Despite decades of advances in the testing and treatment of human immunodeficiency virus (HIV), nearly 40,000 Americans are diagnosed with the virus every year. HIV can affect anyone of any sexual orientation, race, ethnicity, gender, or age, but disparities exist. Stigma and social determinants of health such as income, education, and access to health care contribute to higher rates of new HIV infection for people of color. Black people account for 14% of the U.S. population but make up 42% of the country’s new HIV cases, while Latinos, who account for 18.5% of the total population represent 25% of people with HIV.
Launched in 2019, Ending the HIV Epidemic in the U.S. (EHE) is a federally-funded initiative with the goal of reducing the number of new HIV infections by at least 90 percent by 2030. Boston Medical Center (BMC) is one of the organizations on the front lines of this effort. Funded by the Massachusetts Department of Public Health, the HIV prevention and screening clinic at BMC is a safe space for community members to receive HIV testing, education, and referrals to substance abuse programs and behavioral and primary health care. It’s also one of the largest clinics in Boston to offer pre-exposure prophylaxis (PrEP), the highly effective HIV prevention medication.
HIV prevention strategies
Patients typically find out about the clinic by searching online, through local community organizations, or referrals from other health centers. “Many primary care and family medicine providers are not comfortable talking about sex, so they engage us to have those conversations,” says program manager Marquis Jamison-Harris. BMC also provides the clinic with a daily report of patients who have tested positive for any sexually transmitted infection (STI), which the clinic team uses to follow-up with patients and suggest HIV testing. The majority of patients agree to come in and do testing.
Jamison-Harris and his team do the screening and testing, and if someone tests positive for HIV, they do a warm handoff to the intake team, who then sets them up with a physician for medical care. “It’s a very comprehensive model and we’re all based within Infectious Diseases so a patient doesn’t have to change hands too often,” he explains. If a patient doesn’t present for follow-up care, a DPH outreach team works to bring them back into care.
Common barriers to HIV screening
Though the clinic runs smoothly they contend with both historic and new barriers to testing and care. “We’re always trying to keep on top of what policies have changed and what else might be causing someone to not be able to access care,” says Jamison-Harris. For other programs looking to enhance their HIV screening process, Jamison-Harris notes the importance of addressing three common barriers patients face:
- Stigma. “Sex is not talked about in a lot of cultures, which leaves room for disinformation and negative thoughts,” says Jamison-Harris. “De-stigmatization is really important when it comes to HIV.” BMC’s clinic uses motivational interviewing, which has been shown to outperform traditional advice given in the treatment of a broad range of behavioral problems and disease. “It’s a very private conversation where we allow the patient to take charge,” assures Jamison-Harris, “Our goal is to educate and use the information they share with us to help them make the best choices for themselves.”
- Access to testing and preventive treatment. Patients aren’t required to have a referral or insurance coverage to visit BMC’s clinic, and appointments are readily available. Not only is testing free, but high-risk patients can also get a prescription for PrEP, which is often hard to come by for many patients, but can lower their risk of contracting HIV by over 92%.
- Adherence to medication. For patients on PrEP, Jamison-Harris says adherence is a big challenge. “We're constantly trying to improve our workflow to increase adherence,” he says. “A lot of our PrEP patients are young and don’t have any chronic diseases, so they have a harder time remembering to take their pills.” The PrEP health navigators at BMC advocate for high acuity patients throughout their PrEP journey by answering questions, deciphering insurance coverage and costs, finding resources, and scheduling appointments. “We understand that barriers are disheartening and cause non-compliance,” says Jamison-Harris. “We are here to help.”
After six years at BMC, Jamison-Harris continues to stay engaged and connected to the hospital’s mission of providing exceptional care, without exception. “I like advocating for folks who feel like they have no agency and helping them feel empowered about their health, he says. “We have a committed, supportive team, and I can see that what we do makes a difference in the community by decreasing new HIV infections.”