A task force studying HIV in Fulton County laid out a sweeping set of policy priorities and a comprehensive map for reducing new infections and ending AIDS-related deaths in the county, which has one of the highest rates of HIV infections in the nation.
The Fulton County Task Force on HIV/AIDS recommended expanding HIV testing, speeding people with new HIV diagnoses into care more quickly, reducing homelessness among people with HIV, increasing the availability of PrEP, providing condoms to inmates at the county jail and battling the stigma that still surrounds HIV.
“The statistics are still somewhat sobering in terms of the new infections, particularly among the black men who are having sex with men category. But at the same time I’m optimistic in terms of some of the recommendations that are being made,” Fulton County Commission Chair John Eaves said.
The recommendations came Monday in the final report from the Fulton County Task Force on HIV/AIDS, delivered during an event at the Center for Civil & Human Rights with task force members, supporters, HIV advocates and elected officials. The task force ended its work on Monday; the next day – Aug. 1 – the county established the HIV/AIDS Prevention, Care & Policy Advisory Committee to advise the Fulton County Board of Commissioners on addressing HIV. Commissioners will appoint members to the committee.
It will be up to the new advisory committee to continue advocating for the policy changes.
More than 15,000 people living with HIV in Fulton, about 50 percent more than in 2007. Young people, especially young black men who have sex with men and injection drug users remain some of the highest risks groups. The task force was created in December 2014 after startling statistics highlighted the county's HIV epidemic.
“The biggest thing we can do to prevent HIV is get everybody who has HIV treated. And that is the best thing for their lives and health,” said Melanie Thompson (top photo), a task force member and executive editor of task force's “Strategy to End AIDS in Fulton County.” Thompson is also principal investigator for the AIDS Research Consortium of Atlanta.
When someone tests positive and is able to get connected to treatment and remain in care, they can become virally suppressed and then are unlikely to transmit the virus, Thompson explained.
The Task Force laid out the goal of getting 85 percent of people into care within three days of HIV diagnosis, and increasing the retention rate of people who already have an HIV positive diagnosis to 90 percent. But the barriers to getting people into care – and keeping them in once they’ve started — are complex.
“We need to be very clear that the social determinants of health are driving this epidemic. People who don’t have housing are not going to take medicines, even get medicines, even get into care sometimes because they're not the highest priority,” Thompson said.
In other words, people struggling with homelessness or food insecurity may not have the capacity to also seek medical care while trying to address the underlying instability in their lives.
Housing stability is a major area of concern for the task force, which wants to reduce homelessness among people with HIV to less than five percent.
“So housing first is important, getting people housing, being sure that they get other supports like transportation, food, they get issues of substance use and mental health taken care of. These are really critical issues we that have to continue [to address],” Thompson said.
Securing housing has often been predicated on an individual first getting treatment for substance abuse, going through burdensome bureaucratic processes, or getting past other barriers. Getting people into stable housing — without any preconditions – is critical to addressing the challenges people living with HIV must navigate to stay in care, Thompson explained.
'Patience doesn’t get us very far'
Throughout the presentation on Monday, task force members highlighted one concern again and again: stigma.
“We have really worked on questions of how to address stigma and making our clinics culturally welcoming, so that is going to be a theme that is going to continue and take many years to get to fruition,” Thompson said.
One of the Task Force’s final recommendations is to include “intercultural awareness” – the latest iteration of language around cultural competency – in all Fulton contracts.
“Stigma kills, we cannot tolerate it. We have to make our care and services clients centered, and make it easy to get into care, to stay in care, and to remain healthy,” Thompson said during the presentation.
The issue includes the stigma that people with HIV face in their daily lives, as well as the discrimination they may face when accessing care at a clinic and dealing with staff that make transphobic or racially insensitive remarks.
Eaves and Fulton Commissioner Joan Garner (second photo) were key supporters of the task force. Garner, the commission's first openly gay member, died in April. The task force's final report was dedicated to her.
Eaves said he's optimistic that the task force recommendations will be implemented.
“The Board of Commissioners of Fulton County has been unanimously supportive of HIV/ AIDS Task Force from the beginning. I’m very proud of the fact that it’s bipartisan as well. And so even though I am transitioning out in the next two or three weeks, the board who remains is still committed and so the work will continue,” Eaves said.
Thompson was more cautious.
“These things are not simple, easy, or fast to implement,” she said. “It takes time to implement something that is that broad and sweeping.”
Thompson added that she's not counseling patience.
“I think patience doesn’t get us very far in this, so we have to keep the fire on. But I do think that things are happening,” Thompson said.
In June 2016, the task force released recommendations in four areas – reducing new HIV infections by 25 percent by 2020, increasing access to care, reducing HIV-related disparities and health inequities, and building a more coordinated response to the epidemic.
The recommendations released on Monday would cost about $800,000 to implement, Thompson told the AJC.