The Miami-Fort Lauderdale-West Palm Beach metropolitan area led the nation in new HIV diagnoses in 2017, according to the Centers for Disease Control and Prevention. Florida overtook Louisiana to claim the third-highest rate of new HIV diagnoses per 100,000 people that year, behind Washington, D.C. and Georgia.
However, these diagnoses do not capture all new HIV infections in 2017.
Approximately half of young people living with HIV are unaware that they are infected. The percentage drops in adults, but about one in seven adults remain unaware of their HIV infection. Researchers modeled that almost half of new HIV infections could result from these individuals unaware of their HIV status.
Florida can reduce the rate of new HIV infections by preventing them in high-risk populations. Pre-exposure prophylaxis (PrEP) offers a solution. Fortunately, the Florida Department of Health started offering PrEP for free across the state in 2018. In 2019, we must connect individuals at risk of HIV infection with this service.
The CDC found that that a daily Truvada, an HIV antiviral that is a form of PrEP) reduces the risk of infection by up to 92 percent. The Florida Department of Health identified men who have sex with men (61 percent), female heterosexual contact (19 percent) and male heterosexual contact (13 percent) as the three leading modes of HIV exposure.
I first started PrEP when I moved to San Francisco in 2015. I was only vaguely familiar with the once-a-day blue pill when I met with my primary care physician. At that point, Truvada had been approved by the Food and Drug Administration for about three years, when I was still in college. But I had yet to have any substantive discussion about HIV prevention beyond general safe-sex practices and abstinence.
The prevention benefits seemed as clear to me in California as they did when I moved back to Florida this past summer. I spoke with my doctor, and she told me that the West Palm Beach Health Center recently started offering PrEP. I had never been to the West Palm Beach Health Center before June, but the new program brought me through the doors to reduce my risk of contracting HIV.
PrEP is just one part of the solution to reduce the rate of new HIV infections among adolescents and adults in Florida.
There remain significant financial barriers to healthcare access that can affect whether a person even seeks HIV testing or treatment for HIV/AIDS. Having access to healthcare improves the likelihood that an individual gets tested for HIV. Therefore, we must also improve the continuum of care for individuals at risk for and living with HIV/AIDS.
In 2015, the Florida Senate approved Medicaid expansion in its budget to expand care to low-income Floridians. However, the Florida House refused to expand Medicaid under the Affordable Care Act, which would have brought federal funds to subsidize healthcare coverage for low-income Floridians.
Despite efforts to deprive the nearly 1.8 million Floridians enrolled through the Health Insurance Marketplace of affordable and accessible healthcare, the Affordable Care Act remains a viable tool to reduce new HIV infections in Florida. Unfortunately, the 1.3 million Floridians who would gain insurance under Medicaid expansion must wait for an alternate solution.
In the meantime, Governor-elect Ron DeSantis and the incoming state lawmakers must prioritize reducing new HIV infections in the upcoming 2019 legislative session.
As the Miami-Dade HIV/AIDS “Getting to Zero” Task Force recommended, Florida must make comprehensive sex education available to all Florida youth. Denying our youth this education unnecessarily exposes them to HIV and other sexually transmitted infections.
DeSantis’ selection for surgeon general and secretary of health must recommit to the PrEP program. They must welcome at-risk patients through county health centers’ doors just as they welcomed me this summer.
Florida should be a leader in HIV prevention and treatment — not in new HIV infections.
Daniel Bicknell is a Master in Public Policy student at the Harvard Kennedy School of Government. He is a native of Boca Raton.