9E/83E1E967-BCC2-4A2E-AF19-D2FCF2C8EBF2
• Warren, M. (2020, May 27). Opinion: To accelerate search for COVID-19 vaccine, look to HIV and act globally. Retrieved August 26, 2020, from https://www.devex.com/news/opinion-to-accelerate-search-for-covid-19-vaccine-look-to-hiv-and-act-globally-97267
• What to Know About HIV and COVID-19. (n.d.). Retrieved August 26, 2020, from https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/hiv.html
• What you need to know. (n.d.). Retrieved August 26, 2020, from https://www.iasociety.org/covid-19-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.