MIAMI _ "HIV happens despite COVID-19."
That's the terse message blaring out of a digital billboard adjacent to I-395 in downtown Miami.
Pridelines, the local LGBTQ community center behind the ad, hopes it will help raise awareness of the HIV testing services that are still being offered at the organization's headquarters, near Little Haiti, despite the coronavirus outbreak.
The publicity is badly needed.
Although Pridelines has long been performing HIV screening at its brick-and-mortar center, the bulk of its tests have traditionally been administered out of mobile units that tested people at places like college campuses or in front of nightclubs. Because of COVID-19, that mobile testing program is now shut down.
Another change: all tests provided at the Pridelines center are now done by appointment-only, to make sure there's no more than two people in the building at any given time.
"For us, we have seen a significant drop in the number of people we are testing," said Victor Diaz-Herman, Pridelines CEO. "That's why we have our billboard up ... Just because we are dealing with this coronavirus pandemic doesn't mean that HIV all of a sudden is going to stop."
Pridelines' situation isn't unique, as the spread of coronavirus has disrupted the work of many other centers on the frontlines of HIV/AIDS _ a deadlier infectious disease than COVID-19, if untreated _ across South Florida. The result is a narrower set of options for community members seeking to know their status, this at a time when being immunocompromised means greater vulnerability to the ongoing pandemic.
Last month, the Pride Center and Broward House suspended their HIV testing operations, citing coronavirus. Meanwhile, the AIDS Healthcare Foundation, or AHF, has stopped offering routine testing at its six wellness centers in Miami-Dade, though facilities remain open for treatment, and to test people who believe they've been exposed to HIV. AHF's mobile clinic testing has also been suspended.
The interruption of HIV testing services is taking place as health departments nationwide redeploy infectious disease staff away from STDs and toward emergency coronavirus response roles. That combination, according to experts cited by Politico, could lead to higher rates of STD transmission.
Although the disruption to the HIV prevention system is happening on a national scale, this is where the aftermath could be particularly troublesome, since the Miami metropolitan area is already home to one of the highest rates of new HIV infections in the country.
"We have one of the highest rates of new cases in the U.S.," said Diaz-Herman. "So it's certainly not a time for us to stop doing the work."
Health experts agree that those who know their HIV status and have access to medication are at no greater risk than the average person from the coronavirus.
"The general belief is if someone is HIV positive and they are virally undetectable and their CD4 count (of white blood cells that fight infections) is at" a normal range, "then they are no more or no less likely to have adverse reactions from COVID-19 than anyone else," said Michael Kahane, AHF's southern bureau chief.
The real worry, experts say, lies with the more than 160,000 Americans living with undiagnosed and untreated HIV, whose compromised immune systems could make them more vulnerable to coronavirus.
That's where testing _ the first step to knowing your status and securing treatment _ comes in.
"We think testing is incredibly important," said Stephen Fallon, executive director of Latinos Salud, an HIV prevention group that runs two offices in Miami-Dade and one in Broward County. "A missed opportunity to test somebody and let them know their status might have been your only opportunity ... to let them know to get treated."
As one of the only providers in South Florida still accepting walk-ins for testing, Latinos Salud is seeing more foot traffic at its offices as well as a higher number of new diagnoses, according to Fallon.
"Oddly, March was our second highest number of HIV diagnoses in our 11-year history," he said. "It's alarming. We are a small-ish agency, and to get a dozen new HIV diagnoses in just the month of March is very high for us."
Fallon and Diaz-Herman, from Pridelines, said it's important to continue making treatment accessible throughout the coronavirus crisis.
"We can't just focus 100% of our resources on coronavirus and then forget that there are other diseases that still exist out in the world. HIV is not going to go away because we're dealing with a pandemic," said Diaz-Herman. "We want you to continue to get tested to ensure that if you do contract HIV, that we can get you on treatment sooner rather than later so that your immune system can be strong enough not only to lead a healthy life but also to survive this pandemic."
The fact that testing services are still being provided at some sites doesn't mean it's business-as-usual, as several new precautions are being taken to keep community members and staff safe from COVID-19.
At Latinos Salud, no more than two people are allowed in the building at any given time. Facilities are disinfected three times a day, including a "deep disinfecting" at the end of the day that requires closing time to be moved up by an hour. All client-facing staff members must wear masks.
"We are also handing masks to anybody that comes in the door for testing and they have to wear it, because we can't maintain social distancing if I'm holding your arm to draw blood from you," Fallon said.
Over at Pridelines, staff is now equipped with protective equipment _ including N95 respirator masks and gloves _ and test seekers must answer preliminary screening questions to determine if they've exhibited any of the symptoms associated with COVID-19. A plexiglas panel will soon be installed around the center's reception desk as well as in testing rooms.
Centers that are no longer seeing clients in person are finding ways to support their communities by turning to telehealth and virtual counseling.
For instance, the Pride Center's testing counselors are answering questions about HIV, medical adherence, and related health topics on the phone, fielding over 100 calls every day. They're also referring people in need of testing to providers that haven't suspended services.
For centers that are still open, managing to provide services while still keeping clients safe is a crucial needle to thread.
"I know that everybody's attention is properly on the coronavirus because that is the new threat at hand and I do not want anyone to be cavalier about it or take any risks, including our staff, but at the same time, the HIV pandemic has been with us a long time and it's not going away in Florida," said Fallon. "We have to keep our eye on the ball."
People seeking to get tested without leaving their homes can request a free at-home HIV test kit from the Florida Department of Health.
