As the year to start ending HIV as an epidemic began, a pandemic changed everything

A physician in one of America’s “hot spots” looks at challenges and opportunities

Dr. Finkel is an Assistant Professor in the Department of Medicine and director of the Infectious Disease Fellowship Program at Rutgers New Jersey Medical School. She has been a community medical provider for more 16 years and has coordinated community care for diverse populations at risk, including immigration detainees, LGBQT marginally housed youth and persons who use drugs. She has served as a Principal and co-investigator in the Rutgers NIH sponsored HIV Clinical Trials Unit in both treatment and prevention trials. A member of the Ending the HIV Epidemic working group of the HIV Medicine Association, which produces this blog, she answered questions from Science Speaks the challenges the ongoing COVID-19 pandemic has brought to the administration’s initiative to stop HIV transmissions among some of the most affected areas.

We started 2020 looking forward to the real start of the initiative announced in the president’s 2019 State of the Union address, that aimed to end HIV as an epidemic within the next 10 years. That initiative was funded to begin expanding access to testing, diagnosis, treatment and prevention this year. Then came the COVID-19 pandemic. You work with people who already faced challenges, with high risks of infection, and low access to services, in one of the counties targeted by the initiative, in a state that also has been one of the hardest hit so far by the pandemic. What are some of impacts of the pandemic you are seeing now, among your patient population?

First closures of in-person counseling and testing sites have added to difficulties in getting tested for HIV and sexually transmitted diseases, which, in turn, is the gateway to antiretroviral treatment for people with the virus, and to effective prevention measures, including PrEP – oral pre-exposure prophylaxis -- for people who do not have the virus. Since antiretroviral treatment suppresses the virus it greatly reduces risks of transmission. People with undetectable viral loads don’t transmit the virus. So the closure of these clinics and testing sites may have put more people at risk of acquiring HIV, and put people living with the virus going untreated, and being at increased risk for illness. Also, having an undiagnosed and untreated sexually transmitted disease also increases the risks of HIV infection.

In addition, many people living with HIV are considered at increased risk for more severe illness from COVID-19 due to other conditions that include high rates of diabetes, hypertension and smoking.

Finally, among individuals of transgender experience with whom I work, for many surgeries and supportive services were cancelled. These disruptions lead to greater dysphoria and depression, both of which could lead to decreased adherence to antiretroviral treatment.

With the  challenges of this pandemic, does the Ending the HIV Epidemic have a chance of gaining ground right now?

Yes it does. The work of providing essential health services can’t stop because a new disease presents challenges. The history of progress against HIV is proof that it doesn’t have to be that way. Thankfully for many patients in Ryan White programs here, case management and social services were delivered through phone calls and e-visits and disruption in medication availability has been limited. Pharmacies have been able to do home deliveries of medicines which was a big plus and outreach vans have been able to drop off food deliveries for many of our pantry patrons at our community center. As restrictions in some types of services necessitated by the pandemic continue, we will have to continue to find ways to increase access to services through telemedicine, home testing and community involvement in all efforts.