They Are Still There. Barriers to HIV Testing and Care.

In a conversation with Managed Healthcare Executive®, Genoa Healthcare Sales Director Jennifer Finocchiaro discusses social determinants of health, the LGBTQ+ community and the demographic contours of the HIV/AIDS epidemic.

Jennifer Finocchiaro, Pharm.D., AAHIVP, is sales director for Genoa Healthcare, a behavioral healthcare pharmacy in Renton, Washington.

Finocchiaro focuses on bringing specialized, stigma-free HIV pharmacy services to communities in Arizona, California and Nevada.

Nearly 1.5 million Americans are HIV positive, yet 13% don’t know it. Why is this and what can be done to get more people tested and educated about HIV?

There are several factors at play, including long-standing stigma and discrimination around HIV that has created social and structural barriers. This stigma results in people not seeking necessary testing or preventative care services.

Being underinsured or lacking insurance is another barrier resulting in people not being able to seek the care or therapies they need. Similarly, there may be a lack of structural resources available for people, such as transportation, education on the disease and access to affordable convenient care or social services.

Studies also cite that 32% of patients with HIV are not adherent to their medication treatment? What can be done to address this issue?

Patients are less adherent to HIV treatment for many of the same reasons that may keep them distanced from providers. Social determinants of health, not accepting diagnosis, limited access to preventative options and behavioral health issues are just some of the barriers that lead to a lack of adherence to medications. Pharmacy services that specialize in HIV treatment can give patients a consistent, convenient, and more personal treatment experience, which may help address some of the barriers to receiving and staying engaged in care.

What are the main challenges patients face in accessing treatment today and why?

For this patient population, there are multiple barriers between those with HIV and the treatment that they need. HIV is a serious disease and a diagnosis can impact patients differently. But this disease also disproportionately impacts certain demographics, such as communities of color and LGBTQ+. These patients may feel stigmatized and can experience any number of roadblocks to treatment, including social determinants of health such as lack of transportation or socioeconomic conditions. Because HIV is such a life-changing disease, many patients may also experience dissonance about accepting a diagnosis, or even depression and a lack of motivation to address their health needs.

How do social determinants of health play a role in HIV patient outcomes? What do the numbers show?

HIV disproportionately affects marginalized communities, including members of the LGBTQ+ community and communities of color, particularly cisgender Black and Latinx individuals, gay and bisexual individuals, and transgender women.

For example, in 2019, Black individuals made up 13% of the population of the United States but accounted for 40% of people with HIV.

Similarly, Latino individuals made up almost 19% of the population but accounted for 25 percent of people with HIV.

These numbers indicate that social determinants of health are playing a significant role in HIV patient outcomes, and that education, prevention and treatment are not reaching those that need it most.

Some of these patients are sometimes unable to receive HIV treatment due to lack of stable housing, transportation, health insurance and other barriers. Attending doctor appointments, receiving treatment and remaining adherent to therapy is critical for HIV-positive individuals and for improving health outcomes, lowering rates of transmission and lowering total cost of care in this space.

In addition, these barriers and a lack of support often leads to behavioral health-related issues and mental illness, adding complexities to patient care and increasing costs.

What resources exist for this difficult-to-treat patient population?

The barriers for the HIV patient population often leads to behavioral-health related issues and mental illness, adding complexities to patient care. What has worked remarkably well in helping both HIV and behavioral health patients manage and treat their condition is utilizing integrated solutions that combine clinical and pharmacy to simplify care for patients.

This type of unique high touch model has proven to help patients stay on their medications at a rate of more than 90%, compared to an average rate of about 50% with a traditional approach. It also reduces emergency room visits by 18%, hospitalizations by 40% and significantly reduces total cost of care.