Gina Brown is doing what she can to protect herself from the coronavirus. The 54-year-old grandmother washes her hands religiously and wears a mask and gloves when she leaves home for groceries.
Still, she's fearful — not for herself, but for the more than 500,000 other people like her living with HIV in the South with immune systems that are vulnerable. In Louisiana alone, more than 20,000 people are living with HIV.
Louisiana now ranks third in the nation — behind New York and Washington state — in per capita cases of people infected with the coronavirus, with confirmed cases reaching 1,172 Monday.
But as the number of COVID-19 cases continues to surge, patients and health officials are worried how Louisiana, already at the center of the nation's HIV epidemic, will be able to protect this vulnerable population as it fights the spread of the new pandemic.
"I'm really afraid for the community," said Brown, the community engagement manager at the Southern AIDS Coalition who lives in Chalmette. "My heart is breaking."
In the decades since the first HIV cases were reported in New York City and Los Angeles, the epidemic has shifted from urban centers along the coasts to the 16 states and the District of Columbia that make up the South.
The region accounts for more than half of new HIV cases annually — even though it includes just 38% of the nation's population. Louisiana has the fourth highest rate of new HIV infections in the country.
In 2018, Baton Rouge ranked fourth among the nation's cities for its rate of new HIV diagnoses, with 27.5 cases per 100,000 people, and New Orleans ranked sixth with 24.6 cases per 100,000 people.
“We have poorer health outcomes than the rest of the country,” said Noel Twilbeck, chief executive of CrescentCare, a community health center in New Orleans. “That’s what our fear is: that the coronavirus will exacerbate the problems that already exist.”
The coronavirus has moved so quickly that public health data remain sparse. HIV targets a person's immune system, making them particularly susceptible to getting a viral respiratory infection, especially if they aren't receiving treatment.
In addition, nearly half of people living with HIV in the United States are over the age of 50, placing them at increased risk for severe illness from COVID-19.
There are also higher rates of lung cancer, cardiovascular disease, chronic obstructive pulmonary disease and emphysema among people living with HIV, regardless of whether they are on the cocktail of antiretroviral drug therapies to strengthen their immune system.
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And more than 80,000 people in the South are living with HIV and don't know it — more than in any other region in the country. That means they're not receiving treatment and could face potentially devastating outcomes if they contract COVID-19, said Dr. David Welsh, a pulmonologist at LSU.
The concentration of HIV cases in the region — which stretches from Texas along the Gulf Coast and up to Washington, D.C. — is driven by socioeconomic factors like poverty and unemployment and has largely impacted low-income communities of color.
Nearly half of all Americans without health insurance live in the South. Medicaid is the largest source of coverage for people with HIV in the country, but only seven of the 16 states in the region have expanded eligibility for the program under the Affordable Care Act. Louisiana did so in 2016.
States that didn't expand the government insurance program — including Texas, Georgia and Alabama — have had the most rural hospital closures, according to a study from the University of North Carolina.
Dr. Yihong Zheng, the chief medical officer at Baton Rouge's Open Health Care Clinic, is worried the coronavirus crisis will upend the routines of her patients' already fragile living situations, especially as Louisiana enters a three-week stay-at-home order.
"This situation is creating anxiety, uncertainty and disruption of already chaotic lives," Zheng said. Her clinic treats close to 1,000 people living with HIV, 200 of whom face difficulties remaining on treatment during normal times. That's because many people living with HIV are also battling poverty, mental health or substance abuse issues.
Clinics are offering telemedicine appointments to allow patients to remain at home for checkups, and pharmacies are delivering medicines through the mail. CrescentCare in New Orleans is recording podcast episodes on the coronavirus to keep its clients informed.
For Gina Brown, the silver lining of the crisis is knowing that Dr. Anthony Fauci, director of the National Institute Allergy and Infectious Diseases who has advised six presidents on HIV policy, appears to be in charge.
"Our community knows Dr. Fauci and trusts Dr. Fauci," Brown said. "We know that he is a champion for the community of people living with HIV."