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County expands effort to combat outbreak of HIV infections

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When I walk through the McDowell Healthcare Center, I’m sometimes overwhelmed by the number of people with new HIV infections, like the 27-year-old who appeared recently with rapidly developing black spots on his skin – AIDS-related cancer. He tested HIV positive in August 2018, but delayed treatment because of stigma still associated with the disease.

He is just one of the hundreds of new patients who will seek treatment this year for HIV at my clinic, part of the Maricopa Integrated Health System. No one needs to progress to advanced HIV disease, or full-blown AIDS, because early treatment can prevent this outcome.

Ann Khalsa

Ann Khalsa

In 2017, there were over 18,000 people living with HIV/AIDS in our state, and over 700 new infections. Today, Maricopa County is one of 48 counties across the United States with the highest rates of new infections. These are disproportionately occurring in African American, Native American and Latino communities, which have the highest per capita rates of HIV (36, 16, and 14 cases per 100,000 persons, respectively, compared to seven per 100,000 among whites).

The crisis is so serious that U.S. Surgeon General Jerome Adams visited Phoenix in February to highlight a national initiative to reduce new infections of HIV by 75% in the next five years.

We at MIHS (which is soon to be called Valleywise Health) are fully on board with this national and international goal of “Ending the AIDS Epidemic by 2030.” This means getting to the point of NO new HIV infections. How do we achieve this? There are several very positive developments:

Beginning October 1, patients enrolled in the Arizona Health Care Cost Containment System (AHCCCS) will have insurance coverage for Truvada for PrEP. Truvada has been shown to effectively prevent new HIV infections when taken as Pre-Exposure Prophylaxis (PrEP).

MIHS will be expanding voluntary HIV screening to all its Family Health Centers – 11 primary care centers across Maricopa County – by the end of the year, thanks to a $582,731 grant from the Arizona Department of Health Services. Maricopa Medical Center became the first hospital emergency department in Arizona to begin voluntary HIV testing in 2011. Since then, we have tested nearly 90,000 individuals, confirmed 258 positive results, and linked those patients to treatment.

Since 2018, we have participated in the citywide Fast Track City Initiative, as well as the State of Arizona Antiretroviral Rapid Treatment (START) initiative, in which patients are started on HIV treatment within five days of diagnosis.

Going forward, we believe that HIV testing should be routinely offered to individuals who are at risk or have never been tested.

When MIHS opened the McDowell Healthcare Center in 1989, it was the county’s first and only HIV specialty clinic. This was at the time when AIDS was killing tens of thousands of people nationwide every year and treatment options were few and mostly ineffective. Today, we have many highly effective medication options to treat HIV. For many, HIV has become a manageable, chronic disease.

When individuals with HIV know their status and either take PrEP or quickly start HIV treatment, we can help stop HIV transmission and support the goal of getting to no new infections by 2030.

As the Valley’s only public teaching health system, you can count on our commitment to caring for low-income, safety net patients. Many people infected by HIV are part of this safety net, and like all other patients, these patients deserve the highest level of care.

Ann Khalsa, MD, MS, MSEd, AAHIVS, District Medical Group, is medical director of Maricopa Integrated Health System’s McDowell HIV/AIDS Healthcare Center.

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