By Emily Woodruff
Fewer than 1,000 people were diagnosed with HIV in 2018 in Louisiana – the lowest number of HIV cases in a decade for a state that ranked among the top 10 states for new diagnoses in 2017.
The 989 cases diagnosed in Louisiana in 2018 reflect a new trend. New transmissions have dropped by 12 percent over the past three years, according to the Louisiana Department of Health. State officials chalk up the decrease in new cases to the state’s Medicaid expansion, which gave people more access to HIV medication that makes the virus undetectable and PrEP, a once-daily pill that prevents HIV, as well as increases in screening.
“This provides even more support for the importance of knowing your status and taking control of your infection to suppress the virus in the body,” said Dr. Alexander Billioux, assistant secretary for the state’s Office of Public Health. “As we have said before, undetectable equals untransmittable.”
The number of new cases in 2018 is quite possibly the lowest since 1988, said Billioux, because the low reported numbers from 2005 and 2006 may have been due to issues with data collection around Hurricanes Katrina and Rita.
“We know these storms had a big impact on the state’s health services at that time,” Billioux said. “Since there had not been fewer than 1,000 people with HIV diagnosed each year since 1988, it is quite possible that today’s number is the lowest in a generation.”
Of the 989 new transmissions, about three-quarters were male. African-Americans carried the most severe burden of new diagnoses at 70%. White people made of 23% of the data, with Hispanics making up 6%, Asians making up 1% and another 1% that was multi-race or not specified.
For health professionals who have worked in the HIV/AIDS landscape for decades, the news that Louisiana—often at or near the bottom of U.S. rankings when it comes to health statistics—could be turning the corner on HIV offers hope that the end of the epidemic might be in sight.
“I feel as though we will actually see the end of HIV in our lifetime,” said Fran Lawless, director of the Office of Health Policy & AIDS Funding, a division of the New Orleans Health Department. “I think that’s just on the horizon. This year is the first that I felt that might actually come to fruition. Things were pretty bleak when I first entered this area.”
Billioux said there was a time when HIV felt “insurmountable.” But with the expansion of Medicaid, getting vulnerable people access to treatment means that Louisiana has seen lower HIV diagnoses even as fellow southern states like Georgia, which did not expand Medicaid, see some of the highest rates in the nation. Georgia had 2,698 new diagnoses in 2017, the most recent year data was available, which translates to a rate of 30 people per 100,000. Louisiana’s rate dropped from 28.9 in 2016 to 26.6 in 2017.
The biggest obstacle in continuing to lower the rate of new HIV diagnoses, said Billioux, is getting people tested—which boils down in large part to overcoming the stigma surrounding the virus.
In Louisiana, exposing another person to HIV without their consent, whether it was intentional or transmitted, is a felony punishable by up to 10 years in prison. The law “hurts more than helps,” said Billioux, creating another barrier that discourages testing.
Continuing to reduce HIV transmission sounds easy enough in theory, said Dr. Jason Halperin, an infectious disease specialist at CrescentCare, a New Orleans health center that offers services regardless of health, economic or insurance status. But the testing process can be the biggest of many hurdles.
“There’s complexity,” said Halperin. “We have to be way more proactive and creative in how we test. It should be as easy as going to an ATM.”
Health officials recommend that everyone in the state of Louisiana get tested at least once for HIV—more if a person meets certain criteria that increases their risk. But according to a new report from the Centers for Disease Control and Prevention, less than 40% of Americans have ever been tested for HIV. In Baton Rouge and Louisiana, listed among 50 places in the U.S. that account for the majority of new HIV diagnoses, 17% and 24% had been tested in the last year, respectively.
That stigma remains for people living with HIV, said Dorian-Gray Alexander, an advocate who was diagnosed with HIV in 2005.
“Because of the effective treatment, people are living with HIV,” said Alexander. A decrease in new infections is great, he said. “But there are 22,000 people living with HIV in our state. We need to think about them.”
Removing stigma can start with how people talk about HIV, said Brandi Bowen, director of the New Orleans Regional Aids Planning Council.
“We don’t say the word infected,” said Bowen. “We simply refer to them as a person living with HIV.”
In order to keep rates down, service providers need to not only connect people living with HIV to treatment, they also need to link them to services that increase their chances of continuing to take their medicine and get health care, said Lawless.
“Someone could lose housing if they lost their job because they had to take off work because they were ill,” said Lawless. “If you have nowhere to live, you may not be able to store medication or get transportation to the doctor. Sometimes it’s the little things that begin a downward spiral. There are a whole lot of services we provide to support that individual so they can be whole.”