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Disruptive innovation is key to ending HIV-related health disparities for Black Americans.
Sunday, February 7, National Black HIV/AIDS Awareness Day (NBHAAD), is a day to highlight the disproportionate impact of HIV on Black communities, to celebrate the work of Black HIV advocates, and to support Black people living with HIV in America. We also celebrate the efforts of our local and federal partners, the HIV workforce, and community advocates who have made monumental strides in reducing new HIV infections and continue to champion the Ending the HIV Epidemic Initiative, which aims to reduce new HIV infections nationally by 75 percent in the next five years.
Today is an exciting time. Therapeutics exist that can both prevent and treat HIV, making eradication of this disease achievable. However, HIV-related stigma, social and structural influencers of health, and barriers to effective implementation of these medicines fuel unacceptable HIV-related health disparities for Black Americans. These inequities have been exacerbated by the global pandemic, where Black communities nationwide are experiencing an increased burden of infection, hospitalization, and death.
As we reflect on the work that remains this NBHAAD, we must commit to the critical implementation work that will allow existing and new therapeutics to deliver on their potential to end the HIV epidemic. This work must focus on:
1. Identifying and driving medication uptake for people living with HIV on antiretroviral therapy for HIV treatment and for those at elevated risk of HIV acquisition with HIV prevention medications, pre-exposure prophylaxis (PrEP).
2. Ensuring through adherence and retention support that these medications are optimally effective.
Through effective HIV treatment, individuals living with HIV can maintain an undetectable viral load. People who are undetectable can live long, full lives and cannot pass HIV onto their partners. HIV testing serves as the gateway to link individuals living with HIV to effective treatment and can help identify candidates for PrEP. However, lack of access to HIV testing remains a barrier, especially for Black Americans, 40 percent of whom have never been tested. HIV self-testing is a proven strategy to increase HIV testing access and diagnoses. Self-testing engages individuals who are first-time testers, increases testing frequency, helps connect HIV positive individuals to treatment, minimizes stigma, and during COVID-19 allows safe testing while maintaining the safety of the HIV workforce. HIV testing access for Black Americans must dramatically improve, and self-testing is a critical tool to achieve this goal.
In addition to testing, PrEP is an essential tool for ending the epidemic. Real-world experience tells us that PrEP is a program, not just a pill, and its success requires an increased commitment to improving access and to supporting adherence and retention. Unfortunately, we are failing to ensure that communities most affected by HIV, Black gay and bisexual men and Black cis- and transgender women, are optimally supported by PrEP. A recent study surveying over 4,000 black MSM found HIV prevalence was higher in those on PrEP versus those not on PrEP. One tool to address this issue is PrEP adherence testing, which strengthens PrEP care for both patients and providers. It empowers individuals on PrEP to have data showing them the drug is working for them, and it gives providers an objective data point to help identify which patients need additional adherence or retention support.
On this NBHAAD, we echo the call for disruptive innovation. Ending the HIV Epidemic requires partnerships between community, research, public health, pharma and the private sector to improve implementation of effective treatment and prevention. We must work to address systemic barriers to care, reduce HIV-related stigma, and ensure efficacious tools are available for all, not some.
Stephen S. Tang, Ph.D. is President and CEO of Bethlehem, Pa.-based OraSure Technologies, Inc. Giffin Daughtridge, M.D. is Senior Director Infectious Disease Diagnostics at OraSure.
