Why are more Alaskans in the Interior contracting HIV?

HIV infecting a human cell. (NIH Image Gallery from Bethesda, Maryland, USA, Public domain, via Wikimedia Commons)

The federal Centers for Disease Control and Prevention is working with Alaska’s Division of Public Health to better understand why Fairbanks and the Interior region have seen a cluster of new HIV cases over the past two years. The division requested the CDC’s help to assess what barriers to care might have contributed to the cluster; they completed interviews during August and in October shared results of the assessment with care providers and nonprofits. 

The Fairbanks and Interior region of Alaska sees an average of three new cases of HIV per year, according to the division of public health. But in 2022, there were ten new cases which led to a public health advisory the following January about the cluster. 

Joe McLaughlin, an epidemiologist for the Division of Public Health, said since then, more connected cases have emerged.

“There have been about 24 cases over the last two years, and not all of them are interior cases, but all these cases are linked to the interior cluster,” McLaughlin said. “So, they’re all part of a larger cluster that’s occurred over the last two years.”

The division said it hasn’t seen cases rise throughout the state in general. But, because of the size of the cluster, McLaughlin said the division asked for help from the CDC’s HIV specialists. McLaughlin said typically the division asks for help from the CDC about once every two or three years for support understanding and addressing Alaska’s public health challenges. The CDC talked to health care providers and community members “associated with the cluster” to find out more information about who is vulnerable and why. 

McLaughlin said male to male sexual contact is the main way new cases were transmitted and the assessment found two big risk factors in those newly diagnosed. 

“One is condomless, or barrierless sex, and the other is multiple sexual partners,” McLaughlin said. 

Liz Ohlsen, program manager for the HIV/STD program for Alaska’s division of public health, said more than half of new HIV cases in the cluster were people under 34 years old. 

She said every new positive case is significant, but she said a lot has changed about HIV transmission and treatment in the past decade. 

“People who know their status and know that they’re HIV positive, and are able to get adequate treatment can have undetectable viral loads, and when you have an undetectable viral load, that means that we don’t see transmission through sexual activity,” Ohlsen said. “That means that there isn’t transmission during sex.” 

Current treatments also allow people to live long lives. Over half of people living with HIV in the US are over age 50. And Ohlsen said, pre-exposure prophylaxis or PrEP for short, is a medication that’s extremely effective for preventing HIV transmission. 

PrEP is a pill people take every day and in 2021, the FDA also approved an injectable version which lasts for two months. It’s 99% effective at preventing transmission of HIV from sex when taken as directed. 

Ohlsen said part of the work to reduce HIV transmission in Alaska is making sure barriers to PrEP and HIV testing are reduced and one of the biggest barriers to care is stigma. 

“We really need opportunities for people to get on PrEP, in particular, and to try to combat the stigma that’s preventing people from talking with their doctors about PrEP, from getting tested for HIV, and from talking with partners about HIV,” Ohlsen said. 

And Ohlsen said this stigma varies from social group to social group in Alaska. 

“Some of our social groups have shifted to be much more open around, ‘Hey, I got tested this week.’ ‘Hey, I’m on PrEP now.’ ‘Hey, are you taking PrEP?’ Ohlsen said. “And I think a lot of other social groups aren’t as experienced at helping people connect to PrEP, and helping people know that they should get tested regularly.”

Alaskans can find out about HIV testing and prevention from their health care providers or through the Division of Public Health.

This is part one of a two part story. The second part will look at why people in Alaska have trouble accessing PrEP medication and how the state and nonprofits are addressing barriers. 

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Rachel Cassandra covers health and wellness for Alaska Public Media. Reach her atrcassandra@alaskapublic.org. Read more about Rachel here.

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