Stigma, Unequal Access and an Aging Population: Challenges to HIV Care and Prevention

Rutgers Health experts discuss the pressing issues in HIV treatment and prevention

Despite breakthroughs in HIV treatment and prevention worldwide, critical challenges such as stigma, unequal access and managing the virus for an aging population remain, a group of Rutgers Health experts said at a recent event to address these issues.

These experts, who gathered at Rutgers New Jersey Medical School, underscored the ongoing need for innovative solutions, collective action and advocacy to effectively address these challenges.

During a World AIDS Day event themed “Collective Action: Sustain and Accelerate HIV Progress,” the experts highlighted the importance of education, advocacy and collaboration in overcoming these challenges. This annual event, hosted by the Infectious Diseases Practice (IDP), which provides care for persons with and at risk for HIV infection, was held in collaboration with the Division of Adolescent and Young Adult Medicine (DAYAM).

Shobha Swaminathan, professor and director of HIV Services in the Department of Medicine, Dominga Padilla, professor in the Department of Pediatrics, and executive medical director of DAYAM and Jamir Tuten, program manager at IDP, discuss the event and share insights into the advancements and challenges in HIV care and prevention.

What the pressing concerns in HIV care and treatment and how are they being addressed?
Swaminathan: Stigma and discrimination continue to pose major barriers to accessing care. Effective HIV treatment has helped patients live longer while simultaneously making aging with HIV an increasing challenge. Many older people with HIV face social isolation, loneliness and a lack of support, which negatively impacts their quality of life and ability to live independently. Additionally, despite the effectiveness of treatment, some individuals still struggle with taking medication as prescribed due to issues like mental health disorders, substance use and social instability. To address these challenges, novel therapeutic approaches, such as injectable medications, are being explored. For example, a recent study demonstrated that injectable medication was better than daily pills, even for patients with histories of mental health and substance use issues.

Furthermore, the health care infrastructure must continue to evolve to meet the changing needs of patients and communities. In HIV prevention, a recent study showed that an injection of Lenacapavir given twice a year, led to zero new infections among cis-gender women. Rutgers is part of ongoing studies looking at acceptability and how this drug moves through the body among women and persons who inject drugs.

What advancements in HIV treatment are you most optimistic about?
Swaminathan: I am very optimistic about the potential of new long-acting medications for both HIV treatment and prevention that will allow people with and those at-risk for HIV to live a normal, full life without feeling the need to be “tied” to their HIV pill for treatment or prevention.

I am very optimistic about the potential of new long-acting medications for both HIV treatment and prevention that will allow people with and those at-risk for HIV to live a normal, full life without feeling the need to be “tied” to their HIV pill for treatment or prevention.

Shobha Swaminathan

Professor and Director, HIV Services in the Department of Medicine at Rutgers New Jersey Medical School

Discuss the efforts of the Infectious Diseases Practice in addressing the HIV epidemic.
Swaminathan: The Infectious Diseases Practice has developed a patient-centered model to address the HIV epidemic for adults, which provides comprehensive care, including medical and support services and oral and injectable medications, ensuring that nearly 90 percent of patients receive successful treatment. The program has developed multiple integrated programs: gender-affirming care, substance use disorder and mental health counseling and treatment and offers testing in the Emergency Department, outpatient clinics and on the mobile unit in the community.

Discuss the efforts of the Division of Adolescent & Young Adult Medicine in reducing HIV risk and improving treatment outcomes for young people.
Padilla: DAYAM has played a vital role in reducing HIV risk and improving outcomes for young people. Since its founding in 1976, its focus has been on prevention and treatment for youth aged 13 to 29. It provides counseling, testing, immediate access to HIV care and education, and case management for high-risk negative youth.

What message would you like to share with the public about the ongoing fight against HIV and the importance of continued research and advocacy?
Tuten: The fight against HIV remains one of the most significant global health challenges of our time. Despite significant medical advancements in research, prevention, treatment and education, the battle is far from over. Millions of people worldwide still live with HIV and the stigma surrounding the virus continues to fuel discrimination, hindering efforts to reduce its spread. Ongoing research is crucial for improving the lives of those affected, finding a cure and preventing new infections. Every step forward in treatment and prevention brings us closer to a world where HIV is no longer a life-threatening condition.

Equally important is advocating education, awareness and better access to care. This involves ensuring access to the necessary tools and medications, as well as addressing societal misconceptions and ending the stigma that isolates individuals living with HIV.