Human Immunodeficiency Virus (HIV) remains a significant global health concern, affecting millions worldwide. Understanding the journey of individuals after an HIV diagnosis is important for public health. A primary step in this journey is connecting people to ongoing medical services, a process known as linkage to HIV care. This initial connection to healthcare helps manage the virus and improve health outcomes.
What Linkage to HIV Care Means
Linkage to HIV care refers to connecting individuals diagnosed with HIV to medical services and ongoing treatment. This ensures a person sees an HIV medical provider and undergoes initial health assessments shortly after diagnosis. This connection is often measured by at least one documented CD4 or viral load test performed within a specific timeframe, often within 30 days of diagnosis. Establishing this early connection allows for the timely initiation of antiretroviral therapy (ART). ART helps manage the virus, monitor health progression, and prevent the development of opportunistic infections.
Current Global and Regional Figures
Global efforts to address HIV are guided by targets set by organizations like UNAIDS. The UNAIDS 95-95-95 targets, adopted by United Nations Member States in June 2021, aim for:
95% of all people living with HIV to know their status.
95% of those diagnosed to be on sustained antiretroviral therapy.
95% of those on treatment to achieve viral suppression by 2030.
The second “95” specifically relates to ensuring that individuals diagnosed with HIV are promptly linked to care and remain on treatment.
In the United States, data from the Centers for Disease Control and Prevention (CDC) shows that for individuals diagnosed with HIV in 2022, approximately 82% were linked to medical care within one month of their diagnosis. The national goal for linkage to care in the U.S. is set at 95% by 2025. While progress has been made, disparities exist across different demographic groups. For example, in 2022:
Asian persons showed the highest percentage of linkage to care at 88%.
Native Hawaiian/other Pacific Islander persons were at 74%.
American Indian/Alaska Native persons were at 78%.
Black persons were at 78%.
Women were at 80%.
Factors Affecting Linkage
Several factors influence an individual’s successful connection to HIV care. Barriers include societal stigma and discrimination, which can deter individuals from seeking or continuing care due to fear of judgment or rejection. Practical obstacles, such as geographical distance to clinics, lack of reliable transportation, or perceived cost, can also impede access to services. Mental health issues, substance use disorders, or a lack of health insurance can present substantial challenges, making it difficult for individuals to prioritize or navigate the healthcare system.
Conversely, various facilitators improve linkage rates. Rapid HIV testing services connect individuals to care upon diagnosis. Peer support programs, where individuals living with HIV offer guidance and encouragement, can provide assistance and reduce feelings of isolation. Integrated health services, offering comprehensive care including mental health support and substance use treatment, can simplify the care process. Patient navigators or case managers guide individuals through the healthcare system, helping them overcome administrative and personal hurdles to access treatment.
The Broader Impact of Linkage
Successful linkage to HIV care has far-reaching consequences, benefiting both the individual and broader public health. For individuals, engaging in care leads to improved health outcomes. Starting antiretroviral therapy early helps suppress the viral load, which is the amount of HIV in the body, and strengthens the immune system. This viral suppression reduces the risk of developing opportunistic infections, which are common and severe in untreated HIV, and contributes to a significantly increased life expectancy.
From a public health perspective, successful linkage plays a role in controlling the HIV epidemic. When individuals achieve viral suppression through consistent treatment, the risk of transmitting HIV to others becomes negligible. This concept is widely recognized as Undetectable = Untransmittable (U=U), meaning that a person living with HIV who maintains an undetectable viral load cannot sexually transmit the virus. Therefore, connecting people to care not only enhances individual health but also serves as a preventative measure, helping to reduce new HIV infections within communities.