The progress in the United States' fight against HIV/AIDS has yielded incredibly promising results so far. However, regardless of all the federal and state governments' efforts, the number of HIV diagnoses continues to incline year after year. Since the reporting of the first HIV-positive diagnosis in the US in 1981, approx. 700,000 people have died due to HIV.
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Within the past ten years, the HIV epidemic's epicenter shifted to the Southern states from the country's coastal urban areas. Texas is a southern state, which houses around 50% of the country's HIV infected population, including those living with HIV, have been newly diagnosed or have died of HIV. Texas boasts of the highest rate of new HIV diagnoses while HIV disproportionately impacts Texan minorities.
Although there has been considerable advancement in testing and treatment services across Texas, the rate of HIV transmission and new cases is increasing every year. To reduce new HIV transmissions and improve the quality of life for people living with HIV, regular testing, viral suppression, and retention in HIV care is imperative.
Reportedly, 16% of Texans live with the disease but haven't been diagnosed as yet, which is a concerning issue. CDC reports that around one in seven people infected with HIV in the US is unaware of their condition. Furthermore, not all Texans benefit equally from the advancements made to HIV prevention and medical care.
It is a fact that the Texas populace is impacted disproportionately by HIV primarily due to its extreme diversity. Hence, the only way out is early diagnosis, which is possible through testing and screening. Testing is important to identify those living with HIV at the right stage. If diagnosed early, HIV can be treated with Pre-exposure prophylaxis (PrEP) and non-occupational post-exposure prophylaxis (nPEP). These medicines can effectively prevent HIV transmission among people at increased risk.
Research suggests that those living with HIV are least likely to transmit HIV if they receive effective and timely treatment. It happens because the amount of virus reduces in the body after treatment.
In Texas, low-cost HIV testing and medical care facilities are widely available. The Texas HIV Medication Program has collaborated with the Ryan White Program to increase the accessibility of people living with HIV to proper medical care and treatment.
Texas lags in HIV control measures compared to other Southern states. The state has launched several initiatives and the federal government to reduce the number of cases across Texas. One such initiative is Ending the HIV Epidemic: A Plan for America (EHE). The US Department of Health and Human Services launched EHE to eliminate HIV via action-oriented approaches. It comprises several strategies to follow, the most important of which is routine testing and early diagnosis. Immediate linkage to care is another integral part of this program.
It is a fact that HIV testing is the only gateway for prevention as well as treatment of the disease. However, in Texas, the rate of undiagnosed individuals is relatively higher (18.9%) compared to the national average (14.2%), and so is the rate of new diagnoses (15.7 for Texas and 11.4 nationwide per 100,000 people). The Ryan White Program offers federal funding to facilitate early testing among low-income people with HIV to address this issue.
Under this program, support is provided to over half of the HIV-positive individuals in the US. Around 63% of people that the Ryan White program supports have income below the poverty line. The EHE's success relies on the Ryan White program and demands sustained funding from the federal government.
CDC is funding the Texas State Health Department and local health department to implement scalable and cost-effective HIV prevention programs and policies. The funding is geared towards increasing access to care within Texas's most severely affected regions and communities. Through CDC's funding, evidence-based disease monitoring, staff development, routine program evaluation, and staff development are supported.
Moreover, the CDC offers support to 15 community-based organizations, two local education agencies, and one capacity-building assistance provider in the state. CDC aims to initiate HIV prevention strategies and activities, developed educational programs to encourage delayed sexual initiation, and devise youth-friendly health services.
According to CDC, Texas is among those states that have been severely impacted by HIV. In 2018, the state recorded the second-highest number of new HIV diagnoses with 4520 cases/100,000. Texas also has the fourth-largest number of people living with HIV (around 327.9 per 100,000 persons). The overall number of HIV-positive individuals in Texas steadily increased to over 94,000 in 2018 from 68,000 in 2010.
An analysis of the recent statistics shared by CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention reveals that African-American females comprised almost 51% of Texas's newly reported diagnoses.
Around 37% of African-Americans, 34% of Latinx or Hispanic, and 53% of above 45-years-old adults living with HIV in Texas resided in urban localities, and over 61% acquired HIV via male-male sexual contact. Harris, Dallas, Tarrant, Bexar, and Travis counties had the highest HIV burden.
Texas is listed among the states where the rate of people without health insurance (17.7%) is relatively higher because it hasn't yet expanded Medicaid. Lack of expansion to the state-federal healthcare program for low-income individuals is a significant barrier for HIV prevention and care services and a major driver of prevailing health disparities among people with HIV.
As per the Texas HIV Surveillance Report 2018, in 2015, about 4,476 adolescents were diagnosed with HIV, and most of the new cases were reported among men who have sex with men (MSM). By 2018, the rate of new diagnoses among MSM in Texas reached 70%, which was 62% in 2010. In 2018, 4 out of 5 people with new HIV diagnoses were males. 3 out of 4 cases were either African-Americans or Hispanics, and 3 out of 5 were reported among people below 35-years.
Around half of the newly reported diagnoses were among African-American MSM and Hispanics. In fact, MSM and Black Texans recorded most disproportionately high diagnosis rates. Almost 1 out of 12 MSM in Texas had HIV in 2018.
In the last ten years, the cause of death in 62% of the deceased in Texas' transgender community living with HIV was HIV/AIDS. In 2018, over half of the total HIV diagnoses were among people below 30 years of age. The number of new diagnoses among African-American Texans fell by 6% between 2009 and 2018, and the number for Hispanics increased by 19%.
This increment among Hispanics can be attributed to an increase in Hispanic MSM. However, regardless of the reduction among the Black community, the diagnosis rate was still 2.8 times higher in this group, followed by Hispanics.
The rate of diagnosis for Black females was reportedly five times higher than Hispanic females. It is worth noting that Texans' age profile diagnosed with HIV in 2018 varies considerably by gender. Males lean more towards younger ages, and most new diagnoses were reported among young MSM of color. On the other hand, female diagnoses were more tilted towards the older age.
About 1 in 3 infected females in 2018 were 45 or older. In 2018, 28% of all new diagnoses in Texas were 24 or younger, out of which 24% were males and 16% females. 37% of diagnoses were reported between 25-to-34-year-olds, with 39% males and 27% females. Approx. 19% of the total cases were among people aged 35-44, where 18% were males and 24% females. 21% of the new diagnoses were 45 or older, where 19% were males and 33% females.
Texas lags behind other states regarding offering effective sexual education to adolescents and teenagers. Learning about birth control methods beyond abstinence is required in high school, but health education becomes optional at this stage of academia. Furthermore, Texas doesn't require public schools to address LGBTQ issues while providing sex education. This approach frustrates the transgender people and bisexual community, which make up about 2% of the state's population.
Texas's elementary and middle schools are currently required to offer health education to students from Kindergarten to Eighth Grade. However, when in high school, students don't need to take these classes to meet the state's graduation requirements. Also, Texas hasn't mandated that schools teach sex education, and those that do must promote abstinence as the ideal means of birth control among unmarried young adults. Also, parents have the right to opt their kids out of any lesson of their choice.
To eliminate the prevailing loopholes in the health and sex education curriculum taught at schools in Texas, the Texas State Board of Education is in the process of developing new and more inclusive standards for sex education. If approved, it will become the first-ever revision to the statewide sex and health education policy since 1997. Reportedly, from 2022 onwards, seventh and eighth-grade students across Texas will be offered education about different forms of birth control beyond abstinence.