National HIV Testing Day is a day to encourage people to get tested for HIV, know their status, and get linked to care and treatment. However, as we observe the 24th annual National HIV Testing Day, it's not enough to simply tell people to get tested. Conversations around HIV have become more normalized thanks to the work of HIV activists and storylines in shows like Empire and POSE. But more needs to be done offscreen by health care providers to ensure that young people, especially LGBTQ youth of color, feel empowered to get tested and have access to additional services, like pre-exposure prophylaxis (PrEP), the daily HIV prevention pill, after their results.
About half of young people living with HIV are unaware of their status, according to the Centers for Disease Control and Prevention. While this statistic may be shocking, many young people are unaware because they aren't accessing care due to prior negative health care experience. Unfortunately, I see firsthand the barriers young people face. At Advocates for Youth, the nonprofit sexual health organization I work for, we're working to support LGBTQ young people and youth living with HIV in their own advocacy efforts to raise awareness about lack of accessibility to PrEP. We're also working with young people to ensure sex ed curricula are inclusive and honest and that legislation is passed in states so people living with HIV cannot be criminalized.
Discrimination in health care settings prevents young people, especially LGBTQ young people of color, from engaging in care and getting tested.I see the harms health care discrimination causes close friends when they attempt to access services like PrEP and post-exposure prophylaxis (PEP), medication taken within 72 hours after a potential exposure to HIV. Last month, a friend confided in me that he wanted to begin taking PrEP, which virtually guarantees that a person will not acquire HIV. He identifies as bisexual, but he wasn't out to his doctor, whom he shares with his mother, for fear of being outed. After receiving his negative HIV test results, he asked his doctor about PrEP, to which his doctor responded, "Mostly gay people are on PrEP. Just use a condom." His doctor followed up with inappropriate questions about his sexuality and sexual history. Nervous that he would be outed to his mom, he no longer felt comfortable discussing his sexual encounters with his doctor. As a resilient young person, he fortunately has found a doctor he is comfortable with and who has provided him with a PrEP prescription.
While my friend's story demonstrates a determination to get PrEP, this is not the case for many LGBTQ young people of color who, once denied care, rarely seek out additional health care options. Stigma, discrimination, and confidentiality concerns prevent LGBTQ people, especially young people of color, from accessing crucial sexual health services. Among transgender people who had visited a doctor or health care provider's office in the past year, 29% said a doctor or other health care provider refused to see them because of their actual or perceived gender identity. When a young person's identity and experience isn't validated in a health care setting, they lose the confidence to be their authentic selves in the presence of a provider. This may cause a young person, like my friend, to fear disclosing important information about their identity and health, which can be life-threatening.
Health care providers can do more to support LGBTQ young people and youth living with HIV. On an institutional level, health care providers can increase their support for LGBTQ young people and youth living with HIV by participating in free LGBTQ health trainings. They can create an LGBTQ-friendly atmosphere by providing staff with trainings on culturally affirmative care, routinely asking all patients about their sexual health history, and hosting community events in collaboration with local LGBTQ organizations. They can also support efforts that protect and expand young people's access to sexual and reproductive health services like PrEP. In addition, health providers should externally promote the LGBTQ-inclusive services offered at their health center. Take Cleveland Clinic, for instance -- the Clinic includes information on LGBTQ health, how to access PrEP, and a list of respectful and competent providers directly on its website. This is key. By including information about LGBTQ health on their websites, health centers have an opportunity to remind LGBTQ young people that their lives are valued and validated.
Legislators can play a significant role in HIV education and health care, too.Efforts to ensure young people have access to and information about PrEP aren't radical. Three years ago, California Governor Jerry Brown signed a bill ensuring that HIV-negative individuals who may be at high risk for HIV will receive information about PrEP and PEP during HIV post-test counseling. In April 2019, the Connecticut House of Representatives introduced a bill allowing minors to access HIV and sexually transmitted infection services, such as PrEP, without parental consent. Last month, Atlanta's Mayor Keisha Lance Bottoms introduced legislation to boldly expand access to PrEP, and it was unanimously approved by the city council. Atlanta's legislation authorizes $100,000 to provide PrEP to groups that include LGBTQ young people of color. These legislative wins confirm what many of us already know: Young people deserve confidential, honest sexual health information about PrEP.
On this National HIV Testing Day, and as the administration touts its "HIV plan," we have a responsibility to do more than just point at young people and tell them to get tested. It's our moral imperative to break down the institutional barriers that keep young people from getting tested and accessing care in the first place. All LGBTQ young people, including my friend who had to jump over hurdles to access PrEP, deserve care from providers that is inclusive, non-stigmatizing, and promotes the benefits of PrEP. Health care providers have a duty to ensure that young people seeking them for care are valued, respected, and treated with dignity.