Posted by: megkrupa | February 23, 2013

“In order to leave AIDS in the next generation, we leave no patient behind.”

Yesterday, Dr. Grant Colfax, Director of the Office of National AIDS Policy (ONAP), and Dr. Ron Valdiserri, Director of the Office of HIV/AIDS and Infectious Disease Policy at the U.S. Department of Health and Human Services (HHS), hosted a National HIV/AIDS Strategy Implementation Assessment meeting in Chapel Hill, North Carolina. At this meeting, they addressed steps taken to fulfill the goals of the National HIV/AIDS Strategy (NHAS), as well as next steps and challenges.

Additionally, members of the North Carolina Division of Public Health and medical provider community, as well as LeRoi Lattie, a patient access coordinator for the Lincoln Community Health Center, addressed the audience, which was filled with medical professionals, health providers, HIV/AIDS advocates, academics, PLWHA, and other stakeholders from across North Carolina. Discussions focused on local and state responses to reaching the National HIV/AIDS Strategy goals, as well as current challenges. This blog posts focuses primarily on North Carolina. For more information on Dr. Colfax and Dr. Valdiserri’s updates on the NHAS and ACA, please see my corresponding blog post on the Southern HIV/AIDS Strategy Initiative (SASI) website.

One of the primary focuses of the National HIV/AIDS Strategy is alleviating the burden of HIV in communities most disproportionately impacted by HIV/AIDS, including gay men, MSMs, and people of color. In 2010, black North Carolinians were nine times more likely to be newly diagnosed than whites in 2010, and Hispanics were almost four times as likely. [Source] Also in 2010, the HIV rate in North Carolina for black females was approximately 17 times greater than the HIV rate of white females, and 75% of new HIV cases among males were attributed to MSMs. [Source] “In 2010, MSM accounted for 87 percent of white non-Hispanic male HIV reports, 72 percent of black non-Hispanic male reports and 62 percent of reports for other minority males.” [Source]

The Care and Prevention in the United States (CAPUS) grants, part of the Secretary’s Minority AIDS Initiative, focus on enhancing HIV/AIDS diagnosis, and linkage to and retention in care, among minority communities most impacted by the epidemic. North Carolina was one of eight recipients of this funding, and one of the five southern state recipients. Although still in the early planning stages, North Carolina’s proposal includes plans to hire additional bridge counselors; enhance health outcomes for PLWHA in prison and upon release; introduce telehealth programs, primarily for rural populations; and enhance health surveillance. Additionally, North Carolina is creating a community-driven Men’s Clinic to target minority communities disproportionately impacted with HIV/AIDS. The NC Communicable Disease Branch of the Division of Public Health recently announced the corresponding RFA, with applications due March 11, 2013.   

Jacquelyn Clymore, the State AIDS/STD Director, highlighted North Carolina’s rural epidemic. The numbers are staggering—20% of HIV in North Carolina is rural and 13% is among African Americans. According to the CDC, in 2006, “North Carolina had the highest number of reported cases in rural areas for both AIDS (among 46 states) and HIV (non-AIDS, among 33 states).” [Source] Rural populations face huge barriers to health, including the need to travel longer distances to obtain care, fewer specialized services, a limited health infrastructure, and stigma. [Source] Dr. Michelle Ogle, who serves a rural population and who was featured in Dan Rather Reports, It’s A Southern Thing, noted yesterday that a significant number of rural patients are uninsured. Approximately one-third of her patients are uninsured, relying on programs like Ryan White. [Source]

As part of its CAPUS funding, North Carolina will implement telehealth initiatives, including distance medical learning, to help rural providers, especially those who are not infectious disease doctors, increase their knowledge of HIV/AIDS care. These telehealth initiatives will also expand the number of health providers available to treat people living with HIV/AIDS, ultimately making it easier to access rural HIV/AIDS health care. To combat stigma and other forms of discrimination, North Carolina aims to increase the cultural sensitivity of its health providers, including those serving minorities and transgender individuals in rural areas. This reflects recent research demonstrating that Minorities With HIV Fare Better With Culturally Competent Doctors. North Carolina is also striving to add peer navigators and to better address syphilis/HIV comorbidity, particularly among minority MSMs.  Additionally, CAPUS funding will help fund safe space facilitators, an idea originally facilitated through discussions with NC’s statewide MSM Task Force.

Evelyn Foust, Director of the NC Communicable Disease Branch, emphasized the North Carolina HIV/AIDS Treatment Cascade, which she referred to as “our roadmap” to ending the epidemic. She highlighted that many North Carolinians living with HIV only have one care visit, illustrating both a large need to get people linked and retained to care, as well as recent developments in health surveillance. Foust also noted that organizations looking for state funding should demonstrate where their efforts fall on the cascade and stressed that “in order to leave AIDS in the next generation, we leave no patient behind.”

Stigma in North Carolina was highlighted as a barrier to treatment through an anecdote told by Dr. Colfax. When speaking with a woman living with HIV during his recent visit to NC, he asked what she would like President Obama to know. She responded: “There is still so much stigma and discrimination around HIV.” Stigma is a huge barrier to receiving health care, and “[t]he stigma surrounding AIDS is a key reason that the South is the epicenter of new HIV infections in the United States.” [Source] Foust emphasized that “stigma and discrimination absolutely unacceptable because we are one North Carolina.”

Yesterday, members of the North Carolina Division of Public Health and medical provider community also discussed the state’s many strengths in combatting HIV, including early involvement in the epidemic, a high level of dedication to achieving an AIDS free generation, and the high degree of collaboration and cooperation among and between universities, community health providers, CBOs, and local public health departments. The North Carolina SPNS Integration Project and CAPUS Project were highlighted as illustrations of this collaboration. Additionally, Dr. David Wall highlighted that North Carolina is the first state to integrate all of its health reporting systems into one. However, he highlighted that a more robust electronic health record system across providers was needed, including one that allows the exchange of real-time information with health providers.

Overall, while North Carolina has made much progress combatting HIV/AIDS, there is still much work to be done. In the words of Dr. Ron Valdiserri: “Everyone has role to play in ending HIV epidemic in America.”


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