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Status Neutral HIV Prevention and Care
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Today, powerful HIV prevention and treatment tools can keep people healthy and help end the HIV epidemic. Combining these tools in a status neutral approach can help people maintain their best health possible, while also improving outcomes in HIV prevention, diagnosis, care, and treatment. A status neutral approach to HIV-related service delivery aims to deliver high-quality, culturally affirming health care and services at every engagement, supporting optimal health for people with and without HIV. This approach is especially important now to reduce the unacceptably high number of annual HIV infections and help close the persistent gaps along the HIV prevention and care continuum, which indicate that not enough people are being engaged or retained in HIV prevention and treatment.
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The status neutral framework provides care for the whole person by offering a “one-door” approach: people with HIV and people seeking HIV prevention services can access treatment, prevention, and other critical services in the same place. Normalizing HIV treatment and prevention helps to destigmatize both. In a status neutral approach to care, a provider continually assesses and reassesses a person’s clinical and social needs. The goal is to optimize a person’s health through continuous engagement in treatment and prevention services without creating or deepening the divide between people with HIV and people who could benefit from prevention.
Many barriers may keep people from being engaged in HIV care:
- HIV testing, treatment, and prevention services are often offered separately, can be challenging to navigate, and further emphasizes a division between people with HIV and people who could benefit from prevention.
- Separating HIV services from other routine healthcare misses opportunities to engage people in HIV testing, prevention, and treatment when they seek sexual health or other non-HIV-focused services.
- Providing critical support services—like housing, food, and transportation assistance—is essential to keeping someone in ongoing care, but these services are not necessarily offered alongside what is considered “traditional” HIV care and prevention services.
- Stigma embedded in the experience of many people seeking HIV treatment and prevention services can stop people from visiting health care providers labeled as “HIV” or “STD” clinics.
- Everyone has implicit biases that affect their perceptions of others. The HIV care or prevention services someone receives may be affected by healthcare and other service providers’ implicit biases on race/ethnicity, sexual orientation, gender identity, age, and other factors. These biases, in some cases, may be why a person does not return for care and services.
Status neutral service begins with an HIV test – the pathway to prevention and treatment.
In a status neutral approach, an HIV test spurs action regardless of the result by recognizing the opportunity created by a negative or positive result for an individual to achieve better health:
- If a person receives a negative HIV test result, the provider engages the person in HIV prevention and offers powerful tools that prevent HIV, such as pre-exposure prophylaxis (PrEP).
- If a person receives a positive HIV test result, the provider offers a prescription for effective treatment to help them become virally suppressed and maintain an undetectable viral load, as well as other clinical and general health support services to help achieve a high quality of life.
The status neutral approach aims to advance health equity and reduce disparities by embedding HIV prevention and care into routine care. Integrating HIV prevention and care with strategies that address social determinants of health can help reduce barriers to accessing and remaining engaged in care.
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Statement from Assistant Secretary for Health Levine on Point of Care Testing for Syphilis
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This task force issued new considerations for health care providers who test patients for syphilis. The new HHS document "Considerations for the Implementation of Point of Care Tests for Syphilis," outlines four main differences between syphilis point of care tests and laboratory-based serologic syphilis tests and highlights the best settings to consider the use of point-of-care tests. It also examines parameters for point of care testing program implementation and management, provides answers to common questions, and lists links to related resources.
“Syphilis testing is crucial, as syphilis infections can be difficult to diagnose because many of those infected may not have symptoms,” said Admiral Rachel L. Levine, MD, Assistant Secretary for Health. “The Food and Drug Administration has authorized two point-of-care tests for syphilis that can provide rapid test results during the same visit in about 15 minutes. This can help overcome barriers in our ability to timely diagnose patients in communities across the nation.”
Syphilis is curable but has re-emerged as a global public health threat. Since 2012, congenital syphilis cases have surged in the United States. If untreated, syphilis can seriously damage the heart and brain and can cause blindness, deafness, and paralysis. When transmitted during pregnancy, it can cause miscarriage, lifelong medical issues, and infant death.
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In this activity, an expert discusses how to adapt HIV treatment for people with substance use disorders, exploring barriers to management, effective communication strategies, coordinating care with mental health and substance use treatment providers, and guideline recommendations for developing HIV care plans. Access on-demand activity here.
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Additional Resources:
- [NEW] UW STD Prevention Training Center’s comprehensive STI Video Library: This resource compiles recordings from recent clinical update courses, offering healthcare professionals and educators specialized content on sexually transmitted infections (STIs).
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The Mountain West AIDS Education and Training Center (MWAETC) program is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $3,333,289 with 0% financed with non-governmental sources. The content in this presentation are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government.
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