In Puerto Rico, U.S. Conference on HIV/AIDS highlights hurricane impacts and challenges facing territories

Nearly 3,000 advocates and community-based HIV organizations from all segments of the HIV epidemic gathered in San Juan, Puerto Rico, Oct. 7-11, for the 26th U.S. Conference on HIV/AIDS, the largest conference focused on the epidemic in the U.S. Plenary sessions detailed the recovery efforts following Hurricane Maria in 2017 and Hurricane Fiona’s devastating impact just last month on Puerto Rico and highlighted HIV in Latinx communities. Noted during the talks were the challenges the U.S. territory and others face in maintaining a strong health care safety net, including a cap on federal Medicaid funding and a fixed Medicaid matching rate that is not adjusted based on relative per capita income as is it for U.S. states.  

The effects of hurricanes on people with or at risk of HIV can be particularly severe due to disruption in care and treatment access. Local researchers will be working to assess the impact of Hurricane Fiona on people with HIV, but studies following Hurricane Maria found a drop in viral suppression from 71% to 65% and a more than 20% decrease in access to health care. Natural disasters like those affecting Puerto Rico often exacerbate the underlying disparities affecting racial and ethnic communities disproportionately impacted by the HIV epidemic, including Latinx communities.

In 2019, Latinx men who have sex with men made up 32% of new HIV diagnoses among MSM, second only to Black MSM in the United States. Unequal access to health care, stigma and other social determinants of health have contributed to these adverse health outcomes. Despite prevention efforts, infections among Latinx MSM have remained stable, unlike the declining rates among White MSM and Latinx women. Ten years after FDA’s approval of pre-exposure prophylaxis access, it’s still not reaching communities in need. The Northeast/Caribbean AIDS Education and Training Center surveyed providers in Puerto Rico regarding the challenges related to PrEP, and the top barriers were parental consent requirements to prescribe PrEP for those under 21 years old, lack of transportation, lack of providers and lack of insurance coverage.

HIVMA is committed to ending the HIV epidemic and recently published policy recommendations, which, if implemented, would bring the goals set by the National HIV/AIDS Strategy for 2022-2025 and the Ending the HIV Epidemic initiative within reach. The initiative aims to reduce new infections by 90% by 2030 in the U.S. and address health disparities that have contributed to gaps in HIV prevention. To have the greatest impact, the initiative is focused on 57 priority areas where half of new HIV diagnoses occurred in 2016 and 2017, including San Juan, Puerto Rico.

Unprecedented challenges brought about by natural disasters, the ongoing COVID-19 pandemic and the current monkeypox virus outbreak have slowed HIV prevention efforts in San Juan. HIV providers responded quickly to meet the needs of patients by shifting to telehealth and telemedicine to support keeping patients in care. Now more than ever, the Puerto Rican people continue to demonstrate their resilience in the face of adversity.

On National Latinx AIDS Awareness Day, Oct. 15, the HIV community and providers are reminded to renew our commitment to ending the epidemic and foreground the communities hardest hit by HIV. Take action now by signing on to a petition asking Congress and the administration to develop a national PrEP program to better reach communities in need.