HIV Specialist - June 2021 - 40

TheManagement andCare of
BY VILMARY SIERRA ROSA, MD, AAHIVS
A
CCORDING TO THE CENTERS FOR DISEASE CONTROL (CDC), Puerto Rico has one of the highest HIV
infection rates in the U.S. and has been identifi ed as one of the target areas in the Ending the
HIV Epidemic: A Plan for American (EHE)1. In 2018, 440 persons were diagnosed with HIV in
Puerto Rico with HIV diagnosis rates among adults and adolescents ≥13 years 15.7 per 100,000
population.2 There have been a total of 49,639 reported cases of HIV/AIDS on the island between 1980-2018.2
According to new data from the University of Puerto Rico's Medical Sciences Campus' Integrated Clinical
Trials Unit, the coronavirus pandemic has raised the fi gure to over 50,000 cases.
The COVID-19 pandemic also
came on the heels of another disaster,
Hurricane Maria, which hit the island
in September of 2017. In a study conducted
by the University of Puerto Rico's
Medical Sciences Campus and Columbia
University, Puerto Ricans living with HIV/
AIDS were one of the groups that Maria
impacted most. The study notes viral
suppression decreased from 71 percent
to 65 percent in the entire sample as a
result of Maria's impact. Access to medical
assistance and health services for these
patients fell by more than two percent.
However, today, with the number of
COVID-19 cases slowing declining, and
thanks to advocates, patients, doctors and
other community advocates in Puerto
Rico, conditions are improving for most
people with HIV (PWH). Access to HIV
testing, treatment and prevention are
increasing and becoming more readily
available.
There are many clinics on the island,
both government funded clinics and
private practice offi ces. Puerto Rico's federally
qualitied community health centers
are also known as 330 Centers because
they were established by Section 330 of the
Public Health Service Act. Many of these
centers and some private health clinics
also receive Ryan White funding. The
Puerto Rico Ryan White Part B /ADAP
Providers Network consists of 55 centers:
■ Puerto Rico Department of Health
(PRDOH) Communicable Diseases
Prevention and Treatment Centers
(CPTET, acronym in Spanish) which
includes 8 regional HIV/STI/Hep/TB
Clinics
■ ADAP External Providers Network consisting
of 39 HIV clinical centers
■ Community-based Coordinating
Agencies (CBOs) including 8 agencies,
each designated to a specifi c DOH
Health Region
A big part of the population living
with HIV have government-based health
insurance, which covers most medications,
labs and medical care. If these services are
not covered, Ryan White is the insurer of
last resort.
Unfortunately, most insurance,
including Ryan White, does not cover the
use of pre-exposure prophylaxis (PrEP).
PrEP is typically accessed through private
clinics who have made arrangements with
pharmaceutical companies to distribute
the medication.
This is starting to change with the EHE
initiative, bringing more access to PrEP
through government support. I am hopeful
we will have access to PrEP services
40 JUNE 2021 HIVSPECIALIST WWW.AAHIVM.ORG
http://WWW.AAHIVM.ORG

HIV Specialist - June 2021

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