Posted by StreetWise in Latest NewsGrassroots activists, physicians and professionals met November 19 with the new director of the Illinois Department of Public Health regarding the future of HIV/AIDS prevention and care services on Chicago’s West and South Sides, where there are disparities in income, health and health care.
“It was an excellent meeting that was well-scripted and well-attended, with meaningful dialogue,” said U.S. Rep. Danny K. Davis (D-Chicago), who facilitated the meeting at Loretto Hospital with LaMar Hasbrouck, MD., MPH, who has been director of the Illinois Department of Public Health since April 23. Grassroots groups at the meeting included WHARP (West Side HIV AIDS Regional Planning Council, SHARP (South Side HIV AIDS Regional Planning Council; the two coalitions include community organizations, residents, HIV-positive individuals, churches and businesses.
Davis continued, “The purpose of the meeting was to share with Dr. Hasbrouck the views and opinions of the individuals who were present who are HIV/AIDS activists and to try and find out to the extent possible what plans, thoughts, and ideas, as well as resources which the state of Illinois through its Public Health Department had, that could be used for those purposes.”
Earlier, Davis had noted progress: there are fewer HIV/AIDS infections and deaths in most populations, as well as better education and less stigma than in years past. “Yet we know that we still have a lot of work to do as less than 25 percent of those living with HIV are virally suppressed and many people living with HIV are yet to be diagnosed in the communities,” he said.
His reference was to a report issued in July by the Centers for Disease Control and Prevention (CDC) that said only 1 in 4 of the 1.1 million Americans living with HIV had their virus under control so that they could stay healthy and reduce the risk of transmitting it to others. African-Americans and young people were least likely to receive continuing care and treatment, according to the report.
While 85 percent of whites have been diagnosed, for example, the rate for African-Americans was 81 percent. Thirty percent of whites had viral suppression, compared to 21 percent of African-Americans.
Among younger Americans with HIV, the rates for diagnosis and viral suppression were even lower; just 72 percent of people age 25 to 34 had been diagnosed and only 15 percent had reached viral suppression.
The meeting itself was progress, Davis said. “Introducing him to the people, letting people get to know him and feel him. There’s no one thing or magic, just everybody working together: legislators making laws, researchers doing research, physicians and other providers providing services. It was not just a meeting, but a very important meeting to help him become acquainted with the Chicagoland area. He’s obviously picked up some things; he came from the Centers for Disease Control. He’s also been in New York and all around the country, foreign countries. He’s a public health expert.”
A board-certified medical internist, Dr. Hasbrouck spent 11 years with the CDC as a member of its Epidemic Intelligence Service, (commonly referred to as the Central Intelligence Agency for diseases). He worked in Africa, Asia and South America, as a consultant to the World Health Organization on polio eradication in Bangladesh and with the U.S. President’s Emergency Plan for AIDS Relief. He was an assistant professor and attending physician at Emory University School of Medicine in Atlanta and director of both the Ulster County (New York) Department of Public Health and Department of Mental Health.
The agenda for the November 19 meeting with Dr. Hasbrouck had called for an understanding of HIV prevention and care within the larger context of health care reform. “We know that HIV is not a disease in a vacuum,” the activists noted in prepared material. “It lives in West and South Side communities side by side with other health disparities, income inequalities and health care access issues.”
Given that the November presidential election has ensured the future of health care reform, the activists acknowledged that multiple bodies of government will play a role. They asked what tasks the Illinois Department of Public Health (IDPH) envisioned for itself and how WHARP and SHARP could support those efforts. Would IDPH set up health care exchanges? And where did it stand on Medicaid expansion?
They asked also how decreased funding could affect their ability to address those needs. What could they do to ensure adequate resources?
In an email, Dr. Hasbrouck emphasized the importance of partnerships with organizations like WHARP and SHARP in the effort to most effectively serve the public and provide collective resources and education around HIV/AIDS, particularly at a time when budgets and funding continue to be challenged.
“There’s never going to be enough resources (for HIV/AIDS) but our resourcefulness is limitless,” Dr. Hasbrouck said.
IDPH is not responsible for setting up health care exchanges but supports the effort in Illinois to do so.
“Definitely I think it was an excellent meeting in the sense he understood our issues and concerns” in terms of funding and strategies, said Beverley Walker-Donley, current vice chair and incoming chair of WHARP. The grassroots groups had been concerned that they would be able to continue doing their work after health care reform. They also wanted to play an active role in helping the IDPH shape policy.
Dr. Hasbrouck told them they were on the right track, and he agreed to establish a quarterly meeting with them, Walker-Donley said.
“I asked a question about the decrease in funding and his response was to continue to do what we were doing in terms of sharing information, best practices, making sure we keep the lines of communication open, continuing to be a catalyst in the community.”
Recently, for example, WHARP and SHARP helped push for the five-year extension of the Quality of Life Lottery ticket, known as “Red Ribbon Cash.” Proceeds from this Illinois lottery game, established in 2008, cannot go to the state’s general revenue fund; instead, they assist public and private agencies that work in HIV/AIDS awareness and prevention.
The Quality of Life lottery provided $1.4 million to 14 agencies last year but was set to expire on December 31. An Illinois General Assembly bill sponsored by state Sen. Jacqueline Collins, state Rep. Karen Yarbrough and state Rep. Greg Harris (all Chicago Democrats) extended it to Dec. 31, 2017.
Yet while overall transmission rates are decreasing, people are still being infected, Walker-Donley said. Even before his reelection, President Obama expressed a goal of “getting to zero” infection rates, so she was glad to confirm best practices, to establish a channel of communication with the IDPH, and to be reassured WHARP was on the right course.
Condoms must be used consistently and correctly if someone is in multiple relationships, Walker-Donley said. A monogamous relationship where neither person strays outside for sexual activity also reduces one’s risk to zero. “Once you know you are negative and verifiable, you’re good. But if you are continually putting yourself at risk, you need testing. If you are positive and it’s early on, you can get treatment.”
Walker-Donley’s HIV prevention efforts start with always carrying both condoms and literature on how to use them in her car; she distributes as many as 8,000 a month. Some people take condoms for themselves — or for their friends — while others, particularly in churches, accept only the literature.
“Everybody can pass the word; that person who gets the information can educate somebody else,” she said.
Teens tend to think they are invincible and avoid condoms, which is why she advocates age-appropriate and gender-specific education in schools. “I see young people and sometimes they are hugged up and I say ‘make sure you’ve got your condoms.’ “
She takes condoms to beauty shops and barber shops and even to clothing stores, where she encourages the merchants to put signs in their windows saying that they have the items for free.
Many people tell her that they are unconcerned with HIV since they do not live a high-risk lifestyle involving intravenous drug use or sex work. These are the people she is trying to reach, because even the smallest risk can still cause someone to become infected, she said.
“If you don’t know all about your sexual partner, that person could already be positive,” she said. “I go to churches, and someone will say, ‘oh, me and my husband been together 10 years. I don’t need to be tested.’ That’s just like saying, ‘I don’t need a mammogram this year.’ It’s better to get the information on the front end so down the line you are not needing services.
“We just keep providing the information so everybody can become as educated as they need to be and hope we can get to zero.”
The CDC’s July report that charts various US population groups at five main stages of HIV care (from diagnosis to viral suppression) can be accessed at: http://www.cdc.gov/nchhstp/newsroom/docs/2012/Stages-of-CareFactSheet-508.pdf