Last month, New Orleans hosted the United States Conference on AIDS (USCA), the largest gathering of AIDS-related case managers, policy makers, physicians, health workers and advocates in the nation. It was meant to draw attention to the region's HIV and AIDS rates, which are among the nation's highest: New Orleans and Baton Rouge rank third and second, respectively, in the nation for HIV case rates, according to the most recent National HIV Surveillance report from the Centers for Disease Control (CDC). The report uses data from 2011.
"The South is a major epicenter of the HIV epidemic," says Dr. Michael Gottlieb, an immunologist from Los Angeles who identified AIDS as a new disease in 1981 and who attended the conference last month. "The reasons are complicated and relate to poverty, access to health care, access to information about prevention — to the extent that those factors are present in the South, that's what is contributing to a higher rate in the South."
T.J. Rogers, communications specialist at the NO/AIDS Task Force, echoes this. "[Baton Rouge and New Orleans] have been in the top five or 10 [for new HIV cases] for at least the last 10 years," he says. "We continue to have a problem. The South has between 25 and 33 percent of the nation's population, but we see 60 percent of new HIV cases."
The high HIV and AIDS rate is consistent with other health disparities in the South, which include higher rates of diabetes, heart disease and other ailments. Rogers says the common underlying factors are high poverty and unemployment rates and a lack of education, access to health care and affordable housing. `
"The rates of HIV and AIDS in people who are homeless are three times the national average," Rogers says. "There is a concept of survival sex: you will engage in risky behaviors to put a roof over your head."
Preventing HIV transmission is a matter of getting to know prospective sexual partners, asking them if they have HIV, using condoms until both partners have been tested and are in a monogamous relationship, avoiding compulsive behavior in the context of drugs and alcohol and getting tested, Gottlieb says.
For people who contract HIV, proper care is essential. Rogers says one of the biggest problems is that people either don't receive health care or come into treatment late. By that time, their HIV has progressed to AIDS. This not only affects patients' quality of life and how long they can expect to live, it also can increase the number of new HIV cases.
"When a person is on medication consistently and effectively, their risk of transmitting [HIV] to another person is hugely reduced," Gottlieb says. "That is a critical factor in a region like the South where there is a high transmission rate. Access to medical services and effective antiviral treatment is now a principle strategy toward prevention."
It's a paradigm Gottlieb calls "treatment as prevention": When people with HIV take antiretroviral medications, they reduce the amount of HIV virus in their blood (also known as viral load) until it is low enough to be undetectable. When treated early, the HIV transmission risk is reduced 96 percent, according to a 2011 clinical trial by the National Institute for Allergy and Infectious Diseases (NIAID).
That's why it's essential for people with HIV to get into treatment early. "Retention of the person in care, seeing that he or she consistently takes medication and has good communication with his or her provider is critical as a prevention strategy," Gottlieb says.
"Getting people into care if they are HIV positive and reducing viral load reduces incidences of HIV," Rogers says.
Mondo Guerra, an HIV-positive fashion designer and Project Runway winner, stresses the importance of talking with doctors. Guerra attended USCA as part of an HIV education campaign by Merck called IDesign (www.projectidesign.com).
"IDesign is a program looking to empower people living with HIV to have an open dialogue with their doctor, which I found to be very important in my personal experience," Guerra says. "For a long time, my doctor was the only one who knew about my HIV status."
It's also crucial that patients find a doctor with whom they feel comfortable. "AIDS is complex," Rogers says. "You should be able to have an open and honest dialogue with your physician so they can take care of you the way you need to be taken care of."
From the physician's standpoint, it's important for patients to take the time to educate themselves and come prepared with questions. "Time is limited in the current circumstances of health care," Gottlieb says. "As a doctor, I appreciate an organized patient, because I can be responsive to the questions they have. If I meet a patient who comes in with a checklist, I'm impressed, and that helps me invest in and remember that patient."
Of course, you won't get care without knowing your HIV status. The NO/AIDS Task Force offers free walk-in testing six days a week (visit www.noaidstaskforce.org/testing for a list of sites and hours), and its mobile medical testing unit frequents large events like Southern Decadence and Essence Music Festival. This is part of an initiative to bring HIV testing to people without access to health care and to make HIV testing become a normalized part of health care.
"The CDC recommends HIV testing become a normalized part of care," Rogers says. "Anybody who is a sexually active adult should have an HIV test. Having HIV testing be a part of that expectation of health care on an annual basis will help reduce incidents."
It also will help reduce lingering stigma around HIV and AIDS, Rogers adds. Gottlieb calls the stigma "a vicious circle," and calls on people with HIV to disclose their statuses, while people who are HIV negative should educate themselves and have conversations with HIV-positive people.
"It would help so much if people with HIV were out to their friends, families, their workplace, to societies at large, because then everyone would know someone with HIV," Gottlieb says. "Most people do know someone with HIV. They just may not know that person has HIV because it hasn't been disclosed."
For Guerra, disclosing his HIV status on national television was a life-changing moment. "I didn't go to Project Runway planning on revealing I am HIV positive," he says. "It just happened organically in an intense moment on the show. I know if that moment didn't happen, I probably wouldn't have talked about it ever, to tell the truth."
Guerra is glad he has the opportunity to affect both HIV positive and negative individuals, and he encourages people to continue the conversation about HIV and AIDS.
"It's important to have everyone talking about HIV," Guerra says. "It's been pushed under the rug for a while, and now it's time to talk about it again."