The HHS Office of HIV/AIDS and Infectious Disease Policy (OHAIDP) recently hosted a webinar to foster continued dialogue among diverse stakeholders about challenges, opportunities, and emerging promising practices related to addressing the disparate HIV-related health outcomes experienced by black gay, bisexual, and other men who have sex with men (MSM). The June 25 webinar highlighted innovative approaches and strategies being implemented by state health departments, clinical providers, researchers, and federal partners. With nearly 1,300 registrants, this topic is clearly of concern to many in the HIV community.
For those who were not able to participate in the webinar, below are some of the highlights.
The HIV Care Continuum for Black MSM
Opening the webinar, CDC’s Dr. Omar Whiteside shared a profile of HIV among black MSM in the U.S. and recent data on the continuum of HIV care for black MSM. He observed that black MSM are disproportionately represented among persons with new HIV infections; have lower levels of linkage to care than other blacks; and have a retention in HIV care rate of 46.3%, which is well below the goal of 80% set forth in the National HIV/AIDS Strategy.
State Health Department Responses
Discussing state health department responses to HIV among black MSM, Dr. Ann Robbins of the Texas Department of State Health Services reminded participants of the need and the opportunity to dig deeper into available data to better understand how various sub-populations are faring along the HIV care continuum, both nationally and within states. Dr. Robbins, Senior Public Health Advisor in the Department’s TB, HIV/STD and Viral Hepatitis Unit, presented findings from an examination of the HIV care cascade for black MSM in Texas. Such data are among the tools that states are using to better characterize and understand the issues in their jurisdictions and to better tailor program responses. She observed that a recent national inventory of state health department activities [PDF 548KB] conducted by the National Alliance of State and Territorial AIDS Directors (NASTAD) revealed a shift in resources toward HIV testing, linkage to care, and maintenance in care for MSM, both generally and among black and Latino MSM in particular. Speaking to stigma, what Dr. Robbins called “the bar before the HIV care continuum bars,” she shared a new resource released in June by NASTAD and the National Coalition of STD Directors (NCSD), Addressing Stigma: A Blueprint for HIV/STD Prevention and Care Outcomes for Black and Latino Gay Men , which contains 17 recommendations for reducing public health stigma that prevents black and Latino MSM from receiving optimal health care.
Dr. Andres Camacho-Gonzalez shared his perspective from the vantage point of a provider of care to black MSM in Atlanta, Georgia. Dr. Camacho-Gonzalez, who is also an Assistant Professor at the Emory University School of Medicine, stressed the importance of increasing both generalized and targeted HIV testing and providing early treatment for HIV. From the initial diagnosis of HIV through suppression of the virus, Dr. Camacho-Gonzalez highlighted the need for evidenced-based interventions such as Anti-Retroviral Treatment and Access to Services (ARTAS ) that support case management and ensure linkage to care, and patient navigation using peers to assist patients in successfully progressing along each stage of the HIV care continuum. In addition, Dr. Camacho-Gonzalez emphasized the importance of well-trained and culturally competent clinical staff; the use of technology, including social media, to support treatment adherence and retention in care; the use of incentives to foster linkage, enrollment, and engagement in care; and the critical importance of the Affordable Care Act in supporting HIV care and the patient-level goal of viral suppression.
The important roles that employment can play both in HIV prevention and improving the health outcomes of people living with HIV/AIDS (PLWHA) was highlighted by Dylan Orr, JD, of the U.S. Department of Labor. Mr. Orr referenced a number of studies that have shown a connection between employment and improvements in mental health, decreases in alcohol and drug use, decreases in unprotected sex, increases in retention in HIV care, increases in CD4 counts, and increases in HIV medication adherence. All of these things underscore the potential of employment to improve health outcomes and quality of life for PLWHA. Mr. Orr also highlighted that as part of the Department of Labor’s ongoing efforts to advance the National HIV/AIDS Strategy, the Department has worked to expand opportunities for PLWHA to enhance their job skills and increase their employment options; sought to increase supports for employers to hire PLWHA and maintain their employment; integrated PLWHA into broader employment initiatives for persons with disabilities; and prioritized addressing HIV-related employment discrimination in cooperation with the Department of Justice.
Perspectives on Primary Prevention and Research Priorities
LaRon Nelson, PhD, RN, FNP, of the Center for AIDS Research at the University of Rochester Medical Center emphasized the important role of primary prevention in the HIV care continuum. He advocated for an “upstream” approach to engaging black men in health care. “The time to start thinking about linkage and retention is not at diagnosis,” Dr. Nelson argued. “It’s pre-diagnosis.” Such an approach, he explained, is designed to support health-seeking behaviors and targets black MSM at highest risk for HIV with prevention. This not only establishes a pattern of positive health care experiences and can improve overall well-being, it also has the potential to improve the chances of early detection and linkage to HIV care, should a client already be engaged in a stable health care system at the time he’s diagnosed with HIV. Dr. Nelson’s presentation also stressed the use of HIV and STI surveillance data to improve the health outcomes of black MSM by supporting the identification of black MSM who are at high ongoing risk for HIV infection, as well as the re-engagement and retention in care of black MSM living with HIV. Finally, Dr. Nelson suggested a few areas for future research, including models that address health system innovations in HIV care; anti-racism and anti-oppression frameworks for health care environments; and opportunities for collaborative research among health departments, clinics, community-based organizations, and the federal government.
A key theme running through all the presentations was that deliberate focus and collaboration with clients and other providers are essential if we are to better address the gaps in the HIV care continuum that disproportionately burden black MSM.
As Dr. Ronald Valdiserri, Deputy Assistant Secretary for Health, Infectious Diseases, observed, “Making a positive difference in the health of Americans who are at risk for or living with HIV/AIDS is an important goal for all of us. As outlined in the National HIV/AIDS Strategy, a large part of that job is addressing the HIV-related disparities that persist among black gay, bisexual, and other men who have sex with men, both in terms of HIV prevention as well as care. The ideas and examples shared during this webinar highlight the diversity of approaches that we need to bring together in many communities across the nation to improve HIV services for black MSM.”