Science has made astounding progress in diagnosing, treating, and preventing HIV. Given the oral-systemic health connection, the impact on oral healthcare is significant.
By Genni Burkhart
Forty-two years have passed since the federal government recognized the first official acquired immunodeficiency syndrome (AIDS) cases on June 5, 1981. At that time, HIV and AIDS were highly stigmatized and drastically misunderstood, casting a shadow on those experiencing the anguish and hardship of this relatively new epidemic. Consequently, the CDC announced the first AIDS cases as rare lung infections affecting homosexual men in Los Angeles.
Thankfully, science and medicine have progressed in diagnosing, treating, and preventing the Human Immunodeficiency Virus (HIV) since then. AIDS is the most advanced stage of HIV infection and has tragically claimed the lives of over 700,000 brilliant minds, talented artists, friends, family members, and loved ones.
Oral health is essential for overall health and wellness, and for those living with HIV, it's imperative, as untreated issues can lead to infections, malnutrition, weight loss, and disease.
The Battle Continues
Today, approximately 1.2 million Americans are living with HIV. However, it's estimated that one in seven aren't aware they're infected.
Specific populations continue to be disproportionately affected by HIV, particularly people of color, homosexuals, and bisexuals. HIV stigma and discrimination also contribute to the disproportionate prevalence of HIV in these populations. Access to healthcare, HIV prevention, and treatment services are also limiting factors for many of these groups, compounding the issue further.
It's estimated that 34,800 new HIV infections occurred in the United States in 2019. However, there is some good news. According to the latest statistics from HIV.gov, a period of general stability occurred, and new HIV infections declined 8 percent from 37,800 in 2015 to 34,800 in 2019.
In 2020 there were 30,635 new HIV diagnoses in the U.S., a 17 percent decline from the previous year, likely due to the COVID-19 pandemic impacting HIV prevention, testing, and care.
However, the battle is far from over. In 2020, 18,489 deaths were reported from AIDS.
Access to Oral Care
For those living with HIV who are also under or uninsured, social determinants of health are often the most significant obstacles in obtaining oral care. These determinants include education, socioeconomic status, employment, social support, location and environment, and access to healthcare.
The Ryan White HIV/AIDS Program (RWHAP) was established with bipartisan support on May 16, 1990, to increase access to healthcare for those living with HIV/AIDS. Part F of this program, including the Dental Reimbursement Program (DRP) and the Community-Based Dental Partnership Program (CBDPP), provides funding for oral healthcare for people with HIV and education and training for oral healthcare providers.
Yet, oral health is one of the most unmet needs for those receiving services through this program. Realizing this problem, the Health Resources & Services Administration (HRSA) now promotes integrating oral health into primary care for people with HIV.
Facing the Stigma
TuftsNow recently reported on a highly successful community service learning curriculum for third-year students at Tufts University School of Dental Medicine (TUSDM) in partnership with the nonprofit Boston Living Center (BLC). The BLC provides a multitude of services, including oral healthcare, to those living with HIV/AIDS as well as other substance-use disorders and chronic conditions.
Karin Arsenault, Assistant Professor, Public Health and Community Service, Clinical Program Director, Geriatric Dentistry, and the Interim Chair of Public Health and Community Service, who also supervises students during their rotations, tells TuftsNow that early in the HIV/AIDS epidemic, there was stigma, fear, and apprehension in treating HIV-positive patients. Even those who did treat them, including private practices and dental schools, isolated those patients, using separate operatories and hours away from their regular patients.
However, universal precautions were eventually adopted, drastically reducing the risk of exposure to blood and other bodily fluids. Arsenault emphasizes, "As soon as we had a better understanding of how HIV could be transmitted, slowly some of the stigma associated with it started to go away, at least from the provider side."
For these TUSDM students, the experience of working at the BLC has been transformative. The deep connection with patients has been uplifting, full of laughter, and positive, as told by one student interning at the BLC. Through this experience, a new generation of dentists is helping to dispel the stigmas that linger in treating patients with HIV/AIDS and removing barriers to quality oral healthcare.
Oral-Systemic Health
The research, treatment, and prevention of HIV made significant advances last year, and the improvement in care since the onset of this epidemic in the 1980s has been remarkable.
The medical developments resulting from scientific research have allowed those living with HIV an opportunity to lead healthy, fulfilling lives with less stigma than those infected in the early years of the HIV/AIDS epidemic.
The impact of HIV research on oral health cannot be overstated since these breakthroughs affect oral-systemic health. In particular, those living with HIV/AIDS are at a greater risk of developing various oral health problems due to a weakened immune system.
The National Institutes of Health (NIH) lists these higher-risk oral health problems as follows:
- Aphthous (ulcers)
- Hairy Leukoplakia
- Candidiasis
- Warts
- Periodontitis
- Gingivitis
- Increased cavities
These problems can be lessened with the development of new treatments and possible cures, including the critical use of antiretroviral therapy (ART), thereby enhancing HIV-positive individuals' oral-systemic health and quality of life.
From the Worst News to the Best
In September 1988, Paul Edmonds of San Francisco, CA, received a medical diagnosis that "made his heart sink."
At just 33 years old, Edmonds was given the news that he not only had HIV but the more advanced stage, AIDS. Having just watched his friend waste away from HIV in a matter of months and faced with the constant heartbreak of watching the LGBTQIA+ community around him succumb to the virus, he suspected his days were numbered.
Now, at 67, Edmonds is one of only five individuals who've been "effectively cured" of HIV thanks to a breakthrough stem cell procedure used to treat leukemia. While this treatment is a significant breakthrough, it's not for everyone. The process depends on a rare genetic mutation and the complicated task of finding the exact right match. However, after four years out, Edmonds is still free of HIV.
When interviewed for an article on healthline.com, Edmonds stated his story's main takeaway: Don't give up. Having lived through the height of the HIV/AIDS crisis in the 1980s and 1990s, Edmonds no longer goes to the worst possible scenario when getting bad news. He now knows, perhaps better than anyone, that hope remains.
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Author: With over 13 years as a published journalist, editor, and writer Genni Burkhart's career has spanned politics, healthcare, law, business finance, technology, and news. She resides in Northern Colorado, where she works as the Editor in Chief of the Incisor at DOCS Education.
