Progress Against HIV is Faltering in Southern States

Progress Against HIV is Faltering in Southern States

Facing a yearlong siege from the coronavirus, the defenses in another, older war are faltering.

Originally published in Kaiser Health News.

For the last two decades, HIV/AIDS has been held at bay by potent antiviral drugs, aggressive testing and inventive public education campaigns. But the COVID-19 pandemic has caused profound disruptions in almost every aspect of that battle, grounding outreach teams, sharply curtailing testing and diverting critical staff away from laboratories and medical centers.

The exact impact of one pandemic on the other is still coming into focus, but preliminary evidence is disturbing experts who have celebrated the enormous strides in HIV treatment. While the shift in priorities is nationwide, delays in testing and treatment carry particularly grievous risks in Southern states, now the epicenter of the nation’s HIV crisis.

“This is a major derailing,” said Dr. Carlos del Rio, a professor of medicine at Emory University in Atlanta and head of the Emory AIDS International Training and Research Program. “There will be damage. The question is, how much?”

One large commercial lab reported nearly 700,000 fewer HIV screening tests across the country — a 45% drop — and 5,000 fewer diagnoses between March and September 2020.

Clinics have limited in-person visits and halted routine HIV screening in doctors’ offices and emergency rooms, with physicians relying instead on video calls with patients, a futile alternative for those who are homeless or fear family members will discover their status. Rapid-testing vans that once parked outside nightclubs and bars and handed out condoms are mothballed. And, in state capitals and county seats, government expertise has been singly focused on the all-hands-on-deck COVID response.

Concrete signs of the impact on HIV surveillance abound: One large commercial lab reported nearly 700,000 fewer HIV screening tests across the country — a 45% drop — and 5,000 fewer diagnoses between March and September 2020, compared with the same period the year before. Prescriptions of PrEP, a preexposure prophylaxis that can prevent HIV infection, have also fallen sharply, according to new research presented at a conference last month. State public health departments have recorded similarly steep declines in testing.

That dearth in new data has led to a precarious, unknowable moment: For the first time in decades, the nation’s lauded HIV surveillance system is blind to the virus’s movement.

Nowhere will the lack of data be felt more profoundly than in the South: The region accounts for 51% of all new infections, eight of the 10 states with the highest rates of new diagnoses, and half of all HIV-related deaths, according to the most recent data available from the Centers for Disease Control and Prevention.

Even before the COVID pandemic, Georgia had the highest rate of new HIV diagnoses of any state, though lower than that of Washington, D.C. The Georgia Department of Public Health recorded a 70% drop in testing last spring compared with spring 2019.

The slowdown in HIV patient services “could be felt for years,” said Dr. Melanie Thompson, principal investigator of the AIDS Research Consortium of Atlanta.

She added, “Every new HIV infection perpetuates the epidemic and will likely be passed to one or more people in the months to come if people are not diagnosed and offered HIV treatment.”

Coronavirus testing has commandeered the machines previously used for HIV/AIDS testing, further straining surveillance efforts. The polymerase chain reaction — or PCR — machines used to detect and measure the genetic material in the human immunodeficiency virus are the same machines that run COVID tests around-the-clock.

Over the decades, as HIV migrated inland from coastal cities like San Francisco, Los Angeles and New York, it took root in the South, where poverty is endemic, lack of health coverage is commonplace, and HIV stigma is pervasive.

“There is the stigma that’s real. There is legacy racism,” said Dr. Thomas Giordano, medical director of Thomas Street Health Center in Houston, one of the largest HIV clinics in the U.S. The state’s political leaders, he said, view HIV as “a disease of the poor, of Blacks, Latinos and gay. It’s just not mainstream at the state level.”

Black people represent 13% of the U.S. population but about 40% of HIV cases — and deaths.

Black people represent 13% of the U.S. population but about 40% of HIV cases — and deaths. In many Southern states, the disparities are stark: In Alabama, Black residents account for 27% of the population and 70% of new diagnoses; in Georgia, Black people make up 33% of residents and 69% of people with HIV.

HIV clinics that serve low-income patients also face limitations using video and phone appointments. Clinic directors say poor patients often lack data plans and many homeless patients simply don’t have phones. They also must contend with fear. “If a friend gave you a room to sleep and your friend finds out you have HIV, you might lose that place to sleep,” said del Rio of Emory University.

Texting can be tricky, too. “We have to be cautious about text messages,” said Dr. John Carlo, chief executive officer of PRISM Health Care North Texas in Dallas. “If someone sees their phone, it can be devastating.”

In Mississippi, HIV contact tracing — which was used as a model for some local efforts to track the coronavirus — has been limited by COVID-related travel restrictions meant “to protect both staff and client,” said Melverta Bender, director of the STD/HIV office at the Mississippi State Department of Health.

Of all regions in the U.S., the South has the weakest health safety nets. And Southern states have far fewer resources than states like California and New York. “Our public health infrastructures have been chronically underfunded and undermined over the decades,” said Thompson, the Atlanta researcher. “So we stand to do worse by many metrics.”

Georgia’s high HIV infection rate and the state’s slow pace of COVID vaccinations “are not unrelated,” Thompson said.

The porous safety net extends to health insurance, a vital need for those living with HIV. Nearly half of Americans without health coverage live in the South, where many states have not expanded Medicaid under the Affordable Care Act. That leaves many people with HIV to rely on the federal Ryan White HIV/AIDS Program and state-run AIDS drug assistance programs, known as ADAPs, which offer limited coverage.

“As a matter of equity, insurance is critical for people to live and thrive with HIV,” said Tim Horn, director of health care access at NASTAD, the National Alliance of State and Territorial AIDS Directors. Ryan White and ADAPs “are not equipped to provide that full sweep of comprehensive care,” he said.

Of all regions in the U.S., the South has the weakest health safety nets. And Southern states have far fewer resources than states like California and New York.

Roshan McDaniel, South Carolina’s ADAP program manager, says 60% of South Carolinians enrolled in ADAP would qualify if her state expanded Medicaid. “The first few years, we thought about it,” said McDaniel. “We don’t even think about it nowadays.”

Enrollment in the Ryan White program jumped during the early months of the pandemic when state economies froze and Americans hunkered down amid a grinding pandemic. Data from state health departments reflect the increased need. In Texas, enrollment in the state’s AIDS drug program increased 34% from March to December 2020. In Georgia, enrollment jumped by 10%.

State health officials attribute the increased enrollment to pandemic-related job losses, especially in states that didn’t expand Medicaid. Antiretroviral treatment, the established regimen that suppresses the amount of virus in the body and prevents AIDS, costs up to $36,000 a year, and medication interruptions can lead to viral mutations and drug resistance. But qualifying for state assistance is difficult: Approval can take up to two months, and missing paperwork can lead to canceled coverage.

Federal health experts say Southern states have generally lagged behind getting patients into medical care and suppressing their viral loads, and people with HIV infections tend to go undiagnosed longer there than in other regions. In Georgia, for example, nearly 1 out of 4 people who learned they were infected developed AIDS within a year, indicating their infections had long gone undiagnosed.

As vaccinations become widely available and restrictions ease, HIV clinic directors are scouring their patient lists to determine who they need to see first. “We are looking at how many people haven’t seen us in over a year. We think it’s over several hundred. Did they move? Did they move providers?” said Carlo, the doctor and health care CEO in Dallas. “We don’t know what the long-term consequences are going to be.”

Survived Covid, Aced Her NCLEX: Nurse of the Week Chelsie Turrubiartez, RN is Hard to Stop.

Survived Covid, Aced Her NCLEX: Nurse of the Week Chelsie Turrubiartez, RN is Hard to Stop.

Brand-new RN, Nurse of the Week Chelsie Turrubiartez didn’t allow anything to stand between her and her dreams of becoming a nurse. Over the course of nine eventful months, the 23-year-old Adel, Georgia resident was hospitalized for Covid, graduated from the School of Nursing at Abraham Baldwin Agricultural College, passed her NCLEX, and found an RN position at the hospital where she’s worked since high school as a nurse extender. “It’s like a nurse’s aide,” she explained. “I have always wanted to be a nurse, and now it feels really good to be able to do that.”

In March 2020, as much of the world was locking down and healthcare workers found themselves on the “frontlines” of the pandemic, Turrubiartez was busy studying, attending classes at ABAC, and looking forward to graduating with her class. Then, on the very last day of March, she was hospitalized for Covid and began fighting for her life. “The ventilator was on max setting,” she told the Albany Herald. “They put me in the ambulance, and I had to be on my stomach the entire way. I don’t remember the ride at all. I was out of it.” Her condition started to improve in late April, and Turrubiartez was finally able to go home on May 4, 2020. She hadn’t seen her family since March 31, had missed her last month of school, her eagerly anticipated virtual graduation ceremony, and, well, you do not simply bounce back after spending weeks on a ventilator in the ICU.

Turrubiartez received her associates degree from ABAC, and plans to enroll there for her BSN as well.

As she recovered from her frightening ordeal, ABAC gave Turrubiartez the opportunity to repeat her spring semester coursework that fall and graduate on December 3, 2020. “I was really happy when I graduated!” she said. “I didn’t think I would get a chance to do that.” Adding to her happiness that day, during the pinning ceremony, Turrubiartez received the Lisa Purvis Allison Spirit of Nursing Award and a scholarship check for $500. She followed that up by passing her NCLEX, and then, Southwell Tifton Hospital hired their former nurse extender to work as an RN on their general medicine surgical floor.

Now—with some help from that scholarship check—Turrubiartez is planning to study for her BSN as well. For more details on her story, visit here.

LPN Says Immigrant Detention Center Endangers Detainees and Staff

LPN Says Immigrant Detention Center Endangers Detainees and Staff

Immigrant women receive dubious hysterectomies and staffers openly neglect even basic COVID precautions at Georgia’s Irwin County Detention Center, says LPN Dawn Wooten in a complaint filed by four non-governmental organizations.

According to Wooten, the private immigrant detention facility has refused to test symptomatic inmates, has not been isolating those suspected of having the virus, and is disregarding mandatory CDC social distancing practices. Wooten’s complaint also notes that she and other nurses have been alarmed by the inordinate number of hysterectomy operations performed at the Center. In reference to the frequent and questionable hysterectomies one detainee described the detention center as “an experimental concentration camp.”

COVID-19 safety and treatment are given short shrift at the center, and Wooten says that even before the pandemic the facility was often dilatory in providing medical care for detained immigrants. Since the pandemic, the complaint alleges, the center has made almost no use of its two rapid-response COVID testing machines, and has instead sent swabs to be tested at a local hospital. Wooten was told she should not be “wasting tests” on people she suspected of being infected, and when she inquired about testing one detainee, a co-worker responded, “He ain’t got no damn corona, Wooten.”

In addition to failing to provide PPE for staff working directly with confirmed cases of COVID-19, Wooten’s complaint states that the facility forced symptomatic staff to continue to work in the facility and threatened them with discipline if they refused to work in dangerous conditions. Because she spoke out against such practices, Wooten says that she was transferred from her full-time position to a part-time job in which her shifts consisted of a few hours a month.

On Tuesday, September 15, House Speaker Nancy Pelosi called for an investigation. Regarding the alleged misuse of hysterectomies on immigrant women detainees, Pelosi said “The DHS Inspector General must immediately investigate the allegations detailed in this complaint. Congress and the American people need to know why and under what conditions so many women, reportedly without their informed consent, were pushed to undergo this extremely invasive and life-altering procedure.” She also called attention to the neglect of COVID safety measures and proper treatment, and referred to “ICE’s egregious handling of the coronavirus pandemic, in light of reports of their refusal to test detainees including those who are symptomatic, the destruction of medical requests submitted by immigrants and the fabrication of medical records.”

Project South, one of the organizations filing the complaint, states that “ICDC (Irwin County Detention Center) has a long track record of human rights violations.”

For more details on this story and quotes from Dawn Wooten, see the article in The Intecept.

Nurse of the Week: NICU Nurse Tara Fankhauser Crochets Halloween Costumes for Hospital’s Tiniest Patients

Nurse of the Week: NICU Nurse Tara Fankhauser Crochets Halloween Costumes for Hospital’s Tiniest Patients

Our Nurse of the Week is Tara Fankhauser, a neonatal intensive care unit (NICU) nurse at Children’s Healthcare of Atlanta who crochets Halloween costumes for the NICU babies in her care. This is the fourth year in a row that she’s spent months crocheting costumes for the hospital’s tiniest patients.

Fankhauser is a mom of three in addition to being a NICU nurse. She takes time every year to make the Halloween costumes herself. According to her coworker Alanna Gardner, Fankhauser uses Pinterest and the baby’s different personalities to decide on the perfect costume for them. She usually begins designing the costumes in the Spring and ends on Halloween day.

Fankhauser never repeats a costume. The costumes take anywhere from a few hours to a full day to make. The costumes are gifts; families are able to take them home as keepsakes of their child’s first Halloween. Holidays can be particularly hard for families with children in the NICU, which is why Fankhauser goes to the effort of bringing the Halloween spirit to the hospital’s tiniest patients.

Gardner tells, “What started out as a hobby has quickly become a hospital tradition that brings joy to our families and staff.”

To learn more about Tara Fankhauser, a neonatal intensive care unit (NICU) nurse at Children’s Healthcare of Atlanta who crochets Halloween costumes for the hospital’s tiniest patients, visit here.

Mercer University Announces New Accelerated Nursing Program on the Atlanta Campus

Mercer University Announces New Accelerated Nursing Program on the Atlanta Campus

Mercer University Georgia Baptist College of Nursing (GBCN) has announced a new Accelerated Bachelors of Science in Nursing (ABSN) program will start this month. The program was created in response to Georgia’s ongoing nursing shortage and is designed to be a cost-effective way for students with a non-nursing bachelor’s degree to earn their BSN in as little as a year. 

The program is a collaboration between GBCN and Orbis Education, a company that partners with universities in order to expand and improve on their existing pre-professional programs, primarily in the nursing and occupational therapy fields. The program is looking to admit eight lab groups with 12 students per group for the first semester. 

According to Aaron Van Berg, an admissions counselor at GBCN, Georgia is one of the most severely understaffed states in the country. Georgia needs an estimated additional 13,510 nurses by 2026 to keep up with a rapidly growing population. Atlanta was named one of the best cities for nurses by Forbes with an estimated salary of $63,862 due to the current shortage. 

The ABSN program differs in both the time period it takes to complete it as well as the cost. It’s expected to cost approximately $59,850 in total, while the regular BSN program offered through GBCN is expected to cost $24,102 per year. The curriculum includes a total of 56 credit hours over the course of three semesters. The credit hours consist of online courses, hands-on labs, and clinical rotations.

To learn more about Mercer University’s new accelerated nursing program based on its Atlanta campus, visit here

Argosy University Bachelor of Science in Nursing Program Granted Accreditation

Argosy University Bachelor of Science in Nursing Program Granted Accreditation

The Bachelor of Science in Nursing (BSN) degree program at Argosy University in Atlanta was recently granted accreditation by the Commission on Collegiate Nursing Education (CCNE), which will last through December 2023.

Dr. Charlita Shelton, campus president of Argosy University, Atlanta, tells, “CCNE accreditation reflects that the BSN program at Argosy University, Atlanta, together with its faculty, curriculum, and support systems meet the standards established by the leading professional organization.”

The Commission on Collegiate Nursing Education is an autonomous accrediting agency. It is officially recognized by the US Secretary of Education as a national accreditation agency that contributes to the improvement of the public’s health. The CCNE ensures quality and integrity in all bachelor’s, graduate, and residency programs in nursing nationwide.

The CCNE serves the public interest, assessing and identifying programs that engage in effective educational practices. It is a voluntary and self-regulatory process that supports and encourages continued self assessment by nursing programs as well as continued growth and improvement of collegiate professional education and nurse residency programs.

To learn more about Argosy University’s Bachelor of Science in Nursing program being awarded accreditation by the Commission on Collegiate Nursing Education, visit here.

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