Neighborhood Family Practice (NFP), a Cleveland-based health center, in June launched an initiative to provide pop-up testing locations for rapid HIV tests. Primarily on the west and near-west side of Cleveland, the initiative focuses on areas with higher HIV transmission rates.
This rollout is the latest grant-funded HIV prevention program to come from NFP, on the heels of their HIV awareness campaign that the Buckeye Flame covered last month.
NFP is also working to reduce the stigma of HIV testing and status in these communities.
According to the CDC:
- One in 8 people with HIV in the United States do not know that they are HIV-positive.
- Roughly two-thirds of new HIV infections are among the MSM community (men who have sex with men).
- Black and Latinx populations are prescribed the HIV-prevention drug PrEP significantly less frequently than white populations.
Intersectional marginalizations (such as gender identity, housing and poverty) create additional challenges when it comes to preventing and treating HIV. A recent CDC survey of more than 1,600 trans women in seven major U.S. cities reported that 62% of Black trans women and 35% of Latina trans women had HIV, compared to 17% of white trans women. Forty-two percent of respondents also reported that they had been homeless in the last 12 months, and roughly two-thirds lived at or below the poverty level.
“It’s important to respect people’s lived experiences,” says Brittani Flory, NPF’s HIV prevention nurse. “We meet everyone where they’re at, people of all socioeconomic backgrounds, races and genders.”
“Every number is a person. Every diagnosis is someone’s life.”
– Brittani Flory, RN
Stigma, Fear and Systemic Barriers to Care
HIV, like all sexually transmitted diseases, is underreported due to people not knowing they have contracted the virus. But it’s more than simple ignorance that keeps people from getting tested.
“There’s a lot of stigma associated with it, a lot of denial,” says Dr. Prakash Ganesh, medical director for the Cuyahoga County Health Department and a staff physician with NFP who sees HIV patients.
It’s also difficult for many people to access healthcare because they lack insurance, income and/or transportation. Neighborhood Family Practice offers support with a sliding-fee scale for all patients based on income level, in hopes of reducing these barriers to ongoing care. Patients on PrEP must have regular check-ups and bloodwork – something that isn’t possible if they can’t make it to the doctor.
“All of these compounding factors are adding more barriers,” says Flory. “And also, fear. People still think HIV is a death sentence.”
Mistrust of the Medical Community
Flory adds, “It’s important to also acknowledge the medical mistrust within these communities that our history has set up.”
Communities of color have a long history of being targeted by medical experimentation and lack of informed consent from doctors, so community mistrust is an understandable barrier to this testing initiative.
“This is about getting trust back into the communities.”
– Brittani Flory, RN
One key way to rebuild trust is to partner with respected community leaders to bridge the gap between individuals and the healthcare industry—an approach NPF is using with its HIV outreach. Ganesh says, “Using community health workers and public opinion leaders that the LGBT Center has been using, those are great modes of advocating and educating people about HIV and other STIs.”
In addition to systemic medical mistrust, there’s also a lack of education among providers who aren’t up to date on the latest information about HIV, its treatment and its prevention.
“I don’t think medical providers know enough about PrEP,” says Ganesh. “There’s so much medical information coming out all the time, and it’s hard to keep up. But I think to keep practicing, that’s your job – you need to be up to date on things.”
NFP’s seven health centers put a high priority on HIV education and keeping all providers up to date with the latest data and literature on prevention and care. “We’re committed to making sure our providers and nurses are supported in having the conversation, even in primary care. Your sexual health is part of your overall health,” says Flory.
PrEP is for Everyone
For HIV prevention, Ganesh recommends two levels of protection: PrEP and barrier methods like condoms and oral dams. “PrEP doesn’t protect against other STIs like chlamydia, gonorrhea, or trichomoniasis,” he adds, so getting a full panel of STI testing is an important part of patients’ ongoing sexual healthcare.
“PrEP is for everybody,” says Flory. “It’s been heavily marketed to the MSM community, but pretty much everybody can be on PrEP.”
The rapid testing sites are being scheduled with the support of local partners, including churches and nonprofits. One upcoming location to pencil in: NFP will be offering rapid tests at the Renee Jones Empowerment Center’s upcoming Health Fair on July 29 from noon to 2:00pm.
Anyone can schedule an HIV test and other STI screenings at their local NFP health center. 🔥
Ignite Action
- Get tested and know your status!
- Always protect yourself. PrEP is one of the key ways to address the HIV epidemic, and barrier methods also help avoid viral transmission.
- Medical providers: Learn more about PrEP and HIV to provide better quality care to your patients.
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