Disparities and the Urgent Need for Comprehensive HIV Prevention Strategies to Lower HIV Rates
in Oregon

The HIV epidemic continues to evolve, and while progress has been made, HIV continues to impact communities today. In 2022 there were 244 new HIV infections in Oregon, which is a continued trend of over 200 new infections every year (OHA). Today, there are at least 8,220 people living with HIV in Oregon. To effectively address HIV and HIV-related health disparities, prioritizing disproportionately impacted populations is essential to HIV prevention.

These groups are BIPOC (Black, Indigenous, and People of Color) communities, LGBTQ+ folks, people experiencing homelessness, PWID (people who inject drugs), and others. It is crucial to recognize the underlying healthcare disparities that persist in these highly impacted communities, many of which are experiencing increasing rates of HIV diagnosis. HIV Alliance’s mission is to provide support to individuals living with HIV/AIDS and to increase HIV prevention. This means we work to ensure ongoing access to testing and linkage to care, and we respond to intersecting barriers with comprehensive HIV prevention strategies for at-risk people.

Disproportionate Impact on People Who Inject Drugs

One population that continues to be disproportionately affected by HIV in Oregon is people who inject drugs (PWID). The intersection of drug use and HIV transmission poses a significant challenge. In 2022, 24.3% of individuals assigned female at birth and 22.6% of individuals assigned male at birth who were diagnosed with HIV reported drug use. This underscores the urgent need for targeted interventions, harm reduction strategies, and increased access to healthcare services for PWID.

The link between injection drug use and HIV transmission is multifaceted. Shared needles, often a consequence of limited access to clean syringes, significantly increase the risk of transmission. Additionally, the stigma associated with drug use can deter individuals from seeking testing and treatment, exacerbating the spread of the virus. To address these issues, comprehensive harm reduction programs, including needle exchange services and substance use treatment, must be expanded and made easily accessible.

HIV Alliance follows a harm reduction philosophy. This is a public health philosophy that seeks to empower individuals, remove barriers to accessing the support that they need, and supply pragmatic approaches to risk reduction in a non-judgmental/non-coercive way that is compassionate and accepting of any positive change. Harm reduction supports a wide spectrum of strategies from doing the behavior more safely, to limiting certain behaviors, to abstinence.

In support of this practice HIV Alliance offers a variety of services. We have syringe exchange services across seven Oregon Counties (Lane, Marion, Douglas, Josephine, Coos, Curry, and Washington Counties). The syringe exchange program allows individuals to safely dispose of used syringes, get sterile syringes, and receive safer injection kits. Overdose prevention kits are also available and include Naloxone as well as training on overdose reversal. Onsite rapid HIV, Hepatitis C, and Syphilis testing is available to clients who choose to get tested. HIV Alliance offers peer support services that aim to mitigate the negative effects of substance use by actively and proactively engaging people who are at risk of substance overdose but who may not be ready to pursue substance use treatment. Peer support is a proven method of fostering readiness for treatment while reducing harm of ongoing substance use, thus increasing access to recovery services and leading to better overall health outcomes.

LGBTQ+ Communities and HIV Disparities

The majority of new HIV cases in Oregon are among members of the LGBTQ+ community. In 2020, 22% of new HIV diagnoses were among gay and bisexual men, emphasizing the need for targeted prevention efforts within this demographic. Discrimination, stigma, and a lack of culturally competent healthcare contribute to the disparities observed in LGBT+ communities.

To address these challenges, HIV Alliance works to create safe and inclusive spaces for testing and treatment. The Queer Resource Center (QRC) is a space where HIV Alliance staff and community partners like TransPonder and Sylvia’s Closet provide a variety of resources and services that best serve this community. This includes:
● Gender-affirming hormone injection supplies program
● Rapid HIV, Hepatitis C, and Syphilis Testing
● Narcan/Naloxone supplies and training
● Distribution of safer sex supplies
● PrEP navigation services
● Access to gender-affirming products
● Food pantry
● Resource navigation
● Peer support
● Substance use counseling

Impact on BIPOC Communities

HIV rates also disproportionately affect BIPOC communities in Oregon. Oregon Health Authority data from 2018-2022 shows that Black/African Americans, Native Hawaiian/Pacific Islanders, Hispanic/Latinx, and American Indian/Alaska Natives experienced a higher rate of new HIV diagnoses. For instance, the U.S. Census Bureau reports that Black/African Americans only make up 2.3% of the state’s population, but this demographic reported the highest infection rates. This underscores the need for targeted outreach and culturally sensitive healthcare services.

Barriers such as systemic racism, unequal access to healthcare, and other social determinants of health contribute to these disparities. Structural changes, including increased access to affordable healthcare, educational campaigns addressing the unique risks faced by BIPOC communities, and community-led initiatives, are essential in addressing these disparities. HIV Alliance addresses these barriers in a variety of ways. We partner with community organizations that work with these communities on a daily basis to better understand the needs of individuals and provide support in getting access to needed health care.

Bridging the Gap in Healthcare Access

In conclusion, the health disparities in HIV diagnosis and treatment outcomes in rural Oregon require urgent action. By implementing practical solutions and fostering collaboration among stakeholders, we can work towards achieving health equity for all Oregonians, regardless of their location. Every individual deserves access to quality healthcare and support services, and it’s time to make this a reality.

References:

1. Oregon Health Authority, Public Health Division. (2020). HIV surveillance data: Oregon, 2020. Oregon Health Authority. https://www.oregon.gov/oha/PH/DiseasesConditions/CommunicableDisease/DiseaseSur veillanceData/HIVData/Pages/index.aspx
2. Centers for Disease Control and Prevention. (2021). HIV surveillance report, 2020 (Vol. 33). U.S. Department of Health and Human Services.
https://www.cdc.gov/hiv/library/reports/hiv-surveillance.html