HIV continues to be a serious global health issue. The HIV epidemic not only affects the health of individuals, it impacts households and communities. In the Virgin Islands, 1,061 HIV and AIDS cases were reported between 1983 and December 2014. There were 172 new diagnoses of HIV infection reported between 2008 and 2014. At the end of 2014, 609 people are living with HIV in the U.S. Virgin Islands. HIV has claimed the lives of 452 Virgin Islands residents since the epidemic began. Because there is no cure for HIV at this time, treatment is a lifelong process. Thirty percent of the HIV positive population in the Virgin Islands received care during this period.
HIV viral suppression occurs when a person’s most recent viral load test result is less than or equal to 200 copies/ml. The CDC reports that of the 1.1 million Americans living with HIV, only 25 percent are virally suppressed. Of the 1,061 cases reported from 1983 through 2014, 19 percent of the Virgin Islands HIV population achieved viral suppression. This is an increase of 2 percent from the previous reporting period. Additionally, in the USVI, 69.57 percent of persons that are currently reported in care has achieved HIV viral suppression. The goal of the national HIV/AIDS strategy is 80 percent viral suppression.
During this reporting period , the Virgin Islands is moving toward the CDC’s standard in linking persons newly diagnosed with HIV to care. The HIV Surveillance data show that 62 percent newly diagnosed were linked to care within three months of diagnosis; and 69 percent newly diagnosed were linked to care within 12 months of diagnosis (National Goal – 85 percent person linked to care within three months).
Status of Antiretroviral Medications
The Ryan White Part B Program/ AIDS Drug Assistance Program (ADAP) has been officially removed from all federal restrictions effective April 2015 and the USVI does not have a waiting list for HIV Medications/ Antiretroviral Medication — ART.
Additional ADAP monies awarded since 2010 through an Emergency Relief Program assisted in the implementation of preventive measures and cost-containment strategies to ensure the availability of HIV medications territory-wide. These measures and strategies included:
– Instituting a Policy on Updating of ADAP Eligibility Criteria every three years based on changes with the Federal Poverty Level Data;
– Implementation of the Insurance Continuation Program for patients that are under-insured;
– Implementation of closer coordination with Medicaid;
– Improvements to Data Collection and Tracking Systems;
– Participation in 340B Discount Program & ADAP Drug Task Force Discount Program;
– Re-establishment of the USVI ADAP Formulary and Taskforce;
– Re-establishment of the HIV Planning Group, which consists of all federally funded programs providing HIV services throughout the territory;
– January 2014, a Pharmacy Benefits Manager was selected, which further strengthened oversight of pharmacies and ADAP eligibility. Services include claims adjudication, coordination of benefits and point-of-sale processing for eligible ADAP clients and realization of rebate dollars from pharmaceutical manufacturing companies.
Continued goals of the Virgin Islands Health Department moving forward are to:
– Increase by 40 percent the number of individuals that remain in care. Similar to the national trend, individuals having been dropping out of care. The department is partnering through the HIV Planning Community to develop effective strategies to educate patients so they can team up with their health care provider to maintain long-term health;
– Increase by 20 percent the number individuals achieving undetectable HIV viral loads or viral load suppression;
– Link 95 percent of newly diagnosed HIV and AIDS cases to a health care provider;
– Standardize HIV testing territory-wide by incorporating a more sensitive Rapid 4th Generation HIV tests at various locations;
– Provide annual clinical updates to health care providers on CDC treatment guidelines; and
Continue with Direct Observation Therapy for patients that are chronically non-compliant with taking their medication.
One of our greatest enemies in Virgin Islands society has been secrecy, which leads to stigma and fear. This has impeded people coming forward to be tested or if positive, seeing a health care provider. The Virgin Islands Health Department in conjunction with CDC treatment guidelines is saying from the mountain tops that HIV viral suppression is achievable. Lowering the amount of HIV virus in the body with medication promotes the life span of a person living with HIV infection and greatly reduces the chance of virus transmission.
If you have ever received a positive HIV test and have never been evaluated by a medical professional, make it a priority to visit either the Virgin Islands Health Department Clinics, a private health care provider, or a health care center. The Ryan White Program will determine your eligibility for financial support, and your health care provider will place you on a treatment plan that can lead to the HIV virus being undetectable in your system.
The health care community remains committed to working together to strengthen the territory’s continuum of care for those infected and affected by HIV. It is important that we strategically harness our respective areas of expertise to realize the ultimate goal of Lifelong HIV Viral Load Suppression, which can lead to “Getting HIV transmission to zero by the year 2030.”
Much thanks and appreciation to the staff of the Communicable Diseases Division, STD/HIV/TB Unit, private and community partner agencies for the provision of data, preventative and care services to the residents of the Virgin Islands.
The time to act is now, World AIDS Day December 1, 2015!
For more information, check out www.getit2zerovi.org or call the Virgin Islands Health Department CDD clinic to schedule an appointment at 340-774-9000 ext 4661 on St. Thomas; and 340-718-1311 ext 3061 on St. Croix.