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Diagnose all people as early as possible

The first step to ending the HIV epidemic and eliminating HCV in Indiana is to ensure early diagnoses, reducing the number of people who are not aware of their status. Studies show that earlier detection of HIV/HCV, and adherence to treatment, results in better health outcomes and reduces the chance of transmission.[1] In fact, the CDC estimates that nearly 40% of new HIV infections are transmitted by people who are not aware they are HIV positive.[2] In 2019, an estimated 87% of PLHIV in Indiana were aware of their status, compared to the national goal of 90%. The 13% of Hoosiers who are unaware of their HIV status translates to over 1,800 people who are not receiving the treatment and medical care they need.[3]

The IDOH estimates that there are 69,000 people living with acute or chronic HCV in Indiana in 2020. Nationally, an estimated 40% of PLHCV are unaware of their status, because early-stage HCV often does not cause symptoms.[4] That creates a possibility of 27,600 Hoosiers living with HCV who are unaware of their status, and at heightened risk of long-term complications and transmission to others.

For Indiana to meet the national goal of 90% of residents knowing their HIV status, the Diagnose pillar focuses on the singular goal of diagnosing all people with HIV or HCV as early as possible. This goal will be achieved through integrated strategies around increasing universal HIV/HCV screening and testing, targeted testing for high-risk populations and pregnant women, improved engagement at all levels and types of healthcare providers, and expanded messaging that appropriately appeals to various audiences.  

Engaging PWLE in meaningful ways – through their social networks, as well as paid opportunities within their communities – is an important component in the strategy implementation. Healthcare providers are also called upon to expand their education and involvement by integrating universal HIV/HCV screening and testing into their current practice.

Enhancing and establishing relationships across all types of partners, providers, government entities and high-risk populations is the foundation of this pillar. Building trust and reducing stigma are critical to creating environments that increase the motivation and comfort for people to get tested.

Developing culturally appropriate messaging and communication must connect to the special needs and life contexts of those who are marginalized because of race, ethnicity, socioeconomic status, sexual orientation, age, or gender. Cultural competency must be demonstrated not only by intervention programs and staff but also by surveillance staff, researchers, and those delivering prevention services, care, and treatment programs for HIV/HCV. They must be able to adapt their approaches to benefit individuals and groups from varying cultural backgrounds.[5]

Finding ways to quickly connect people who test positive to immediate comprehensive treatment will have the most impact on ending the HIV epidemic and eliminating HCV in Indiana.

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[1] US Department of Health and Human Services. (2020). Viral Hepatitis National Strategic Plan. Retrieved December 22, 2020 from https://www.hhs.gov/sites/default/files/Draft-Viral-Hepatitis-National-Strategic-Plan-2021-2025.pdf

[2] Centers for Disease Control and Prevention. (2020). Cultural Competence in Health and Human Services. Retrieved from https://www.cdc.gov/dhdsp/docs/cultural_competence_guide.pdf

[3] Centers for Disease Control and Prevention. (2011). High-Impact HIV Prevention. Retrieved from https://www.cdc.gov/hiv/pdf/policies_NHPC_Booklet.pdf

[4] Centers for Disease Control and Prevention. (2020). HIV Testing. Retrieved November 21, 2020, from https://www.cdc.gov/hiv/testing/index.html

[5] Indiana Department of Health. (2019). HIV Statistics. Retrieved from https://www.in.gov/isdh/23266.htm