Local treatment and prevention efforts are strong on this National HIV Testing Day
Christine Charlson | WCPO Contributor
3:43 PM, Jun 26, 2017
11:52 AM, Jul 1, 2017
Correction: A prior version of this story incorrectly identified the assistant health commissioner for Hamilton County. WCPO regrets this error.
CINCINNATI -- There are ever-increasing treatment and prevention options for HIV, but the message isn’t necessary reaching those at risk for spreading or contracting the virus.
But there are numerous efforts in the Tri-State to change that, including several events on National HIV Testing Day, which is June 27.
According to Central Community Health Board bilingual health educator and counselor Marco Trujillo, young people are one of the most difficult groups to educate in terms of prevention. He said one in five new cases of HIV in the U.S. appear in those between ages 13 to 24.
“So these kids think that nothing is going to happen to them,” Trujillo said. “And it’s incredible how our youth population is having these problems right now. We have 13- and 14 year-old girls who are pregnant and with HIV.”
The spike in new cases among youth may stem from the fact that HIV has become widely treatable condition, Trujillo said. Unlike a decade ago, he said people with the virus usually only have to take one daily pill as opposed to 20 or more. He said daily medications like pre-exposure prophylaxis, or PrEP, reduce the risk of contracting HIV from 92 to 99 percent for those who use it. Also, post-exposure prophylaxis, or PEP, significantly reduces the risk of contracting HIV if taken no later than 72 hours after exposure.
The problem, he said, is getting the word out to at-risk populations before they test positive.
“So it’s a challenge. I can tell you after 11 years of doing this, this has been the hardest year,” he said.
In addition, Trujilo said as a bilingual health educator, it’s become increasingly difficult to reach the Tri-State’s undocumented population as fears of deportation have pushed them further into the shadows. While many are in need of health care and testing services, he said they’re afraid to go to clinics or hospitals.
He explained these individuals now exponentially increase risk of exposing others to the virus, as they no longer have access to preventive medications.
“The Hispanic community is afraid -- even citizens or legal permanent residents are nervous,” he said. “I have clients from all over, Dayton and Lexington that come up here because they want to know more, but they don’t want to get an HIV test in the place where their family lives.”
During the past few years, the number of new HIV cases in Hamilton County has remained consistent, with 138 reported in 2015 and 135 reported in 2016. Hamilton County Public Health Assistant Health Commissioner Craig Davidson said while it’s a good sign numbers aren’t increasing, it still means each year more people are living with HIV.
“In terms of new case rate, we’ve stayed fairly level. However, we are still are among the highest new case rate in that state at the county level,” Davidson said.
To help ensure all those in need of healthcare receive treatment regardless of status or income, he said they provide a full-time dedicated linkage to care coordinators to help guide newly diagnosed individuals through the process.
“That person works with them and manages them and takes care of them from a case-management standpoint, goes to appointments with them, makes sure that they’re set up on a course of care,” Davidson said.
To explore increased prevention options, the University of Cincinnati is currently conducting a clinical trial to test the intravenous medication cabotegravir. The study’s principal investigator, Dr. Carl Fichtenbaum, explained cabotegravir is injected every two months and will be randomly tested with approved PrEP medication Truvada, which is taken daily. He said the worldwide study will follow 4,500 at-risk participants for two to four years to test its effectiveness.
“Our hope is that there really is no difference between the two medications, that they’re both very effective at preventing HIV transmission. That’s our hope,” Fichtenbaum said.
While the drug will ideally be approved for both men and women, the trial is limiting participants to those at the highest risk -- men and transgender women who have unprotected sex with multiple male partners. He said African-American men who have sex with other men are at the highest risk, with one in two chance of contracting HIV during their lifetime. He added young people ages 13 to 29 are the ones currently driving the epidemic.
“Young people are the ones the most vulnerable, because it’s when people become sexually active and it’s also when we take lots of risks,” Fichtenbaum said. “Think back to your youth and the decisions that you made -- some good, some bad.”
Even with advances in treatment, he said not everyone is guaranteed to live a healthy, normal life with HIV. He said those who are financially stable and find out early on can live a fairly normal life. However, for those who live with any type of socio-economic hardships, he said life with HIV can be challenging.
“If you have any certain handicaps in life of anything, it’s not a fun disease,” he said. “And I see lots of people with premature problems and many other conditions as a result of this. So I think it’s not something to be taken lightly.”
Seventy volunteers will participate in the clinical trial. Fichtenbaum said they feel fortunate at UC to be one of only 40 sites in the US testing the medication. The study will give local high-risk participants additional options to keep from contracting HIV, he said, with the ultimate goal of reducing the number of new cases in the Tri-State.
“We were pretty lucky to be one of the sites; there were lots of other cities that wanted this study in their locale,” he said. “So I think it’s a credit to our community and institution and our group here that have really invested a lot of time and effort into this field and wanting to make Cincinnati a better community.”
For more information or to enroll in the study, those interested can call 513-584-6383.
HIV by the numbers
At the end of 2013, an estimated 60,900 youth were living with HIV in the United States. Of these, 51 percent, or 31,300, were living with undiagnosed HIV. That's the highest rate of undiagnosed HIV in any age group.
Among youth who were diagnosed with HIV in 2014, 68 percent were linked to care within 1 month -- the lowest rate of any age group.
Among youth who were diagnosed with HIV in 2012 or earlier, 55 percent were retained in HIV care and 44 percent had a suppressed viral load -- the lowest rate of viral suppression for any age group.