World AIDS Day 2017: Treatment improves, more outreach needed

A diagnosis of HIV or AIDS is not what it was 25 years ago.

Bill Hardy, president and CEO of Equitas Health, said when he first started work in the early 1990s for the organization — formerly the AIDS Resource Center — if you learned you had AIDS, you were getting a death sentence.

“Half of all people who were diagnosed with AIDS up until 1996 died within 18 months of diagnosis,” said Hardy, speaking from Equitas’ Dayton office.

As Equitas prepares to mark World AIDS Day on Friday, Hardy reflected on how medical treatment has dramatically advanced. 

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There’s no cure and no vaccine for HIV, but Hardy said there are drugs that are getting closer to both. Viral suppression drugs can reduce HIV to an undetectable level.

“They’re healthy, they’re living well and they can’t transmit the virus to anyone else,” he said.

“There’s still no cure, but it’s pretty close to what we’ve been hoping for.”

Additionally there’s prevention treatment, pre-exposure prophylaxis treatment or PrEP, where people at high risk of getting HIV can take a daily pill that can reduce the risk of getting HIV from sex by more than 90 percent and reduce the risk from getting HIV through injecting drugs by more than 70 percent, according to the Centers for Disease Control.

“Between viral suppression and PrEP for HIV negative folks, I can’t believe in my lifetime how far we’ve come,” Hardy said.

People living with HIV diagnosis     
The number of residents living with an HIV diagnosis by county since 2012.      
Source: Ohio Department of Health    

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A little under 1,000 Ohioians were newly diagnosed with HIV in 2016, increasing the total number to 23,169 people living with an HIV diagnosis.

There were 264 Ohio deaths of people with HIV in 2016.

In Montgomery County, there were about 1,400 people living with an HIV diagnosis in 2016, and about half had AIDS, according to the Department of Public Health.

Nationally, the most impacted population is young, gay men, with black and Latino gay men disproportionately affected.

Hardy said Equitas has had success with helping people suppress their viral load to an undetectable level, with 87 percent of its patients achieving viral suppression verses about 49 percent of the U.S.

With the advances in medicine, Hardy said the main issue now is to reach out to people with HIV or at risk for getting the virus.

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Particularly in rural areas, residents can have difficult times accessing care. Not all physicians are willing to prescribe PrEP or are culturally competent with LGBT health care.

Hardy said he’s also been closely watching federal health care legislation that might alter access to care, like the potential removal of the individual mandate to have health care or the various repeal and replace efforts.

The spread of opioid addiction also relates to the prevention of HIV and AIDS. Sharing needles accounts for about 6 to 8 percent of new HIV infections.

He said the opioid crisis is almost single handedly responsible for the growing spread of the Hepatitis C virus.

“And Hepatitis C is a high co-indicator very often for people who have HIV,” he said.

He said part of the outreach approach at Equitas is the organization moving away from being a disease specific organization, to being a health care group that offers a range of health care services and encounters a broader range of the population that it can offer testing services to.

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“Come see a dentist, come see a counselor, come your primary care provider because you’ve got a sore throat or the flu, and while your there we’ll test you for HIV and STIs,” he said.

The evolution of their approach can be seen in the evolution of the former AIDS Resource Center in Dayton rebranding last year as Equitas Health.

“Its much more effective approach in our opinion, especially for young folks who didn’t want to walk into the building with AIDS over the front door,” he said.

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