"A Social and Political Pandemic”: HIV Disparities in LGBTQ+ People

Welcome back to Contagion’s new podcast, Contagion Community, where we delve into some of the social factors that create and widen healthcare disparities.

This Pride month, Contagion Community is highlighting the healthcare needs and disparities unique to the LQBTQ+ community. Joining us for June’s podcast are Steven Wolfe, DO, MPH, and Stuart A Fisk, CRNP, of the Allegheny Health Network (AHN).

Fisk and Wolfe work with LGBTQ people who are living with HIV. In this episode, they delve into the intersectionality of the disease, emphasizing that HIV prevention and treatment is especially needed for transgender people of color.

Wolfe and Fisk both identify as gay men, and thus have a personal as well as professional stake in ensuring LGBTQ+ people have access to comprehensive healthcare.

“We need more physicians, like myself, out there who really understand what the community’s needs are,” Wolfe said.

Asked about the current state of the HIV epidemic, Wolfe said, “62% of people who are trans and Black have HIV…I think we’re going in the right direction, but I think that we need a lot more work when we’re thinking about the minority populations.”

Fisk added that 25-30% of people newly diagnosed with HIV are being diagnosed at the end stages of the disease. “We do not test people routinely for HIV,” he said. “To have the biomedical ability to end a pandemic as tragic as this one, and not do it because we’re failing to give people a $2 test, is really a bad thing.”

Besides testing, Wolfe said pre-exposure prophylaxis (PrEP) is another HIV preventative measure that is vastly underutilized. Wolfe cited study data suggesting 96% of transgender women were aware of PrEP, “but the reality of it is only 32% of transgender women were actually using PrEP to prevent HIV. That’s a huge gap.”

Fisk pointed out that similar disparities exist for injection drug users, who are at high risk of getting HIV but are “rarely if ever” offered PrEP. “People of color in general who have risk of HIV acquisition are typically not being offered PrEP or do not take PrEP.”

“The problem is that HIV carries the stigma of the populations that it most impacts,” Fisk said, noting that our society’s criminalization of queerness, homelessness, and injection drug usage exacerbates HIV disease disparities. “The HIV pandemic has always been as much a social and political pandemic as it’s been a medical pandemic. Until we deal with those political and social issues that create risk, we will not see the end to this pandemic.”

Fisk has been working with marginalized people since the beginning of his nursing career, which he says has helped him become a better healthcare provider and a better human.

Wolfe noted that caring for people living with HIV is often not only about providing healthcare, but also mitigating the stigma these patients may have experienced throughout their lives. “The HIV pandemic has always been as much a social and political pandemic as it’s been a medical pandemic. Until we deal with those political and social issues that create risk, we will not see the end to this pandemic.”

The experts emphasized that HIV and LGBTQ+ healthcare should not be seen as specialized care. “This is care that should be integrated with regular primary care,” Fisk said, with Wolfe adding, “A transgender person should not have to go to an endocrinologist to get their hormones.”

Allegheny Health Network’s Positive Health Clinic has 3 different locations in the Pittsburgh area of western Pennsylvania. You can find out more by calling (412) 359-3360 or emailing PHC@ahn.org.

Missed Episode 4 of Contagion Community? Listen here.

Listen in on the conversation and feel free to offer your feedback on this episode, interest in participating in the podcast, or suggest ideas for future episodes. Please email your correspondence to Nina Cosdon: ncosdon@mjhlifesciences.com.