If you, like me, are a person living with HIV in the U.S., you’ve very likely been wondering whether you’re in one of the priority groups for the COVID-19 vaccine in your state. You might be asking: Are folks with HIV where I live included as a part of the Centers for Disease Control and Prevention (CDC) Phase 1c recommendations? (That would put us just after the 1a group, which included health care and long-term care facility workers, and the 1b group, frontline essential workers and folks over 75.)
Phase 1c includes, in addition to people over 65 and other frontline workers, “people aged 16-64 years with underlying medical conditions which increase the risk of serious, life-threatening complications from COVID-19,” according to the CDC.
However, note that the CDC lists HIV as one of several conditions that might increase a person’s risk for becoming severely ill from COVID-19.” Those other conditions include steroid use, autoimmune diseases, and organ transplants that can cause an “immunocompromised state.” Additionally, the latest CDC coronavirus guidelines specify that only people “with a low CD4 cell count or not on HIV treatment” are part of this potentially immunocompromised group.
Those are the guidelines that states are using to draw up their own COVID vaccine priority phases. It's important to note that these are only recommendations, not hard-and-fast rules. But so far, few states have gone so far as to issue their own lists of all conditions they will consider part of Phase 1c. This is at least in part because, as TheBody learned when we reached out with this question to several states that have high COVID rates or large HIV-positive populations, many states are still running out of their vaccine supply while trying to complete their Phase 1a and 1b vaccinations.
Which U.S. States Are Prioritizing COVID-19 Vaccination for People Living With HIV?
You can keep track of your own state’s vaccination policies using this Kaiser Family Foundation (KFF) reference page. As outlined in KFF’s February 16 update, 12 states or jurisdictions explicitly include HIV as part of those with an immunocompromised state, for the purposes of clarifying who would be included in Phase 1c of their COVID-19 vaccination:
- New Hampshire
- New Mexico
- New York
- North Carolina
- Rhode Island
- Washington, D.C.
Another seven states, KFF reports, broadly include immunocompromised state, without specifying whichconditions are included. Those states are Alabama, Arkansas, Delaware, Illinois, Vermont, Wisconsin and Wyoming.
That said, because HIV is listed among the CDC’s Phase 1c conditions, it’s safe to assume that more states will eventually follow suit.
Health department reps in New Jersey, Pennsylvania, and Washington, D.C., also told TheBody they’re using an honor system, meaning you don’t have to bring a note or other documents from your health care provider saying you have HIV or any other underlying condition.
Additionally, on February 11, the national research and policy think tank Act Now: End AIDS Coalition sent a letter to officials at the U.S. Department of Health and Human Services (HHS) urging them to explicitly include people living with HIV "in the criteria used to define persons considered immunocompromised for purposes of determining eligibility for Covid-19 vaccination."
The letter comes on the heels of "recent evidence published by the New York State Department of Health AIDS Institute and the New York City Department of Health and Mental Hygiene (DOHMH) [that] shows that people with HIV (PWH) in New York have experienced significantly higher rates of COVID-related hospitalization and mortality than the general population."
The letter also points out that the higher rates of COVID severity among people with HIV in New York State may also be partly due to cofactors, including other underlying conditions and greater exposure to COVID due to race and class factors such as crowded housing or having to continue working outside the home.
Three Facts to Keep in Mind About HIV and the Coronavirus
For all that the CDC is listing HIV as an underlying immunocompromised condition, it’s important to note three things. The first is that well-managed HIV—meaning that a person is taking their meds daily, has an undetectable viral load, and has a CD4 count ideally above 500—is usually linked to a functioning and basically “normal” immune system, as opposed to the bad old days before we had great treatment options, when unmanaged HIV led to AIDS and slowly destroyed the immune system.
The second thing is that, thus far, it appears that folks with well-managed HIV (and no other underlying risk conditions) are not at higher risk for severe or fatal COVID illness.
And the third is that, while not enough folks with HIV have gotten the COVID vaccines to say definitively that there is no special interaction between the vaccines and HIV, there were in fact a small number of people with HIV involved in the clinical trials for some of the current coronavirus vaccines, and so far, nothing seems different for them compared to how the vaccines went down in everybody else.
So that’s what we know as of February 16. Keep checking that KFF reference page to see what your state says—and if anything particularly notable arises, we’ll let you know!