Chapters Transcript Video Using the Tools at Hand: HIV Testing as Standard of Care Using the Tools at Hand: HIV Testing as Standard of CareOriginally Broadcast: July 19, 2021 10:00 - 11:00 AM EDT Good morning everyone. My name is Gina Brown. I'm a principal medical scientist of Gilead Sciences and on behalf of Gilead, I'd like to welcome everyone to this presentation theatre. This theater is focused on the role of primary care and improving the awareness of HIV testing. At the entry point to the prevention and treatment care continuum. Today's program will highlight the impact of structural barriers to HIV testing in communities, our communities that are most impacted by HIV. The program will also examine the health inequities in black and brown communities that impact HIV testing and care and that have been exacerbated by COVID-19. The agenda for today's program will have a 20 minute keynote presentation, a 20 minute panel discussion in a 10 minute audience Q and A. Our presentation will be given by dr Lynn paxton. It's on using the tools at hand. HIV testing is that the standard of care and our panel discussion will be led by dr theO hodge. The panelists will include Dr Latisha Ella, Pray and Dr Lynn Paxton and it will explore the best practices and opportunities for making HIV testing the standard of care. Afterward we'll have an audience Q and a session where you'll have a chance to ask our faculty questions on the content of today's program. So please click the button below your screen to submit a question at any point during the program. A moderator for today is Dr THEO Hodge. He's a well known infectious disease specialist in Washington D. C. And he's medical director of the Washington Health Institute. Dr Hodges also worked consistently and managed an interest in managing people living with HIV. He's an HIV consultant at the Marie Read Health center community and the Community of hope in Washington, D. C. He is also a strong advocate for the LGBTQ community and he served as a primary investigator on HIV prevention trials. Dr Hodge Good Day everyone. I had the distinct privilege to introduce our keynote speaker. Dr Lynn Paxton. Dr Paxton is the district health director at Fulton County Board of Health in Atlanta Georgia, a position she took up last year. She has had extensive 22 year career with the Centers of Disease Control and Prevention where she served at one point as a zika co coordinator for the C. D. C. S. Center for Global Health. Dr Paxton is an international leader and HIV Prevention and Prep. I turn it over to you Dr Lynn paxton but thank you Dr Hodge, I have to say, I really admire your delivery to you've got me fascinated already just listening to my own biography. So anyway, I wanted to welcome everyone here to using the tools at hand. HIV testing is standard of care. It's a plenary session has been made possible by Gilead Scientists, Sciences and the National Medical Association. Yeah, so as you know, on this bright, beautiful morning, I you know, I think there's no better time to talk about the key role that HIV testing plays in um all of our initiatives, all of our hopes all of our efforts to help end this epidemic. And HIV testing is a key pillar of federal initiatives to help end the epidemic. Now, as all most of you are, all of you know, there is the 10 year ending the HIV epidemic or otherwise known as E H. E. Plan aims to reduce new infections to less than 3000 per year by the year 2030. And if we reduce infections to this level, that would essentially mean that HIV transmission would be rare and it would meet the definition of ending the epidemic. So not we're not, You know, it doesn't mean you have to get to zero, but if we can get to 3000 or below, we will be ending this epidemic. And the four key strategies of the US Department of Health and Human Services or DHHS to ending the HIV epidemic are as follows. Diagnose all people living with HIV as early as possible, increasing the number of new and existing patients tested for HIV in highly impacted areas by expanding outreach within their communities and increasing routine and risk based HIV testing of health center patients. So treating people living with AIDS rapidly and effectively to reach sustained viral suppression. People living with AIDS who take HIV medicines as prescribed and stay virally suppressed will not transmit HIV to a partner via sexual intercourse. So increasing the proportion of people living with HIV who are viral expresses. A key strategy to prevent new HIV transmissions. Then we have to work on the other side of the equation to which is preventing new HIV transmissions by using proven interventions, expanding access to pre exposure prophylaxis or prep for which is taking medicines by people who are HIV negative to prevent becoming positive um to increase access to other services and to surrender services programs in the condoms. And we need to be able to respond quickly to potential HIV outbreaks. There are new methods show where HIV is spreading most rapidly, which allows for us to invest in geographic hotspots, using data to guide decision making and supporting the establishment of locally tailored plants. In addition, the D h h D H H S H I V. National Strategic Plan for 2021 to 2025 was updated in january of this year. And this plan complements the EHE plan and has a broader focus across federal departments and agencies beyond the DHHS and all sectors of society. And it lists four goals to guide HIV efforts across the nation, prevent new HIV infections, improve HIV related health care outcomes that people living with HIV reduce HIV related disparities and health and inequities and achieve integrated, coordinate efforts that address the HIV epidemic among all partners and stakeholders. And this plan also spells out, you know, some significant objectives and strategies. It identifies minority populations that are disproportionately affected by the HIV epidemic and offers ways to measure progress. So as we talk more on about testing, we have to, you know, I like this slide because it shows that there what is referred to as the status neutral HIV care continuum and testing is the entry point for both of these for people at risk for HIV and it's the outlines the stages that people living with AIDS or those at risk for HIV go through to reduce the risk of HIV transmission or acquisition. So for both HIV positive and HIV negative individuals, HIV status is just one element of a person's health. A comprehensive behavioral and biomedical risk reduction services for the prevention of HIV and treatment for people living with age require that you have to be engaged in care. So you can see that's prominently displayed at the top of this of these circles here. And actually the steps along the care continuum are similar for both HIV positive and HIV negative individuals and the sustained engagement and care is important to achieve and to maintain health. And what many of us might not think about or think about a lot is that HIV negatives made individuals may not be accustomed to the importance of sustained engagement and care. And that's something that we have to keep emphasizing to people, even people who are not HIV positive. So testing again is the entry point is I'm going to keep emphasizing to the status neutral HIV care continuing and this outlines the stages that people living with AIDS or those at risk for HIV go through to reduce the risk of HIV transmission. However, what we all know as practicing physicians or just interested members of the, of the community is we know that stigma and other social determinants can influence this HIV care continuing continuing before an HIV diagnosis is even made. And up here, you see, there's a number of things pointed out too that we many of us experience we've seen on a daily basis affecting our patients, racism, transphobia, shame, misogyny, violence, stigma, homelessness. And these are very important social determinants that can have an effect on HIV care. So what we're going to talk about now is that the CDC um has identified certain populations that account for the largest numbers of HIV infections. And on on this slide you'll see that um, the CDC has identified that these populations bear an especially heavy burden and account for the largest numbers of HIV infections. And so success in HIV prevention can only be achieved by addressing these disparities and working to achieve health equity. And these hard hit populations include gay, bisexual and other men who have sex with men are M. S. M. And they are the population that's most affected by HIV in the United States and dependent areas stigma, homophobia, homophobia and discrimination put em sm of all races and ethnicities, susceptible to multiple physical and mental health problems and can affect whether they see whether they seek and receive high quality health services including HIV testing treatment and other prevention services and in 2019 adult and adolescent M. S. M. Accounted for 69% of the 36,801 new HIV diagnosis in the United States and the dependent areas that year. And many black and latin X. M. S. M. With HIV, particularly young M. S. M. Are even unaware Of their HIV infections. You know, their estimates that like anywhere from 10 to 15% of people at any one time just are not even aware that they are infected with HIV. So blacks and african americans are the most affected, racial or ethnic population. United States, Independent areas and they account for 50 42% of all new HIV infections in 2019. Hispanics or Latin X. are also disproportionately affected, accounting for 29% of all new HIV infections in the United States in 2019, persons who inject drugs or P. W. I. D. Accounted for approximately 7% of diagnosis in the United States in 2019. And transgender individuals are heavily affected by HIV and account for 2% of all new HIV infections in the United States in 2019 and in 2019 among transgender adults in the adolescents, the largest percentage of diagnoses of HIV infections was for transgender females at 93%. So the risk of HIV and other health outcomes is driven largely by social determinants of health, which we're all familiar with. And these are the conditions in which people are born, grow, live work in age and they include factors like socioeconomic status, education, neighborhood and physical environment, employment, social support networks and as well as access to healthcare. So on this next slide, we're going to be talking about the HIV, you know, just more information about the disproportionate effect on marginalized communities in the United States. Okay, so From 2015 to 2019, we did see approximately 9% decrease in new HIV diagnoses in the United States. The overall lifetime risk for an HIV diagnosis in the United States is one in 106. So and there, but there are large disparities. This number does not, you know, it has to be picked apart because there are very large disparities that persist based on sex, race, ethnicity, sexual orientation and other risk groups. So, based on the state on data from 2009 to 2013, more than six. The risk upon men, Let's look at men first, uh, that black M. S. M have the highest risk for being diagnosed with HIV in their lifetime compared to other groups. And if you look at men alone, the first, you know, the left part of this of this slide, you'll see that um among that black men, the rate is more than six times higher than in white men. And in latin X men, the rate is nearly three times higher than in white men. Right? If you look down again, but you'll see that for MSM the risk is approximately 88 times higher than for heterosexual men. For black M. S. M, the rate is five times higher than white M. S. M. And for latin X, it is for two times higher than white msn. And looking at women, we see that the risk among black women is approximately 17 times higher than that in white women. And for Latin X women, it's more than three times higher than white women. You know, these are actually pretty stunning, stunning figures that always shocked me every time I look at that. So if you look at the maps of the, of the uh, of the United States Here, we're looking at some of the, you see, these are all delineated sort of basically by counties and of the 677 disproportionately black counties, which means that in other counties, in other words, these are counties in which the population is composed of at least 13% black Americans, 91% of those 677 counties are concentrated in the southern United States. Not only are rates of unemployment and lack of insurance high in those 677 counties, but diabetes, heart disease and HIV are as well. So, according to the Kaiser Family Foundation, And I quote here, the south has relatively higher numbers of poor uninsured adults than in other regions, has higher uninsured rates and more limited Medicaid eligibility than other regions and accounts for the majority, nine out of 14 of states that opted not to expand Medicaid. As a result, more than nine and 10 people in the coverage gap reside in the south, so transport, social and health services are generally inadequate in rural areas and there is slow adoption of the latest HIV testing treatment and prevention services, so to speak, a little bit more about these racial and ethnic disparities and HIV treatment and care. Based on a 2012 survey of 540 for black m. S. M, 29% the people participating in this survey reported that they are experiencing racial and sexual orientation stigma from health care, providers. And 48% of participants reported mistrust of medical institutions and now they were racial and ethnic disparities in health related outcomes among people living with HIV compared with other racial ethnic groups. Black people living with HIV are less likely to be engaged in care to receive antiretroviral, antiretroviral therapy and to adhere to A. R. T. All of which may contribute to their lower survival rates. So latin people living with HIV are more likely to be diagnosed later in the HIV disease continuity content continuum oftentimes with AIDS concurrently resulting in greater delays in care entry and A. R. T. Use black and sm living with HIV experienced stigma from health care providers which was associated with longer gaps in time since their last HIV care appointment. Black M. S. M. Living with HIV who reported greater levels of medical mistress and stigma also were less likely to have high cd four counts. L. G B T. Q. Plus people and people of color living with HIV where at least two times as likely to experience physically rough or abusive treatment by medical professionals compared with their white counterparts. HIV prevention uptake is much higher among white men and white women than their black counterparts. Less than half of Latin X living with HIV are receiving medicine to treat their infection. And about three quarters of men who have a prescription for prep medicines are white and only 9% of black. You know. Again, once again, pretty stark statistics about the this enormous disparities. Now again, we've all now also been living through the covid epidemic um for the last year and a half. And what we'll see on this slide, the next slide is that Covid 19 is just exacerbating what we already knew about these existing racial disparities in the communities that are most affected by HIV and oh again you'll see that this slide shows these disparities and I hope you can see it, you can see it well and that racial and ethnic minorities are disproportionately being impacted by Covid 19. So sort of a double whammy most heavily affected HIV and by Covid. And this does extend to other to other diseases as well. So we need to improve access to testing and in the C. D. C. Monitors select prevention and care objectives to assess progress toward achieving the national goals that I spoke of earlier in the presentation based on the CDC report published in 2020 blacks african americans were among five racial and ethnic groups tested later in their HIV illness. During 2018 meeting a stage three diagnosis of age AIDS, which was based on the first city, four tests performed or documentation of an AIDS defining condition less than or equal to three months after a diagnosis of HIV infection. However, compared with other racial ethnic groups, blacks or african americans were the least linked to HIV medical care within one month after diagnosis and among the least linked to HIV medical care within three months after diagnosis. So, linkage to HIV medical care was measured by documentation of at least one CD 4 or viral load tests performed less than or equal to one month or less than or equal to three months after diagnosis. This is again pretty pretty stark that people are being diagnosed later and then being less less likely to be in care. So we're talking, we're talking about what you know about community based organizations in this next slide. So according to the CDC National Prevention Information Network in Pen, more than 10,000 organizations in the United States provide HIV testing services and among these, 86% offer conventional blood HIV testing, 40% rapid blood testing and 0.4% mobile testing services and 0.3% rapid oral HIV testing. So the statistics show that there is an opportunity for community based organizations to evolve testing technologies to reach people where they are. For example, home HIV testing has been found to increase the number of HIV tests, as well as testing by people most vulnerable to HIV. In response to COVID 1956% of providers Reported this is about a number of out of this is 161 providers reported providing clients with home HIV test with an additional 21% planning to offer home HIV test in the future. You think so now we need to look at ways to increase, Sorry. Yeah. Ways to increase urgency around HIV testing. I thought, I'm sorry. I thought that I had, I had put that on mute. So the important thing is we need a multi pronged approach. So on this side there's a list of things that we'd like you to consider. We need a multi pronged approach to reducing barriers to care in HIV AIDS. And several strategies can be effective, including engaging the community, help institutions recognize stigma, expand RT access and use address social stigma stigma and the environment, respond to the needs of stigmatized populations and use the media to show that HIV has a human face. This is just not a series of statistics and we need to involve people living with HIV AIDS in service delivery. So reducing HIV related stigma and other berries to care has been shown to improve HIV testing practices. Now, some face faith organizations or F. B. O. S have helped to expand the reach of treatment programs and reduce stigma with their emphasis on helping those in need. Some F B O s have been key partners with the C D. C and their global response to HIV through the President's Emergency Plan for AIDS relief or Pepfar. The CDC has partnered with FBS to kill critical black gaps in existing programs. Some of them have located men who are living with HIV and extended testing and treatment services to them, increased access to HIV treatment for Children and adolescents, provided safety nets and community support to people on HIV treatment and reduce sexual violence among people of all ages and played a key role in developing HIV prevention strategies. And this has been done. And there's some very interesting programs going on throughout the United States and we're gonna, we're gonna talk about specifically about one taking place also down here in the south, but in one of our sister states Louisiana. So one example of a success of a successful HIV testing campaign among back communities is in Louisiana's East Baton Rouge Parish Parish, which include which launched really innovative efforts to expand HIV diagnosis, treatment and prevention is part of the EHE plant. So the rate of people living with HIV AIDS in Louisiana's East baton Parish, Rouge Parish, it's like, I wish I had a better accent. East baton Rouge Parish is three times higher than the national average. Three times. However, the parish is invested in ending HIV in his community, thanks to leadership from the mayor's office, the Louisiana Department of Health Office, Public Health, the STD HIV epidemic, Hepatitis program, Gilead scientists, chief operating officers of hospitals, emergency departments, nurses and doctors, community health care workers and other community members. So you see this is a group effort and the initiatives include helping community members confront barriers to HIV testing and care. A team of community of five community health workers was hired through the EHe initiative to take health and prevention services out into the community. In these, health workers offer a range of services including navigating the sometimes very complicated application process, application processes for food assistance, Medicaid and Social Security, as well as HIV testing, treatment and prevention services. And this holistic approach has been effective And in the final quarter of 2019 the East Baton Rouge Parish Community Health Worker Team conducted 100 and 79 HIV test and referred 227 people for integrated screening for HIV HCV and syphilis. And so another thing to do. Another initiative is that they did was making opt out testing routine in emergency departments and the C. D. C. Recommends that hospital emergency departments and other health care settings offer routine opt out HIV screening. East Baton Rouge was able to put this into practice through the partnership of many stakeholders and now opt out HIV testing is available in two local emergency departments, Largely due to these efforts. From 2016 to 2018, East Baton Rouge parish is rate of late stage HIV diagnosis until which until that time period had been the highest in the nation, was cut in half. In addition, hospitals in East Baton Rouge worked with their electronic medical records providers To integrate a testing flag so that triage nurses are automatically notified when a patient is between the ages of 13 and 64 and should be tested. They also developed a clear path to link people living with HIV to follow care within seven days of diagnosis, the parish plans to integrate rapid HIV testing into additional health care locations such as specially health clinics and correctional facilities. Another tenant, another initiative is empowering the local community to take the lead and ending the HIV epidemic. And in this parish in the east Baton Rouge parish hired a coordinator with the expertise in the energy and the passion to facilitate the development of a formal blueprint for ending the HIV epidemic in East Baton Rouge. The plan is currently being developed and will be implemented, monitored and overseen by staff at the Louisiana Department of Health. It will identify strategies that will have the biggest impact on diagnosing, treating and preventing HIV in East Baton rouge while also addressing social determinants of health such as housing, transportation and behavioral health. So a lot of this information that's coming out on this next slide, um we have an opportunity to end, help end the HIV epidemic through promoting testing as the entry point to this HIV care continuum continuum along with employing other tools and initiatives such as art, proven models of effective HIV care and prevention, prepped medicines, post exposure prophylaxis, syringe service programs and new laboratory and epidemiologic techniques And so working together, we have and I like this quote from john Ammerman, who I've known for a long time is that today we have the tools to end the HIV epidemic, but a tool is only useful if it's in someone hand someone's hands and this is why it's vital to bring testing and treatment to everyone with HIV and change the course of the epidemic and with these powerful data and tools, we have a once in a generation opportunity opportunity to end the HIV epidemic and it is my sincere hope that everyone in this virtual room and he's listening to this well, you know, become energized to apply these things that we know work and to it's incumbent upon us to go out into the community and to reach people where they are and to bring testing to them to get them into treatment too. Do to help people with prevent that. We know of prevention of transmission and we can do this. It's going to take a lot of effort, but we can do it. We've got the opportunity, we have the tools we just need to use them. And so I just wanted to thank um I thank thank you all for listening to me today and thank Gilead and the organizers of the conference for inviting me to do this today. Well, I hope you enjoyed that very dynamic presentation like our dr Lynn paxton. We're moving forth to the next segment of our program and that is of the panel discussion. This is going to be exciting. You've heard from our dynamic dr Lynn paxton. I have again the distinct privilege of introducing our second Panelist, Dr Latisha L'Opera. Dr L'opera is assistant professor in the division of infectious diseases and director of diversity and inclusion, graduate medical education at the University of Alabama at Birmingham. Dr Blueberry has published widely in the field of HIV prevention and crept among young black men who have sex with men in the South. Research interests include prep for HIV and the impact of the social determinants of health on stds, including HIV. It is with great anticipation, I anticipate our panel discussion and so let me set it up for you. The first portion of our panel discussion will focus on making HIV testing a part of routine health assessment and on the next steps that can be taken to address the silence surrounding HIV testing, prevention and treatment among providers in the health systems that serve the black community. I will remind our audience if you have questions, place the minimum the trap in the chat please. So as we begin our panel discussion, the first question is going to go to Dr celebrate Dr Lebron. We just heard this dynamic presentation by DR Paxton. We understand that ending the epidemic. It all begins with a test. It all begins with that test, the HIV test and the results. Either the prevention talk or the treatment talk are the results of getting the test, but how she got to get the test. So we know that in so many health care facilities, HIV testing is not routine. What do you say? How do you engage the health care provider who says to you well, you know, dr low, bring my patients on at risk. Why should I be doing HIV testing? How do you get those people to become part of the solution and ending the epidemic? Well, I think that's a wonderful question. I'm so happy to be here, especially talking to providers who are black, you primarily serve black communities. I think that the best way is to stop having these conversations in a risk frame. We can't keep moving forward when we're talking about sexual health and HIV Prevention and SD I prevention only, talking about risk. We need to talk about promotion and in that lens having people who provide primary prevention, who are primary care providers, emergency room doctors sometimes are the first line and seeing an engaging patients into the healthcare system, teaching them to do that in a non stigmatizing way where it's universal and it's outside of their own hands, but really a part of route routine protocols. I think it's probably the best way to move forward and we know that emergency rooms that engage and implement opt out systems have wonderful improvements and their ability to test people regardless of their risk screen for HIV. And I think that's what we have to do throughout. Um there are certain things and certain measures that we roll out at certain age frames and when you do that for HIV testing as well. Okay, well you tell me, what are some of the biggest hurdles that you feel practitioners face and making these, making testing routine? I mean I think stigma, I think um sometimes with our own biases we don't always recognize that people benefit from HIV testing and I think it's because we only think of HIV in the lens of you've done something wrong that warrants testing, You've done something wrong that warrants this S. T. I screen. And that's not how we should be framing this and learning about it in medical school. This is a part of sexual health and health is the key word here. So as a part of that health frame offering S. T. I. Testing and HIV testing should just be routinized in that lens alone. Thank you. Doctor Lover. The next question is going to go to dr paxton. Sometimes a major health crisis can ultimately strengthen health systems in unforeseen ways. Is this the case of COVID-19? Are there likely to be any silver linings when it comes to HIV prevention and treatment initiatives in a post Covid 19 world? Yeah, I mean, I think that's a great question. I mean, I tend to be more on the cock eyed optimist side of the, of the scale anyway. Um, but I do think, yes, I think there are because one thing is that the Covid epidemic has showed us as was as was presented with the slides is okay. It really highlighted that there are these, these disparities and whenever you highlighted at least you have a better chance of bringing it to the attention of the people who matter. And by that, I mean, the people who control funding the people who control legislation and all that. So that is 11 thing that happens. So there has been a relative, I don't want to jinx it, but there's been a relative flood of money coming in to combat Covid, many of which can also be used. Um, and two after the Covid epidemic is controlled, can be used to, you know, try to address these disparities. For example, here at the CDC has put out a grant that is specifically looking at decreasing the disparities in Covid. You know that how Covid has been affecting different communities of color and other disadvantage. But those same things that will, that will are, that will decrease the disparity for Covid will also do that for other things. It's not just just because the money was just said about Covid doesn't mean that some of the things that we are doing to reduce disparities won't also have a benefit for other diseases such as HIV stds, even diabetes and and and the like. And then on the very practical side for we use part of the money that we were given to invest in mobile units to go and be able to do Covid testing and Covid vaccination in the community. Those vehicles are not going to go poof at the end of the covid epidemic. And so our plan already is that when they are no longer needed for covid, they are going to be repurposed so that we can do more HIV testing. We do do already do mobile at HIV testing, but so we can do more of that so we can do other things that are going out into the community to get to people. So, so yes. Would I ever want to go through a pandemic like this again just to get these benefits? No, but it's the silver lining that you that you spoke of. Thank you so much. Doctor Paxton for that response. So how can we expand our HIV testing prevention and treatment efforts without overlooking other needs that patients may consider more pressing. And I'm sure you come in contact with this where patients are like, that's so nice. You want me to get tested, but I need to eat. Where am I going to sleep tonight? How do you how do you look at that? Um, and get HIV testing done. And while considering the more pressing needs that patients may consider um, a priority over HIV testing. So I can say that as an HIV provider, we've done something very well when it comes to HIV care, which is the ability to have funds allocated to really provide holistic services. So, if you have housing needs, we have money set aside for that. If you have food insecurity, we have money set aside for that. And we have not necessarily mirror that when it comes to prevention and primary care services were able to offer people who likely, as we saw from dR packs this talk have a higher likelihood of being diagnosed with HIV due to systemic barriers, contextual barriers, and systematic racism. So, in saying that I think that you need policy change, um number one, address some of the issues that cause barriers. People engaging in care, but also on an individual and on uh provider level, having a greater uh discussion and education of providers when they're engaging with their patients to make sure that they're not only solely focused on one aspect of health, but focusing on holistic health. And that means talking to your patients about their lived experiences, about what barriers are to care and integrating their health needs and that conversation into that larger picture. I mean, that would be my recommendation. Okay, thank you dr celebrating. And the next question is to you, what steps can we as health care practitioners take to normalise HIV testing as part of routine primary health care and ensure patients do not feel label or stigmatize? How can how can we do that? I mean, I think at a young age first when people are engaging with the health care system and their pediatrician's office, having conversations about sexual health would be key. Um, and that way, as their number one, going through the health care system is not an abnormal occurrence for someone to talk to you about your sexual health and take a sexual history. Um, that's on I think the health care system size and hold, but on the provider side, learning how to take sexual histories and engage in our patient with our patients in a way that's not stigmatizing I think is key and that's going to require changes in how we train and the kind of training that we're doing right now, especially talking to organizations that are primarily filled with black providers because we know that black providers are more likely to address health disparities related to heart disease, have healthy babies and mothers have healthy deliveries. And same thing I think needs to be the case when it comes to HIV prevention S. T. I. Care. Um having these types of educational sessions for providers that we know are more engaged with black community members would be key. So, you know, we've heard dr paxton's um presentation and I have to say the facts, which we all know are quite shocking um in terms of lifetime risk of acquisition of HIV. Do you doctor elaborate field those statistics and you mentioned earlier that it shouldn't be framed and risk. However, as dr paxton mentioned in her presentation, african american men who have sex with men are five times more likely than a caucasian man have sex with men to come down with HIV. And if you if you drill down deeper, Fifty% African American colour, 48. Those that would automatically put these people at high risk. Do you feel those sort of statistics might be at least helpful in opening the eyes of our african american providers and looking at their patient populations and taking a sexual history? I think those numbers are important, but I think that you can't look at numbers um in a silo, you can't look at those numbers by themselves. If you look at breast cancer statistics, we know that black women are more likely to die from breast cancer than white women. That's not because it's something that they've done personally. Um Right, that's because of all those social determinants of health that we talked about, that cause black women be more likely to have bad outcomes and be diagnosed later when it comes to breast cancer. The same thing can be said for HIV rates and S. T. I rates. Um, there have been a lot of studies that have shown that behaviors among black, gay and bisexual men who have sex with men and black women are no different and sometimes actually more protective than other populations. So when we're communicating this information to our patients, it's important to number one, given that whole picture, this isn't something that um, you as a black gay man has done to yourself. That puts you at risk. This is a larger issue. This is about the environment in the community and society in which we live that has led to these inequities and now we need to put more resources into these communities to fix it. No, I would agree with that. But the question is engaging the provider. Obviously, I agree with you in terms of talking to the patient, but it is our african american providers that seem to look at me and say, why should I test my patient? And that is where I think statistics are important in terms of engaging the provider. I agree with you. No one wants to put that on the patient to make them feel that, you know, there's something wrong with them. But if you open the eyes of the provider, they may say, oh, women hold up, pull up, my patients are at risk. And so I need to take these steps to enhance and uplift the medical health of my patients. Sexual history is a major portion of overall health. If you don't take a sexual history. Hello. So that was that was my point in terms of engaging the provider. I fully agree with you in terms of actually speaking to the patient, but at least in my experience and talking to healthcare providers, I always get my patients aren't at rest. You know, I think even when engaging the providers, yes, give them statistics, but give them statistics with that holistic view, all of the information, not just the numbers. Because when you educate people and you're using that language a lot of times that frames their mind on how they're viewing HIV testing and STD testing. So if they're viewing it from a Oh no, your population is at risk. They need to view it from. We're all at risk. And because of the larger picture of what's happening in society that's putting these populations at higher quote unquote risk of getting HIV. Okay, thank you dr low price. You know, we will move on to the next portion of our very dynamic panel discussion and our next conversation will focus on the steps we can take to address the silence around HIV testing, prevention and treatment among providers and in health systems that serve black and brown communities. So the first question is going to be to dr paxton, why is there silence around HIV testing, prevention and treatment among many providers in health systems that serve black and brown communities? Yeah, well, it's complicated. I wish I could say oh I've got the one answer for, you know, for that, but I think it's all tied in to what was the themes of this presentation today? Um providers live in the community to providers often have the same prejudices or biases or whatever, you know, reflective of their of the community. Having an M. D. Degree doesn't necessarily mean that or practitioner or whatever, it doesn't necessarily mean that you are going to necessarily accept everything out there. So what I think that um so we have that going, we have that going on and I thought I've often and I've often spoken to a number of providers who maybe they do have really good intentions and they say yeah I I like specifically about testing, I remember speaking to somebody this was a couple of years ago now but still I was saying well I was I was encouraging him to do more you know opt out testing and uh you know to just test everyone that you know as they come in and just try to normalize it and all that. He says dr lin, I don't know why you called me dr lambert dr lin, you know, it says, you don't know my group if I talked to this, you know, if I, you know, talk to this 21 year old woman and say that you know about getting an HIV test, she's gonna think I'm calling her a slut or something like that, and I said, well no, not necessarily, you need to we need to give you know work on tools for how you can better explain this and to take away some of this this stigma, and it actually took a lot of work with him and with this group and I think that we did make some make some inroads there, but it did take a lot of work and made me realize that as dr Hodges, you just said we do need to do a lot of work with the providers themselves because there are some people who, you know, they're willing to do to do all this or to do this or to change their own mindset um you know, but they think that they're going to run into a barrier that they're going to turn off certain people and then they say, well I don't want to do that because I got to get this person, you know, I got to get them to do their health screening at their cholesterol checked and I need to get them to do this, not the other and I just don't want to turn them off by talking about HIV and stds and so don't ask me to do this. Well no, no, let's change your thinking. So I do think that there's a there's quite a bit of work that we that you know, that we need to do and I and I do not under I do not underestimate the influence of, of stigma and about their as being, as being a deterrent buried care, but I also, and I cannot stop, I have to say, but we also cannot avoid the fact that it's not, it's like the economics play into this people of color, you know, in particularly here in Fulton County, where I live where I work. You know, they simply don't have as much access to to care. As many, so many don't have insurance, so many do not have or they might have insurance or they have to work every day. They can't take the time off to, you know, to to go and wait in a doctor's office or something like that. So there are just so many, so many levels and so many barriers that we have to work out that I wish I could say there's there's one reason, there's one reason for this, but there isn't. So that's why you have to look even at the end of the individual community level. Because what might be the case in a rural, primarily african american community? What those barriers are, it's probably very different from what we see here in downtown Atlanta. So I have, you know, we have to I urge everyone to work together like baton rouge, did you know, work together in sort of a multidisciplinary, multi community, um, initiative to look at what's going on in your community, What do you need to do in your community to address what's going on with your constituents? Thank you. Dr paxton, we're going to move into our audience questions. So are there are any questions from the audience? Are our illustrious panelists, Please please let me know. Uh, the first question has come in what if any provisions are made for pretest counselling of adolescents who may often report they will be at risk for suicide if their test comes back positive. Either panelists um I don't know. I always hope something Doctor Lopes would jump in on this one first. Uh, but I think that the whole point of pretest counselling is to look at the person in front of you as an individual. So um and to be responsive to what is brought up to you. So I would think that if somebody, you know, we're just say to me, uh this is what I'm going to do, you don't stop there and say, okay fine, you know, move on. You, you explore, you try to find out what is it that is going going on here because sometimes that's a knee jerk reaction. I'm a mother and 18 year old and I'm really familiar with knee jerk reactions. Um, but you know, but if you take a little time and you say, okay, let's let's let's go a little deeper on this. You know, what exactly do you think it's going to happen? It might be that somebody will say to you, I don't want to do that because if I'm positive my boyfriend's gonna kill me and they mean it kill me, okay? So they think that they would be at a physical rip. Others, it's something, it's something different. So, I mean, all I can say is with pretest counselling, you need to make sure that your counselors are sensitive and that they're trained to react and respond to what is brought up during this council. No, I completely, you have everything you said dr facts and I think ultimately the other aspect of this is, um, making sure that we're educating a lot of times when I'm talking to clients who are getting testing. There's still this, a lot of beliefs are misinformation about HIV and there's a lot of power and what we currently have in regards to treatment for people who test positive for HIV. So spreading the word that undetectable equals un transmittable. This is not a death sentence. If you were to test positive for HIV, what tools would you need to be able to live? Like a healthy um, life at that point? And what resources we will have available for you when you test or if you test positive. I think it's also key. Okay, well, thank you. I will remind the audience again, if you want to submit a question, um, do it by the button on their screen and the next question for either panelists, how can we as providers ensure that is HIV testing becomes the standard of care. It is accompanied by HIV prevention services or treatment inappropriate patients. Um I think by doing what we're doing right now, having these conversations and changing provider opinions about how they offer HIV and STD testing. Thinking of it like dr paxton says a toolkit and I completely when you were having that conversation with the provider that you gave an example for, I agree. It's a continual process a lot of times. It's um talking about changing how you practice care. So, um I think going to talks like this, but also on a continual basis, trying to grow and learn and change our practices that we've been doing for decades. Sometimes it's going to be key. Mhm. Thank you dr Labarre. And this question is to either one of you and here it is. How to let's see, what does this say, What steps can we take to address the high levels of mistrust towards testing treatment and prevention and communities, individuals that have arisen um as a result of a historical legacy of medical abuse around people. That's a big deal with every single day now of my working life because obviously with the covid pandemic, that immune and with the Trying to get people to get vaccinated, I literally hear this 10 times a day um and it's it's legitimate. You know, I mean like the you know it's like tuskegee was a crime against humanity and I hear about it you know a lot but what I bring up and I do a lot of webinars, I do a lot of one on one. I have been down in the streets talking to people about this literally down the street, I remind people yes, tuskegee was a crime against you against humanity. However, what came out of Tuskegee really changed how research is done in the United States that there are now. And I spent 22 years at CBC as a researcher and there are and also I was I was advisor, I was used to chair the advisory committee to the uh, to the, to the FDA. So I kind of have seen it from all all sides the levels of, of institutional review, board review. You know, if you're going to do any kind of human subjects testing, you have to go through many levels of ethics review and no matter what sites you're at, each site has to do it. Once you have, you know, got, you know, then when you go to the FDA, there's more, I mean, so I tell people that yes, tuskegee was a crime, but tuskegee happened 50 years ago. And since then there have been enormous enormous changes. It's still that they're still distrust. I mean what I looked at the newspaper today and there are people still calling for Dr Fauci is head because they don't trust the you know they don't trust the NIH, they don't trust C. D. C. Uh they you know we have we I'm sorry this whole thing about misinformation out there is very very real. I get emails literally every day with people with very copiously sourced um you know emails that have um untruth in them sometimes outright misinformation. A lot of cherry picking. And we see that all the time. And I and so I think that we have to work at this systemically. We have to work. I work with individuals. I talked to people individually. I urge them to go talk to their physician trusted physicians are and other health care providers. They do have, you know, you actually do have a very big um, you know, on what your patients on what your patients do. But we also have to work more structurally. We have to root out the sources of misinformation about HIV, about STD is about whatever, wherever we find them. Don't let it just stand. I don't if I see that something is happening that it is like actually wrong or misleading, I think we all have to try and correct it. So anyway, that's my little so fucks doctor. Look, I have nothing. That's exactly what I think and believe and you know, the power of black and brown doctors as you were saying to effect change. Having your voice out there talking about covid vaccines. Having my voice out there, talking about vaccines. Dr Hodges the same thing with HIV testing and STD testing. I think it's huge. I've had so many people say to me, you know, Dr e because they say dr E because my name can be hard to pronounce doctor because you said it, I'm gonna go get a vaccine. You know what I mean? And that's that's just huge. Yeah. Actually, I posted my picture on facebook when I got my vaccine and I can't tell you how many of my patients did. I guess I'll do this now. It's it is is very important. Yeah. Um I'm wondering do I have time for this last question I'm going to go for it unless someone says no. Oh, I do. Yes. Okay. How can we strike the delicate balance between protecting the privacy of our patients and encouraging a normalizing status neutral approach to care. Mhm. Either Palace are both. You know, it's an interesting I don't have the answer to this. I think we talked about this on a state level, how we can attack and have a sex future continuum by the same methods that we use for HIV for people who are testing for HIV. So making sure that we have services to connect people that we know that they're testing, but also the issue of privacy that people have and have a right to when it comes to I got tested. I don't feel like someone should contact me to let me know about based off of that information. So I don't really have an answer as to how to strike that balance. I think it's going to require probably a change in social norms and how we look at health care overall um to have a better trust with our communities about what we're going to do with that data and how we're going to use that information. Um looking at more for our population health standpoint. They have an individual level health standpoint. Thank you. Dr e Dr Baxter, you have a response. I don't really have anything more to answer. It's a very complicated, you know, sort of question to try to answer in the last two minutes of our but I think the most, but I think we've succeeded in one thing and doing this Foundation, it's just bringing it out bring it on the table. Because I know that just even I'm hopeful that people who are listening to this presentation, just even hearing that this sort of question, you know, we'll sort of make them, you know, go home. And I started thinking about, well, what can I do about this, you know, how can how can I make it make a difference? And if we've done that, if we succeed in doing that, then I will consider this as having been an hour well spent. All right, well thank you Dr paxton and I will thank both of our Distinguished Palace. Dr Lynn Paxton and Dr Latisha Ella pray for their participation in this very important discussion about HIV testing. I will turn it now back to Dr Brown, thank you all. Thank you for the Attentive audience. I have a little bit of business first and one is um we we have a post program survey, it's optional, but you'll get it via email. It would be really helpful for us to get your feedback um and it will strengthen the future programs that we've been doing and we will continue to do with the National Medical Association. I want to thank each of our panelists. Dr lo pray dr paxton and led by the amazing dr theO hodge this conversation about HIV testing, HIV testing in our community and how this really can play an effort play a huge role towards ending the epidemic, both knowing your status and getting treatment as prevention, getting treatment for your health, normalizing the sexual health conversation so that our providers understand that sexual health is health and it's all part of how we keep our patients and how we keep our communities healthy has been really excellent. I hope that people will take this home with them as a way to think about how to normalise HIV testing within the groups of patients that they see. So I want to finish by both thanking the panelists, thanking the audience for participation and also thanking Gilead for allowing this to happen and the enema for our wonderful partnership that lets us work towards getting to our clinicians and making sure that our communities have the best health available, so have a great rest of the conference and enjoy your day. Thank you. Mhm. Mhm. Created by
