In new offensive against HIV, metro Atlanta is a battleground
The map of the United States shows four blue dots clustered in northern Georgia. They represent the metro Atlanta counties of Fulton, DeKalb, Gwinnett and Cobb.
It’s not exactly surprising that the four — the most populous in our state — are among 48 counties in the nation that the Trump administration is targeting for its plan to stop the spread of HIV.
President Trump announced the plan in his State of the Union address last week.
HIV is the virus that causes AIDS, a disease that has killed millions around the world. Much progress has been made in keeping patients alive by thwarting the development of the fullscale disease, but a key to anti-HIV strategy is preventing new infections.
Georgia is the No. 1 state in rates of new infections, and metro Atlanta is No. 3 among metropolitan areas, says Dr. Wendy Armstrong of Emory University, and medical director of the Infectious Disease Program at Grady Health System. Grady’s Ponce de Leon Center, which provides HIV services, has 6,200 “active” patients, and the number is rising, Armstrong says.
“We have a huge epidemic, a lot of new infections,” says Dr. Carlos del Rio, chair of the Department of Global Health and professor of epidemiology at Emory’s Rollins School of Public Health.
“We were in the state of inertia” in the fight against HIV, adds del Rio, also professor of medicine in the Division of Infectious Diseases at Emory School of Medicine. “Hopefully (the White House initiative) will light a fire.”
The administration’s plan will deploy the people and prevention and treatment strategies needed to reduce new HIV infections by 75 percent over the next 5 years, with the hope of a 90 percent reduction within 10 years, according to the CDC’s director, Dr. Robert Redfield.
More than 50 percent of new HIV diagnoses in the United States in 2016 and 2017 occurred in 48 counties, Washington, D.C., and San Juan, Puerto Rico, said the U.S. Department of Health and Human Services (HHS).
The plan would increase investments in these hot spots through existing programs like the Ryan White HIV/AIDS Program, which provides care to low-income uninsured people, NPR reported. The federal government would provide funds to create a local “HIV HealthForce” in these targeted areas to expand HIV prevention and treatment.
“Almost 90 percent of new infections are transmitted by people who do not know they are infected or who are not being retained in treatment,” said HHS Secretary Alex Azar.
The Trump administration initiative has raised hopes among community leaders here in Georgia.
Besides the 48 county “hot spots” designated by federal health officials, they are targeting seven states with high rates of the disease in rural areas. There’s a Southern feel to them: Oklahoma, Missouri, Kentucky, Arkansas, Alabama, South Carolina and Mississippi.
According to the CDC, more than half of the new HIV diagnoses in 2016 — about 20,000 — were in the South. Of those Southern cases, two-thirds were from male-to-male sexual contact, Dr. Eugene McCray, director of the CDC Division of HIV/AIDS Prevention, said at a Center For AIDS Research symposium at Emory in November. One in five new diagnoses were among women.
This region has the highest death rate from HIV infection. More than 1 million Americans live with the virus.
Factors leading to high HIV numbers in the South include a social stigma surrounding the disease; poverty; lack of insurance and access to care; and no Medicaid expansion in most Southern states. McCray said income inequality, discrimination and poorer health outcomes are more widespread in the South.
Medicaid expansion under the Affordable Care Act would extend insurance coverage to many people with HIV, experts say. Most states have adopted expansion, making more low-income people eligible for the program, but Georgia’s elected leaders have consistently rejected that as too costly.