On Dec. 1, the R.I. Department of Health announced Rhode Island has met the first target of the 90-90-90 initiative, a global effort at ensuring that by 2020, 90 percent of people living with HIV will know their status, 90 percent of people living with HIV will be engaged in HIV care and 90 percent of people living with HIV will have viral suppression.
The first target, 90 percent of those with HIV knowing their status, was met at 93 percent, RIDOH announced at a world AIDS day event Dec. 1 at the Rhode Island Foundation.
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Providence Business News asked Tom Bertrand, chief of the Center for HIV, Hepatitis, Sexually Transmitted Diseases and Tuberculosis Epidemiology at the R.I. Department of Health what reaching the milestone means for Rhode Island, and the state’s efforts toward reaching the remaining goals.
PBN: Rhode Island recently celebrated achieving the first of the 90-90-90 initiative goals in reaching 90 percent of the population living with HIV will know their status. How did the state health care community achieve this?
BERTRAND: This achievement is very significant because we want people who are HIV-positive to know their status and be in care so that they can be healthy and minimize the risk of transmitting HIV to others.
There are a number of factors that led to this achievement, including better screening for HIV among primary care providers, expansion of open hours at The Miriam Hospital STD Clinic, and the ability of community-based organizations (i.e., AIDS Care Ocean State, AIDS Project Rhode Island and Project Weber/Renew) to conduct rapid HIV testing in nonmedical settings and reach high-risk individuals. Despite this achievement, we estimate that there are still 280 living with HIV in Rhode Island who don’t know their HIV status, and about three out of four of these individuals are gay, bisexual, or other men who have sex with men.
HIV can be a silent disease that someone does not know they have, so we encourage all sexually active individuals, as well as people who use injecting drugs, to get tested for HIV at least yearly.
PBN: The other two milestones were not celebrated during world aids day earlier this month. How close is the state to reaching each of those goals?
BERTRAND: The other two milestones focus on ensuring that people who are living with HIV are regularly seeing their doctors and that they achieve an undetectable HIV viral load by regularly taking their medications. We have made some progress toward these goals in the past two years, and we estimate that between 65 percent and 70 percent of people living with HIV have seen their doctor in the past year and have an undetectable HIV viral load. Our goal is 90 percent for these targets and we are working with health care providers, community-based organizations and other state agencies to reach them.
PBN: What are the primary obstacles to reaching those goals?
BERTRAND: There are a number of factors that can impact whether a person living with HIV regularly accesses health care and takes their medications. Some people struggle with stable housing, mental health issues, and/or don’t have transportation to get to their medical appointments or to a pharmacy.
Systems are being put in place so that clients at AIDS service organizations are matched with peer navigators and “buddies” to help them overcome these barriers. We are also working with a variety of partners to see how we can improve housing and transportation options through policy changes such as free bus passes and stronger housing-referral systems, such as steps we are taking to create a centralized system of available housing options.
PBN: Has the opioid addiction epidemic in the state contributed to more HIV infections? How closely are the two issues related?
BERTRAND: We are fortunate to have ENCORE (Education, Needle Exchange, Counseling, Outreach, and Referral), a very robust needle-exchange system in Rhode Island that is managed by AIDS Care Ocean State. Their efforts have contributed tremendously to drug-user health in Rhode Island, especially as it relates to preventing the spread of HIV and opioid overdoses.
Due to their ability to meet the needs of their clients, the number of newly diagnosed HIV cases among injecting drug users has been less than five in recent years – a tremendous public-health success.
In addition to providing clean syringes, ACOS also distributes naloxone and teaches their clients how to use it in order to prevent accidental drug overdoses.
PBN: Please share a story illustrating this issue from your point of view.
BERTRAND: I have been a volunteer HIV test counselor for five years and I have given positive test results to many people who did not know their positive status.
Their concerns often include how it will impact their health, as well as how it will impact their relationships with family, friends and co-workers. While there are now medications to help people living with HIV lead healthy and long lives, not to be underestimated is the emotional toll that living with HIV can have. Stigma, discrimination and shame can often be experienced by people living with HIV, making it unlike most other chronic diseases.
It’s our priority at the Rhode Island Department of Health to not only prevent HIV infections and improve the health outcomes of people living with HIV, but also to help people living with HIV lead quality lives that are free of stigma and discrimination.
Rob Borkowski is a PBN staff writer. Email him at Borkowski@PBN.com.
