Written by Jessica Lynn Nichols // Illustrated by Alexia Carcelli
April is an important month for raising HIV/AIDS awareness, highlighted by two national days of recognition. Learn more about the communities affected by this disease, and ways for Ohioans to stay healthy.
The month of April includes two days of HIV/AIDS awareness, recognized by the Centers for Disease Control and Prevention (CDC). National Youth HIV/AIDS Awareness Day was April 10, followed shortly by National Transgender HIV Testing Day on April 18. It is essential to recognize the impact of HIV/AIDS on communities who are disproportionately affected when compared to other demographics. According to the CDC, 21 percent of people diagnosed with HIV in 2017 were young people ages 13 to 24. The CDC also estimates that 14 percent of transgender women have HIV. Within these subgroups of age and gender, communities of color are more vulnerable to HIV/AIDS. Of all gay and bisexual men under the age of 24 who were diagnosed in 2017, 51 percent were Black and 25 percent were Latino. Furthermore, 44 percent of Black trans women and 26 percent of trans Latinas are HIV positive. The CDC has found that young people, transgender people and people of color are all less likely to receive medical care for prevention, testing and treatment. This disparity could be caused by a combination of sociological factors, including discrimination and lack of financial means.
It is also worth noting one of several notable gaps in the available statistics. The CDC acknowledges that their data regarding HIV risk, diagnosis and treatment among transgender men is limited. Trans men have not been the subject of extensive HIV/AIDS study and issues of sexual health among trans men have often been overlooked. The available data demonstrates that trans men of color are vulnerable to HIV infection at rates comparable to trans women of color. Based on what is known about the means of HIV transmission, it is likely that many trans men are at high risk of infection, especially trans men who have sex with cisgender men. Also, underrepresented in the existing data are trans people who are nonbinary, genderqueer or otherwise do not identify as women or men. One can be hope that data collection with regard to transgender people will improve with time. For now, it is essential to remember the urgent need to raise awareness of HIV/AIDS in marginalized communities.
To prevent HIV infection through sex, the CDC and the World Health Organization (WHO) both recommend using barriers such as condoms and dental dams. The organizations clarify that condoms are most effective for HIV prevention when used along with lubricant to minimize risks that the condom will break or tear. They further warn that sex is not the only behavior that risks HIV infection. The CDC found that 10 percent of people diagnosed with HIV in the United States are people who inject drugs. Because HIV is transmitted through specific bodily fluids, blood among them, it is possible to become infected by sharing needles with someone who has HIV. People who inject drugs can avoid HIV infection by using sterile needles. Many state and local governments make sterile needles accessible to the public for free through Syringe Services Programs (SSPs). Circle Health Services offers a needle exchange SSP at their offices in Cleveland at 12201 Euclid Avenue Monday, Wednesday, Thursday and Friday. Similar programs are maintained in other Ohio cities.
Another method of preventing HIV infection through sex or needle use is pre-exposure prophylaxis (PrEP). PrEP is a prescription medication, taken daily as a pill. WHO lists some of the people who can most benefit from a PrEP prescription, including men who have sex with men, transgender women, people with HIV-positive partners and people who inject drugs. The prescription Truvada is proven to reduce risk of HIV infection for all of these groups. Another prescription approved for PrEP, Descovy, has been studied in cases of people assigned male at birth who are at risk of HIV infection through sex, as explained on the CDC website. The Cleveland Aids Clinical Trial Unit maintains a list of healthcare providers who can prescribe medication for PrEP.
Even when using all available prevention methods, it is essential for everyone to stay informed about their personal health. Cleveland MetroHealth recommends for every sexually active person to be tested for HIV. MetroHealth further advises that people with multiple partners, people with HIV positive partners, those who share needles, participants of sex work and people diagnosed with sexually transmitted infections (STIs) should test regularly. This testing should be at least once every year. There are many locations in and around Cleveland where people can get tested for free. The AIDS Taskforce of Greater Cleveland offers free testing every Wednesday at the LGBT Community Center of Greater Cleveland, from 4 p.m. to 7:30 p.m. Free HIV testing is also available at most Planned Parenthood locations.
Local studies: clevelandhiv.org/upcoming-vaccine-studies/
Other resources in Cleveland: clevelandtaskforce.org
People who test positive for HIV may struggle with fear and shame, not only related to the health concerns of their diagnosis, but also the social stigma. Discrimination in housing, employment and other areas of everyday life are real concerns for people living with HIV. Much of the discrimination HIV positive people experience is based in misconceptions about the transmission of the virus. Medical professionals and the CDC make the facts clear. HIV cannot be transmitted through food, drink, saliva or sweat. Kissing and skin-to-skin contact with a person who is HIV positive will not transmit HIV. Oral sex is extremely unlikely to transmit HIV, and that low risk can be reduced further through the use of barriers.
Not only can the risk of transmission be minimized, but HIV itself is a manageable condition. An HIV positive person who regularly takes prescribed antiretroviral medications will reduce the level of the virus in their body until, WHO notes, the virus becomes undetectable by most tests. This makes it possible to preserve their immune systems and quality of health. When the amount of virus in the body (also known as the viral load) is low, the chances of transmission to an HIV negative partner are also low. As the CDC states, once a person reaches an undetectable viral load, transmission through sex becomes nearly impossible.
While there have been significant medical advancements, it remains that at this time, there is no cure for HIV/AIDS. Research continues to find newer, increasingly effective methods of prevention and treatment. These efforts include clinical trials of an HIV vaccine. Some of these trials are held in Cleveland, through the Case Western Reserve/University Hospitals AIDS Clinical Trials Unit. Ongoing discoveries foster hope that a future without HIV is in sight. The best contribution we can make is to keep conscious of how we and our communities can stay healthy, whatever our HIV status.