Den­ver two-thirds of way to­ward goal

In­ter­na­tional health e≠ort aims to quash epi­demic by 2030

The Denver Post - - FRONT PAGE - By Jen­nifer Brown

Shan­non Southall re­mem­bers it was 10:30 on an April morn­ing nearly 25 years ago when her life screeched off its path.

It was 1992, and she was the first per­son her doc­tor had ever di­ag­nosed with HIV. Southall, who was in­fected by her cheat­ing fi­ancé, had only asked for the blood test as a rou­tine fol­low-up af­ter she was poked with a nee­dle dur­ing her work as a med­i­cal as­sis­tant.

Southall, now 52 and di­rec­tor of a Den­ver ad­vo­cacy or­ga­ni­za­tion for peo­ple liv­ing with HIV and AIDS, was di­ag­nosed early, be­gan a drug reg­i­men al­most im­me­di­ately and reached “vi­ral sup­pres­sion” in 1997, mean­ing there was no de­tectable virus in her blood. She is the model pa­tient, one who has ac­com­plished all three goals set by the in­ter­na­tional health com­mu­nity to end the AIDS epi­demic by 2030.

To get there, Den­ver — along with many other ci­ties across the world — pledged to meet three mea­sures by 2020: 90 per­cent of peo­ple with HIV know they have it, 90 per­cent of those di­ag­nosed are re­ceiv­ing care and 90 per­cent of those in care have, thanks to med­i­ca­tion, no de­tectable virus in their blood.

Den­ver is two-thirds of the way there, of­fi­cially reach­ing a 90 per­cent di­ag­no­sis rate ear­lier this year and, this fall, achiev­ing the “vi­ral sup­pres­sion” bench­mark.

The tough­est mea­sure for Colorado has been get-

This is a health is­sue, not a be­hav­ior is­sue.” Shan­non Southall, di­rec­tor of a Den­ver ad­vo­cacy or­ga­ni­za­tion for peo­ple liv­ing with HIV and AIDS, who tested HIV pos­i­tive at the age of 26

ting 90 per­cent of peo­ple di­ag­nosed with HIV into med­i­cal care, said Dr. Sarah Rowan, di­rec­tor of HIV and vi­ral hep­ati­tis pre­ven­tion at Den­ver Pub­lic Health. Ev­ery­one liv­ing with HIV should see a doc­tor at least once a year, and many pa­tients need mul­ti­ple vis­its. Yet only about 75 per­cent of Den­ver res­i­dents with HIV showed up at a med­i­cal ap­point­ment within the past year, ac­cord­ing to data from Den­ver Pub­lic Health.

Be­gin­ning in 2017, pub­lic health of­fi­cials will in­ten­sify ef­forts to keep track of pa­tients who haven’t been to the doc­tor and call them.

Ag­gres­sive ap­proach

The city’s Depart­ment of En­vi­ron­men­tal Health plans to at­tack that health mea­sure as ag­gres­sively as it has the first two, with what Mayor Michael Han­cock calls “one of the most com­pre­hen­sive net­works sup­port­ing peo­ple liv­ing with HIV.” The depart­ment’s “of­fice of HIV re­sources” dis­trib­utes $7.9 mil­lion in fed­eral fund­ing, much of it for pre­ven­tion and treat­ment pro­grams at Chil­dren’s Hospi­tal, Den­ver Pub­lic Health, and the Univer­sity of Colorado Hospi­tal.

The med­i­cal cen­ters have ramped up test­ing, di­ag­no­sis and fi­nan­cial help to cover pre­scrip­tion costs.

Den­ver Pub­lic Health of­fers free or low-cost test­ing weekly at the GLBT Com­mu­nity Cen­ter, the down­town non­profit HeyDen­ver, the Den­ver Swim Club and the Mid­towne Spa, all pop­u­lar hang­outs among gay men, the most at-risk pop­u­la­tion along with peo­ple who have sex with mul­ti­ple part­ners. Peo­ple ages 25-29, who grew up in an age when HIV in­fec­tion is a chronic, man­age­able con­di­tion rather than a deadly di­ag­no­sis, com­prise another high-risk group.

The ma­jor­ity of those whose test re­sults are pos­i­tive are linked to a clinic within 30 days.

About 1,800 peo­ple with HIV are pa­tients at the Univer­sity of Colorado in­fec­tious disease clinic, where phar­macy man­ager Jasjit Gill helps them get free or re­duced-cost med­i­ca­tion through the state’s AIDS drug as­sis­tance pro­gram. The once-a-day pill to treat peo­ple with HIV costs about $3,000 per month, although Med­i­caid gov­ern­ment in­sur­ance cov­ers most of the cost of the pre­scrip­tion.

About half of the phar­macy’s pa­tients are re­ceiv­ing state as­sis­tance for pre­scrip­tion costs. Some of them are home­less, which makes it hard for staff to fol­low up with them. “The hard­est part is get­ting peo­ple to show up here,” Gill said. “How do they even put down an ad­dress?”

Out of all pa­tients with HIV who vis­ited a doc­tor or clinic within the past year, 90 per­cent were in vi­ral sup­pres­sion — part three of the three-step in­ter­na­tional goal. That means med­i­ca­tion to sup­press the virus was re­duced so that it is not de­tectable through a sim­ple blood test, although an an­ti­body test still would de­tect an­ti­bod­ies. Pa­tients in vi­ral sup­pres­sion do not progress to AIDS and the pos­si­bil­ity of disease trans­mis­sion is dra­mat­i­cally re­duced.

Pub­lic fund­ing also goes to­ward mar­ket­ing cam­paigns, in­clud­ing one called “Den­ver Brings It Up.” The ads, mostly on gay-dat­ing web­sites, en­cour­age test­ing and of­fer in­for­ma­tion on PREP, a daily pill that can pre­vent HIV in­fec­tion.

The first case of AIDS in Colorado was di­ag­nosed in 1982, and since then, 19,100 peo­ple have been di­ag­nosed with HIV. More than 6,000 have died. An es­ti­mated 12,900 Coloradans are now liv­ing with HIV.

Na­tion­ally, the num­ber of new HIV cases fell 19 per­cent from 2005 to 2014. An es­ti­mated 14 per­cent of peo­ple with HIV in the United States do not know they have it, com­pared with 10 per­cent in Den­ver. The per­cent­age is de­rived by es­ti­mat­ing the preva­lence of the disease and sub­tract­ing the num­ber of di­ag­nosed cases.

The 2020 goal is a step to­ward end­ing the AIDS epi­demic by 2030, a world­wide ef­fort led by the United Nations. In lo­gis­ti­cal terms, the end of the epi­demic means new HIV cases are rare, and when they oc­cur, they do not p-rogress to AIDS. “They will go on and live long, healthy lives,” Rowan said.

Southall’s life took an abrupt “right in­stead of tak­ing a left” the day her doc­tor told her she had HIV. At 26 years old, she drove straight to her fam­ily in Gree­ley. Although they were sup­port­ive, for years they washed her dishes sep­a­rate from their own and were con­cerned about show­er­ing af­ter her, and one brother-in-law re­fused to let her see his chil­dren. A new boyfriend freaked out when he learned she had the virus. “All that stigma, thrown at me by my own fam­ily,” she said.

Southall got mar­ried six years ago, and be­cause the virus in her blood is sup­pressed, her hus­band has not been in­fected. Her first drug reg­i­men re­quired her set­ting an alarm to take med­i­ca­tion at 3 a.m., one of 20 pills each day. Now she takes just three.

A new ca­reer

The di­ag­no­sis also led to a new ca­reer. Southall founded and then ran the Women’s Light­house Project for 13 years, help­ing women with HIV find med­i­cal care. Now she heads Rocky Moun­tain Cares, which works on pre­ven­tion, ed­u­ca­tion and med­i­cal-care man­age­ment for peo­ple liv­ing with HIV.

Be­sides the 90-90-90 in- ter­na­tional goals, Southall’s or­ga­ni­za­tion is work­ing to elim­i­nate stigma and the per­cep­tion that some­one who asks for an HIV test has been “sleep­ing around or us­ing drugs,” she said.

“This is a health is­sue, not a be­hav­ior is­sue,” Southall said. “It should be part of a reg­u­lar test at the doc­tor if you are sin­gle and sex­u­ally ac­tive. The big­gest bar­rier to that is the stigma that comes along with having to ask for an HIV test be­cause you’ve ‘done some­thing.’ ”

Rocky Moun­tain CARES ex­ec­u­tive di­rec­tor Shan­non Southall hugs a pa­tient at the clinic Fri­day. The ad­vo­cacy group works with HIV/AIDS pa­tients. Andy Cross, The Den­ver Post

Andy Cross, The Den­ver Post

AIDS pa­tient Louis Ruh­lin kisses his dog Har­ley dur­ing an ap­point­ment at the Rocky Moun­tain CARES fa­cil­ity Fri­day. Ex­ec­u­tive di­rec­tor Shan­non Southall looks on.

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