Monday is National HIV Testing Day. Here's some background on efforts to fight the virus.

Monday is National HIV Testing Day, marking 41 years since the HIV epidemic first surfaced in the United States in the 1980s.

Over the years, advocates across Georgia have continued to promote safe sex, regular screenings and to fight the stigma surrounding the virus.

While there have been strides in HIV treatment and prevention — rates of infection in the general population have gradually declined in recent years — the virus is still considered an epidemic by the Centers for Disease Control and Prevention. As of 2019, 53% new HIV infections were in the South.

“Every other week, I'm working with a patient in the ICU who didn't get medication, didn't get diagnosed, because their provider didn't test them [for HIV] and didn't think that they were at risk, because whatever demographic they were from,” said Patrick Reilly, HIV testing, prevention and linkage program coordinator for the Northeast Georgia Health District.

Statistics

According to the Ending the HIV Epidemic in the U.S., a multi-government agency effort to curb HIV transmission, more than 1.1 million Americans are currently living with HIV.

In 2020, Georgia had the fourth highest HIV diagnosis rate in the country overall, and the highest rate of HIV diagnosis in the country for the state's Black population.

“I would not say that Athens is unique in Georgia ... but I would say that Georgia is unique in all of the United States,” Reilly said.

“One misconception I often hear is that the high rates of HIV/AIDS in communities of color are associated with high-risk behavior, but is this untrue,” Lisa Bateganya, an HIV PrEP coordinator at the Equality Clinic of Augusta, wrote in an email. “It is due to structural inequalities that make communities of color more in contact with the disease and less likely to treat it.”

“If you have communities that are disproportionately impacted by syphilis, gonorrhea, heart disease, cancer — those are going to be the same communities that are going to be disproportionately impacted by HIV,” Reilly said. “HIV is not different. It's not its own health disparity. It's part of a package of health disparities that needs to be addressed.”

HIV Stigma

“When you look at HIV prevention, it's not as straightforward as it was 10 years ago, when you would just think about community education and testing and things like that,” Reilly said.

However, according to Maiah Wiley, another HIV PrEP coordinator at the Equality Clinic of Augusta, there is still definitely a stigma associated with HIV testing, diagnosis and prevention.

While for the most part, LGBTQ+ patients at Equality Clinic are willing to get tested regularly and talk about HIV, some are hesitant to start Pre-exposure Prophylaxis, or PrEP, even if they are perfect candidates.

According to Ending the HIV Epidemic, PrEP is a medicine people at risk for HIV take to prevent getting HIV from sex or injection drug use. When taken as prescribed, it lowers the risk of contracting HIV by about 99%.

A major way PrEP coordinators work to end the stigma surrounding HIV is by promoting open conversations around sexual health. One of these strategies is an “opt-out” model of testing.

Traditionally, when someone comes in for a physical exam, they are already expecting to have a provider look at their vital signs and run other tests to examine other health indicators. An “opt-out” model just adds HIV screening to the other tests.

Patients can still say “no” and “opt-out” of a test, but this makes screening a regular part of the process, rather than an exception to the rule.

“It also increases testing, because then more people are getting tested and you're not making it weird,” Reilly said.

Solutions

Living with HIV has also changed dramatically since the 1980s.

The main pillar of combating HIV infection these days is treatment as prevention. A popular school of thought in the field is known as “Undetectable Equals Un-transmissible”, or U=U.

According to Reilly, if someone who is diagnosed with HIV gets onto medication, within about four weeks (depending on the number of virus particles in their blood, or their viral load), when a health-care provider repeats the person’s blood labs, that viral load is undetectable.

Medication completely suppresses the viral load, which means there’s no longer a trace of HIV in the patient’s blood and the infected person can no longer transmit the virus.

“From that one standpoint, if everybody in the United States just got tested, and if they were positive, got onto medication, we would have no new infections in the United States,” Reilly said.

As medicine is evolving, so does the law’s treatment of those who are living with HIV.

This year, the Georgia Legislature passed Senate Bill 164 to modernize HIV related laws to align with the current scientific understanding and best public health practices for treating and preventing HIV.

“We have been fighting for this for so many years. … I can’t believe it passed,” Reilly said.

Under the previous law, if someone was HIV positive and didn’t disclose their condition to a sexual partner, they could be charged with a felony, regardless of whether they were actually contagious.

Now, if a person living with HIV has an undetectable viral load, and therefore not contagious, they will no longer be criminalized for not disclosing their status. The bill also still contains provisions to punish anyone who tries to intentionally spread HIV.

“I believe that SB164 is a step in the right direction towards normalizing HIV diagnoses — many other transmissible diseases, such as hepatitis, do not have the stigma associated with them that HIV does.” Wiley wrote.

Ultimately, HIV is no longer a death sentence like it was 40 years ago.

“Three weeks ago, I diagnosed a 21-year-old, young woman,” Reilly said. “Her life expectancy doesn't change. She can still have children; she can still get married to somebody who's HIV negative. She's not putting the child at risk, not putting the partner at risk, her quality of life does not need to change.”

This article originally appeared on Athens Banner-Herald: Monday is National HIV Testing Day, another step in fighting the virus