HIV & AIDS

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New Study Explores Effectiveness of AI Chatbots in HIV Prevention

A new study conducted by the California HIV/AIDS Policy Research Centers (CHPRC) explores the potential of artificial intelligence (AI) chatbots to aid in HIV prevention efforts. The research led by Marisa Fujimoto at UC Berkeley and the Northern California HIV/AIDS Policy Research Center is titled “Evaluating AI Chatbots for HIV Prevention: An Assessment of Response Quality and User Tailoring” and examines the ability of AI-driven chatbots to deliver accurate, engaging, and personalized health information to people from groups affected by HIV and community-based organizations. More information is available at www.chprc.org.

As healthcare increasingly turns to digital solutions, this study provides critical insights into how AI can be leveraged to address HIV prevention in communities that may face barriers to traditional healthcare access. The research assesses not only the technical performance of these chatbots but also how well they cater to individual needs, offering an evaluation of both response quality and user-tailoring in a public health context.

Key Findings Include:

  • High Response Accuracy, but Variable Clarity: AI chatbots can provide HIV prevention information and guidance that is accurate and neutral in tone across a wide range of HIV prevention topics, including pre-exposure prophylaxis (PrEP). However, some responses had a disjointed flow, lacked clear conclusions, and/or did not follow current best practices for use of non-stigmatizing HIV language.
  • Personalized Engagement: Chatbots successfully simplified their responses when asked, but they largely did not tailor their responses to the needs of specific populations, such as transgender users or users in specific locations.
  • Opportunities for Integration with Existing Public Health Services: When responses are reviewed and tailored by health professionals, AI chatbots may be a valuable tool for community-based organizations to enhance the efficiency and quality of service provision and to support the development of educational materials. 

“New and innovative ways to enhance HIV care and prevention efforts are needed, especially to reach younger, tech-savvy groups who may turn to digital solutions for health information,” said Marisa Fujimoto, the study’s lead author. “Based on our results, we are cautiously optimistic about the use of AI chatbots for HIV prevention by individuals from communities affected by HIV, community organizations, and health providers. Chatbots are capable of providing reasonably accurate information with few access barriers and could be used best in conjunction with advice from health professionals to optimize information and provide referrals to services.

Nevertheless, our research also raises important questions about how to ensure that AI chatbots provide inclusive guidance that addresses the needs of communities disproportionately affected by HIV, like those seeking gender-affirming care.”

The research, funded by the California HIV/AIDS Research Program through the University of California Office of the President, was led by Marisa Fujimoto, Lauren Hunter, and Sandra McCoy from the University of California, Berkeley School of Public Health, alongside Simon Outram and Laura Packel from the University of California, San Francisco.

About California HIV Policy Research Centers
Three collaborative California HIV/AIDS Policy Research Centers, funded by the California HIV/AIDS Research Program, support research and policy analysis that addresses critical issues related to HIV/AIDS care and prevention in California. The work of the research centers focuses on a “rapid response,” which involves short-term research projects designed to quickly address questions that emerge in a dynamic health policy environment.

California Center for HIV Syndemic Policy Research
The California Center for HIV Syndemic Policy Research (CalCenSyn) is led by Dr. Laramie Smith (UCSD) and Dr. Orlando Harris (UCSF). CalCenSyn seeks to expose the root causes of HIV and syndemic conditions through community-focused capacity building. such as tobacco, substance use, and socio-structural barriers to treatment through its community-academic collaborative.

Southern California HIV/AIDS Policy Research Center
The Southern California HIV/AIDS Policy Research Center, led by Dr. Ian Holloway (UCLA) and Dr. Jamila Stockman (UCSD), celebrated a successful year of collaboration. Their collective work includes academic manuscripts, policy briefs, infographics, conference presentations, consultations with the California Board of Pharmacy, and has garnered additional state and federal funding.  In 2024, the Center is examining the implementation of the California Healthy Youth Act, California’s comprehensive sex education law; the intersection of HIV and intimate partner violence; and strategies to implement integrated HIV prevention and treatment services, especially for women experiencing violence.

Northern California HIV/AIDS Policy Research Center
The Northern California HIV/AIDS Policy Research Center is led by Dr. Emily Arnold (UCSF), Dr. Sandra McCoy (UCB), and Laura Thomas (San Francisco AIDS Foundation). In 2024, the Northern California HIV/AIDS Policy Research Center is planning to examine the impact of staffing shortages on the HIV healthcare system and is looking forward to working collaboratively with the other PRC on rapid response research addressing syndemic factors that contribute to HIV in California.

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An injectable HIV-prevention drug is highly effective — but wildly expensive

The hotly anticipated results are in from a landmark pair of major clinical trials of a long-acting, injectable HIV-prevention drug that only requires dosing every six months.

They are sensational.

Thrilled over the news Thursday that lenacapavir was 89% more effective at preventing HIV than daily oral preventive medication among gay, bisexual and transgender people, plus previous news that the injectable drug was 100% effective in cisgender women, HIV advocates are looking to the future. They hope that if rolled out broadly and equitably, lenacapavir could be the game changer the nation badly needs.

“These kinds of results are unprecedented,” said Dr. Jared Baeten, senior vice president of virology clinical development at Gilead Sciences, which manufactures lenacapavir. “I have moments like this where I truly am speechless. What this can mean for the trajectory of the HIV epidemic is everything that all the world has imagined for years. We can actually turn off new infections.”

And yet, as battle-worn public health advocates stand on the front lines of an over four-decade effort to finally bring the U.S. HIV epidemic to heel, they find a cold, hard fact staring back at them: Lenacapavir is extraordinarily expensive.

Calling lenacapavir’s clinical trial results “nothing short of amazing,” Jen Kates, director of global health and HIV policy at the nonpartisan health nonprofit KFF, said the news “raises the stakes on the importance of getting this new tool to all those who need it, in the United States and around the world. The track record thus far has unfortunately not been a good one.”

Gilead also manufactures Truvada and Descovy, the two daily oral tablets approved for use as pre-exposure prophylaxis, or PrEP. The pharma giant has already secured approval for the injectable drug in treating highly drug-resistant HIV.

Lenacapavir’s current list price for use as HIV treatment is $3,450 per month. Gilead has not yet indicated whether it will set a different price for the drug’s use as PrEP. A company spokesperson told NBC News on Thursday, however, that the reference point for the price of lenacapavir as PrEP will not be its current use as treatment. It remains unclear whether that statement signals a willingness on the part of the pharmaceutical giant to bring the injectable drug’s price down closer to Earth for its use as HIV prevention.

Given that Truvada has been available as a generic since 2020 and now costs as little as $20 per month (Descovy remains on patent and has a $2,200 sticker price), it remains unclear whether, absent some perhaps novel form of government intervention, insurers will indeed make lenacapavir available widely enough to have what epidemiologists predict could be a sweeping public health impact.

Another injectable drug, ViiV Healthcare’s Apretude, which is dosed every eight weeks, has a $1,965 monthly sticker price and since hitting the market in December 2021 has failed to gain traction in the U.S.

Gilead plans to submit lenacapavir for approval for use as PrEP to the Food and Drug Administration by the end of the year. So this powerful new HIV-prevention tool could hit the U.S. market by mid-to-late 2025.

An HIV-prevention upgrade is badly needed. Since Truvada was approved as the first form of PrEP 12 years ago, the drug has failed to achieve anything in the U.S. approaching its awesome impact on HIV rates among gay and bisexual men in wealthy Western nations such as Australia and the United Kingdom. Those countries boast the type of streamlined sexual-health-care systems that the fragmented U.S. health care system lacks.

“The entire story of PrEP is a missed opportunity,” said Amy Killelea, a health consultant in Arlington, Virginia, and a prominent HIV advocate.

Unprecedented clinical trial results

The advanced clinical trial of lenacapavir in gay men was launched in 2021 at 88 sites across the U.S. and Latin America, and in South Africa and Thailand. It enrolled more than 3,250 cisgender men and transgender and nonbinary people who have sex with male partners.

The participants were randomized to receive either lenacapavir or Truvada on a placebo-controlled, double-blind basis, meaning neither the participants nor the researchers knew who was getting which drug. They were instructed to return every six months for an injection and to take the one dose of the provided pills daily.

A planned interim independent analysis of the trial results indicated that two out of 2,180 participants who received lenacapavir contracted HIV during the trial, as did nine out of 1,087 people who got Truvada. For the lenacapavir group, this represented an 89% lower HIV rate than those in the Truvada group and what Gilead estimated was a 96% lower infection rate than would be expected absent either drug.

Given the clear statistical superiority of lenacapavir over Truvada, the trial’s blinded phase will now be ended several months early. The participants will be informed of which drug they received and provided the option of receiving either going forward.

Lenacapavir proved safe and well-tolerated, with no major safety concerns, according to Gilead. One catch is that the subcutaneous, or under the skin, injection of the drug in the abdominal area leaves a small deposit that can be visible among those with low body fat. It is possible that in real-world use, some will find this off-putting or stigmatizing.

When taken as prescribed, Truvada is over 99% effective at preventing HIV; Descovy is comparably effective. But poor adherence to the daily oral PrEP regimen compromises oral PrEP’s efficacy. And gay and bisexual Black men in particular — the group with the highest HIV rate — have often posted particularly low adherence rates in oral PrEP studies.

The Centers for Disease Control and Prevention estimated in May that between 2018 and 2022, annual U.S. HIV transmissions declined by a modest 12%, from 36,200 to 31,800 cases. Approximately 7 in 10 new HIV cases are in gay and bisexual men, with Black people and Latinos in this group acquiring the virus at much higher rates than their white counterparts. Transgender women, in particular those of color, are also at substantial risk of the virus.

A problem that has bedeviled the CDC and HIV advocates for over a decade is that, in particular given the disproportionately high rates of the virus in their respective demographic groups, Black and Latino gay and bisexual men have never adopted PrEP use at the critical mass needed to truly bring the U.S. epidemic to heel among them. Meanwhile, PrEP has accelerated a long-standing decline in HIV among their white counterparts, exacerbating the gap between the groups.

HIV advocates worry that lenacapavir could only widen such racial disparities further.

“Oral PrEP has been around since 2012. Look at our failure,” said Jirair Ratevosian, an associate research scientist at the Yale School of Nursing. “How do we learn from the past so we don’t squander the opportunity?” 

Excitement about lenacapavir’s potential

Dr. Hansel Tookes, a professor in the infectious diseases division at the University of Miami Miller School of Medicine, was the most bullish HIV expert to speak with NBC News about lenacapavir’s prospects.

“I am borderline delusional,” Tookes said of his excitement about how lenacapavir could benefit, in particular, the Southern gay men of color he’s charged with helping protect from HIV.

The South, where the effort to treat and prevent HIV remains hampered by the refusal by seven of 11 states to expand Medicaid under the Affordable Care Act, accounts for half of all new HIV cases, according to the CDC.

“Right now, the challenge is having people take a pill every day to prevent something that they don’t have,” said Tookes of the difficulty of engaging young people in particular in such a banal, forward-thinking routine. “Having to get an injection twice a year is an easier sell.”

Dr. Boghuma Titanji, an infectious disease specialist at Emory University, said she frequently sees new HIV diagnoses in Atlanta, where her university is based, especially among young Black and Latino men who have sex with men.

“These groups often lack access to and information about existing PrEP options,” she said. “While lenacapavir is a valuable addition to our toolkit, for it to reach its full potential, it must be made accessible to those who stand to benefit the most from its effectiveness.”

After Gilead released its initial findings in June from an advanced clinical trial of lenacapavir in cisgender women and adolescent girls in sub-Saharan Africa, HIV advocates immediately put pressure on Gilead to provide the drug at a scalable cost to lower-income nations. This chorus is sure to get louder now that lenacapavir is officially highly effective at protecting gay and bisexual men and trans people as well. Still to come are results from ongoing clinical trials of the drug in people who inject drugs and cisgender women in the U.S.

On Thursday, Gilead stated in a release that the company is committed to delivering “lenacapavir swiftly, sustainably and in sufficient volumes, if approved, to high-incidence, resource-limited countries, which are primarily low- and lower-middle-income countries.” The company is in “active discussions with the HIV community” about these plans.

“It’s not progress if lenacapavir’s cost and other structural challenges impede access, domestically or globally,” said Tim Horn, director of medication access at the public health nonprofit NASTAD. “The results of the drug’s clinical trials, he said, “must be to the benefit of all people at risk for HIV, including those with cost-related hurdles to state-of-the-art prevention and care.”

CORRECTION (Sept. 12, 2024, 3:15 p.m. ET): A previous version of this article misstated the monthly sticker price of ViiV Healthcare’s injectable drug Apretude. It’s $1,965 monthly, not $3,930. The price per injection, which is administered every two months, is $3,930.

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 AIDS United welcomes Dr. Jirair Ratevosian to the board of trustees

The AIDS United board of trustees is proud to announce the appointment of Dr. Jirair Ratevosian to the Board, effective August 21, 2024. Dr. Ratevosian will serve on the Fundraising Committee and chair the upcoming fall fundraiser with Emmy-nominated actor and Advisory Council member John Roberts.

“I am deeply honored to join the AIDS United board of trustees at such a critical time in our fight to end the HIV epidemic, Dr. Jirair Ratevosian stated. AIDS United has been a beacon of hope and action, advocating tirelessly for those most impacted by HIV. I look forward to working alongside this dedicated team to drive forward our shared mission of equity, justice, and impact for all communities.”

“We are thrilled to welcome Dr. Jirair Ratevosian to the AIDS United board of trustees,” said Dr. Eugene McCray, Chair of the board of trustees. “His professional expertise and personal integrity strengthen our commitment to ending the HIV epidemic in the United States.”

Dr. Ratevosian (he/him) is an Associate Research Scientist at Yale University and holds appointments at the Duke Global Health Institute and the Center for Strategic and International Studies. With over two decades of experience spanning public service, nonprofit work, the private sector, and diplomacy, Dr. Ratevosian has an exemplary record of advancing global health and human rights initiatives. He has built partnerships with governments and international organizations, developed bipartisan political coalitions, and spearheaded advocacy efforts that have raised billions of dollars for the global HIV/AIDS response.

His efforts have also modernized laws and policies to align with public health evidence and promoted global peace and justice for genocide survivors. From 2021 to 2023, he served as Acting Chief of Staff and Health Equity Advisor to Ambassador John Nkengasong at the U.S. State Department. Previously, Dr. Ratevosian was the Corporate Social Responsibility Director for Gilead Sciences, Legislative Director to U.S. Congresswoman Barbara Lee (2010-2014), and Deputy Director at amfAR.

In 2023, Dr. Ratevosian launched a historic bid for Congress, driven by his vision of a more equitable, inclusive, and healthy society. He holds a doctoral degree from the Johns Hopkins Bloomberg School of Public Health, an M.P.H. from Boston University, and a B.S. from UCLA. His contributions have been featured in publications such as the Bulletin of the World Health Organization, The Lancet, The New York Times, The Body, and The Washington Post.

Following Dr. Ratevosian’s appointment, the board of trustees will comprise twelve trustees. “Jirair is an exceptional leader in the HIV/AIDS movement, and we’re proud and excited to welcome him to the AIDS United family,” added Jesse Milan Jr., President and CEO of AIDS United. 

To learn more about the AIDS United board of trustees, please visit the AIDS United website at aidsunited.org/team

For interview requests with spokespersons from the AIDS United board of trustees or Executive Team, please contact Senior Communications Manager D. D’Ontace Keyes at communications@aidsunited.org.

About AIDS United: AIDS United’s mission is to end the HIV epidemic in the U.S. through strategic grant-making, capacity building, technical assistance, and policy and advocacy. AIDS United works to ensure access to life-saving HIV care and prevention services and to advance sound HIV-related policy for the populations and communities most impacted by the U.S. epidemic.

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Tennessee put sex workers on sex offender registry for having HIV. They will be removed.

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The Tennessee government has agreed to scrub sex workers who were unjustly convicted of being sex offenders due to an HIV diagnosis from the sex offender registry following a settlement this past Monday.

The lawsuit, OUTMemphis vs. Lee, concerns a Tennessee criminal statute regarding Aggravated Prostitution, which says that if any sex worker knows they are HIV-positive and has sex, they can be put on the state’s sex offender registry, regardless of whether the other party knew or if there’s proof of intent to transmit the infection. An additional lawsuit was filed by the U.S. Department of Justice earlier this year on the same issue.

“The Aggravated Prostitution statute does not provide for any inquiry into the underlying facts and circumstances in an individual case,” says the ACLU in their initial complaint in the OUTMemphis case. “For instance, the statute does not allow for consideration of the alleged sexual activity at issue; the degree of the risk of HIV transmission involved (if any); whether preventative measures such as a condom, PrEP, or PEP were used; the client’s HIV status; whether the accused individual has a suppressed viral load; nor whether their HIV status has been disclosed.”

The complaint continues, “A person with HIV can be convicted of Aggravated Prostitution for offering or agreeing to engage in sexual activity in exchange for compensation without actually engaging in that activity, or for engaging in, offering, or agreeing to sexual activity that carries no risk of HIV transmission”

At least 83 people are believed to have been affected by this, and most of them are Black and/or transgender women in the Memphis area, where police enforced this statute more and targeted marginalized individuals.

The settlement details how aggravated prostitution has been removed from the list of offenses that can put a person on the sex offender registry, and that notice of this must be given on the Tennessee sex offender website alongside letters sent to those affected by this law. The specific claims made by the plaintiffs regarding the illegality of the law are not going to be debated. Instead, the law will be overturned with the state paying legal fees for the plaintiffs.

“The General Assembly has also permitted anyone who is registered solely because of a conviction for one of these offenses to request termination of registration requirements with the Tennessee Bureau of Investigation,” says the letter.

“Each of us, regardless of our race, our genders, or our HIV status, deserves to be treated with dignity and respect and welcomed as full members of our communities,” said Milo Inglehart, staff attorney at Transgender Law Center, in a press release for the initial lawsuit. “With today’s filing, we join the ACLU, ACLU-TN, OUTMemphis, and our individual plaintiffs to challenge the counterproductive and discriminatory Aggravated Prostitution statute that unlawfully singles out people living with HIV, disproportionately impacts Black transgender and cisgender women, and places lifelong, punitive restrictions on those who are criminalized for trying to survive.”

The ACLU of Tennessee said in a statement, “We are pleased to share that today we entered into a partial settlement with the state of Tennessee on behalf of OUTMemphis and our individual plaintiffs. Through this settlement, the Tennessee Bureau of Investigations has agreed to promptly, fairly, and efficiently facilitate the process of removing people from the sex offender registry who were on it due to convictions for aggravated prostitution.”

“Tennessee’s discriminatory aggravated prostitution statute irrationally targets people living with HIV who engage in sex work, regardless of whether they take steps to ensure against HIV transmission. This settlement is one step towards remedying those harms by addressing the sex offender registration. However, as aggravated prostitution remains a felony, our legal team will continue to fight to overturn this statute and ensure that no one in Tennessee is criminalized based on their health status.”

LGBTQ Nation reached out to OUTMemphis and the Tennessee attorney general’s office for comment. Neither responded before this article was published. This article will be updated if they respond.

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Life-saving HIV clinic unexpectedly closes its doors with little explanation

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Last Thursday, a long-running HIV clinic, Rainbow Health in the Minneapolis-Saint Paul Twin Cities area of Minnesota, abruptly closed its doors, laying off 85 employees and ending thousands of people’s access to LGBTQ+ focused HIV care.

The union representing the employees, Service Employees International Union, said in a statement, “We are shocked, saddened and angered by this news, both as staff dedicated to Rainbow Health’s mission and even more so for our clients and community. We are left with many huge questions: How could this massive decision come with no warning? What happened to the funding that the organization has been receiving? What was happening with leadership and the Board that got us to this point?” 

The closure was announced suddenly, with employees being given only four hours’ notice before their jobs ended and the clinic shut its doors for good.

“I have clients, former clients, that are still calling on the official from which I’m bound to return anytime this week. I don’t have answers,” Uzoamaka McLaughlin, a former medical case manager with Rainbow Health, said in a press conference. “I can’t send them anywhere because I don’t know where to send them. We are here demanding that they pay us because the union is [fighting] on our behalf. We are here demanding that they do justice…. It’s unacceptable. We have not done anything wrong. We were just doing our job.”

In an announcement on Facebook, Rainbow Health said, “With a heavy heart, we announce the closure of Rainbow Health. Due to insurmountable financial challenges, we can no longer sustain our operations. We deeply regret any inconvenience this may cause and thank you for understanding during this challenging time. Your health and well-being remain our top priority.”

Staff was reportedly given no notice of this closure beforehand, being told in a last-minute meeting. This came just a few days after after the clinic’s Chief Financial Officer quit and the union voted to remove the CEO of the company, who had been receiving a rate of pay in the millions along with multiple bonuses.

“I learned a few minutes before one o’clock that I had until 5 p.m. to terminate services with my almost 40 clients, cancel all my sessions for the rest of the day. I was booked until 7 o’clock. I had a client in the waiting room while staff was just in the hallway sobbing,” said Lee Start, a psychotherapist formerly with Rainbow Health, in a press conference.

“We had a new therapist that was supposed to start today,” Start continued. “We have new staff from two weeks ago, from three months ago. This was all very, very sudden and shocking. As of a week ago, two weeks ago, there was a huge push for us to start to see more clients. I know there were a lot of new clients on the books. I know a new client started on Thursday. There were new clients scheduled for this week, for both the clinic and our PrEP pharmacy.”

McLaughlin also alleged that there was a culture of racist abuse at the company, with the union being created in 2022 following concerns about racial discrimination against Black and Indigenous employees. Cited in support of this was an open letter by employees from that time period.

“We’ve had issues of multiple lawsuits concerning the agency from individuals,” McLaughlin said. “So the truth is, there have been different levels of abuse. And the Board was not stepping up to address that because the Board equally was seeing the level of lawsuits against the agency. And yet, and yet they did not do anything…. They did not do anything to support or help Rainbow Health or even the staff come to terms with [the decision].”

The union also reports that the Board of Directors didn’t answer questions from staff regarding the decision to close the clinic during this meeting. A complete lack of money is the closest thing to an explanation that employees were able to come up with.

One employee, Rik Kutcher, described in a press conference how Rainbow Health had helped him move to Minnesota and get treatment for HIV and addiction. 

“I was connected to a transitional housing program for two years that helped me get to a place in my life where I could elevate my life,” Kutcher said. “All of these services, I got food assistance, all of these services came from Rainbow Health. And had I not had those services, I don’t know if I would have gotten to a place in my life to elevate to where I am today.”

“And I’m proud to say that I have been seven years into a recovery and came to this agency four years ago being able to give back to the community with what I’ve received beyond the services, the support, the understanding of what it is to live with HIV. And I know firsthand how important these services are to our community,” Kutcher added.

One employee hosted a name change clinic pro bono after the layoffs, which featured over 50 people attending. Others were working to contact clients who were on food and rent assistance.

According to the union, these mass layoffs violate their contract with Rainbow Health, which specified the need for at least 30 days notice before any layoffs occurred. A separate layoff of three to four people occurred in April, when financial concerns were initially discussed. These employees were also given same-day notice, but they had their paid-time-off paid out, unlike the currently laid-off employees.

Staff were only vaguely made aware of financial issues in the nonprofit. Discussions were had as far back as April during previous layoffs, but the Board and other executives did not respond to questions about the future of the company and what the financial findings were.

“We saw a pattern emerge that executive leadership at Rainbow Health were unwilling to actually answer questions directly relating to our finances. As the picture grew more clear over the months we kept demanding answers,” said former employee Ash Tifa. “There it was clear that we weren’t being given the full story. We knew that when we opened, staff were aware there was serious financial turmoil. If you look at the fundraising numbers, we were not pulling in what we were expecting.”

“We were not communicated with any of their findings until Thursday last week. We had corridor conversations about our financials, but nobody had actually come out to tell us this was their findings. And this was the reason that they shut us down. No, we don’t know anything about why or the reason they took their decision,” said McLaughlin.

The union still plans to support both former employees and clients, regardless of how the Board continues to act.

“The union approach is twofold. We are going to continue demanding that we are paid out our paid time off and also paid for the 30-day notice that we were never given. And then we [demand they have] a meeting with the union, which our contract stipulates,” said Tifa.

“The second thing we’re doing for union staff is being a place together,” Tifa continued. “We are still standing in solidarity and support for each other. And we are going to continue to have these conversations about how we show up for one another as former staff, not just the former unionized staff, but managers, non-union staff, former employees. Rainbow Health is an organization that had a really large impact on a lot of people. And we are going to continue to work with the queer and HIV-centered nonprofits that continue to do this work.” 

“There are union staff and managers who are working pro bono to ensure a continuity of care for clients and patients. Individual members are going really, really far to ensure that clients are as taking care of as they can be. And as a union we stand with them and are here to support them in any ways we can,” Tifa said.

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HIV cases are increasing among younger queer Latinos

Although HIV transmission rates have declined from 201 to 2022, one demographic is seeing a rising share in new HIV infections: young Latino men, the Associated Press reported.

Young Latino men are the most at risk for HIV infection, according to the Centers for Disease Control and Prevention (CDC). This demographic recently accounted for nearly 33% of new HIV infections even though they only make up 19% of the United States population.

African-American men still have the highest rate of new infections from HIV. However, Latino gay and bisexual men accounted for the largest amount of new HIV cases in 2022. Kentucky, Louisiana, Georgia, and South Carolina have the highest rates of these new diagnoses.

The finding comes at a time when the U.S. Department of Health and Human Services (HHS) is three years into a federal initiative to end the U.S. HIV epidemic.

HHS seeks to increase access to HIV treatment and information by allocating funding into areas that have the highest infection rates. HIV rates declined 23% from 2012 to 2022, but there are still currently 1.2 million people living with HIV in the U.S., including those who don’t know they’re infected.

In 2022, Kentucky, Louisiana, Georgia, and South Carolina saw the highest rates of new diagnoses among Latinos. But in South Carolina, there is enough funding for only four community health workers focused on HIV outreach, some of whom are not bilingual; leaving Latinos who only speak Spanish cut off from healthcare resources. 

Public health advocates say that the federal government should redistribute funding to focus on HIV prevention, including access to testing and pre-exposure prophylactics (PrEP), a medication that greatly reduces the likelihood of HIV transmission. Only 4% of the almost $30 billion dollars in federal funding for HIV healthcare has gone to prevention.

Advocates say that outreach efforts at churches, training bilingual HIV testers, and testing at clubs on Latin nights could all help decrease new HIV infections in Latino communities.

“HIV disparities are not inevitable,” Dr. Robyn Neblett Fanfair, director of the CDC’s Division of HIV Prevention, in their call for additional funding and awareness around this disparity.

The aforementioned study also noted that although South Carolina saw HIV infection rates double among Latinos from 2012-2022, the state has not yet expanded HIV mobile testing in rural areas, where the need is greatest. 

Likewise, in Shelby County, Tennessee the Latino HIV diagnosis rate rose 86% from 2012 to 2022, yet health department director Dr. Michelle Taylor said, “There are no specific campaigns just among Latino people.” 

Shelby County received $2 million in initiative funding in 2023, setting forth a response plan that acknowledges Latinos as a target group for HIV treatment and outreach.

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Human Rights Campaign initiative strives to overcome HIV stigma

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TheHuman Rights Campaign is pioneering a new frontier in the fight againstHIVstigma and health disparities. The organization’s GENERATE initiative, part of HRC’s celebrated “My Body, My Health” campaign, is a beacon of hope and empowerment for Black and LatineLGBTQ+ young men living with HIV. 

Launched in 2023 with a blend of advocacy, storytelling, and education, GENERATE is more than a program—it’s a lifeline. “This initiative is about transforming lives,” says Torrian Baskerville, the dynamic director of HRC’s HIV and Health Equity program. “We are equipping these young men with the tools to not only survive but thrive.”

The program promises a transformative six-month journey for its eight lucky participants. The most recent application period closed at the end of May. The trans and cisgender men selected will be flown toWashington, D.C., for an immersive weekend of workshops and networking events. Participants will delve into the complexities of mental health, especially as it intersects with HIV, under the guidance of a licensed mental health therapist who shares their lived experiences.

“Access to mental health services has always been a significant barrier,” Baskerville notes. “We’re tackling this head-on by embedding mental health support into every facet of the program.”

After their initial training, participants return to their communities armed with knowledge and a renewed sense of purpose and community. Regular check-ins and ongoing support are in place to ensure they stay on track with their personal goals, whether it’s achieving viral suppression or excelling in their careers. The significance of this continuous support cannot be overstated, as these young men often face isolation and stigma that can hinder their progress. Baskerville says that the GENERATE initiative is committed to their success every step of the way.

The initiative also responds to the pressing need for tailored support within marginalized communities. Baskerville, himself a Black man living with HIV, emphasizes the importance of representation and relatability in this work. “When participants see themselves reflected in their mentors and peers, it creates a powerful sense of belonging and motivation,” he explains. The program provides critical resources and fosters an environment where participants can share their experiences and learn from one another.

The cohort members will be announced later this month, and the program will officially begin in July. The stakes are high, but so is the potential for impact. Baskerville says, “If even one participant walks away with a clearer path to a healthier, more empowered life, we’ve succeeded.”

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Appeals court maintains PrEP coverage under Obamacare in win for HIV prevention

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PrEP access has been maintained for most Americans after an appeals court ruling ended a lawsuit that challenged the medication’s coverage. 

In a ruling that upholds crucial components of the Affordable Care Act, the Fifth Circuit Court of Appeals ruled on Friday in Braidwood Management, Inc. v. Becerra, mandating that most insurance providers continue to cover preventive services, including PrEP medication, while deeming parts of the law unconstitutional.

The Advocatewas first to report in 2022 that the plaintiffs, led by Jonathan Mitchell, an ultraconservativeTexas lawyer with a history of challengingLGBTQ+ rights, argued that the ACA’s requirement for insurance plans to cover preventive services violated their religious freedom. They specifically objected to covering PrEP, pre-exposure prophylaxis, a medication that prevents HIV transmission, citing their Christian beliefs against homosexuality.

Judge Reed O’Connor of the U.S. District Court for the Northern District of Texas, who has also been allergic to LGBTQ+ causes, initially sided with the plaintiffs, ruling that the ACA mandate infringed on their religious freedom. The Department of Justicequickly appealed to the Fifth Circuit Court of Appeals, which has jurisdiction over Texas,Louisiana, andMississippi.

In itsruling, the Fifth Circuit upheld the lower court’s decision but limited the scope of the exemption to the plaintiffs in the case. This means that the broader mandate requiring most insurance providers to cover preventive services, including PrEP, remains in effect for the rest of the nation. 

The court also addressed constitutional issues regarding the appointments of the United States Preventive Services Task Force members. It determined that these members are principal officers under Article II of the Constitution and must be appointed by the president and confirmed by the Senate. While this raised constitutional concerns, the court reversed the district court’s decision to vacate all agency actions enforcing the preventive care mandates, deeming the remedy overly broad.

Lambda Legal, an advocacy group for LGBTQ+ rights, responded to the decision with cautious relief. “Lambda Legal is relieved after the recent narrow decision by the U.S. Court of Appeals for the Fifth Circuit in the case of Braidwood v. Becerra that ruled most of the nation’s insurance providers must continue to cover PrEP medication and other preventative services,” said Jose Abrigo, Lambda Legal’s HIV project director.

Abrigo pointed out that the ruling’s limitation to the plaintiffs ensures broader protections and national healthcare policies remain intact. However, he expressed concerns about the potential for future legal challenges that could threaten healthcare rights and protections for millions of Americans.

He emphasized the importance of preventative care, noting that PrEP plays a critical role in the fight against HIV and AIDS. Access to such preventive measures is crucial for reducing preventable diseases and promoting public health. “Lambda Legal will closely monitor any further developments related to this case and similar legal challenges,” Abrigo said.

The case will likely go to the Supreme Court when either side appeals the ruling.

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We have made unthinkable progress in the fight against HIV/AIDS. Where do we go from here?

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Since HIV was first discovered in 1983, medical experts and scientists have grappled with how to best treat the condition. In the 40 years since, there have been significant advancements in treatment that have lengthened lifespans, made identification of the virus easier, and improved the quality of life for those living with HIV and subsequent AIDS diagnoses if patients do not remain in care. 

Over the past four decades, a diagnosis of HIV has evolved from essentially a death sentence to what is considered a manageable chronic condition. From the first identification of the virus that causes AIDS, it would take four years to develop and gain FDA approval for the first medication treatment, called AZT. 

AZT had been originally developed to treat cancer but was found to be effective in interrupting the HIV-infected cells’ ability to make new viruses and was hailed as a game changer, proving that HIV was treatable. However, it would take many more advancements to loosen the death grip that HIV/AIDS had on the world in the 1980s and through the 1990s.

Challenges and limitations 

While initial HIV treatments brought about hope for those who acquired the virus, they also presented a host of challenges and certain limitations. Traditional antiretroviral regimens were complex, necessitating a cocktail of drugs taken simultaneously, and each drug within the cocktail had its own dosing schedule and side effects, ranging from vomiting and diarrhea to insomnia and bone marrow suppression. 

The complex nature of early treatments lent itself to human error in dosing and non-adherence to the regimen. Those who were living with HIV and in areas with limited resources, such as rural areas or those facing homelessness, were more likely to lack adherence to the regimen and suffer the consequences of dosing errors — if they were able to access antiretroviral medications at all.

The side effects of early HIV/AIDS treatments significantly diminished the quality of life for patients. Although AZT was hailed as the “light at the end of the tunnel” by the company responsible for its production, it was also fast-tracked through the approval system. Additionally, AZT was still costly and out of reach for many. 

Over time, HIV mutated and began to resist AZT. By 1992, AIDS had become the number one cause of death for men ages 25 to 44. It became evident that scientists and experts had to go back to the drawing board to find out how to better combat this stronger strain of the virus.

Advancements in HIV treatment and prevention

As the Centers for Disease Control (CDC) and other experts on HIV and AIDS learned more about how the virus was contracted, spread, and progressed once someone acquired the virus, they began to develop stronger, more effective treatments and prevention methods. 

In 1990, the CDC developed a patient-centered counseling model for the prevention of HIV. This model focused on the important aspects of consent, confidentiality, counseling, correct test results, and a connection to prevention, treatment, and care. This approach wildly changed how the medical community faced the virus and those who carried it, focusing on the human aspect of care instead of a virus-centered model. 

Clinical trials for HIV treatments continued through the 1990s, with different antiretroviral approaches established to see which were most effective in making the virus undetectable. Meanwhile, methods of preventing HIV and other sexually transmitted diseases, such as condoms, became a hot topic of conversation. Everywhere one looked in the early 1990s, people were talking about safe sex. Tests for HIV improved as well, with the first oral HIV test introduced in 1994. By 1995, the first protease inhibitor was approved by the FDA, opening the door for “highly active antiretroviral therapy” (HAART) and ushering in renewed optimism. 

By the end of the 1990s, medical experts were advocating for a “hit early, hit hard” approach to HIV infections, coined by HIV/AIDS researcher Dr. David Ho. This approach advocated for an earlier introduction of highly effective antiretroviral treatment to keep people healthier for longer and is still widely used today to keep HIV undetectable in people for years through early, aggressive intervention. 

What advancements mean for those living with HIV

In the past 20 years, there have been other major strides in HIV and AIDS treatment, including the development of pre-exposure prophylaxis (PrEP medication), highly effective antiretroviral therapy (ART), and even the beginning of clinical trials for a possible HIV vaccine. While it may still be too early to tell if we can eliminate HIV for good, these significant steps forward have brought a measure of hope to communities more commonly affected by the spread and stigma of HIV and AIDS. 

Clinics such as ours, Hope & Help in Winter Park, Florida, continue to offer free HIV testing, primary care availability for those with HIV, and prevention education. Our efforts harken back to the early days of the AIDS epidemic when groups such as the storied Friends in Deed created support for a population who felt as if they had been abandoned. These community efforts go a long way in supporting those who are living with HIV and AIDS, offering not only medical care but also necessary emotional assistance. 

While statistics show that the number of new HIV infections has diminished, the problem has not disappeared. Real change will come with continued scientific study, support, fundraising, and education. As we continue to harness the power of collaboration and technology, bold solutions in HIV treatment will pave the way for a future where HIV/AIDS is not only significantly managed but eventually eradicated.

Lisa Barr is the Executive Director at Hope and Help Center of Central Florida, Inc. d/b/a Hope & Help. She has the privilege of leading an incredible team of talented, compassionate, and dedicated nonprofit healthcare professionals who make a difference every day. For over nine years, she has been overseeing the strategic planning, implementation, risk management, and organizational development of this vital community resource that provides HIV/STD prevention, education, testing, and treatment services. With an MBA from Johns Hopkins University and a background in business development, marketing, and grant writing, Barr brings a combination of analytical skills, strategic thinking, and creative problem-solving to her role. She is passionate about enhancing the quality of life and health outcomes of Hope & Help’s clients, partners, and staff, as well as expanding the organization’s reach and impact in the region. Her mission is to foster a culture of excellence, innovation, and collaboration that enables Hope & Help to fulfill its vision of a world without HIV/AIDS.

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Victory! Lambda Legal Announces Settlement of Case on Behalf of Former Military Cadet and Midshipman Living with HIV

Lambda Legal and co-counsel Winston & Strawn LLP, Perkowski Legal, PC, and Scott Schoettes today announced they have reached a settlement with the Department of Defense (DoD) in a lawsuit filed in 2018 on behalf of a former Navy midshipman, Kevin Deese, and a former Air Force cadet, John Doe (a pseudonym), who were denied commissions after graduating from their respective service academies because they are living with HIV. The settlement provides for Deese and Doe to be commissioned as officers in recognition of the status and military careers they qualified for and earned years ago. 

“We are gratified that our clients, who were denied officer commissions they had earned because of the U.S. military’s discriminatory policy of withholding career advancement opportunities from HIV-positive service members, will now be able to achieve their goals,” said Kara Ingelhart, Senior Attorney at Lambda Legal. “Service members living with HIV, once affected by an outdated, discriminatory policy, no longer face discharge, bans on commissioning, or bans on deployment simply because they are living with HIV.”

“Joining my brave co-plaintiff in this case was, for me, about demonstrating the very leadership that inspired me to a military career. I follow the mantra of 2004 Naval Academy graduate Travis Manion—“If not me, then who?” said plaintiff Kevin Deese. “Now, ten years after my Naval Academy graduation, future midshipmen and cadets living with HIV will be able to commission with their classmates upon graduation. And I could not be more proud to finally be commissioning.”

“We are grateful for the opportunity to work with Lambda Legal and others to overturn the military’s outdated and unconstitutional policies concerning people living with HIV,” said Bryce Cooper at Winston & Strawn. “Our pro bono efforts, in both the district court and the Fourth Circuit, have brought about a meaningful, and long overdue, change for service members living with HIV.”

This settlement also follows the June 2022 DoD policy changes to some of the military’s former policies that discriminated against service members living with HIV that confirmed service members living with HIV who are asymptomatic with undetectable viral load “will have no restrictions applied to their deployment or to their ability to commission . . . solely on the basis of their HIV-positive status.” That 2022 policy change had the effect of preventing what happened to Deese and Doe from impacting future military academy cadets who seroconvert while in their course of their college education. And those changes followed a groundbreaking federal court ruling in April 2022 that ordered the DoD to stop enforcing those discriminatory policies. The ruling came in two cases—Harrison v. Austin and Roe v. Austin, combined for purposes of discovery and summary judgment—for which Lambda Legal served as co-counsel with Winston & Strawn LLP, Greenberg Traurig LLP, Scott Schoettes, and Peter Perkowski.

As of this release, counsel and clients are currently waiting for a U.S. District Court to rule on the military’s last remaining bar preventing people living with HIV from joining any branch of the U.S. Armed Services in the lawsuit, Wilkins v. Austin.

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