By Januari Leo
Houston has the highest number of new HIV/AIDS cases in the state of Texas, yet there is no collective sense of urgency to combat the disease. One out of every 200 Houston residents, according to the Houston Health Department, reports living with HIV—a reality with incalculable social, financial, and public-health consequences. Although we have the medical and scientific knowledge to end the epidemic, political and healthcare leaders aren’t paying attention to social factors that perpetuate the disease in the Houston area.
Thanks to a generous grant from the Ford Foundation and AIDS United, Houston’s HIV leaders have developed a citywide roadmap—the first in Texas—that offers more than 30 recommendations to end the epidemic. The ambitious goal is to decrease new HIV cases by half—from roughly 1,200 per year to 600—over five years.
“Roadmap for Ending the HIV Epidemic in Houston” outlines five core areas that need to be addressed in order to achieve this goal. Those include (1) prevention of HIV in the first place, (2) access to care for those living with it, (3) addressing social factors that exacerbate it, (4) enacting criminal-justice reforms to slow it, and (5) rethinking public policies and funding to manage it. The approach is intersectional and multidisciplinary. “We must draw on solutions and engagement from the medical, policy, faith-based, criminal justice, and education communities. Relegating responsibility to just healthcare providers has never and will never be effective,” says Venita Ray, Legacy Community Health’s public affairs specialist who led the creation of the plan.
Similar to other citywide plans in the U.S. aimed at combating HIV/AIDS, the plan focuses heavily on prevention and treatment while emphasizing key populations: men who have sex with men (MSM, all ethnicities and ages), heterosexual African Americans, and transgender individuals. Recommendations include expanding routine HIV testing and expanding the market for Pre-Exposure Prophylaxis (PrEP), the daily pill that has over a 90-percent chance of protecting people from the virus. In addition, because Houston is incredibly diverse and home to large African-American, Latino, and LGBTQ populations, healthcare providers must emphasize cultural sensitivity. “People will not walk through the door to access care if they do not feel welcome,” says Ray.
Keeping people living with HIV/AIDS in care and virally suppressed is key. Holistic management can stop it from spreading. For this reason, it is important to expand access to care for those with HIV/AIDS by utilizing women-centered care models, streamlining protocols, training more healthcare workers on the Ryan White HIV/AIDS Program, and offering mental-health and substance-abuse treatment. The federal Ryan White program provides a comprehensive system of care that includes primary medical care and essential support services for the uninsured or underinsured living with HIV, and the Houston Ryan White Planning Council has officially endorsed the plan. “The work we do together with the END HIV Houston Campaign is meant to break down the barriers preventing many people from receiving the benefits of these advances, in an effort to stop needless deaths and halt the progression [and transmission] of HIV/AIDS,” says Steven Vargas, chairperson of Houston’s planning council.
Along with prevention and treatment, interested parties must focus on the social determinants of health that prevent people from seeking treatment and acquiring an adequate level of health literacy. Particularly pronounced in Houston are the issues of poverty, racism, violence, stigma, homophobia, and transphobia. A “health is wealth” initiative, anti-stigma campaigns, and increased faith-based involvement would aid in combating the HIV/AIDS epidemic.
Due to high rates of HIV among incarcerated individuals, there is a need for programs targeting this population before and after they transition back into society. Community organizations should partner with the correctional system to create drop-in centers that would provide HIV care, primary care, and mental-health services for those just released. “We as a community must make it [easier for incarcerated individuals] to obtain identification cards, temporary housing, and a 30-day supply of HIV medication as they transition back into society” says Ray.
Finally, public policy at the local and state levels appears indifferent to eradicating HIV. “The City of Houston and Harris County should emulate other major cities, including San Francisco and Atlanta, in allocating funds for programs aimed at prevention. Private entities should also contribute toward these programs,” says Ray. At the statewide level, strengthening Medicaid would reduce the cost of care—a well-documented problem in a state with the highest rate of uninsured in the nation.
This report provides solutions—most of them practical, and a few aspirational. It is the job of Houston’s stakeholders to decide which solutions are feasible to implement, and to then take action. This is the beginning of the end of HIV in Houston.
Januari Leo is the director of public affairs for Legacy Community Health.