The Atlanta HIV Epidemic That Remains

HIV risks are not diminishing in Atlanta as testing becomes more readily available across the city. Photo Illustration by Vanessa Johnson | The Signal

HIV in Atlanta has steadily climbed to reach an epidemic level on par with developing countries and isn’t getting any better.

Earlier this summer, Dr. Carlos del Rio, co-director of Emory University’s Center for AIDS Research, told the Atlanta Journal-Constitution that HIV levels of Downtown Atlanta were “as bad as Zimbabwe or Harare or Durban.”

But why?

According to HIV.gov, more than 1.1 million people in the US are living with HIV and less than 14 percent know their status. Over 50 percent of all new HIV infections are in the South. There are 2,386 new cases a year in Georgia, and 75 percent of the impacted indreside in Atlanta. The CDC recognizes an epidemic as anything affecting 1 percent of a population. Over 4 percent of all black men in Fulton County live with HIV. Gay and bisexual men account for 67 percent of all diagnoses, and of that number, 83 percent are African-American.

Derick Wilson, a member of the Fulton County Board of Infectious Disease, said that one out of two black men who have sex with men (MSM) will be HIV positive in their lifetime “if things don’t change.”

“We are at 42 percent of what we’ve documented. When we think about all the undocumented people and the people unaware of their status, the number is closer to 50 percent. This speaks to some real systematic issues,” he said.

LEARNING FROM THE PAST

Fulton County started the Fulton County Task Force on HIV/Aids on World Aid’s Day in June 2014 and created the Permanent HIV Prevention, Care, and Policy Advisory Committee to lead the plan to tackle HIV in Atlanta. Fulton County said their mission through these new departments was to turn the city into “a community without new HIV infections or AIDS-related deaths, where all individuals living with HIV will be virologically suppressed while receiving uninterrupted care and treatment, free from stigma and discrimination, and grounded in the recognition that access to healthcare is a human right. Persons without HIV will be educated, empowered, and able to access tools to prevent HIV transmission.”

But a year later after Fulton County’s 2014 promises, they failed to deliver on that statement and mishandled close to $28 million that was meant for spreading HIV testing and awareness. The money was federal CDC grants that were meant to target the HIV epidemic head on. Almost half of all the money the CDC granted to Fulton County that was intended as a resource in the fight against HIV was returned because of issues with management.

Wilson said the reason behind Fulton County’s money mismanagement was because the programs receiving the money were new.

“Whenever you start a new program, there’s always complications. Getting the right mechanisms in place in order to put money out on the street, those kind of things happened and, unfortunately, money didn’t get out in the manner that we had wanted to get out. We certainly got dinged well deservedly for not putting the money out the way it was supposed to be, but we got most of the money back and put it out.”

Now Wilson says the county put in physical controls to keep the programs in check, and that’s where Wilson’s job description comes in.

“My job is to work with all of our staff–our fiscal staff, our administrative staff–to really make sure we have an understanding of where the money is going and where we can recapture things here working with our providers as well.”

TACKLING THE STIGMA

John Eves, in his Office of Chairman letter, included the Fulton County Task Force progress report that stated, “While other cities and states have seen their epidemics lessen, our epidemic has stubbornly persisted, feeding off of economic and social inequalities, stigma, and discrimination.”

That same discrimination is what Georgia Equality Director Jeff Graham said the state needs to get rid of in order to effectively address and prevent HIV.

“We need to create a safe space for folks to be able to self-disclose their HIV status. To recognize this isn’t a judgement from God, it is not a condemnation of a certain lifestyle, it is not about bad choices– it is a human condition, a medical condition. We need to address issues such as sex shaming in general, the attitudes towards gay and bisexual men and especially gay and bisexual men of color who feel they have multiple layers of oppression that they have to deal with,” he said.

And Wilson said the biggest factors leading to HIV now are social and not lack of prevention.

“You can’t talk about PrEP without first talking about someone’s homeless situation or jobless situation, because all of these things of all the social determinants are going to come first. Until you really can get them stabilized in a few core key areas of these structural issues, you aren’t going to be able to impact their prevention profile at all.”

He said that means that there needs to be a trained staff that can go out and target those communities, understand them, and convince them about the importance of protection and testing.

Fulton County is working to bring more awareness to the issue at the community level, such as speaking with local pastors to mention testing in their services. Several new programs have been popping up around Atlanta such as the HIV Free Testing Van that drives throughout Edgewood and by Grady, stopping for quick and free testing anywhere, aiding in the HIV testing accessibility problem.

Other times, Graham explained, individuals are ignored when it comes to treatment.

“Transgender individuals often are misgendered and not called by their preferred pronouns and often referred to as ‘it.’ These individuals are pushed away from the treatment intended and created to benefit them and even greater increase distrust in government and healthcare,” he said.

“At the end of the day, to be able to live a healthy life with HIV, you have to have access to quality medical care, including access to medications. Hand in hand with those are things like insurance, such as Georgia not having expanded Medicaid. Low income people who are HIV positive, but are not sick enough, don’t have access to Medicaid,” Graham said.

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