For an HIV long-term survivor like me, I have no fear of stigma when I go to my doctor. When I think about my treatment, it’s more than just connecting and bonding with one doctor; I bond with a whole health care team, including nurses and social workers. It’s not just about getting pills. But I know for newly diagnosed folks it can be daunting to sit in the waiting room of a new doctor, worrying about who else sees them there.
Now, during the COVID era, people living with HIV can see their doctors from the comfort of their homes, due to the rise in telehealth medicine, or video visits with their physicians. As a patient living with HIV, I think telehealth is changing the way people with HIV access care in many ways.
Telehealth Increases Access to Health Care and Improves Health Outcomes
In March 2020, Congress passed the Coronavirus Preparedness and Response Supplemental Appropriations Act.
This legislation eased telehealth requirements by removing restrictions on a patient’s location. Before the COVID-19 pandemic, patients needed to be in designated rural areas to receive telehealth. But that’s no longer the case. Also, telehealth visits are reimbursed at the same level as in-person visits.
The legislation expanded the kind of health care providers who can provide telehealth to include nutritionists, psychologists, and social workers, to name a few. Of course, more options are always best, which means these telehealth accommodations increase the access people living with HIV have to treatment and care.
A recent study examining the relationship between having a consistent health care provider and clinical outcomes concluded that people living with HIV who saw their infectious-disease doctor on a regular basis had better clinical outcomes.
People living with HIV who have consistent care are more likely to take their medicines and reach an undetectable viral load. Undetectable equals untransmittable (U=U) means that people living with HIV who consistently adhere to their HIV treatment can reach an undetectable viral load and that people living with HIV with an undetectable viral load cannot transmit HIV via sex.
In addition, people living with HIV who have an undetectable viral load have better health outcomes.
Several media outlets have highlighted the practical importance of the U=U message, meaning that people who are undetectable cannot transmit HIV sexually. This message has improved the sex lives of many people living with HIV, including their self-esteem and health outcomes at large. As people living with HIV become healthier, they need less medical care and save money and time.
Telehealth provides a certain level of confidence and privacy, thereby increasing the treatment participation and literacy of people living with HIV. If all barriers preventing people from accessing HIV treatment are addressed and all people living with HIV have consistent HIV treatment and care, we can see the end of HIV and AIDS.
Telehealth Saves Time and Money
For a woman living with HIV like me, an infectious-disease doctor visit means that I have to take a whole day off. I have to plan for childcare or hop my kids in a car to go with me. I have to plan my route and deal with traffic in downtown Detroit, then find a parking spot and unload my babies. Then I have to deal with health insurance at reception: choosing the cheapest insurance between employment-tied insurance and state health insurance (Medicaid). Both insurance eligibility criteria keep changing with income and my pregnancy status. By the minute I get into the doctor’s office, I am out of breath and sweating. I am not alone. The majority of people living with HIV in the U.S. go through the same process every time they see their infectious-disease doctor. In contrast, a virtual infectious-disease doctor visit takes less than 30 minutes and saves me from all the stress. It does not mean that as people living with HIV we will not have in-person doctor visits; it means we will have fewer in-person visits, saving money and time.
With all of the benefits, we should be looking at telehealth as giving public health a lot of opportunities. Telehealth could give us the opportunity to increase the number of people living with HIV who access and stay in HIV care, as well as the number of people who receive mental health counseling or access support groups.
We Still Need to Improve Access to Affordable Health Care
While I’m praising telehealth, it’s important to remember the need for more affordable health care in the U.S. Obamacare provides affordable health care to millions of Americans, including people living with HIV, regardless of their employment status. It has survived several attacks from Republicans and survived challenges in the Supreme Court. At the same time, many Americans lost their jobs, thus losing health insurance tied to their jobs. As the HIV community, we must hold the Biden/Harris administration accountable and make sure they protect the Affordable Care Act while also making health care even more affordable by providing health care for all Americans regardless of their employment status.
In addition, though telehealth has many advantages, due to a lack of access to broadband and high-speed internet, some Americans don’t really have access to this new medical wonder.
Now, access to fast internet is an essential health care tool. We must make sure that nobody is left behind. In our 2021 HIV-response strategies, we must add a demand for providing fast internet and electronic devices to low-income families.
Also, telehealth eased access is temporary: The Coronavirus Preparedness and Response Supplemental Appropriations Act stipulates that easing access to telehealth is directly related to the period of COVID-19 crisis. As we take advantage of telehealth services, there is uncertainty on when this may end. As people living with HIV who need consistent care, we must be the first to share our successful stories and advocate for increased access to telehealth beyond the COVID-19 crisis.