Carlos del Rio, MD, is a Distinguished Professor of Medicine in the Division of Infectious Diseases at Emory University School of Medicine, Executive Associate Dean for Emory at Grady Health, and Co-Director at the Emory Center for AIDS Research. Dr. Del Rio also serves on the AIDSVu Advisory Committee.
Q: You have spent much of your career studying hard-to-reach populations, such as substance users, to improve HIV outcomes and prevent infection for those at risk for HIV. Why did you decide to focus your research on this?
These vulnerable populations are the people most heavily impacted by many epidemics, such as HIV, Hepatitis C, and now COVID-19. One thing I learned during my research was that we refer to these population groups as hard-to-reach populations. However, I think of them as hardly-reached populations – they’re not hard to reach if we engage with them, but we frequently forget about these groups.
However, I think of them as hardly-reached populations – they’re not hard to reach if we engage with them, but we frequently forget about these groups.
In turn, we call them hard-to-reach because we don’t think of them as easily accessible, but that doesn’t mean these communities aren’t there. The key importance of engaging with these at-risk populations is to work with them directly to offer access to prevention, treatment, and care simultaneously.
Q: Recently, you published an article in the New England Journal of Medicine refining the clinical descriptions of COVID-19 in its quickly changing epidemic landscape. How does COVID-19 complicate both short-term and long-term HIV care, especially for high-risk populations?
I think COVID-19 creates an increased burden of vulnerability in a population. For example, African Americans are at high risk of HIV – now, they’re at high risk of getting infected with COVID-19 as well. This further increases the stigma and discrimination because these populations are seen as a problem, rather than the consequences of a multitude of public health epidemics.
Q: Due to massive waves of resources and funding shifting to COVID-19 efforts, many other public health problems have lost essential support—including HIV. How would you reassert the urgent need for HIV support and resources amidst the COVID-19 pandemic while continuing to address this global public health crisis?
It’s unfortunate that we live in a world of silos. Right now, the focus is on COVID-19 testing and outreach. Why not have HIV testing at the same place and time? I will take a page out of the research study in Africa. It was not focused on just HIV testing, it was about really improving the health of the population by conducting glucose monitoring, blood pressure monitoring, and HIV testing simultaneously. I think we need to have a more holistic approach to improving people’s overall health. If we are going to be out there in the community and doing COVID-19 testing, let’s also do blood pressure testing, glucose monitoring, HIV testing, and more. We recently wrote a commentary in Clinical Infectious Diseases calling for this more integrated approach. Comprehensive and integrated clinical approaches create less silos among diseases, reducing stigma and alleviating reallocation of resources.
Q: There’s been a lot more focus on the importance of at-home testing and telemedicine recently because of the pandemic. How do you see predict these changes will impact testing efforts for other infectious diseases, such as HIV?
As a result of the pandemic, we’ve seen a dramatic decrease in the number of people going to HIV counseling and testing sites. But this has also allowed us to seek alternative ways for screening. In terms of COVID-19, we’re going to see a lot of advances towards at-home testing. Let’s figure how to incorporate HIV testing in a similar way to make it more accessible and easier for patients.
Q: The theme for World AIDS Day this year is “Ending the HIV/AIDS Epidemic: Resilience and Impact,” but the goal of ending the HIV epidemic by 2030 may be difficult to reach now that resources and focus have shifted to COVID-19. What do you see as necessary to continue towards reach our Ending the Epidemic goals, even during COVID-19? What would be your message to the HIV community on World AIDS Day?
I think we must keep our eye on the ball. We must make sure that we continue doing two things. First, ensure that people on antiretroviral therapy retain their care through the pandemic. Many providers are supplying patients with larger amounts of medication at a time to reduce the number of in-person visits and offering telehealth options. What else can we do to keep people engaged in care?
Second, scale up PrEP availability and use. Many places are seeing a decrease in PrEP availability and access because of the pandemic. Increasing the number of people who are virally suppressed and PrEP use are crucial to ending the HIV epidemic. We must not lose sight of those two important goals.
To the HIV community, I think the most important thing is that if you are living with HIV, seek or continue with treatment. If you are at risk of HIV and not on PrEP, then get on PrEP. It’s extremely difficult during a pandemic to stay in care, especially with so many hardships like unemployment and housing loss, but we are here to help you and ensure you continue your care. Clinics are making enormous adjustments to try to ensure that they remain accessible and available for patients.
For providers, my main message is to work with the community. Work with your patients and the vulnerable groups that really need you to figure out how to make HIV prevention and treatment easiest for them during these immensely challenging times. Find out what we need to do to continue towards achieving our goals of ending the HIV epidemic. Even during a pandemic, I would not like to see missed opportunities on viral suppression or increasing PrEP access and use to mitigate the risk of infection and avoid lifelong antiretroviral therapy.
As we think about this pandemic, we all need to do our part to decrease transmission of COVID-19, such as wearing a mask. Just like taking therapy, using a condom, or taking PrEP, wear a mask – because the mask of today is the condom of the past.