Mike walked hesitantly into the Baltimore City Health Department (BCHD) sexual health clinic. When he asked for Earl, a peer navigator he was scheduled to meet, he avoided eye contact. Even though Earl had promised the clinic was a safe space, Mike was anxious about being judged for his sexual behaviors. Earl put him at ease right away. No one, Earl said, was judging him for having multiple sexual partners or how he met them.
Sitting across from him, Mike felt himself relax. As Earl walked him through the pros and cons of taking PrEP, a daily pill that protects against HIV, Mike decided that, at this time in his life, being on PrEP was the right decision for him.
HIV is a virus that attacks the body’s immune system. With treatment, the virus is kept at bay and those living with HIV can enjoy a full life span. Without treatment, almost all develop AIDS. HIV lives in blood, semen, rectal and vaginal fluids, and breast milk. It is primarily spread by unprotected vaginal and anal sex and by sharing needles.
HIV can be prevented. Condoms remain a mainstay of HIV prevention campaigns. PrEP, which stands for pre-exposure prophylaxis, provides a new option. Taken daily, PrEP prevents HIV from taking hold in the body, protecting the person from infection. Backed by years of study, PrEP is one of the most powerful tools we have to stop the spread of HIV.
With advances in HIV medications, people living with HIV can maintain a high quality of life for a longer period of time than ever before. Although a cure for HIV is yet to be found, people living with HIV who are on medication can reduce the virus to very low levels in their blood—so low that it is undetectable by current testing methods. When this happens, they can have sex with effectively no risk of passing the virus on to others. This is the message of the campaign U=U: “Undetectable=Untransmittable.” The key is people must be aware of their HIV status, in medical care, and adherent to medication.
HIV remains a public health priority in Baltimore, where an estimated 12,600 are living with HIV. Around 80 percent of those with HIV in Baltimore are African-American. Six out of 10 people newly diagnosed with HIV identify as gay, bisexual, or same-gender-loving men. Compared to people who inject drugs or engage in heterosexual sex, men who have sex with men, regardless of how they identify, are the most vulnerable to HIV in Baltimore. In addition, the brunt of the HIV epidemic is felt by young people. Forty percent of new HIV infections in Baltimore occur among people in their 20s. Our youth are getting infected with a lifelong condition they will need to manage the rest of their lives.
HIV is not limited to those who are black, young, or men who have sex with men. Women make up one third of the epidemic. The risk for HIV among transgender people is three times the national average. The risk for Hispanic people is three to four times higher than for white people. Despite years of success in reducing HIV among people who inject drugs, thanks largely to BCHD’s syringe exchange programs, health officials fear the worsening opioid epidemic may reverse these gains.
For all these reasons, sexual health and HIV prevention are social justice issues. Even with advances like PrEP and U=U, we will not fully address the HIV epidemic until we eradicate HIV stigma.
BCHD is addressing the complex social challenges of HIV. For example, BCHD hosts Baltimore in Conversation, a social engagement initiative that fosters dialogue among the LGBTQA community, health care providers, and allies through storytelling and shared conversations that build empathy and inspire action. BCHD provides HIV testing throughout the city, ensures those who are newly diagnosed with HIV are linked to care, provides peer navigators, and offers HIV testing and PrEP at BCHD sexual health clinics.
One in six people in Baltimore with HIV do not know they are infected. As we fight to roll back new HIV infections, we call on everyone to get tested for HIV. Learn if PrEP is right for you. Check out prepmaryland.org for PrEP resources and HIV testing sites. And join us! Check out our Baltimore in Conversation Facebook page, facebook.com/BaltimoreInConversation. Attend our next storytelling event coming up in May. Partner with us to build a healthier and stigma-free Baltimore.
Dr. Adena Greenbaum is assistant commissioner for clinical services for the Baltimore City Health Department. Dr. Leana Wen is the health commissioner of Baltimore.
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