Nevada had the highest rate of new HIV diagnoses in 13 Western states, according to the most recent, reliable 2019 data from the Centers for Disease Control and Prevention (CDC).
At a rate of 16.6, the Silver State was well above the nationwide rate of 12.6 new HIV infections per 100,000 people. Clark County’s rate for new infections was even higher at 19.8, ranking the Las Vegas metropolitan area 12th of 111 large metropolitan areas nationwide. Approximately 10,740 people were living with HIV in the Las Vegas area in 2019.
Working on bringing those numbers down, Genoa Pharmacy opened in April at the Arlene Cooper Community Health Center. Chief clinical officer Leana Ramirez says one of the first steps is cutting through the stigmas of sexually transmitted infections and HIV testing.
“When you think about the health care system, does your doctor know who you sleep with? I think one of the biggest problems is that we’ve separated our sexual health from physical health. And that’s not the case,” says Ramirez.
The health center, located at Downtown LGBTQ nonprofit the Center, provides an environment where patients can feel welcome and comfortable sharing those details. Ramirez points out the health center’s separate entrance, which provides some discretion for anyone who doesn’t want to use the Center’s highly visible front door. At the health center entrance, there’s a Trac-B vending machine with clean syringes, alcohol swabs, hygiene kits and Naloxone.
“You name it, we try to stock it here … It’s all about harm reduction,” she says, pointing to a condom dispenser on the wall. “Because we are a sex positive clinic, we talk about sex … All we’re here for is to help people and to educate people.”
Also known as human immunodeficiency virus, HIV is spread through sexual contact, contaminated needles or blood and can be passed through the placenta during pregnancy. HIV can cause the development of AIDS (acquired immunodeficiency syndrome), which weakens the body’s ability to fight infections and certain cancers. HIV and AIDS were first identified in 1981; and although the disease no longer makes headlines, the virus continues to pose serious risks for the public.
Upon the 2019 launch of the federal Ending the HIV Epidemic initiative, the CDC reported that decades-long progress in lowering HIV infections had “stalled,” with some groups experiencing stabilizing or even increasing rates of infection each year. As part of that initiative, Clark County was identified as one of 48 metro areas targeted for HIV prevention, diagnosis and treatment.
Spokesperson Dawn Cribb at the Nevada Division of Public and Behavioral Health says that public health agencies statewide have been working with partners and providers to promote pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP), and connecting individuals with supportive programs that can assist with treatment. “Treating HIV early can help to slow damage caused by HIV infection and reduce the chances of transmitting it to others,” she says.
The Division of Public and Behavioral Health also administers the federal Ryan White Program, which provides assistance for those who are uninsured and underinsured.
“Through the Ryan White Program, Nevada residents can access needed core medical and support services, such as medical case management, transportation, mental health, medication and health insurance assistance,” Cribb says.
Of 448 newly diagnosed cases of HIV in Southern Nevada in 2019, nearly 73% were linked to care within one month after diagnosis, according to Clark County’s Ending the HIV Epidemic Plan for 2021-2026.
Prevention and treatment: PrEP, PEP and ART
In addition to HIV testing, condoms and safe practices when using injectable drugs, the medication PrEP can prevent the transmission of HIV, reducing the risk of getting HIV from sex by 99% and from injectable drugs by at least 74%, according to the CDC.
For those who have been or suspect they’ve been exposed to HIV, PEP can provide protection post-exposure. It must be taken within three days of exposure, for at least 28 days. According to a report published in the National Library of Medicine, studies have shown PEP to be more than 90% effective when taken properly.
“We are seeing an uptick in our PrEP and our PEP numbers,” Ramirez says. In April, the health center had about 80 patients on PrEP—double the previous year’s monthly average.
“But we’re still not there yet. We’re still missing a huge piece, and we’re still not seeing our HIV infections drop. That’s part of our challenge every day—how do we bring more people in?”
Having Genoa Pharmacy up and running has helped facilitate an increase in patients taking those vital medications. In 2021, Nevada passed a law authorizing certain pharmacies to prescribe and dispense PrEP and PEP without a prescription from a doctor.
Still, getting PEP within the three-day timeframe—essential for the medication to be effective—could prove a challenge for some. “The medication’s expensive, so not every pharmacy has it,” Ramirez says.
“If you have an exposure, let’s say Friday evening, and every place is closed on the weekend, [then] you come in on Monday [and] suddenly, you’re under the gun. And then you have to navigate insurance.”
The Arlene Cooper Community Health Center has a full-service lab that can provide blood and STI test results including HIV—meaning, if a patient were to test positive for HIV, they could start them on antiretroviral therapy (ART), which prevents transmission, in the same visit. The clinic works with most major insurances, connects patients with assistance programs and doesn’t turn anyone away for inability to pay.
“To us, Rapid ART is when they’re in that room, [if] they get that preliminary positive, we put medication in their hand. If we have somebody who comes in and we get them their new diagnosis, [then] we need to see them through.”
National HIV Testing Day
The CDC recommends that everyone ages 13 to 64, regardless of sexual orientation, get tested for HIV at least once. Groups with certain risk factors should get tested more often. Sexually active gay and bisexual men should test every three to six months, guidance says.
According to Clark County’s Ending the HIV Epidemic Plan for 2021-2026, only 41% of Southern Nevadans have ever been tested for HIV. In 2018, the CDC estimated that just 79.3% of those living with HIV in Clark County had been diagnosed, meaning approximately one in five people living with HIV in Clark County are unaware of their status.
On National HIV Testing Day, June 27, the Southern Nevada Health District will offer expanded free HIV testing via its mobile testing unit and partners around the Valley including two Walgreens locations. The health district also operates Collect2Protect, in which residents can receive free at-home HIV tests.
The Center, in addition to free HIV testing offered, will host an event with presentations, community resources, food and giveaways.
“We have such opportunities. We have such great medications. We have a knowledge about HIV that we can absolutely make an impact [with]. It’s just a matter of getting it out there to the masses,” Ramirez says. “We’ve got to take charge of our bodies and make sure that we know how to protect ourselves.”
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