By Lee Storrow
Like so many other health care conferences and meetings across the globe, the 23rd International AIDS Conference went virtual.
The biennial event was supposed to take place July 6-10 in San Francisco and Oakland, where researchers from UNC Chapel Hill would, once again, be headliners.
The event, one of the world’s largest public health convenings, brings together thousands of researchers, advocates and people living with HIV every two years to present the latest research and policies to end the HIV epidemic globally.
One of the headlines of this year’s conference was an announcement of new data showing that an injectable form of Pre-Exposure Prophylaxis (PrEP) given every eight weeks was better at preventing HIV transmission than taking a daily pill.
HIV Prevention Trial Network (HPTN) study 083 enrolled 4,570 cisgender men who have sex with men (MSM) and transgender women across 43 sites across the globe. The UNC Chapel Hill – Clinical and Translational Research Center and Regional Center for Infectious Disease in Greensboro were both research sites for the study.
“Injectable long-acting PrEP provides a great alternative to daily oral therapy,” said Myron Cohen, a researcher at UNC, who was one of the study co-principal investigators.
Cohen has been working to cure AIDS for a long time. He led the groundbreaking research, published in 2011, showing that antiretroviral therapy can be used to prevent transmission of HIV, the virus that causes AIDS. In 2011, that research was named the breakthrough of the year by the journal Science.
Cohen also directs the Institute for Global Health at UNC Chapel Hill.
Terry Munn with Triangle Empowerment Center in Durham said the finding was positive but said it’s still a challenge to get Black men who have sex with men started on taking PrEP consistently.
He cautioned that while an injectable was certainly an exciting advancement, there are still significant barriers for those Black men to access important HIV prevention tools.
“I have to get the African American community to accept that what’s in this needle can change your life. We have to do more marketing to our community,” says Munn. “People with insurance will jump on this. People that are educated will jump on it. I doubt very seriously that the community that needs it the most will want it without trust and information.”
“The conference inspired my continual work in North Carolina to end the HIV epidemic by reinforcing the need to approach the epidemic in an interdisciplinary, holistic and human rights manner,” said Donte Prayer, health access coordinator at NC AIDS Action Network. Prayer also attended the South Africa conference in 2016. “HIV policies and science are ever evolving and this conference forum assisted with keeping me updated on opportunities for education, networking and best practices.”
Medicaid expansion stabilizes care
Another piece of research from UNC Chapel Hill looked at the role of Medicaid expansion on health insurance churn and how that affects women living with or vulnerable to acquiring HIV.
People receiving Medicaid, the state and federally funded insurance program for low-income people with disabilities, seniors, children and some of their parents, frequently cycle on and off of the program as they gain and lose work and income. That can make it difficult for those patients to receive consistent care and follow-up.
The UNC researchers analyzed data about 3,341 women (65 percent Black, 71 percent living with HIV) and concluded that women in Medicaid expansion states had “better churn outcomes,” namely, they lost coverage less often and gained and kept coverage more consistently. The researchers concluded that Medicaid expansion would “stabilize insurance for women with or vulnerable to HIV and improve downstream health outcomes.”
“It’s certainly relevant to North Carolina,” said Andrew Edmonds, a UNC infectious disease epidemiologist. “Multiple sites from the state were included, including women from both urban and rural areas.
“The bottom line message is Medicaid expansion is helpful to stabilize health insurance.”
Though multiple pieces of legislation were introduced in North Carolina to expand Medicaid coverage during this year’s legislative session, the General Assembly gaveled out with no action taken to expand, even as hundreds of thousands of workers lost coverage since the onset of the COVID-19 pandemic. North Carolina is currently one of only 13 states who have not expanded Medicaid.
Beyond medication
Another set of UNC researchers examined access to care for people living with HIV by performing interviews with 10 staff members at a publicly funded HIV clinic serving rural North Carolina to identify barriers to care. They concluded that the unmet need was extensive.
The lack of transportation services or transportation vouchers was reported as the number one change the clinic wished to make to keep patients in care. The researchers also identified how creating a welcoming environment and offering flexible hours could also improve access to care, and should become priorities for clinics.
Donte Prayer, health access coordinator at NC AIDS Action Network, attended AIDS 2016 in South Africa and participated in a number of sessions from his home during the virtual conference this year.
He said that while the PrEP research was exciting, getting HIV patients into care and keeping them there, is “more than just medication.”
“If we’re not working across public health to increase access to insurance, giving people access to transportation, and all the other things, we’re not really doing the work to end the HIV epidemic,” he said.
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