IN THE LOOP

The International AIDS Society (IAS) held the biennial International AIDS Conference, AIDS 2020, online from July 6-10. The biennial meeting is organized by the International AIDS Society and brings together scientists, policy makers, healthcare professionals, people living with HIV, funders, media, and community.

The conference was supposed to be hosted by the cities of San Francisco and Oakland, but was moved to a digital platform due to the COVID-19 pandemic.

A few of the many stand-out presentations at the conference include:

• New reports on the efficacy of injectable PrEP
• A large U.S. study examining no link between people living with HIV and COVID-19
• A presentation on a Brazilian man who may be the first report of a functional cure through anti-retroviral treatment.

Several organizations provide access to AIDS2020 presentations, including aidsmap.com and HIV.gov. Follow the links below to scan topics featured at the conference. Scroll down for links to specific presentations on injectable PrEP, HIV treatment, vaccine research and more.

COVID-19 has had a major impact on HIV and STD services in California and across the U.S., according to several studies presented at AIDS 2020. Researchers from the California HIV/AIDS Policy Research Centers (CHPRC) presented data from an online survey of 70 community-based organizations demonstrating the impact of COVID-19 on efforts to address HIV, hepatitis C, and STDs in the state.

While the majority (67%) of organizations reported providing services via telehealth, other critical services have been reduced or suspended due to the statewide stay-at-home order and social distancing guidelines. Over half (57%) of respondents had reduced or suspended HIV testing, one-third (34%) had reduced or suspended STD testing, and one-fifth (21%) had reduced or suspended their PrEP programs.

These findings are consistent with data presented from Fenway Health, an LGBTQ healthcare facility in Boston, which demonstrated significant declines in the number of people starting PrEP, refills of PrEP prescriptions, and testing for STDs since the beginning of the COVID-19 crisis.

Researchers analyzed electronic health data for 3,520 clients with at least one active PrEP prescription between January and April 2020. During that time, new PrEP starts decreased by 72%, PrEP refill lapses increased by 191%, and the total number of clients receiving PrEP declined by 18%. In addition, the study found testing for HIV and for gonorrhea and chlamydia decreased by 85%.

In addition, the study found that vulnerable groups were more likely to have lapses in PrEP care. Young people, Black and Latinx clients, transgender individuals, and those who were publicly insured were more likely to have prescription refill lapses.

In a related study, the American Academy of HIV Medicine (AAHIVM) assessed the impact of COVID-19 on PrEP use, risk behavior, and PrEP provider practices. The researchers conducted electronic surveys of PrEP users and prescribers in late April and early May, at the height of shelter-in-place orders.

Of the 394 PrEP users who responded, nearly a third reported that they had discontinued PrEP. Most respondents stopped voluntarily, typically because they no longer needed it due to low perceived HIV risk. More than half said they had not had sex with a partner while sheltering in place.

The provider survey showed that PrEP generally remained available, but over 90% of the 188 prescribers reported restricting or changing their practice to reduce face-to-face contact. In addition, almost three-quarters of providers had to delay recommended HIV and STD testing.

“Reducing the number of new HIV transmissions and ensuring access to critical HIV prevention services must remain a public health priority during this challenging time,” AAHIVM executive director Bruce Packett said. “My hope is that clinics and HIV prevention providers can continue to adapt to changing circumstances by offering expanded use of telehealth services and other innovative tools to help meet the evolving needs of people at risk for HIV.”

The Los Angeles County Board of Supervisors passed a unanimous motion this week to establish an anti-racist County policy agenda. The motion, authored by Supervisor Mark Ridley-Thomas, calls on the Board to declare racism as a public health issue and to prioritize its elimination from County policies, practices, operations, and programs. The Supervisor called out centuries of “unchecked anti-black racism” as the root cause of negative health and social outcomes for Black/African American Angelenos, and emphasized that people in positions of authority need to dismantle biases within the system and engage in substantive self-examination. Each Supervisor spoke in support of the motion during the meeting, and the directors of various County departments also voiced their support and eagerness to build anti-racist policies and programs Countywide.

The motion calls for legislative, policy, and programmatic changes that will prioritize physical and mental health, housing, employment, public safety, and justice in an equitable way for Blacks/African Americans and requires an annual report on progress made. The Supervisor stressed that it is no longer sufficient to support diversity and inclusion initiatives. Instead, County leadership and individual departments must identify and confront explicit institutional racism and advance policies and programs that advance racial and social equity, diversity, and fairness. Los Angeles has the opportunity to set a new national standard and become a leader of anti-racist policymaking and program implementation.

APLA Health applauds the Board of Supervisors for this motion, and especially Supervisor Ridley-Thomas for his leadership in moving forward the County’s work in addressing systemic racism and building a truly anti-racist system.

Supervisor Ridley-Thomas stated in the Board motion that no child is born with racist worldviews, and just as racism is learned, so can it be unlearned and “replaced with the adoption of beliefs, actions, movements, and policies to oppose racism”.

Additionally, APLA Health’s Government Affairs staff sit on the Los Angeles County Commission on HIV and will actively participate in the implementation of this motion across the Commission’s work, reviewing the recent recommendations of the Commission’s Black/African American Community Task Force and developing a comprehensive anti-racist policy agenda.

You can read the full motion here.

As Black Lives Matter protests were conducted across the nation and around the world in response to George Floyd’s videotaped murder at the hands of a Minnesota police officer, APLA Health’s Black leadership took the opportunity to look at the experience of Black staff and patients/clients. They embarked upon an internal initiative to address issues of race and its impact on the experiences of Black staff, patients/clients, and board members. The intent of the initiative is to develop anti-racist processes and procedures that will have long term, lasting impacts on the organization’s culture.