Chapters Transcript Video The Importance of Testing and Care in Helping End the HIV Epidemic The Importance of Testing and Care in Helping End the HIV Epidemic Originally Webcast: Friday, December 3, 2021 | 1:15 - 2:15 PM greetings and welcome to Gilead Sciences workshop titles the importance of HIV testing and care in ending the HIV epidemic. My name is Jessica clark community liaison at Gilead sciences covering the new york boroughs and I'm joined by Anthony Hello everyone. I'm Anthony Gutierrez, I'm the community liaison that covers Washington D. C. And Virginia, excited to be with you. Thank you Anthony and thank you all for joining us today. You know, we're really excited to have this discussion around HIV screening, especially at a time where the COVID-19 pandemic has significantly disrupted HIV screening in many health care settings. Therefore, for our discussion today, Anthony and I will highlight the role of HIV screening as the entry point to a status neutral framework that includes linkage to care and prevention. We'll also discuss the role of sexual health as it relates to self perception of risk and stigma. And finally we'll discuss the need for culturally responsive care as a path to health equity. After our presentation. Stick around because Anthony and I will meet you in a zoom conference to continue our discussion and to hear from you about how your respective agencies have been navigating our new normal while working to end the HIV epidemic. Now, as we continue, we know that since the beginning of the HIV epidemic, tremendous progress has been made towards reducing the impact of HIV on our communities. We've seen the evolution of various global national and local initiatives set priorities such as the natural, the national strategy to prevent new HIV infections improve. HIV related outcomes of people living with HIV reduce HIV related disparities and health inequities and use a coordinated approach to involve all sectors and stakeholders. The common thread that binds all of these initiatives together is an ongoing commitment to routine HIV testing, which becomes increasingly important as it relates to linkage to care. Now I'll turn it over to Anthony who will continue to discuss HIV testing as an important intervention. Thank you, Jessica And it's so, so true. We have some amazing aggressive goals and in the epidemic We were just updated with our National HIV Strategic Plan on World AIDS Day a couple of days ago when we saw numbers like 75% reduction of new infections by 2025, by 2030 and that's our pathway to ending the epidemic. But the only way we're really going to achieve that is really leveraging how testing is provided and what comes of a testing opportunity. I know when I started in the HIV field over 15 years ago, the role of HIV testing and the goal of HIV testing was to know your status and in that counseling intervention was to be able to give information and education around reducing HIV risk. But today with a therapeutic interventions that we have, the role of testing is really about language to care. And so when we talk about how testing is going to play in a central role to ending the HIV epidemic. It's how we're utilizing that experience to get us into the HIV care continuum on a status neutral level. But as we move ahead, we see that as it was 40 years ago, is today one of the biggest barriers to addressing. HIV has to do this stigma and we can see a word cloud of not only stigmatizing issues that we have to deal with, but the social determinants of health that influence people's ability to enter into the HIV care continuum. So as we look through what testing needs to look like and the importance of culturally responsive care, it's always a key front and center how we're utilizing our experiences and our interventions to be able to also address racism, stigma, transphobia, violence, poverty. Because when you do HIV work, you're doing social justice work. So what do we mean by the HIV care continuum and a status neutral approach. We look at the next slide, we see that HIV testing is the entry point. It still serves as the place in which people are first introduced to what areas of HIV they're going to go through depending on the results of their test. So, if someone comes in and is diagnosed positive and thus living with HIV, we want them to go into the HIV care continuum that's gonna link them into care, get them on antiretroviral therapy lee with a goal of viral suppression and if somebody tasks and their result comes back negative, but they're at risk for HIV or highly vulnerable to HIV, We want the same exact response of linkage to care. Getting them on an effective prevention option, which many times is prep and then remaining them on that prevention option. As long as the risk is still there or what we call virally protected. So as we can see from this setup, the linkage to care looks very similar regardless of the results of the test. But the way in which people get navigated through that care continuum starts with that HIV experience. So let's look next at what that looks like with regard to the intervention for those vulnerable to HIV. We have prep medicines as we know by the CDC has shown us as over 99% effective at preventing HIV diagnosis. So when we think about all, the you know tools that we have in our toolbox, there's probably none that rise higher then prep when utilized effectively on a daily basis. That gives us about 99% protection. And since the FADA approved medicines in 2012, we've seen an uptick of people utilizing the state of the art intervention as of 2019, we saw more than 235,000 people engaging with prep, which is amazing and great But we already know that there's probably 1.1 million people in the United States who could benefit from a prep intervention. So while 235 is wonderful. We're only a quarter of the way there. And when we think about what we're seeing with regard to the United States preventative Services task force giving prep a great a recommendation. It's basically anyone who's at risk should be offered track as an intervention for HIV. So let's look on the other side of the care continuum and those who are diagnosed with HIV, we see that the D. H. S. Now advises that any individual living with HIV should start therapy right away. Uh It is there to increase what we're looking for is an increase of art therapy which we've seen through the media initiation. We also see the decrease of viral suppression as well as the improvement of the rate of suppression among people living with HIV. So everyone living with HIV should be on treatment and when should they start immediately or as soon as possible. And one of the goals with regard to treatment is viral suppression. And when we see on the next slide we're also looking at viral suppression as being a tool for prevention. This is known as treatment as prevention and what we want is to ensure that all people living with HIV know the benefits about immediate initiation of therapy That their offer therapy regardless of their CD four lbs. And then patients understand the importance of adherence in order to maintain that viral suppression. And once we've maintained that viral suppression we have with the community deems or calls U equals u. In our next slide, we see that when undetectable equals transmittable for over six months that we have effectively no risk of transmitting HIV through sex. So when you combine this with our technology around threat and our technology around treatment as prevention, we have these biomedical tools to help us achieve that 75% in just three years, 2025 and 90% by 2030 which are amazing goals, but which are reachable with these particular interventions. So if we move along, we know that it's not just biomedical interventions that are going to prevent the HIV epidemic. It's how we package HIV health along with sexual health. And so Jessica is going to take us through uh that importance here in these slides. Thank you Anthony. You're right. The how is so important because ending HIV means we must also discuss sexual health because it's such an essential part of our overall well being yet stigma and other factors continue to cause barriers. I'd like to point out a portion of the sexual health definition from the World Health Organization, that sexual health is not merely the absence of disease or dysfunction or infirmity and a portion from the american sexual health association, that it's the ability to embrace and enjoy our sexuality throughout our lives. It is important that we continue to highlight the interconnectedness of sexual health of physical health and mental health reinforcing the idea that health and sex truly belongs together, the more we nurture that understanding the more we normalize sexual health being treated as essential, just like our overall health. I invite you all to really think about how you would personally define sexual health. Now, as we move on, we recognize that sexual health discussions between patient and provider are pathways to testing prevention and ultimately treatment but don't always occur as often or as comprehensively as they need to. Ending HIV means finding culturally responsive ways to have conversations meaningful conversations about sexual health, which includes questions about partners practices, past history of stds prevention methods and even family planning these discussions. These questions are especially critical because as you see on the next slide, self perception of HIV risk is low in certain populations, meaning that few people perceive themselves to be at risk for diabetes and even HIV even though they may be thus. In addition to a community wide education gap, there remains an incredible gap in knowledge about HIV risk, STD transmission and overall sexual health at the individual level. Further provider bias can also impact a patient's perception of their own risk. Um, but and it's so important for us to recognize that and so we can implement interventions to go against that this can lead to individuals not feeling the need to be tested, not feeling the need to ax partners to be tested prior to sexual activity and not feeling the need to learn or consider other preventative options in this particular survey, there was a stark difference in the testers assessment of risk compared to the people surveyed. This highlights the need to increase and normalize sexual health conversation to really illuminate potential risk and introduce prevention options. Now, this also highlights the importance of health care workers, narrowing the gap between their assessments of the patient's risk and the patients perceived risk. Now, when we look closely at specific populations, we see that HIV onto the next layer, we see that HIV continues to disproportionately impact marginalized communities And that while new HIV diagnoses declined from 2015 to 2019, disparities still exist with a higher lifetime risk in men who have sex with men and black women than heterosexual men and women of other races, respectively. Ending HIV means identifying holistic and culturally responsive strategies to reduce risk in all populations while using a health equity lens moving forward. This also means recognizing the role that internalized and externalized stigma plays in detracting from sexual health discussions. Proactively dismantling HIV stigma is so critical at every step of the HIV care continuum. And that does include HIV testing. So how we deliver a reactive HIV test is just as important as how we deliver a nonreactive test. So it's important to recognize just recognize the ways in which stigma. Language, distinguish stigmatizing language can impact one's ability to get tested or inquire about prevention options and even seek treatment. Now I'll be turning it over to Anthony who will walk us through what culturally responsive care looks like. Thank you, Jessica. We've mentioned it now a few times and it's been a theme throughout U. S. C. H. A. The great privilege of catching a little bit of the plan mary and it was such a wonderful conversation. But this idea of cultural competence or cultural humility and cultural responsiveness is that the crocks of the work that we do. Right? So let's break down a little bit because we like to use the term and we really emphasize culture humility. And how is that different from cultural competence? The way that we define cultural competence in health care is a respectful and effective response of individuals and systems to people of all cultures and ways that affirm the worth and dignity of individuals, families and communities and the way in which we define culture humility. It takes cultural competence one step further. It entails an ongoing commitment to self reflection and to creating beneficial and non paternalistic relationships. It's a journey of ongoing lifelong learning with that without a final destination. One of the things that I love about that cultural humility definition an idea is it puts the onus or it puts the emphasis on the health care worker, right? So that it's about us not being a barrier to somebody else's health care. So that idea of ongoing commitment of self reflection is knowing our bias is knowing our privilege and how that affects the way in which we, as healthcare professionals deliver care. That's the last thing we want to be is a barrier to someone else accessing HIV services and thus hitting our goals of ending this epidemic. So if we move along, we see that when we put cultural humility into practice, we're going to achieve what Jessica was telling us about a few slides ago around health equity and health equity is about delivering specific individualized hair given that person's situation and background so that we're able to hit equal or similar results regardless of who you are. So it's looking at cultural diversity and putting in social justice in order to achieve this pathway to health equity. And the only way we're going to be able to do that is understanding the importance of what Jessica was telling us around comprehensive care that uses de stigmatizing language that normalizes sex and health and ensures that people have the resources they need to adequately prevent any new HIV infections. And if we move one step further and we look at what that looks like on an individual level, it's patient centered care, right? And I feel like that is something that we own in the HIV field and we've come to see to be highly effective is when we individualize the care that we give to our clients, because we understand that people have dynamic, complex lives and that the only way that they're able to fully navigate this process is to ensuring that we are personalizing the care that we give. So when we do that, we're going to promote engagement and retention and HIV care, we're going to increase the trust and the collaboration between patients and HCPS our frontline staff because we know that health care plan needs to be a plan that the patient owns, not just the provider and it increases patients confidence and their own abilities to make health care decisions. What we're doing is we're trying to build confidence and autonomy and our clients giving resources the information in the education to do so. So if we move further, we're going to see that practicing cultural humility is about taking the clients lied about how we talk about sex, how we introduce interventions following the patients lead by using terminology and labels that they give us right, that's the culturally responsive element of it and then creating a learning culture in order to give patients the best care. Our patients are constantly growing and we need to make sure that we are growing with them and we need to aim to integrate overall healthcare with HIV care and that includes mental health support. So when we think about practicing cultural humility, this is an ongoing thing. One thing I love about the HIV field and the work that I do is that it never gets boring, right? It is the one constant is change in our field. So if we are doing anything the same that we did five years ago today, we're totally not on the mark, especially after Covid. It basically means that anything that we did two years ago needs to look remarkably different today. And if we just take our patients lead, if we're sensitive to the changing environment, we're going to be able to match them with where they're at giving them the tools that we have and we that they'll be able to access them. So before we move on to our robust discussions, I'm going to let Jessica take us home and conclude this portion of our programming. Thank you Anthony. We have the tools to end the HIV epidemic in our lifetime. We truly do have the tools to end the HIV epidemic in our lifetime and to highlight dr Merman's message, he says today we have the tools to end the HIV epidemic, but a tool is only useful if it's in someone's hand. This is why it's vital to bring testing and treatment to everyone with HIV and change the course of the epidemic and with an expanded toolbox for prevention and treatment while incorporating routine testing, routine HIV testing, S. T. I screening, engaging traditional and nontraditional stakeholders, increasing comprehensive sexual health discussions while reducing stigma and doing all of this through a culturally responsive lens. We can truly end HIV. So we are at the end of our presentation portion for today. Thank you for joining us for this first half, We will now transition to our zoom conference, where Anthony and I will continue the discussion so click the button below to join us in the zoom room. See you soon. Thank you. Created by
