HIV/AIDS – The Atlanta, Georgia Connection
By way of definition, HIV is short for human immunodeficiency virus. This virus harms the immune system by destroying the white blood cells that fight infection which puts the individual at risk for serious infections that could lead to death and some forms of cancer. AIDS stands for acquired immunodeficiency syndrome which is the final stage of the HIV virus. Now that we understand what both acronyms stand for and the definition for each, let’s talk about how the virus destroys lives and what is being done about it.
Atlanta is the capital city of the State of Georgia. The racial makeup for Atlanta is 54% African-American, 38% White, 0.2% Native American, 5.2% Hispanic of any race and 3.1% Asian. During the 1950s and 60s, Atlanta was a major part of the civil rights movement with Dr. Martin Luther King, Jr. and other movement leadership. More recently, Atlanta’s airport, Hartsfield-Jackson Atlanta International Airport was named the world’s busiest airport by traveler passing through the airport. In the mid-1990s and 2010, the City of Atlanta razed nearly all of its public housing, about 17,000 units and 10% of all housing units in the city.
HIV was first recognized as new disease in 1981 and has now been labeled as one of the most devastating infectious diseases in modern history. The disease has been estimated to have infected close to 60,000,000 people and 25,000,000 deaths have been attributed to it worldwide. In the United States alone, over 700,000 people have died as a result of the virus with a disproportionate number of these cases in the southern region of the United States. Southern states also accounted for more than half of newly diagnosed cases of HIV/AIDS in recent years.
Atlanta, Georgia is home to a large concentration of gay individuals, especially in the metro-area of Atlanta, Georgia which has the fifth-highest rate of newly-diagnosed HIV cases in the United States. According to statistics, these new cases are concentrated in a specific population of young black men who are having sexual relations with men. Fulton and DeKalb counties in Georgia have the highest density of newly-diagnosed cases in Georgia, with over 21,000 new cases in 2013 according to the Georgia Department of Public Health.
Atlanta has the largest income gap between rich and poor residents and many whose income falls below the poverty level which contributes to having no access to health insurance. Some poor blacks in Atlanta do not have anywhere to sleep or a way to feed themselves, so seeking healthcare for HIV is not a priority for them. Half of African-Americans live below 200% of the poverty line and the number of people without health insurance is 1.5 times greater than that of Whites. This inequality contributes to unequal access to health care professionals, preventative and treatment services and requires rural residents to travel further to urban areas to obtain these services.
A mapping project led by Patrick Sullivan, a former CDC director of HIV surveillance who worked closely with state and local health departments found that African-American were more concerned about being stigmatized than their white counterparts. This made it more difficult for them to seek healthcare or counseling for their illness. One participant in the study even went as far to put medication in a different bottle so that friends and family members did not discover his status of being HIV positive. At the Grady Memorial Hospital’s FOCUS HIV testing program, it was reported that half of the patients that tested positive already had full-scale AIDS by the time that they were diagnosed. Further research has shown that there is a higher incidence of HIV infection amongst young, black males than their white counterparts not because of reckless behavior but merely due to healthcare status and the “partner pool” from which they date.
In Atlanta, the steps to secure a HIV healthcare appointment is very time consuming which can cause further frustration for a person that has been newly diagnosed and not seek medical attention. Atlanta is not proactive in securing healthcare for those patients who have been diagnosed with the virus and are seeking healthcare.
In order to make an impact on the spread of HIV/AIDS, there needs to be new implementations of information, testing and treatment. In Fulton County, Georgia, the jails are filled with predominantly young (median age of 33), male (71%) and black (87%) which has designated as a high risk HIV population. A pilot program was initiated by Anne Spaulding wherein the voluntary use of rapid HIV testing was part of the intake process at the jail. If an inmate tested positive, treatment was immediate, sometimes before they left the jails. Being aware of their status allowed these people to follow through on treatment and not inadvertently spread the infection. Fulton County also created a task force that included local healthcare providers, patients with AIDS, community activists to get newly-diagnosed people into some form of treatment within 72 hours. This service runs out of a local medical center called the Ponce de Leon Center in Georgia which serves close to 6,200 patients in that area alone.
Avoiding infection in the first place is one way to help eradicate the disease. There is a promising new medication that is being offered called Truvada. This drug is a one daily pill that when taken along with practicing sex, helps prevent becoming infected. It is certainly not a cure for HIV/AIDS but it does help reduce the number of new cases of infected individuals. Persons that wish to take Truvada cannot already be infected with the virus but the medication can help someone that has the potential to become infected lessen their chances of acquiring the virus.
There are also other strategies being put into place to help eradicate and/or slow down the progression of HIV/AIDS cases. First, diagnose all individuals with HIV as early as possible once they become infected; (2) treat the infected rapidly and effectively to obtain optimal viral suppression; (3) prevent at-risk persons from becoming infected with the HIV virus by using PrEP; and (4) identify and react to clusters of newly-acquired infections to help prevent new cases. As it stands right now, total eradication of the HIV/AIDS virus is not immediately realistic due to sheer number of new cases of infection reported. A realistic goal would be epidemic control. Ways to attain this goal would be ARV therapy, use of PrEP, condom use, needle and syringe exchange programs as well as enhancing the availability of healthcare services.
The Trump Administration announced plans to help stop the spread of AIDS. The Atlanta counties of Fulton, DeKalb, Gwinnett and Cobb were among those counties that will be targeted due to the fact that Georgia is the state with the highest number of new infections and metro Atlanta is number 3 among the metropolitan areas. The Administration’s plan includes sending the people, prevention and treatment strategies that are needed to reduce new HIV/AIDS infections by 75% in the next five years with the goal of reaching 90% reduction within 10 years. The plan is to increase money being sent to the locations that already have programs in place and to provide more care to low-income, uninsured residents. The Secretary of Health and Human Services, Alex Azar, believes that as many as 90% of new infections are being transmitted by persons that did not know they had the infection or who have stopped seeking treatment. According to the CDC, two-thirds of the new HIV diagnoses, about 20,000 in the South were from male-to-male encounters. One in five new diagnoses of the virus is women. The southern region of the United States has the highest death rate from HIV according to the CDC. Many states voted for expansion of the Affordable Care Act which would allow more people to be eligible for healthcare but Georgia elected leaders routinely reject the expansion expressing that it is too costly.
My personal assessment of the work that is being done to help combat the HIV/AIDS status in Atlanta as well as other southern states is bleak. Due to the fact that many of the southern states as populated by people that live under the poverty level and do not have access to some of the basic necessities such as place to live, food to eat or even the basic healthcare available to them, it is hard for me to believe that much can and will be done to help these people live better, stronger and longer lives. The population of HIV infected persons living in the south will not get any better and will likely get worse because it is not on the agenda of the Republican Party. It seems that without allowing people with lower incomes to have better access to healthcare, the situation with the spread of the HIV virus and other diseases as well, will continue to spiral out of control. I personally feel that more work needs to be done to educate the community about how the virus is transmitted, there needs to be more open conversation about the infection and better access to healthcare and the medication needed to prolong lives as well as preventative medications. Atlanta, as well as other southern states, have been inundated with new cases of HIV infections but it does not seem that anyone is very interested in helping those in need. It really feels like as long as it doesn’t affect the rest of the nation, we’ll just let those states drown in their situation which morally is outrageous to me. Not helping those southern states get their high numbers of infection down will not stop the spread of the virus and there is absolutely nothing to stop those infected and prone to be infected from moving to other states which can result in the same situation happening elsewhere.
More money needs to be funneled into the communities that are hardest hit with the newest cases of infection. I believe that with better education about how the virus is transmitted, access to healthcare that doesn’t bring a the “stigma” of having HIV/AIDS, having someone to live and access to food, etc., will allow a person that is infected or has the potential to become infected to focus more on their health instead of having to make a decision of survival on the streets and their healthcare. The non-concern for people of color that are being infected with this disease is very disheartening and just as with the opioid crisis, until it hits home for those that are in power, no one cares. Eventually, if more attention is not focused on the spread of this disease, it will not just be the concern of those of color or those of a certain sexual behavior, it has the potential to move across lines become a far greater public issue.
- Reif, S., Geonnotti, K. L., & Whetten, K. (2006). HIV Infection and AIDS in the Deep South. American journal of public health, 96(6), 970–973. doi:10.2105/AJPH.2005.063149
- Yaylali E, Farnham PG, Cohen S, Purcell DW, Hauck H, Sansom SL (2018) Optimal allocation of HIV prevention funds for state health departments. PLoS ONE 13(5): e0197421
- McKenzie,M., Aids in Atlanta, Emory Health Digest, pp.1-13.
- Fauci AS, Redfield RR, Sigounas G, Weahkee MD, Giroir BP. Ending the HIV Epidemic: A Plan for the United States. JAMA. 2019;321(9):844–845. doi:10.1001/jama.2019.1343
- Jones J, Sullivan PS, Curran JW (2019) Progress in the HIV epidemic: Identifying goals and measuring success. PLoS Med 16(1): e1002729. https://doi.org/10.1371/journal.pmed.1002729