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Op-ed

To overcome inequities in Baltimore’s HIV care, we must overcome inequities in the community | GUEST COMMENTARY

A mobile HIV testing truck stops on Monument Street in Baltimore near Old Town Mall in 2015.

A recent article in this newspaper (“As new HIV diagnoses continue to fall in Baltimore City, disparities remain in the Black community,” Jan. 9) correctly points out the lingering inequities that cause HIV diagnoses among Black residents to remain higher than in other communities. This trend has long been understood — and battled against — by the city’s HIV care providers, case managers and community health advocates.

Chase Brexton Health Care was founded more than 40 years ago to serve Baltimore’s LGBT community. During the height of the AIDS epidemic in the late 1980s and early 1990s, our staff members and volunteers were first responders within their community. Along with a handful of other organizations across Baltimore, we offered the compassion and care that many suffering from HIV and AIDS could not find elsewhere. The heroism of those individuals continues to inform and inspire the HIV care we deliver.

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Today, we see more than 2,500 patients living with HIV. In an effort to effectively combat HIV disparities that affect the Black community, our Infectious Disease Committee actively monitors viral load suppression for our African American patient population. Under our care, 90% of our HIV patients are virally suppressed, meaning their viral load is so low that it does not appear on lab tests. With the new scientific consensus that Undetectable = Untransmittable, this also means that they cannot spread the virus — one of the keys to ending the HIV epidemic. We also provide pre-exposure prophylaxis, or PrEP, to 149 patients at risk of contracting HIV; PrEP has been proven to reduce the risk of contracting HIV by 99 percent when taken daily.

But we are also well aware of the cultural stigma that living with HIV can have in marginalized communities, where the risk of being identified as positive can threaten a person’s safety and access to resources. Fears of discrimination and threats of violence can lead many to hide their HIV status and attempt to manage the disease privately — and, potentially, risk spreading it to others.

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To counter this, our outreach workers and peer navigators focus on empowerment within communities, helping those at risk of contracting HIV access our preventive services, and removing obstacles to care such as fear for their safety. Our outreach efforts foster trust within these communities, decrease stigma, and create a sustainable avenue for prospective patients to seek help and increase their health literacy.

At the heart of this effort is our POWER Project (Protecting Ourselves With Every Resource), established several years ago within our Social Work and Outreach Department. Last year, the POWER Project team was on hand for more than 40 events around the greater Baltimore area, offering health information, testing, and PrEP consultations.

Their efforts are supported by a mobile testing and information van, a visible presence at these events and around the community. A new food pantry at our Mt. Vernon Center and coming soon to our other centers, aimed at removing food insecurity as a barrier to good health. To combat transportation issues, ensure continuity of care, and maintain patient medication adherence, our pharmacy now provides free, discreet medication delivery to all our patients living with HIV. Additionally, we provide ongoing check-ins via secure telehealth, phone or computer, with a service that is available on even the most reduced internet or mobile connections, to ensure access to consistent care exists for all of our patients.

Finally, we have come full circle and engaged long-term HIV survivors to help inform our outreach and HIV prevention efforts. No one knows the struggle against HIV better than they do. Our ElderPride council is composed of LGBTQ Elders age 50 and older, many of whom have been passionate community advocates for decades. Thanks to advances in HIV medications, they remain a vital link to our past and voice guiding our future.

Overcoming historical, entrenched inequities which lead to higher HIV rates among certain populations is no easy task. But those of us who provide HIV outreach and care know we cannot end the epidemic until we succeed in overcoming the disparities that plague our community.

Sebastian Ruhs (sruhs@chasebrexton.org) is the chief medical officer of Chase Brexton Health Care, a Federally Qualified Health Center headquartered in Baltimore.


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