Snapshot: HIV/AIDS in North Dakota
Scientific advancements mean that a diagnosis of HIV (human immunodeficiency virus) is no longer an automatic death sentence for patients.
But the miracles of modern medicine can sometimes be a double-edged sword. If they believe that the disease is no longer so serious, some people may not take the precautions that will keep them from contracting the disease or transmitting it to sexual partners.
“If you’re sexually active and you think you’re at risk of getting (HIV), then you should be on a pre-exposure prophylaxis,” said Dr. Casmiar Nwaigwe, an infectious disease specialist at Medical Arts Clinic in Minot.
According to the Centers for Disease Control and Prevention, the pre-exposure prophylaxis can reduce risk of contracting a permanent HIV infection by up to 92 percent when a patient takes the pill every day as ordered. When patients combine the treatment with other pre-cautionary measures, such as regular use of condoms, the risk of transmission is decreased even more significantly.
Patients must also visit a medical professional every three months while they are on the treatment.
There are also treatment options for people who have already been infected with HIV/AIDS that can help them lead long, healthy lives.
Treatment is no longer as burdensome as it might have been a couple of decades ago, when AIDS/HIV patients often took multiple pills a day at specific times.
“Most of our patients are on one pill a day,” said Nwaigwe.
The cost of treatment should also not deter patients from seeking treatment, as there are many programs that help patients pay for the medical care that they need.
“Paying for the treatment has not been a barrier for any of the patients we see,” said Nwaigwe.
Social and psychological barriers continue to exist.
“There’s still a lot of stigma, a lot of misinformation,” said Nwaigwe, who said newly diagnosed patients are often understandably terrified.
Red Fox Sanchez, the tribal health director for the Mandan, Hidatsa, Arikara Nation in New Town, said she thinks more education has improved awareness of HIV/AIDS, but it is still an uncomfortable subject for many on the reservation.
Doctors can help by providing treatment to stabilize them and information about living healthy lives.
“We help them understand they’re not alone,” said Nwaigwe.
Nwaigwe has a bag full of condoms in an exam room that is plastered with informational posters about HIV/AIDS. Patients sometimes take them when no one is looking, which is exactly the point.
Nwaigwe said North Dakota continues to be more conservative than some other places he has lived and some patients might not count on the support of their families. For instance, some patients might not want their family members to know that they are living with HIV or AIDS. Patients who are gay may not have told their family members that they are gay, even if all their friends are aware of their sexual preference.
People of any age or background or sexual preference can become infected with HIV/AIDS, but some populations are of greatest concern to the professionals at the North Dakota Department of Health.
Lindsey VanderBusch, HIV/STD/TB and viral hepatitis program manager at the health department, said the state has seen an increase in HIV infections in men who have sex with men and who are meeting their partners anonymously.
“We’re seeing a rise in (all) STDs, we’re seeing a rise in people who are unaware of (who) their sex partners (are),” said VanderBusch. “…You can’t wait for the health department to call and tell you that you might have been exposed… we don’t always know who they are.”
Sanchez also said that gay and bisexual men are at higher risk of contracting HIV/AIDS.
“For Native Americans, HIV has increased with gay and bisexual men by 63 percent over the last decade,” she said.
In 2015, of the 152 diagnoses of HIV among Native American men in the country, some 79 percent or 120 were among gay and bisexual men, said Sanchez. Of the 55 Native American women who were newly diagnosed with HIV, 40 of them contracted it through heterosexual sex. HIV diagnoses rose about 19 percent among Native Americans overall between 2005 and 2014, but went up 63 percent among gay and bisexual men over that time period, said Sanchez.
The state health department refers to this population as “men who have sex with other men” because some of them identify as heterosexual but have sex on occasion with males as well.
Both Nwaigwe and VanderBusch emphasized that medical professionals will not judge behavior, but it is important for people to protect themselves and their sexual partners by taking the preexposure prophylaxis if they have not been exposed or medication that can suppress the virus in their body to undetectable levels if they have already been exposed to HIV. Intravenous drug users are also at higher risk of contracting HIV.
“The majority of our cases are young,” said VanderBusch, in their twenties. She said the prevalence of HIV/AIDS in North Dakota is low compared with other states.
“Last year our prevalence was 390 individuals,” said VanderBusch. She said cases are spread out across the state.
Statistics show a higher rate of HIV/AIDS infection among blacks, a category that includes both native born African Americans and immigrants from Africa. Some have moved to North Dakota from out of state, but were infected with HIV in other places. Once they are treated and the condition is stabilized, the majority are able to lead healthy lives, their virus level is undetectable and they cannot transmit the disease to others with casual or intimate contact.
“There’s not any risk to the people in your community, even if they bleed,” said VanderBusch.
Still, it’s not a virus that should be taken lightly, even though it is more akin to a chronic medical condition than the deadly disease it was when the public first became aware of AIDS in the 1980s. It is better that people take precautions so they never catch it at all, said VanderBusch.
“It’s still a hard road, there’s still a lot of complications, a lot of healthcare (that is required),” said VanderBusch.
Sanchez said costs can also be significant, even though there is assistance available.
“The lifetime treatment cost can be estimated to $379,668,” she said. “There are patient assistance programs for persons living with HIV to help with the cost, the Affordable Care Act is also a resource… by the way, open enrollment ends on December 15, 2017. The Ryan White Program, a comprehensive system of care that includes primary medical care and essential support services for people living with HIV who are uninsured or underinsured (also helps.) The program works with cities, states, and local community-based organizations to provide HIV care and treatment services to more than half a million people each year. The program reaches approximately 52 percent of all people diagnosed with HIV in the United States.”
Education is another component that professionals say is hugely important.
Ninth graders at Minot High School, as at other schools across the state, learn about sexually transmitted diseases including HIV and methods of prevention. Minot High emphasizes that abstinence is the best way to protect against contracting the disease.
Teens on the Fort Berthold Reservation participated in a youth conference last spring to educate the public about HIV/AIDS.
“On March 20, MHA Nation Tribal Health held a Native American HIV/AIDS Youth Conference to recognize National Native American HIV/AIDS Awareness Day,” said Sanchez. “My assistant, Mariah Antell and I brought in a HIV survivor to tell her story, the state health department addressed students of what HIV/AIDS and other STDs are and how to protect themselves, Deanna Romero, Physician Assistant and a certified HIV specialist of Salud Health of Denver, Colo., spoke about providing HIV care to Indian Country. We also had rapid HIV screening for students and as an incentive. Once students got their results back they got a door prize ticket for a chance to win a pair of Bruno Mars concert tickets that was held in Fargo in August. We also had the students play the HIV transmission hand shake game where they could see how easy it is to catch/spread not only HIV but other STDs. The response was great from students and I was surprised of how open the students were with their questions. I was happy to see they were not scared to ask questions. Mariah and I are working on being able to rapid HIV screen in our tribal health department for anyone who wants to know their status, making easy access for the people living on Ft. Berthold Reservation.”
Sanchez said she and Elbowoods Public Health Nursing Director Marilyn Yellow Bird are continuing to work to bring more awareness, education and prevention activities to Fort Berthold.
“HIV/AIDS is an uncomfortable subject and I want to bring everyone out of that so they can start talking openly about HIV/AIDS, STDs and sex with their children, nieces (and) nephews, granddaughters (and) grandsons in order to protect themselves,” said Sanchez. “A good start was on December 1, 2016 on World AIDS Day, Marilyn and I conducted the first rapid HIV screening for the public. I was not expecting a lot of people to show but in the end we had to exceed our screening times because we had (a) good number of people get screened and educated… I think the stigma is lesser, but it could be better. One day I would like to see where people can accept HIV as a chronic condition, end the stigma, live full, healthy lives and of course most important of all, find a cure!”