Ten years is a rather monumental anniversary. For married couples, a decade together might warrant a party, a nice dinner, or traditional gifts made of aluminum or tin to signify the union’s ability to last through time. But for the partnership between Walgreens and Greater Than AIDS, there was only one way of celebrating the milestone: making their in-store, free HIV testing program the biggest it has ever been.
Tina Hoff, senior vice president of the Henry J. Kaiser Family Foundation (KFF), the organization behind the public information initiative Greater Than AIDS, had been planning this year’s testing event for months. As in past years, the plan was to bring community-based organizations and local health agencies to Walgreens stores around the country in support of National HIV Testing Day on June 27, so that anyone who walked in the door could get a free, confidential HIV test, counseling and educational materials to help connect them to appropriate care. Over the last nine years, the Greater Than AIDS/Walgreens National HIV Community Partnership has provided more than 57,000 free HIV tests and reached even more with information.
“Since this is our 10th year working with Walgreens, as well as the 25th anniversary of National HIV Testing Day, we were looking at having the highest level of participation we've ever had, in the highest number of cities,” Hoff says. “And then, COVID-19 hit.”
As the pandemic spread across the U.S., non-emergency healthcare was thrown into a state of limbo. Routine vaccinations were missed, cavities went unchecked, elective surgeries had to be rescheduled. Like so many other healthcare providers, those focused on HIV found themselves limiting in-person non-emergency care. Concern mounted that there would be an increase in HIV rates as a result.
Thanks to science, there are medications that can effectively keep HIV at undetectable levels, as well as pre-exposure prophylaxis (PrEP) which preemptively protects high-risk individuals from contracting HIV. But here’s the rub: without testing and access to appropriate healthcare professionals, patients living with and at risk of acquiring HIV will not benefit from these advancements, and HIV can easily spread through communities – especially those that already suffer from health and economic disparities.
At the corner of smashing stigma
Even pre-COVID-19, getting people tested for HIV was a challenge. When Walgreens began working with Greater Than AIDS a decade ago, the hurdle wasn’t social distancing, but stigma.
“There was a lot of interest in seeing how we could bring more attention and support to particularly hard-hit parts of the U.S., and Walgreens had such great visibility and presence in so many of the communities we were looking to reach, Hoff recalls. “By bringing local providers into Walgreens stores, we help them connect with their communities in ways that break down that stigma and lets them develop relationships.”
Maybe next year, HIV Testing Day will be back at Walgreens stores across the country. Maybe there will be face-to-face interactions, relationships forged, and even the kind of laughter that can turn anxiety and fear over testing into relief and understanding. But even if these live events are paused for now, Greater Than AIDS and Walgreens will continue to support local organizations who refuse to abandon the needs of their communities – pandemic or no pandemic.
“We’re here to support local organizations as they're transitioning to new ways of delivering care in the age of COVID, so they can keep getting people the care they need,” says Hoff. “Walgreens and Greater Than AIDS help bring everyone together, but it’s the community-based groups who are actually on the ground, making it happen. They are what gives this program life.”
It’s especially important to have local, community-based organizations participating in the testing events because it’s not just about the test itself. It’s also about connecting people to care, so that regardless of the outcome of the test, they will return to a trusted provider for ongoing healthcare, which could help them prevent infection in the future. This includes PrEP, which can reduce the risk of HIV infection by more 99 percent when taken daily.
Unfortunately, this year, the opportunity to make these connections through in-person testing events was not in the cards. But with the CDC reporting HIV testing being down 50 to 70 percent since March, Greater Than AIDS and Walgreens had to find another way to fulfill their commitment to ending the HIV epidemic.
One door closes, another opens
From virtual pharmacy visits to at-home beauty consultations, WBA has found new ways to champion the health and well-being of its customers from a safe distance. When it came to supporting HIV Testing Day, they weren’t going to let logistics get in the way.
“With or without a pandemic, in our stores or at home, it remains critical to highlight the role testing plays in prevention and care,” says Brad McElya, senior manager of specialty pharmacy for Walgreens. “This disease is something we’re focused on year-round, with more than 3,000 HIV-trained specialists in our stores. Luckily, there was a solution available to us: in-home testing kits, which we could support Greater Than AIDS in supplying for free to high-need areas.”
To meet the need for alternative means of providing testing, Walgreens and Greater Than AIDS, together with OraSure Technologies, pivoted to provide 10,000 OraQuick® In-Home HIV Test kits to local health agencies and community-based organizations to distribute at no cost to those unable to get tested in person.
One of those agencies is SisterLove Inc. (SLI), a women, family and community-centered HIV and reproductive health nonprofit in Atlanta. Founded in July of 1989 as a volunteer group interested in educating their neighborhoods about HIV prevention, self-help and safer sex techniques, they have since become a powerful army of good, fighting the health inequities that disproportionately affect Black communities.
“We got into the business of HIV testing and counseling because women were being left out of the equation. But all of the things that exacerbate our health concerns – the social and economic conditions that impact us in terms of poverty, lack of education, holding multiple jobs – were putting us at risk of the virus and other chronic illnesses,” says Lisa Diane White, deputy director of SLI. “We just had to pay attention.”
Adapting in real time
Prior to COVID-19, SLI had a full-time staff engaged in testing hundreds of people per month, as well as holding health and wellness workshops and community health events. Even as stay-at-home orders and restrictions forced SLI to physically shut its doors, the work continued virtually, with staff answering calls and ensuring the community was referred to other agencies that remained open.
“Like everybody else, we thought we would be back to business soon, but that never happened,” White says. “But people were still calling, needing tests, and they couldn’t wait until next month, or whenever things opened up. Most people are coming to us because they need to know right away if they’ve been exposed to HIV. They need the test; they need counseling sessions to at least determine what type of exposure they may have had, to determine if they need to see a doctor and get on post-exposure prophylaxis, which needs to be taken within 72 hours of exposure.”
SLI set about perfecting the system of getting home tests to clients, walking them through the process and linking them to appropriate care. But for an organization that had always been a physical part of the community, spreading the word that HIV was still a risk and testing was still available even during a pandemic, posed a challenge.
“The world may be ever-changing, but one thing that hasn’t changed is that people are still having unprotected sex,” White points out. “If you have a smart phone and social media accounts, that’s an easy method of getting out all sorts of information, but many people have lost jobs in the past months and don’t have income coming in to pay for these privileges. So, we're like, tell a friend to tell a friend to tell a sexual partner, and then tell another friend because that's how the word is going to get out.”
Using word-of-mouth and at-home tests, which they either mailed out or distributed in person when it was safe to do so, they were able to quickly adapt to the circumstances and needs of their community – something they’ve been doing since the day they opened their doors.
“This is what we do,” says White. “We understand stigma, we understand risk and transmission and counseling and testing – all things that are more important than ever with COVID-19 as well as HIV, so our work is very much needed.”
Caring for our own
According to Hoff, the ability to understand the unique needs of your community is what makes organizations like SLI so important to ending HIV, as well as other health issues that plague those in lower-income Black and Brown communities.
“I think what's really unique about the program that Greater Than AIDS has put together with Walgreens is that it works in collaboration with community organizations,” Hoff explains. “It's really about building their capacity, supporting them in the work they do and recognizing the critical role they play.”
“Whether it’s HIV or COVID, certain zip codes are hit harder than others,” says White. “And we're living in those same zip codes. When we say we’re community-based, we mean it – because our population is our social life, our professional life, our faith life. So when we speak, we may speak from our own places of risk. We are the community, we look like the community and we come from the community.”
Since Walgreens has a presence in many neighborhoods suffering from health disparities, it gives WBA an opportunity – and a responsibility – to create positive change.
“We believe Walgreens’ collaboration with Greater Than AIDS is critical to unlocking the end to HIV/AIDS,” says McElya. “Continuing to support our partners and organizations within the community who are driving awareness and education about HIV infection status and ways to prevent HIV – something we’ve been doing as a company for more than 35 years – will bring us one step closer to ending the HIV epidemic.”
Walgreens is mobilizing in other ways to support putting an end to HIV. They recently donated dispensing services to the U.S. Department of Health and Human Services for the Ready, Set, PrEP program, making PrEP available at no cost to people without prescription drug insurance coverage at all Walgreens locations. And in 2019, Walgreens joined the Undetectable=Untransmittable, U=U Campaign, which advocates for universal access to treatment, care, and diagnostics to save lives and prevent new transmissions.