Sunday, December 1, is World AIDS Day, and we’ve come a long way since the first World AIDS Day in 1988. But despite medical strides, people still face barriers to accessing sexual health care, particularly in remote and transient communities like Provincetown.
That's why registered nurse Jeffrey Schaffer started a program at Outer Cape Health Services called testNtreat. CAI’s Gilda Geist spoke with Schaffer to hear how the program is going five years in.
Gilda Geist What is the Outer Cape Health Services’ testNtreat program?
Jeffrey Schaffer I started this program in 2019 because Provincetown is a very transient and visited place. I would see people trying to access services for sexual health and run into issues with insurance coverage, whether they didn't have it or it was based in another state. So I started this program to provide access to testing and to treatment so that would be more accessible for folks.
GG What kinds of services do you provide through the testNtreat program?
JS We can do sexual health testing and treatment. We also provide access to PrEP, which is HIV pre-exposure prophylaxis, which means that if you're at risk for acquiring HIV—which would really kind of be anybody who's sexually active or involved in injection drug use—PrEP is a way to protect yourself from HIV.
So PrEP is 99 percent effective. It's a pill, or now there's also an injection. There's also PEP, which is a post-exposure. So if you, let's say, have a sexual encounter where maybe barrier protection like condoms were used, but then maybe not completely used or failed, and you might be at risk for acquiring HIV, then there's a post-exposure regimen which we can provide access to as well.
In addition, we also provide HIV case management, because one of the great ways of preventing HIV transmission is called U=U, or undetectable equals untransmittable. It’s a way of looking at treatment as prevention, meaning that if someone is living with HIV and they're undetectable—meaning that for at least six months they've been on medication and that their labs show that they have an undetectable viral load in their blood—then they cannot transmit it sexually to someone else.
So all those are things that we now have in our toolbox. And testNtreat is developed to help people access those, because with the health care system as it is, it's not easy to really acquire those tools.
GG The way we as a society talk about and deal with HIV has changed a lot over the years. Now that we have these treatment options like PrEP and PEP, what would you say is the biggest issue with HIV today?
JS I think the biggest issue today is that it's still assumed to be associated with things that people have stigma about. So whether it might be injection drug use or sexual activity, people have feelings about those kinds of things, and judgments.
Like if someone's diagnosed with lung cancer, there's different empathies that we may or may not give someone based upon whether they never smoked a day in their life, or whether they smoked a pack a day. And so the more that we as a society get towards looking at something as not a judgment and just going like, ‘I’m going to treat this person. How do we get to the point that it's not contagious and that person's taken care of and not worrying about where it came from?’ the better for everyone. Because stigma associated with this results in people not getting tested because people don't want to get tested, because they don't want to find out they've got it because then they have to deal with it.
GG What is one thing you wish people understood better about HIV?
JS We as a society have so much judgment about sex, but yet, everybody's having it. I think we get so wrapped up in trying to make it pathological that we forget that it's also part of a healthy life. The way I look at it is, ‘What's my goal as a provider?’ I always say my goal is for someone to be comfortable and safe where they're at. So whether that's with one person, a mutually monogamous relationship, or whether it's polyamorous, or whether they're just dating around and sex is part of that journey, I think it’s something so ingrained in being a human being that having judgment against it doesn't make any sense.
