In the 30-year-old battle against HIV, in which early detection and treatment are seen as the way to eradicate the virus, Wake County is again stepping up its fight with a plan to reach its most reluctant patients.
The county’s Human Services/Community Health Division will use a nearly $259,000 state grant to set up a new clinic dedicated to young minority men, who are at the highest risk for HIV and the illnesses that go along with it, but are also the most difficult to persuade to come in for testing and treatment.
The money comes from a $5.6 million grant the state Department of Health and Human Services received last year from the federal Centers for Disease Control and Prevention.
North Carolina is one of only eight states – all in the South, where HIV infection rates are disproportionately high – to get the funding. It’s being used to find new ways to reduce the prevalence of HIV and AIDS by getting those most at risk for the virus to get tested and to get those who have the virus into treatment so they are less likely to spread it to others.
Research by a UNC scientist, hailed as the breakthrough of the year when it was announced in 2011, shows that with early treatment to suppress the human immunodeficiency virus, a patient is 96 percent less likely to transmit it to someone else. But nationwide, researchers say, about 20 percent of those who have the virus don’t know it because they have never been tested for it.
The CDC has recommended that everyone between the ages of 15 and 65 get tested at least once for HIV, and those who are involved in non-mutually monogamous relationships get tested more.
“There are two things that drive everything about HIV care in the 21st century, at the state and national level,” said Jacquelyn Clymore, AIDS director for the N.C. Department of Health and Human Services. “The first is that everybody is tested and knows if they are HIV-positive, and the second is to have everyone who tests positive get treated, so the virus is suppressed. That’s the holy grail.”
In addition to being less likely to spread the virus, an infected person who is “virally suppressed” will have a longer, healthier life than one who lets HIV run its course and become AIDS. They’ll also have lower medical costs over their lifetime because they won’t be as susceptible to other illness that take advantage of a compromised immune system.
Wake’s working strategy
Wake County already is a national model in its work against HIV and AIDS; across the U.S., only an estimated 25 to 28 percent of people with HIV are “virally suppressed,” in part because so many don’t know they have the virus and many of those who do know don’t go for treatment, or go for a while and drop out.
In Wake County in 2011, the most recent year for which numbers are available, there were 2,721 people living with diagnosed HIV. More than 1,000 of them get their care at the county’s HIV/STD clinic, in the Health and Human Services building on Sunnybrook Road.
Of those, about 80 percent are virally suppressed.
The clinic has an aggressive testing program to encourage at-risk people to find out if they have the virus, offering free, confidential tests at the clinic and at more than a dozen other locations. Those who test positive are encouraged to get treatment at the clinic, which includes staff from UNC Hospitals such as Dr. Robert Dodge. If his patients start missing appointments, Dodge calls them. If they still don’t come in, clinic counselors will call, go to their home and send a certified letter to try to persuade them to come back.
There are many reasons an HIV patient may not come for treatment. Because the disease is more likely to affect the poor, patients are less likely to be insured and to have a regular physician. They may fear going to a free clinic because of the stigma of HIV and AIDS. They may lack transportation, or they may be unable to take time off from work to see a doctor, or unable to find child care long enough to get to an appointment. Case workers help with all of those issues, contributing to the clinic’s success, which was noted when Dodge and clinical program manager Karen Best were invited to Washington last week when President Barack Obama issued an executive order to step up work to reduce HIV and AIDS.
“It’s very rare for someone in this clinic to die of AIDS,” said Dodge; patients are more likely to live long lives and die of heart disease or cancer or some other ailment.
Improving on success
Dodge and Best say they could improve the county’s odds against HIV if they could get the 680 or so people locally who are unaware they have the virus to get tested and enrolled in treatment.
Statistically, most of those are likely to be adolescents or young African-American or Hispanic men who have sex with other men – the most challenging group to get to seek regular health care of any kind, including HIV testing and treatment.
For the next three months, the county will conduct surveys and focus groups with patients, doctors and others involved in the local fight against HIV to determine the most effective way to run a clinic where this group of potential patients would feel comfortable and safe.
Most likely, said Clymore, the state’s AIDS director, it will be connected somehow to an existing facility but one that isn’t associated with HIV, AIDS or STDs, to avoid the stigma of those diseases. It would offer evening hours. It would be a place where men could come for holistic care, including screenings for prostate disease, diabetes and other illnesses, and educational programs on a range of issues. Patients would be tested for HIV and, if positive, be referred to the county’s clinic for treatment.
The clinic could open as early as this fall and would have funding through the current grant for two years.