On a sweltering June day in 2021, Nicole, whose real name has been changed to protect her privacy, walked into an HIV treatment clinic in Atlanta, Ga., expecting something different. She had shouldered a lifetime of discrimination for being both Black and transgender while also dealing with HIV, diabetes and hypertension. She worked as a manager of a fast-food restaurant while parenting several LGBTQ youths.
Nicole arrived 30 minutes late for our appointment after a long commute into the city during rush-hour traffic. As we discussed her gender identity, sexual health and romantic partners, I saw a surprised look on her face, suggesting to me that few clinicians had asked her these questions before. Her physical exam was mostly normal, except for extensive anal warts. “They’ve been there a long time,” she said. “No one knows what to do with them.
These disparate HIV health outcomes are complicated by a labyrinth of bureaucracy within medical spaces that make it nearly impossible for many to access medications that should be within their reach. This includes cumbersome paperwork to obtain ART if one is uninsured, underresourced clinics and medical staff burnt out from COVID, and institutional policies that prioritize visit numbers and copay billing over patient-centered care.
The burden of improving HIV prevention and treatment is now on the shoulders of our medical systems. As we seek to provide more equitable care, statewide and national policy improvements must be accompanied by changes within health-care systems and clinics: We must enhance case management staff to ensure patients can get to their appointments and understand the processes required to access treatment.
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