Doctor sees opportunity to end HIV diagnosis

Last week, I raised this issue when I did not share with you a conversation with Dr. Melanie Thompson about President Donald Trump's announcement in the State of the Union address of this year to end the HIV epidemic in just 10 years.

Thompson, you may remember, has spent the last 30 years trying to help overcome the AIDS epidemic in America, to care for people living with HIV (which causes AIDS), to prevent its spread, to seek new drugs for HIV treatment and prevention, and to work at the national and local levels to influence policies and create plans to end the HIV epidemic.

Like many people working on the front lines of the epidemic, his optimism about Trump's announcement was cautiously tempered.

Suspicious because she knows it will take a lot of work and a constant commitment. Optimistic because when she looks at cities like San Francisco and New York, she sees what is possible.

The number of people living with HIV in San Francisco is about the same as in Fulton County. Yet in five years, the number of new HIV diagnoses has decreased by more than half to 221, while Fulton County has nearly 700, essentially unchanged over five years. The number of cases in New York has decreased by 36% in five years.

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What is the difference? Not only have both cities invested in global public health, but state and local governments have invested funds and expertise in the fight against HIV. Public health leadership in these cities has been very effective in implementing innovative programs such as providing free PrEP in clinics, same-day HIV treatment and opening sexual health clinics to fight against sexually transmitted infections.

>> RELATED: How improved medicines have helped fuel the HIV epidemic

The story is quite different here in Georgia.

According to Thompson, for example, for decades, states and counties have not demonstrated strong public health leadership on HIV.

On the other hand, "It's the South where poverty, income inequality and inadequate public health systems overlap with racism, homophobia, transphobia and stigmatization of people." living with HIV, "she said. "Stigma literally kills people here."

Thompson said that while Ryan White clinics, at the national and local levels, were very effective in treating people living with HIV, local clinics were underfunded and understaffed, and addiction and mental health services were inadequate. . As Georgia lacks Medicaid expansion, the Ryan White program is the only safety net for uninsured people living with HIV. Ryan White provides not only medical care, care and mental health services, but also anti-HIV drugs at no cost. It also helps patients to buy health insurance, often cheaper than providing drugs.

Even though Atlanta's eligible metropolitan area, in Atlanta's 20 counties, has received more than $ 26 million in 2018, funds have been growing slowly, while the number of people living with HIV continues to increase more quickly.

The only Grady's Ponce Clinic now hosts more than 6,200 people living with HIV, an increase of 33% in 10 years, but without a proportional increase in funding. Every year, the number of patients needing care in the Greater Atlanta area has grown faster than funding, so clinics have been asked to do more with less.

>> RELATED: CDC refuses funds to fight rapid rise in black and Latino HIV cases

While clinics struggle to take care of all those currently in care, there simply is not enough manpower and funding to provide care; In Fulton County, 50% of HIV-positive people are no longer receiving care, Thompson said.

"Without additional funding, we will certainly see a worsening of the epidemic, and this could be dramatic. It's a time bomb. We need to help people stay in care so that they continue to take medication so that the virus remains undetectable, "Thompson said. "It keeps people healthy, but also addresses the public health problem of HIV transmission. In 2019, the poorest people are those who lead a complex life. They do not have housing or transportation to clinics, and they often have other addictions and mental health issues that have not been addressed. And they often do not have any other access to health care. "

>> RELATED: Morehouse College Bets on PrEP to Prevent HIV

Another problem to be solved is that there is no funding flow for PrEP, pre-exposure prophylaxis, to help prevent HIV.

"Unlike other countries that are progressing, Georgia has not invested a single penny in PrEP," Thompson said. "Prevention of HIV infection can be effective up to 99% in the case where a single tablet is taken once a day with good compliance. But the people who need PrEP the most do not get it in Georgia, where racial disparities are blatant. Of the black gay and bisexual men who could benefit, only 12% have PrEP. We do not even have data on women and transgender people at risk. We desperately need the expansion of Medicaid in Georgia to fully extend access to PrEP. "

We had some good news last week on this front.

A bill introduced in the state legislature would give Governor Brian Kemp the power to pursue two different types of waivers so that the state could change the way it administers federal health care programs.

A waiver specifically relates to Medicaid. The other would seek to reduce insurance costs for consumers.

At the same time, Thompson said PrEP was caught between CDC funding and the Health Resources and Services Administration. She hopes that this new federal initiative will provide a solution to this problem.

Anyway, we probably will not hear about it until early March, when the White House budget will be released.

"It's a 10-year plan," said Thompson. "We need to see multi-billion dollar funding every year to end the epidemic, but I'm afraid it's unlikely."

At home, she believes that the new federal initiative will require a comprehensive and innovative approach at the county level to succeed. Thompson hopes to see Fulton County take the initiative to organize other Atlanta metropolitan counties and associate with cities, particularly the city of Atlanta. , to review and adopt the Fulton County HIV / AIDS Working Group's 2017 AIDS Strategy, the predecessor to the new Fulton County HIV Advisory Committee.

She said, "It's time to do something different if we want different results."

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