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"Survival is a priority over putting a pill in your mouth for a number of our participants, and that is the public health challenge we must address," said study first author Dr. Seble Kassaye, an associate professor at Georgetown University Medical Center in Washington, D.C.
"The truth of their lives is a lot less rosy than a few lines of statistics in a summary report can reveal," she added in a medical center news release.
The study of nearly 2,000 HIV-positive women in Washington, D.C., New York, Chicago and San Francisco who have been followed since 1994 found that many have been able to control their HIV levels, off and on.
But ongoing challenges such as mental health, unstable housing and lack of social support prevent many from achieving effective and sustained HIV suppression, according to the authors of the study published May 17 in the journal JAMA Network Open.
The women were interviewed and gave blood samples every six months to determine whether their HIV was well controlled or uncontrolled, a condition called viremia.
Over 23 years, 29% were at low probability for viremia; 39% were at intermediate probability; and 32% were at high probability.
Between 2015 and 2017, 71% of women achieved sustained HIV suppression, including 35% with a high probability of viremia, according to the researchers.
"So, the rosy picture is that 71% of the women achieved viral suppression, but the granular detail tells us that some women are doing very well with 89.6% of the women in the low probability of viremia consistently suppressed in the recent years, but others are still struggling to get to viral suppression," Kassaye said.
Because current HIV drug treatment is much less toxic than it used to be and is now suggested for anyone who has the virus, it's widely used. But obstacles persist.
The study found that women in the high viremia group were more likely to report depressive symptoms (54%) and have higher levels of illicit drug (41%) and alcohol use (14%). They were also less likely to have stable housing (66%); and more likely to die prematurely (39%).
Kassaye said public health issues and stigma surrounding HIV remain common in Washington, D.C.
"My colleagues have treated generations of HIV-positive women: grandmothers, their daughters, and their granddaughters," she said. "I have seen women with HIV who do not have any support, but if that person develops cancer, there will be a roomful of people coming to the clinic with her."
Achieving universal HIV treatment and viral suppression will require what is known as "wraparound" care, she said.
That's a term for non-medical services to assist patients who may need help taking medications regularly, getting to appointments on time or coping with stress. This safety net can also include help with housing, transportation, child care and the like, according to the global health strategy firm Rabin Martin.
-- Robert Preidt
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SOURCE: Georgetown University Medical Center, news release, May 17, 2019