ATLANTA — Dr. Melanie Thompson, a veteran of four decades of HIV and AIDS research, stood at the front of a wood-paneled room in Georgia’s Capitol, known in local parlance as the Gold Dome.
A chart titled “Persons living with HIV in Fulton Co., 2007–2014” appeared on a screen behind her; the vertical bars grew taller with each year. Most of Atlanta is in Fulton County. Thompson pointed out to the audience of 30 that Georgia ranks second among U.S. states in the rate of new HIV diagnoses, behind Louisiana, and that Atlanta ranks fifth among metropolitan areas with populations of 500,000 or more.
To make matters worse, she added, only 73 percent of the people in the Atlanta metro area who have HIV know it, because not enough people are getting tested for the virus. (The national average is 87 percent.)
“We’re not even following CDC guidelines” for HIV screening, which recommend that all health care facilities provide the test, she added. “We need to change this.”
Thompson was speaking at a two-day symposium hosted by the Georgia Legislative Black Caucus. With 60 members, the group bills itself as the nation’s largest.
The event was one moment among many in recent months that together indicate the seriousness of the HIV/AIDS epidemic in the Atlanta metro area and the growing number of public- and private-sector efforts, often innovative, to bring the area in step with other large cities nationwide that have kept the virus and disease in check, resulting in healthier lives and fewer deaths.
“Atlanta is like New York was in the ’80s in the need to develop a public health response to a serious [HIV] epidemic,” said Devin-Barrington Ward, an advocate based in Washington, D.C., who helped organize the Georgia symposium.
The issue is particularly acute for young gay and bisexual black men. One Emory University study followed a group of Atlanta-area men ages 18 to 39 who had sex with men during 24 months and found that 12.1 percent of the black men under 25 contracted HIV, compared with only 1.0 percent of the white men under 25 — “one of the highest figures for HIV incidence ever recorded in a population in the resource-rich world,” according to the National AIDS Manual. What’s more, AIDS is the leading cause of death among black people in Georgia ages 35 to 44, according to the state Department of Public Health.
Grady Memorial, one of the nation’s largest public health hospitals, also found alarming numbers, through a grant-funded project that allowed its staff to offer opt-out HIV screening to all patients entering its emergency room: About half the patients diagnosed with HIV already had clinical AIDS. This means they had the virus for years and not received the sort of treatment that would prevent further deterioration of their immune systems.
“None of my colleagues [nationally] are seeing those numbers,” said Dr. Wendy Armstrong, a researcher at Emory University’s Center for AIDS Research. “It’s appalling.”
But Thompson wasn’t at the symposium just to highlight the area’s problems. Only weeks earlier, she finished editing a plan put together by dozens of experts, with local government backing, a Strategy to End AIDS in Fulton County. The county is home to 1 in 4 people with HIV in Georgia, so the ambitious goal of the plan’s name has implications for the state as a whole. She was at the symposium to ensure that at least some of the state’s legislators knew what was at stake and what could be done.
The plan’s benchmarks include expanding screening for HIV at health care facilities so that the share of people who know they are infected increases from 73 to 90 percent; tweaking Georgia’s laws to allow minors to take an HIV test without parental consent; expanding use of pre-exposure prophylaxis (PrEP), or taking anti-retroviral drugs to reduce the risk of becoming infected; and linking people to effective treatment within three days of getting an initial HIV diagnosis.
Similar plans have netted good results in cities such as San Francisco and New York; the strategy Thompson has helped put together is the first of its kind in a major metropolitan area in the Deep South, said Jeff Graham, the executive director of Georgia Equality, an LGBT advocacy organization.
This is important because the South is considered the one region in the country where scientific advances in testing and treatment have not reached those who need it most, because of a combination of social marginalization, ignorance about the virus and the disease and lack of political will. Poverty, a lack of health insurance and Georgia’s and other states’ decisions not to expand Medicaid under the Affordable Care Act further complicate the matter. The result: a regional public health problem that is particularly acute in the Atlanta metropolitan area.
Graham recently launched another innovative effort at his organization. Called the Youth HIV Policy Advisors’ Program, it aims to connect men and women ages 18 to 30 who are living with HIV to Georgia legislators so that “the people most impacted by the challenge [of living with the virus] can communicate directly to policymakers,” he said. The participants in the program have produced a series of policy recommendations for lawmakers to consider in the 2016 session.
Graham, who has been involved in HIV advocacy since the 1980s, said he is “not aware of anyone else taking this approach in the country.”
Another Emory-based project, HIV Continuum, involves using digital maps in five cities, including Atlanta, to see where people are getting diagnosed with HIV, where they’re getting care and where care is effective, among other data. The maps — which allow users to filter for age, race, ethnicity and gender — have been used to direct health care facilities in their outreach efforts to test people for HIV, said Travis Sanchez, a public health researcher at the university and one of the project’s lead developers.
Ronald Johnson, the vice president of policy and advocacy at AIDS United, a Washington-based policy and advocacy organization, said he hasn’t seen a mapping project similar to Sanchez’s. Commenting on the HIV Continuum, the Fulton County plan and the youth project, he said that Atlanta’s health care community is “open to innovative approaches.” At the same time, he added, the area “faces tremendous odds.”
Contributing to those odds are the unwillingness of a conservative legislature to expand Medicaid; a mistrust of public health facilities by the community at large, particularly in Fulton County, where the county government failed to spend several million dollars in Centers for Disease Control and Prevention funding aimed at HIV prevention from 2012 to 2014; and a lack of knowledge about the disease. Nearly 20 percent of Georgians said in a recent survey that they thought HIV could be transmitted by sharing a drinking glass, for example.
There’s also the fact that Georgia has a county-based health department system, and with 159 counties, the state is second in number of counties only to Texas, which has 254. This makes it hard to coordinate and monitor public health efforts. “It’s really important that we don’t silo ourselves,” said Thompson, referring to the Fulton County plan.
Finally, there’s the issue of stigma. After Thompson spoke at the symposium on HIV/AIDS, Democratic state Sen. Vincent Fort went to the lectern. He has been in office since 1996, and his district includes Fulton County. “My district is ground zero for this epidemic,” he said. “This is not theory to me.”
But he was one of only eight legislators who attended the event. Thompson said, “Moralism around homosexuality has kept people in power at arm’s length from this issue. We have to get beyond this.”