AIDS and the state of public health

Moderated by Rick Badie

We turn attention to preventive health care since today (Thursday) happens to be National Black HIV/AIDS Awareness Day. A former CDC researcher writes that early HIV detection is paramount to curbing the virus, which more than 40,000 Georgians live with. Two college officials outline statewide progress made in preventive care since the establishment of the Department of Public Health.

Tide turning for public health

By Phillip Williams and James Curran

In less than two years, a move made with the future of Georgia in mind is already yielding returns.

The establishment of the Department of Public Health is a signature achievement in Georgia’s quest to vanquish public health challenges that plague us. What some might have considered a bureaucratic move has resulted in greater flexibility for the state’s public health workforce, a more efficient allocation of resources and collaborations between partners.

DPH has been able to streamline our government’s ability to address public health challenges and elevate important issues by having our commissioner, Dr. Brenda Fitzgerald, report directly to the governor’s office.

The establishment of the department was the latest in a list of steps to shore up Georgia’s public health footing over the past decade. We’ve seen an increased emphasis on higher education to advance research and equip the next generation. We’ve placed a priority on programs that utilize public engagement to help raise awareness of challenges we face. A diverse set of public and private entities has begun to grapple with issues like obesity, diabetes, infant mortality and other key public health challenges. DPH also has enabled Georgia to be one of a handful of states to compete for a federal project to prevent HIV through enhanced detection of infections, linking persons to lifesaving care and reducing transmission.

Creative initiatives have come to the forefront, including Gov. Nathan Deal’s SHAPE initiative to tackle childhood obesity. DPH is bringing together multiple partners including the Georgia Department of Education, the Atlanta Falcons, the Atlanta Braves and Children’s Healthcare of Atlanta. Beginning with a basic tool to assess the physical fitness of the children in our schools, SHAPE also provides resources and training to educators and parents to help youth live a healthier lifestyle.

DPH is building a partnership with the National Guard to strengthen the state’s disaster preparedness efforts. The partnership is considering collaborations that benefit the Guard, DPH and the public in exercises, coastal evacuation plans for hurricanes, mass dispensing of pharmaceuticals during health disasters, and use of mobile field medical units.

Another key advancement deals with emerging technology to share existing resources. Dr. Fitzgerald has a goal of incorporating telehealth — the use of communication technologies for clinical care, patient teachings and home health — in every health department. Last year, only five of Georgia’s rural health districts were wired for telehealth. Soon, all of the districts will be wired.

It cannot be understated how important these advances are. Telehealth removes barriers to care by providing a medical access point in every county while bolstering the access local doctors have to specialists. Efforts to curb childhood obesity will lead not only to a healthier population, but a strong financial footing for our state. A more integrated, robust, emergency preparedness plan is necessary for us to weather harsh disasters.

Georgia has begun reversing many of its most troubling public health trends. After ranking No. 43 in 2008 in America’s Health Rankings, a ratings system that compiles multiple factors and ranks all 50 states according to the health of their population, Georgia moved up to No. 36 in 2012. There’s still much work to do, but we are trending in the right direction.

The advances we have made in less than two years demonstrate the value of a public health department. Like many of its citizens, the state of Georgia struggles with its health. The foundation we have laid with the new department has put Georgia on a path to better address and combat its health challenges.

Dr. Phillip Williams is dean of the College of Public Health at the University of Georgia; Dr. James Curran is dean of the Rollins School of Public Health at Emory University.

Early HIV detection vital

By Gerald Schochetman

Every 9.5 minutes, someone in the United States is infected with HIV.

Within our nation, Georgia has long been among the most profoundly affected states, consistently ranking among the top 10 for the number of AIDS cases and the infection rate. Today, more than 40,000 Georgians are living with HIV/AIDS. In fact, among some groups in Atlanta at particularly high risk, more than half of the individuals who are living with HIV are unaware of their infections.

A renewed focus on early detection is the next round of battle in the local and global fight against HIV/AIDS. A few weeks ago, the New England Journal of Medicine published research confirming that early treatment of HIV slows damage to the immune system, may delay need for long-term treatment, and reduces risk of transmission. Another study in the same journal showed that individuals who began antiretroviral therapy within four months of infection experienced enhanced recovery of the immune system to an extent not seen in patients who started treatment in later stages.

The common denominator in both studies, and in the body of HIV scientific knowledge, is the importance of early diagnoses. With the right information about HIV status – at the right time – individuals within and beyond Georgia can begin turning the tide. However, with 1 in 5 people who have HIV not knowing they are infected, many of those who are HIV-positive will, in fact, not be diagnosed in this early phase of the disease when they are most contagious.

Having been on the front lines of the battle with HIV/AIDS since the very beginning, I can attest to the fact that the single most effective defense against the spread of this virus is for individuals to get tested and to know their HIV status. A great deal of the progress we have made in controlling the spread of HIV is, in part, a story about steady improvements in diagnostic tests for the virus. The first real victory against HIV occurred in 1985 with Abbott’s development of the world’s first FDA-approved blood test to detect HIV antibodies. For the first time, testing on a national scale was possible.

Earlier detection is the latest frontier. The good news is that modern testing technology advances have led to a new generation of tests known as HIV combo tests that can accurately provide results within two weeks of exposure to the virus. These tests are available now and are best accessed through conversations with health care providers. By detecting both antigens (the actual HIV virus) and antibodies to the virus, the tests can help patients reduce risky behavior earlier and begin antiretroviral therapy sooner.

HIV is an equal-opportunity virus: No matter the race, gender or sexual orientation, an individual can become infected if not properly protected. But just as there’s an equal opportunity for infection, there’s equal power in knowledge and early detection.

Dr. Gerald Schochetman is senior director, infectious diseases and diagnostic research for Abbott Diagnostics.

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David Maggio

February 8th, 2013
10:36 am

N,

Yes, you matter! When you volunteer for your local HIV/AIDS organizations, you matter! When you are not part of the chain of transmission, you matter! When you educate yourself and other, you make a difference! When you post your concerns, engaging in this discourse, which others will read, you are involved!

David Maggio

February 8th, 2013
10:31 am

Zeke, there is no evidence of moral decay based on HIV data, but it might tell us something about human behavior. As an example, consider tooth decay. Flossing 45sec daily may add years to your life by reducing systemic inflammation, but do YOU floss every day? Other public health recommendations include washing your hands to avoid catching or spreading the cold or flu or norovirus, but we are not perfectly compliant with that one either, are we? Five servings of fruits and veggies daily? Doubt it. American Heart Assoc recommends 45min of daily aerobic activity daily- do you ever slip up on that one? Point is, the inability of the public to follow public health recommendations for individual and community health is highly variable, and contingent on many socio-economic and personal factors. It isn’t immoral to practice unsafe sex, it’s just risky. Every day, you and I accept the risks that come with life, mitigate as best we can, and accept our lumps when we must. HIV doesn’t discriminate between the developing or the developed world, although incidence is higher in Africa due to transmission dynamics unique to their population, lack of access to quality health care including ART. Some of the same socio-economic variables that drive transmission in other countries can be found in localized epidemics in the U.S. However, Africans and no less moral than Americans and morality has nothing to do with sexual transmission of HIV or IV drug use. Placing value judgements on people’s moral systems is not helpful and increases stigma. Let he who follows all of public health’s “shoulds” daily be the first to cast the first stone. What we need is more compassion and empathy and less finger wagging.

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zeke

February 7th, 2013
10:23 am

Useless! Unless or until there is a gross change in moral values and morality in general, this is a lost fight! The problem simply shows the moral decay of our society! Almost like we are in sub Sahara Africa! instead of in the most advanced, affluent country in the World!

n

February 7th, 2013
7:39 am

Are we relevant? The HIV epidemic takes millions of public funds to bring it under control and eradicte it. What can John Q. Citizen do to have a part in turning the tide against this dreaded disease.
In the fast pace of daily life dominated by the technology of computers in the assembly lines, tabasco factorie,s where is the place of the public? We should have more involvement.

Reality

February 6th, 2013
4:54 pm

HIV is a horrible virus. I hope that some day scientist will find a cure (a way to totally kill the virus).