103: Ending the HIV Epidemic

Dr. Joseph Kanter, Louisiana’s State Health Officer, talks about fighting the HIV epidemic during the COVID-19 pandemic as ASTHO releases a set of 10 policy briefings focused on public health issues expected to be priorities this year; ASTHO offers...

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Dr. Joseph Kanter, Louisiana’s State Health Officer, talks about fighting the HIV epidemic during the COVID-19 pandemic as ASTHO releases a set of 10 policy briefings focused on public health issues expected to be priorities this year; ASTHO offers a new blog article including information about an innovative HIV testing program; and Dr. John Wiesman offers thanks for the people battling to control the COVID-19 virus.

ASTHO Health Policy Prospectus: HIV – Ending an Epidemic

ASTHO Blog Article: ASTHO Policy Watch – Ending the HIV Epidemic

CDC Webpage: CDC Museum COVID-19 Timeline


ASTHO logo


This is Public Health Review Morning Edition for Monday, January 24th, 2022. I'm Robert Johnson. 
Now, today's news from the association of State and Territorial Health Officials. 

January means the return of lawmakers to Capitol Hill and state houses across the country, all of them looking to address policy opportunities and challenges. 
ASTHO has assembled a set of 10 legislative policy briefings focused on public health issues members can expect to get the most attention this year. Over the next few weeks, we'll touch on each of these topics in a conversation with a public health leader. 
Today, we begin with HIV. Louisiana state health officer Dr. Joseph Kanter talks about the effort to end the epidemic—it's today's morning conversation. 
The fight to end HIV continues, even if we don't hear much about it because of the pandemic. How has COVID-19 impacted the campaign against HIV? 
You know, it's been a challenge, was absolutely no way around that. The COVID pandemic has interrupted our fight against HIV in a number of ways: it's taken our eye off the ball; it's diverted resources away from what is also a very important, very pressing public health challenge. 
HIV testing rates have gone down across the country past couple years—we're missing more cases that are out there. A number of state health departments and local jurisdictions that did divert staff and resources away from the fight against HIV, for obvious reasons, but there is a toll on the other end of that. 
And much like a number of other chronic and serious diseases, we have our work cut out for us as we—hopefully—come out of the other side of this pandemic making up for lost ground.
So, that's to say there are a lot of public health priorities—and HIV is certainly one of them—that's going to require our attention to make up for what has been lost in the past couple of years. 
What about this year? Do you think we can make any progress against HIV in 2022? 
I absolutely do. You know, folks in public health are really good at walking and chewing gum and doing 12 other things all at the same time because we have to, and that's just like what we have to do that this year. And I've been impressed that a number of states have managed to make significant progress on certain objectives for the HIV epidemic over the course of the pandemic.
There's now 17 states that are doing a novel at-home testing program for people who were at risk. There are three states which have been able to put forward laws allowing pharmacists to prescribe PrEP, which is a good initiative to expand access to the important medication. There's now a total of 38 states that have modernized their syringe service program laws. There's nine states that, just over the past couple of years, have further modernized and decriminalized hypodermic needles.
All those are really important initiatives, and a lot of that has been done throughout the course of the pandemic, to those states' credit. So, you know, in every crisis there always is opportunity. I certainly think some of the lessons we've learned in COVID are relatable to the HIV efforts. Certainly public health departments have more resources at their disposal now than they did at the onset of the pandemic, and the hope is that they'll be able to use those to build capacity to address all sorts of public health issues, certainly including HIV. 
There's a lot of walking, talking, and chewing gum at the same time right now in public health—it's an overloaded public health agenda. So, how do you address HIV prevention and treatment, given all of that? 
Well, you know, the good news is that, at this point in the game, we have a pretty good roadmap. We have a good sense of what works in the fight against HIV. You know, the underlying dynamic hasn't changed that. About 80%, four out of five new cases of HIV being spread are spread from an individual who either doesn't know they have HIV yet, or is not in stable treatment. This isn't rocket science, and that's essentially a low-hanging fruit that we can go after. 
And initiatives like: expanding access to PrEP, making it easier for people to get it; making it easier for people who suffer with addiction to access sterile injection equipment through certain service programs; better case management, meeting people where they're at; and then, ultimately reducing the stigma of the disease itself—reducing the stigma of HIV and AIDS—will help us along that track. 
None of this is new, but I do think we have more resources now after the two-year experience with COVID. It's difficult to keep your eye on the ball when there's so many other pressing issues; but in terms of disparities, HIV is ever significant. And we have—particularly here in the American South where we have about 50% of the cases, 50% of the deaths if not more—there are stark disparities across racial lines, across sexual orientation. 
We have to keep our eye on the ball here. I do think that we're well positioned to do so going forward. 
Tomorrow, Wisconsin state health officer Paula Tran stops by to discuss health equity, another ASTHO policy priority. 

We just heard Dr. Joseph Kanter talk about the work needed to end HIV in the US. ASTHO has a blog article on the topic. The article previews the legislative policy briefing and includes a link to information about an innovative HIV testing project that reached almost 5,000 people, a third of whom had never been tested for HIV. 
There's a link to the article in the show notes. 

Finally this morning, we conclude our conversation with Dr. John Wiesman, the former Washington state secretary of health who led his department's response to the first confirmed case of COVID-19 in the country two years ago. 
What about your advice for people in public health? What kind of wisdom can you share with them for this year coming up as they try to get through yet another year of dealing with this? 
Well, first of all, it's thank you. Thank you for what you've been doing. This is incredibly difficult work and it not only impacts the individual, but it impacts their entire family. And so, thank you for that work. 
Then, I guess I would say it is, you know, come together at the federal, state, and local level, and let's get our communications clear. Let's consult with each other in timely fashion to make sure we can all pivot as we need to and pivot together. This does require pivoting; a new variant comes along, and something changes, and we've got to rapidly respond to new data, but we do that best when we do that together. And so, I would encourage that. 
And then, the piece of we have to take care of each other; so, support each other, figure out how we take time off, figure out how we start limiting our workdays to something more reasonable so that we can operate at our highest level of thinking, which is just hard to do when you're as overwhelmed and stressed as people have been. 
You can hear the full conversation with Dr. Wiesman in our last two reports. Those were aired on Thursday and Friday of last week. You can find both reports in your feed immediately before the show you're listening to right now. 

That'll do it for today's report. 

Be sure to join us again tomorrow morning for more ASTHO news and information. 
I'm Robert Johnson. You're listening to Public Health Review Morning Edition. Have a great day. 

John Wiesman DrPH MPH

Professor of the Practice & Director, Executive Doctoral Program in Health Leadership, University of North Carolina

Joseph Kanter MD MPH

State Health Officer, Louisiana Department of Health