Chapter 1: Why HIV Needs to be Managed Differently

Moderator: Dr Lopes, why does HIV need to be managed differently?

Dr Maria Lopes: Well, thank you, Eric. Well, first of all we still are in an era of an epidemic. HIV is still classified as an epidemic in the US, and obviously multiple steps still have to be taken to manage the spread of HIV as a communicable disease. And here's some facts and figures.  

We have 1.2 million people that are living with HIV, and this is as of 2022. 

In a single year alone, we had over 38,000 new diagnoses of HIV, and one of the things that really makes HIV different than other disease states is the racial and ethnic makeup of where the majority of cases are coming from, which happen to be minority groups, right? You can see on the right-hand side that the greatest contribution is coming from the African American population as well as Hispanic. Furthermore, over 60% of new HIV diagnosis in the US are obviously coming from these populations, and health disparities is a big issue.  

So, one of the additional factors that sets HIV apart is this high impact on social determinants of health, particularly with people living with HIV and as you can see, people living with HIV, they have a higher prevalence of disability, of poverty, of homelessness, compared to the total adult population, with 83% of individuals living with HIV reporting at least one social determinant of health indicator.  

If you don't have access to care, if you don't have transportation, stable housing, it's very difficult to take care of yourself, and even to care about your own health. So, the ability to seek treatment directly impacts adherence. There's higher likelihood of missing appointments. There's less likelihood of being adherent to treatment, and certainly less likely to have durable viral suppression if you have HIV. So social determinants of health need to be addressed so the people that seek treatment that they need are supported, and HIV transmission, hopefully we can make a dent in terms of reducing the incidence and the prevalence.  

The final factor to highlight is stigma.  

And as illustrated here, stigma affects individuals at every stage of the HIV journey, whether it's prevention, whether it's treatment, or whether it's testing. And stigma can greatly influence a person's willingness to seek and receive appropriate care of HIV.  

So, it's critical to consider the profound impact that stigma can have on individuals living with HIV, and discrimination, exclusion from workplaces, families, social circles, and based on misconceptions and prejudices can certainly have pretty severe impacts on someone in their choice of treatment or prevention. And stigma in HIV is distinct, unlike other chronic diseases. Due to deeply ingrained misinformation in the public regarding both the disease itself and the individuals most affected, it has really a profound impact on patient's receptivity to PrEP, to treatment, and to ongoing care.