Social Determinants of Health Targeted at USCA 2018

ORLANDO, Florida — To enroll and retain people with HIV in treatment, physicians and HIV care providers need to acknowledge the social determinants of health and the barriers that keep patients, especially young people of color, out of care.

"We have to look at the context of the moment we're in," said Moises Agosto, treatment director at the National Minority AIDS Council and one of the organizers of the upcoming United States Conference on AIDS (USCA) 2018.

On the one hand, the current administration is pulling back from the Affordable Care Act and promoting policies that stigmatize specific communities, such as immigrants and black people. On the other hand, "HIV care is becoming more medicalized."

"If physicians don't acknowledge the social drivers of HIV and don't get to know the structural challenges that gay men of color face to get access to treatment, they will not be successful" at retaining patients in care, said Agosto.

The meeting will feature care models from community clinics and organizations, such as Allies for Health + Wellbeing, an HIV community organization that has been offering free anonymous testing for sexually transmitted infection in Pittsburgh since the 1980s.

Highlighting Models That Work for Patients

For many years, people newly diagnosed with HIV would leave the test center armed with their diagnosis, facts, and a referral to a doctor. Today, they leave with an HIV counselor at their side and go through a set of doors directly into the Allies' health clinic. The health clinic opened in 2016 to provide wrap-around health and social services to people living with or at risk for HIV.

Once there, they meet Ashleigh Garcia, an acute care nurse practitioner.

"I explain to them that it's going to be okay, even though I know they may not feel that way right now," Garcia told Medscape Medical News. First, she orders the usual blood panels for kidney and liver function and an antibody test to confirm the diagnosis. Next, she offers treatment.

"So when you walk down the stairs after getting this diagnosis and you're holding one pill, or two pills, you're thinking, 'this is all I have to do to be okay'," she explained.

The clinic implemented the rapid antiretroviral treatment program recently. So far, all eight people enrolled have stayed in care, she reported. And although many have not been on treatment long enough to know whether they have suppressed viral loads, Garcia has seen some of her patients, primarily young black men who have sex with men, reach viral suppression in as little as a month.

You come see your doctor, get some food, get case management. Anything we can do to help people better their lives with the diagnosis of HIV, that's what we're going to do.

Garcia and her team will be at USCA to present their model, answer questions from other clinicians, and explain how they adapted a well-resourced model from San Francisco so that it works in their smaller Rust Belt city.

As a provider, Garcia said it is a relief to know that she can provide care to people who are still coming to terms with their diagnoses. But that care is not enough to change people's lives, so Allies also provides behavioral healthcare, a food pantry, and case-management assistance with transportation, housing, and emergency financial needs.

"It's a one-stop shop," she said. "You come see your doctor, get some food, get case management. Anything we can do to help people better their lives with the diagnosis of HIV, that's what we're going to do."

Bringing Science and Community Together

Traditionally, USCA has been tailored to people of color living with HIV and their community organizations. This year, a grant from the National Institute of Allergies and Infectious Diseases has allowed organizers to collaborate with the Center for AIDS Research to expand scientific offerings. The goal — to bring more science to the people on the ground — will be reflected in a special morning session on HIV cure research.

"We're very excited about the peer research possibilities," said Agosto. "Part of this goal is to bring to USCA more scientific information so that the rest of us can learn what is happening and what is feasible."

The opening plenary of the meeting will feature Alicia Garza, cofounder of Black Lives Matter, and other activists, including representatives from the Urban Indian Health Institute in Seattle and the Wall Las Memorias in Los Angeles. In addition, gun-control activist and Marjory Stoneman Douglas shooting survivor David Hogg will speak.

And just as Carlos del Rio, MD, from Emory University in Atlanta, urged at the Conference on Retroviruses and Opportunistic Infections earlier this year, as reported by Medscape Medical News, physicians and providers attending USCA will be encouraged to stand with their patients in the HIV movement.

"We are making a call to the movement" with the conference theme of Fight Back, Fight HIV, Agosto said. "And I absolutely believe that medical providers and physicians are a part of that movement."

Follow Medscape on Twitter @Medscape and Heather Boerner @HeatherBoerner

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