Justin Winston’s world shattered when he tested positive for HIV.
“‘How do you feel? Is it attacking you?’” he recalled his case manager ― who evaluates the needs of HIV-positive patients and helps them navigate the complexities of their care ― asking during his first appointment. Winston found the questions comforting because he realized he didn’t have any symptoms.
Winston, 34, is one of the more than 10,000 people living with HIV in Baltimore, according to the Baltimore City Health Department. The number of HIV cases in Baltimore has dropped incrementally over the past five years, but the rate at which Black people are diagnosed is substantially higher than their percentage of the population.
For example, there were 236 new diagnoses each in 2017 and 2018, 199 in 2019, 178 in 2020 and 161 in 2021 — a steady decline per year, said Adena Greenbaum, assistant commissioner for clinical services and HIV/sexually transmitted infections prevention for the health department.
“Thirty years ago, Baltimore would have 1,000 cases of new HIV diagnoses each year,” Greenbaum said. “We’ve gone from 1,000 cases each year to under 200 cases for the past three years.”
But Baltimore’s HIV population is high compared with a similar-sized city with similar demographics. In Newark, New Jersey, there were 5,381 people living with HIV in 2020, according to online resource AIDSVu, which compiles data about HIV. That year, there were 138 new diagnoses, according to the site.
In Baltimore, the majority of HIV infections are among Black men who have sex with men.
There are 6,989 men and boys 13 or older living with HIV in Baltimore; 5,643 of them are Black, 616 are white, 335 are Hispanic and 395 are other races, Greenbaum said. There are 3,490 women and girls 13 or older living with HIV; 3,052 are Black, 155 are white, 100 are Hispanic and 183 are other races.
Mary Anderson, a spokesperson for the Montgomery County Health and Human Services, said in an email that racial disparities in HIV risk are part of a complex dynamic of structural inequity.
“Studies show that [racial] disparities are often linked to disparities in health care and housing access, as opposed to rates of condom use or number of sexual partners, for example,” Anderson said.
In Montgomery County, HIV diagnoses have fluctuated. For instance, there were 168 cases in 2017, 130 in 2018, 138 in 2019, 77 in 2020 and 102 in 2021, according to Anderson.
The 2022 HIV rates will be available in June, she said.
Two years ago, national health leaders met in Baltimore to explore ways of combating HIV rates after the city, Montgomery and Prince George’s counties were chosen for a program aimed at ending HIV in the U.S., The Baltimore Sun reported.
“Over the next several years, we will be able to measure the impact of ‘Ending the HIV Epidemic’ efforts to increase HIV testing, linking newly HIV positive residents to care immediately, assisting those who have fallen out of care with reconnecting to care, and increasing numbers of PrEP referrals for eligible residents who have tested negative for HIV,” Anderson said. PrEP stands for preexposure prophylaxis, drugs that people can take to prevent HIV infection.
Preventive outreach efforts, including expanded testing and needle exchange programs, have contributed to the decline in the number of new diagnoses, Greenbaum said.
PrEP and post-exposure prophylaxis (PEP), a drug used after HIV exposure, also contributed to the decline. Greenbaum said the city provides both medications at no cost. PrEP without insurance ranges from $2,000 to $4,000 per month, according to Minneapolis-Minnesota Aliveness Project, a HIV support group.
A crucial component of HIV prevention is treating the infection to reduce a patient’s viral load, or the quantity of the virus, to an undetectable level, she said.
Of the 161 new cases in 2021 in Baltimore, 84% were among the Black population, 6.2% were Hispanic, 5.6% were white and 4.3% were among other races, Greenbaum said. The most recent census shows that 62.4% of Baltimore’s population is Black, 31.9% white and 6% Hispanic.
Numerous factors contribute to the disease’s disproportionate impact.
Lack of transportation, inability to take time off work for doctors’ appointments and a relatively low number of Black people who use PrEP are contributing issues, Greenbaum said.
“There’s probably a combination of reasons — I think one of the reasons why these disparities still exist is that these are complex issues without a single answer,” she said. “What we try to do is to address as many of them as much as we can.”
Eric Anderson, who is HIV positive, works as a funding specialist for the Ryan White HIV/AIDS Program. The program, named for a 13-year-old boy who contracted AIDS from a blood transfusion in 1984, is one of the funders of the University of Maryland Center for Infectious Diseases.
Anderson said socioeconomic issues, such as prostitution, and a lack of faith in the health care system contribute to the disparity. He noted that fear of being used in an experiment may be to blame for the low uptake of PrEP among Black people. Those fears are rooted in infamous instances such as the Tuskegee syphilis study, in which Black men in Alabama were used as test subjects, and the late Baltimore County resident Henrietta Lacks, a Black woman whose cells were taken without her consent for decades of worldwide research.
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He advises health care professionals to change the way they raise awareness about HIV, for instance, by making messages in advertisements more relatable to everyday people, as opposed to “beautiful” individuals.
Meanwhile, Winston continues to make strides.
He is an HIV counselor and outreach ambassador for the Pride Center of Maryland. He recently got engaged. He receives treatment at Chase Brexton Health Services in Mount Vernon and takes his HIV medication once a day.
Winston said he used to experience side effects from his medicine, like dizziness and headaches, but that’s stopped.
“The only time I remember my status is when I take my pill [or] go to an appointment,” he said.
On Dec. 14, he launched a nonprofit support group called My Mile My Shoes at the AmASSI Center For Black Wellness & Culture, a nonprofit in Charles North that offers HIV/AIDS prevention services, among others. The group is for people who either have HIV or are close to someone who does.
“I turned something negative into positive,” he said.