National Native HIV/AIDS Awareness Day: A Time to Address the Impact of HIV on Native People and Focus on the Efforts that will End the HIV epidemic
By: Rick Haverkate, National HIV/HCV Program Coordinator, Indian Health Service
National Native HIV/AIDS Awareness Day (NNHAAD), recognized on March 20, is a day to address the impact of HIV on Native people across the U.S. and territorial areas and to honor the work of Native community advocates, leaders, and organizations in response to HIV. The 2021 theme “Zero is Possible Together: Innovation + Awareness” encourages education and collective action to prevent the transmission of HIV.
Today, more than ever, we have the tools and the science to end the HIV epidemic. Medications exist that can both prevent and treat HIV, making an end to this disease achievable. However, unacceptable HIV-related health disparities for Native communities exist, fueled by HIV-related stigma, social/structural influencers of health, and barriers to implementing these medicines. The impact of these health inequities has been amplified over the last year by the COVID-19 pandemic. American Indians and Alaska Natives were 3.5 times more likely to be diagnosed with the disease than non-Hispanic whites, and their mortality rate was almost twice as high.*
As we look beyond this NNHAAD, we must focus on the critical implementation work that will allow existing and new medications to achieve their potential to end the HIV epidemic. We’ve identified two key areas of focus: (1) identifying and increasing medication uptake for people living with HIV (antiretroviral therapy) and those at increased risk of HIV acquisition (PrEP), and (2) ensuring adherence and retention support that make these medications optimally effective.
With effective HIV treatment, individuals living with HIV can maintain an undetectable viral load and live long, full lives – including family and relationships. It’s important to note that people who achieve an undetectable viral load cannot pass HIV onto their sexual partners.
HIV testing can link individuals living with HIV to effective treatment and help identify candidates for PrEP. However, there’s a hurdle to overcome: lack of access to HIV testing. As many as 34% of American Indian and Alaskan Native individuals living with HIV do not know their status**. Thankfully, there’s a solution. HIV self-testing is a proven strategy to increase HIV testing access and diagnoses. Self-testing engages individuals who have never been tested, increases the testing frequency, connects people with HIV to treatment, and reduces stigma. During COVID-19, self-testing has allowed individuals to test while maintaining the safety of essential healthcare workers. Ensuring access to HIV testing for Native communities must dramatically improve, and self-testing is critical for reaching this goal.
Along with testing, PrEP is a critical tool for ending the epidemic. Thanks to real-world experience, we know that PrEP is a program, not just a pill. Renewed commitment to improving access and supporting adherence and retention is essential to its success. Unfortunately, our efforts sometimes fall short of ensuring that Native communities unduly affected by HIV, including gay and bisexual men, individuals who inject drugs, transgender women, and Two-Spirit persons, are optimally supported by PrEP. Data demonstrates that adherence and retention wane over time for individuals on PrEP. A novel tool to address this issue is PrEP adherence testing, strengthening PrEP care for both patients and providers. It gives individuals on PrEP the data they need to show the drug is working for them. And thanks to objective data points, it helps providers identify patients who may need additional adherence or retention support.
I fully support this year’s NNHAAD theme: Zero is Possible Together: Innovation + Awareness. Ending the HIV Epidemic requires partnerships between the community, research, public health, pharma, and the private sector to improve effective treatment and prevention implementation. It also requires an investment in culturally responsive service delivery and meaningful engagement with affected communities. It will take innovation, awareness, and working together to address systemic barriers to care, reduce HIV-related stigma, and ensure access to effective tools. Please join the effort!
This content was adapted for NNHAAD in collaboration with Giffin Daughtridge, MD.
*Burki. Lancet, 2021
**IHS.gov