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N.C. Ending the Epidemic Plan hopes to end HIV through education

nc ending the epidemic
It's getting increasingly difficult for patients to afford Truvada, also known as pre-exposure prophylaxis, or PrEP, because of the drug's high price and insurance company efforts to restrict the use of coupons that shield patients from it. (Heidi de Marco/KHN/TNS)

The N.C. Department of Health and Human Services and the N.C. AIDS Action Network unveiled on March 5 the N.C. Ending the Epidemic Plan — a collaborative statewide effort to end HIV. 

An estimate from 2017 showed that 35,045 people in North Carolina live with HIV, and there were around 1,310 new diagnoses that year.

The plan would build on 35 years worth of HIV research and care by hosting in-person events and conducting digital outreach to connect with community stakeholders such as providers, people living with or vulnerable to HIV and their friends and families.

Evelyn Foust, head of the NCDHHS’s Communicable Disease Branch in the Division of Public Health, which is spearheading the project, said she is excited about the initiative.

“Treatment works, and that’s the miracle of this century, so now we just need to push and really help as many people as we can get into care and prevent new infections for those who are not yet infected,” she said.

Prevention methods include condoms and pre-exposure prophylaxis, a medication designed for populations who are at high risk for HIV infection that reduces the chance of acquiring HIV by more than 90 percent when taken as directed by a medical provider. 

Eighty-six percent of people living with HIV served by specific HIV programs or HIV medication assistance program are virally suppressed, meaning that they cannot transmit the virus.

It is estimated that 12 percent of people living with HIV in North Carolina are unaware of their status.

Foust explained that, though HIV testing is free through North Carolina’s local health departments, not all sexually active people are getting offered a routine test during their annual exam.

“We think some of that’s because sometimes physicians are still hesitant to talk to their patients about sex,” she said.

Dr. Peter Leone, a professor of medicine and epidemiology at UNC’s School of Medicine and Gillings School of Global Health, said the awkwardness surrounding conversations about HIV has to do with people's difficulty talking about sex and sexuality in this country.

“There’s stigma associated with the infection itself, and the other issue is that the lifestyles that we know put people at greater risk are also stigmatized in our society,” he said.

Dr. Victoria Mobley, a medical epidemiologist at the Communicable Disease Branch, said people living in rural areas not only often have limited access to transportation to receive care, but they frequently fear that people in their community will find out about their diagnosis.

“There’s also the underlying and interwoven complexity of how stigma prevents people from accessing the resources that are available because of the discomfort that comes along with the concern that others might find that they have HIV,” she said.

Mobley said the first step of the plan is meeting with community members to hear their viewpoints. After gathering that information, the team will be better prepared to address their short and long term goals, like making improvements to transportation to care centers and combating stigma.

Dr. Myron Cohen, the director of UNC’s Institute for Global Health and Infectious Diseases, praised the state for its progressive work in HIV prevention.

“They’re recognized leaders in this field and, as they work across the state, I don’t think there are barriers. I just think all of this is a question of resources and time, but the state has done a great job in all candor,” he said.

Lee Storrow, the executive director of the N.C. Aids Action Network, said there is still more work to be done in terms of funding.

“We’ve seen some success in North Carolina to secure new funding for HIV and Hepatitis, but I think in many ways we’ve still got a long way to go,” he said.

Leone said he thinks the plan is a noble effort, but that he has questions about the ability to actually carry it out. He mentioned there hasn’t been much success eliminating infectious diseases. He explained that since both HIV prevention and treatment involve taking a daily pill, many demographics do not see the point of taking preventative measures.

He also said racial and socioeconomic inequalities are present.

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“HIV isn’t any different than a lot of the other health disparities that we see that have to do with institutional racism, lack of access to care and, in the case of minority populations, especially African Americans, ruralness in the South, in which case there are issues around transportation or access to care,” he said.

Ending HIV, Leone said, requires addressing these broader issues.

“It has to be sustainable, meaning the funds can’t just come in for 5 years,” he said. “It’s going to have to address the broader needs of health care access in general, so I don’t think you can just treat your way out of the epidemic.”