October 13, 2015

You and I will defeat AIDS: North Carolina, we will eliminate unmet need!

Erik Valera

Program Director

Latinos in the Deep South

Latino Commission on AIDS


National Latino AIDS Awareness Day (NLAAD) is October 15th and the theme is, You and I Will Defeat HIV/AIDS. The notion of defeating anything is based on envisioning your accomplishment as a result of the defeat. Depending on your perspective, defeating HIV/AIDS might be as humbling as receiving a nervous patient checking in for her first HIV medical appointment or as ambitious as finding a cure then eradicating the virus from the earth (¡si se puede!). As Program Director for Latinos in the Deep South at the Latino Commission on AIDS, I envision a south where Latinos[1] have a life free of stigma and unfettered access to health care and other quality of life services. From my perspective defeating HIV/AIDS is based on overcoming inequities that stand in the way of this vision. It’s not merely my vision that’s important, but that our work is part of a concerted comprehensive effort that compliments the contributions of my colleagues from every community and discipline. Battles are won every day in our field and they should be celebrated in perspective for providing us with hope. Therefore, to commemorate NLAAD I propose that the North Carolina HIV community commit to defeating HIV/AIDS by eliminating the unmet need in our community.

North Carolina, we will eliminate unmet need!

The North Carolina Department of Health reports for 2013 that of all the people living with HIV in North Carolina, our HIV providers have met the needs for HIV-related primary health care in 73.9% of the 36,300 people living with HIV (Surveillance, 2015). That’s to say, almost three quarters of all people living with HIV in North Carolina were engaged in care during the past 12 month, by evidence of a CD4 test, a viral load count, or that they were provided medicine for HIV. Although the goal is to ensure that all 36,300 people are virally suppressed, we know that 26,857 people with HIV were somehow engaged in healthcare – and that’s fantastic! However our opportunity is to close the gap that creates a disparity for the 26.1% with ‘unmet need’. By doing so North Carolina would achieve 100% met need. It’s a winnable battle and a demonstration that North Carolina is committed to Defeating HIV/AIDS.

How to eliminate unmet need for HIV related primary health care in North Carolina

To eliminate unmet need we should understand the scope of the problem. The 26.1% that were not engaged in their HIV medical care is comprised of ~9,475 people. A tangible number that we can already perceive decreasing month by month. So who are these people? In 2013, Approximately 3,875 or 40.9% are Hispanics, 2,445 or 25.8% are Black/African American, and 2,302 or 24.3% are white. The proportion of Hispanics with unmet need had risen from 27.3% in 2009 (Surveillance, 2015). Addressing this racial/ethnic disparity or gaps in care for unmet need would begin to reverse the trend.

We conducted an assessment that included the relationship Latinos in the south have with the healthcare systems in a report titled Latinos in the Deep South: Visible by Piercing the Stigma Veil. (Vega, Klukas, Valera, & Montenegro, 2015; Vega, Klukas, Valera, & Montenegro, 2015). Within it we examined the relationship Latinos in the Deep South[2] have with the health care system. Many of the barriers we discovered can be impacted quickly with policy changes at the organizational, regional network, and state wide level, policies that address the three As: availability, accessibility, and acceptability of medical service for the 3,874 Hispanics living with HIV would greatly impact the proportion of those with unmet need.

Using the three A’s framework across the spectrum of services for your clinic or service organization will provide you with the insight for the Hispanic population not engaged in services. It might mean questioning hiring policies that give preference to qualified candidates proficient in English and Spanish and with relevant cultural experience. Networks of care may select to make medical interpreting for all HIV services an essential service rather than a support service.

PLWH are living with unmet needs for HIV primary care. Closing the gaps in care is possible with the support of North Carolina’s HIV community. It’s a necessary win that every clinic and community based organization can measure and address. The regional networks of care ought to hold each other accountable for reaching the most vulnerable patients. Nevertheless, to successfully meet this challenge the HIV community in North Carolina will have to confront the structural challenges that keep Latinos from going to their HIV medical appointments.

Surveillance, N. C. (2015). 2013 North Carolina Epidemiologic Profile. Raleigh, NC: North Carolina Department of Health and Human Services.

Vega, M., Klukas, E., Valera, E., & Montenegro, J. (2015). Latinos in the Deep South: Visible by Piercing the Stigma Veil. New York: Latino Commission on AIDS.

[1] The terms Hispanic and Latino are used interchangeably in this posting.

[2] Deep South is described as NC, SC, GA, AL, MS, AL, and TN for the purposes of the report.