In 2019 the U.S. Department of Health and Human Services (HHS) announced a bold plan, Ending the HIV Epidemic in the U.S. (EHE) to end the HIV epidemic in the United States by 2030. When the first cases of AIDS emerged, people believed that only men who had sex with men can contract the virus but after doing thorough research, it was disclosed that the virus can be transmitted through anal, or vaginal sex, or sharing needles, syringes, or other drug injection paraphernalia.
There’s been a massive improvement with treatment in the last vicennial. From taking daily pills to receiving injections 6 times a year.
I had such a wonderful educational time speaking to Dr. Maurice Brownlee “Dr. Mo” Chief Wellness Officer and Medical Director at Baal Perazim Health and Wellness Services. The conversation was centered around the evolution of HIV, particularly about injectable PrEP, HIV medication, and the EHE initiative to reduce the number of new HIV infections in the United States by 75 percent by 2025, and then by at least 90 percent by 2030, for an estimated 250,000 total HIV infections averted.
Sit back and enjoy the interview.
Thank you, Dr. Mo, for your time today. What is the inspiration behind your choice of career as a health practitioner?
Yeah. So, I got into health care because of the disparity that I saw in our community, particularly the black and brown communities. I just did not see enough of us people of color. And when I did see it, I didn’t see enough reaching back. And so, I wanted to be a part of that. That’s the reason why I leaped to do what I do. I wanted to make a change. I want to be able to provide health care from the perspective of someone who didn’t have health care. There have been many times I didn’t have health care and I didn’t know how I was going to be able to see the doctor. So, once you have walked in those shoes, you’re able to understand. You’re able to have empathy.
When you say HIV, I see life. I see happiness. I see the same thing that I see in my patients who are non-infected, and who don’t have HIV. No difference.
So, when we talk about HIV, as an HIV Specialist and a black gay man, what’s the first thing that comes into your mind?
It has evolved. Before I got educated on HIV many, many years ago, I would see sadness, I would see gloom, I would see despair and hopelessness. But I must tell you now, having treated over 3000 patients with HIV, when you say HIV, I see life. I see happiness. I see the same thing that I see in my patients who are non-infected, and who don’t have HIV. No difference. So, when we talk about that, that’s my perspective. Believe it or not, we are only seeing about three new HIV cases a year at my organization. So that’s phenomenal, right? So new acquisitions, at least in this area of HIV cases, have declined. And by next year, when Gilead Sciences introduces its new product to the market, it is going to be instrumental in reducing the number of new HIV infections in the United States by 75 percent by 2025, and then by at least 90 percent by 2030. But we have to make sure that people have access to the new stuff. However, going back to the question, what do I see? I mean, I see a life equal to a person who does not have HIV. So, I am positive, I am optimistic when it comes to HIV.
But the one thing I think I will tell you is this: We as African Americans or people of color, we’ve got to do better. And what I mean by that is when we have gotten this diagnosis, we have to stay in care. And we got to be responsible. I can’t tell you how many people of color have HIV and fail to disclose their status. I can’t tell you how many people of color living with HIV and AIDS and refuse to take their medications. And here’s what they do, Perez, they run to my white counterpart, and my white counterpart would tell them straight up; If you’re not going to take your medicine, you need to stop wasting my time. And they will fire them from their practice. And then they (people of color) will say it’s racism. But they just wasted that provider’s time. We are living in an era where many HIV Specialists are retiring and leaving the specialty. This means available appointments are dwindling, when we are non-compliant, or we miss our appointments we take an appointment from a patient who is compliant.
I’m the same way. You’re not going to have me in a room for 20 minutes every two months or whatever the case may be, telling you the same thing. If you don’t want to take responsibility for your diagnosis or who you are, then there’s nothing I can do. I’m going to give you the tools that you need to be successful in living with HIV, but you, the patient must be responsible. This means, taking your meds, disclosing your status when the time is right, stay engage with your provider, and showing up for appointments.
I will emphasize all that to say this. And here is what separates me from other providers. I understand that people of color are challenged with a different set of social determinants and barriers that we cannot ignore. So, when I encounter a patient who is not taking his/her meds. I ask, do you have food? Do you have a place to live? I understand that food, and shelter will almost always take priority over adhering to medication.
Wow! Thank you so much, Dr. Brownlee. You know, you’ve even you’ve answered my third question. Let’s talk about injectable PrEP and HIV medication: Do you think this is the road to Ending the HIV Epidemic in the U.S. and why?
Let me tell you, Perez. It is so amazing. And it’s like a moral issue for me because the pharmaceutical companies, don’t need my help and they don’t need your help either. They are making money like crazy. And we know that they did us wrong. They did all this research about HIV and AIDS and medications, but they never included us in the studies knowing that our bodies were so much different than our white counterparts. So, it’s almost sad. But I got to give props were props due. This is a game changer but there are two parts to it:
- At least here in Illinois, the good part is that it’s such a game changer because if you do not want to take a pill every day, you don’t have to. Now you can take a shot and you could take that shot every two months. You don’t have to go every month. So, the bottom line is, if for whatever reason, you don’t want to take the pills every day, then there is another option for you. You can now take a shot. And that shot is every two months.
- Now, here’s the sad part about it. Insurance companies have been very slow to catch on. And so, what that means is this: for example, I’m in Illinois’ and on the commercial side, Chicago Blue Cross and Blue Shield of Illinois seem to be denying all of my patients’ requests for injectables. Other insurance companies are denying them as well. So, you have people who have been on the fence about PrEP for HIV prevention and are now reconsidering. They are telling me If there’s an injectable, I’ll take it! And these are people who have insurance. And so that person who we couldn’t convince to consider PrEP to prevent HIV is left on the fence. Providers now have an extra tool to link at-risk people to HIV prevention, but insurance has become a barrier for many. Here’s the good news, at least in Illinois it is. Medicaid is covering the injectable PrEP. Back to your question, what is even more exciting, about HIV and HIV prevention is there are every six months injectables in the pipeline as we speak. This is a game changer in our fight to reduce the number of new HIV infections in the United States by 75 percent by 2025, and then by at least 90 percent by 2030, but we got to do more! We got to start advocating for insurance companies to cover these injectables now. You can’t tell me that you have something that will help us but only a certain amount of people can have access.
Insurance companies want you to go on taking the pills instead of the injectables because they cost more.
If I’m getting your point correctly, insurance companies are being barriers to injectables right now. What is their excuse or what is the main problem? Is it because it’s too expensive?
Years ago, Perez, this little bottle prep medication was 1300 to 2000 dollars a month. Now, I buy this little bitty bottle of medication for $10. And It’s Truvada. So, what your insurance wants you to do is they want you to go on that instead of the injectables as they do cost more. That is the difference. So, yes, there is a major barrier when it comes to accessing it. It is cost. However, could the medication be a little cheaper? Perhaps it could be. But the battle that I have now is with the insurance companies. This is because people who are at risk should be able to have access to injectable medications and nothing should stop that from happening.
Boys and Men of Color (BMOC) have some of the most disparate health outcomes as a result of broad, social factors. What advice do you have for BMOC today with regard to health and wellness? Now, this is not just HIV. This is health and wellness.
That’s a good question. So, we know that wellness starts at a very young age, and part of the reason why BMOC lag behind their Caucasian counterparts is that we were not introduced to the healthcare system at an early age. And so, I tell my young mothers and my young fathers to:
- Introduce your young people to the health care system. But it has to be the right system. Find a system that is welcoming, provides preventive care and introduces them to that system. Let them see you getting preventive wellness care. Let them see you being happy about going to see your provider. Let them see you engaging in your health with your provider. When they see that, they would mimic that behavior so that when they do get of age, they would do the same thing. And they won’t go years and years without being engaged with some type of health provider. And when it’s time to elect insurance benefits or so on and so forth, they won’t have the attitude that my health is second and they would have the attitude that even if it’s $50 a week out of my paycheck, I’m going to pay it because my health is first.
For the youth today, I will tell you:
- Stay engaged with your healthcare provider.
- Be responsible. When you show up for your appointment, know what you’re going to the doctor for. If you can’t remember your symptoms, put them on your phone because one of the new things happening is that some healthcare providers are gaslighting patients. Patients are coming in, they’re trying to explain what’s going on, and the providers are throwing them off. But if the patients are going in, knowing what they’re talking about, and being able to explain what’s going on, then they are more likely to be taken seriously.
- Show up and be on time for your appointments. This is also a part of being responsible and respectful of your healthcare system. Remember respect is earned, not given. If you are not going to respect your healthcare system, it is not going to respect you.
- If you’re given and you have agreed to a treatment plan, follow it. I can’t tell you how many BMOC living with diabetes come in for their diabetes check every three months with crazy blood sugars (A1C). Undoubtedly, it’s because of poor compliance. But, on the same visit, they will ask for a Viagra prescription.
So, I get my prescription pad and write: “You wouldn’t need Viagra if you controlled your blood sugar. Take your medication!”
Thank you so much, Dr. Brownlee. This is very educational.