At this Atlanta clinic, staff counsel people about getting tested for HIV, perform the test, talk about the consequences of the result, and, if necessary, arrange for people to receive treatment immediately. Sometimes – far too often – they are present as patients die.
An HIV-positive diagnosis is no longer a death sentence. Effective drugs mean people can with HIV can lead normal or even extraordinary lives.
But that requires people getting tested, acknowledging they have the virus, and taking the medicine to manage it. For some people, that is too much.
Doctors at Grady say that each year they lose around 100 patients to Aids-related illnesses. The figure is horrifying; in London, a city of 10 million people, 42 such deaths were recorded in 2017, and 51 in 2016.
And as the doctors at Grady point out, those deaths were at just one of several hospitals in the city of Atlanta, which has a population of just 500,000.
“The numbers alone are certainly astonishing. For 2016 and 2017, a single hospital in the Atlanta area, we have lost over 100 individuals a year. Mostly young people,” says Jonathan Colasanti, an assistant professor of medicine in infectious diseases.
“The tragedy is not only do they tend to die very painful, drawn-out physical deaths, but the tougher thing for me to watch, is the emotional aspect,” says Colasanti. “The number of people that we watch die alone, with no one in the room with them, surrounded by no family, is one of the greatest tragedies of our time.”
He adds: “That’s not everybody. Thankfully there are moments of peace at the end, and surrounded by loving families. That number of 100 is tragic in and of itself. But that is one hospital.”
Experts say that a gay black man in the United States has a one in two chance of being diagnosed with HIV. In Atlanta, it is even worse, with those odds perhaps closer to 60 per cent. There are many reasons for this, but racism, homophobia, poverty and lack of education about HIV are all contributors.
The doctors at Grady seek not only to work as physicians, but as educators working to overcome the ignorance and stigma that lead some people to avoid taking medicine, rather than admit they have the virus. Others will decide to forgo the drugs because they do not want their family to know.
“For some, looking at those pills is a daily reminder of their illness,” says Colasanti.
The Grady clinic, which is associated with Emory University School of Medicine, is one of the projects supported by the Elton John AIDS Foundation, a charity being supported by The Independent and Evening Standard.
Recently, Sir Elton and Evgeny Lebedev, owner of the newspapers, visited Atlanta, to meet doctors, community workers and survivors. They also got tested for HIV to show how quick the process could be and to encourage others to do so.
In a joint statement, they said: “As we write, 37 million people globally are living with HIV. Last year alone, 1.8 million people contracted the virus and 940,000 died of an Aids-related illness. This need not happen.
“Today’s medicines not only enable those living with HIV to have full and fulfilling lives, but also ensure they cannot pass the virus on to others,” they added.
Wendy Armstrong, professor of medicine at Emory, carried out the tests on the two special visitors.
She says a tester has to be confident in what they are doing, comfortable about talking to the patient and ready with a plan of action for treatment if the result is positive. “The second you hear that you’re HIV positive, you may not hear anything else.”
Armstrong says there are a number of reasons why the American south has HIV infection rates comparable to several countries in southern Africa, while much of the nation has looked away, perhaps believing the disease was defeated in the 1990s.
One was the enduring stigma associated with the virus among some communities. Among some African Americans there is still understandable suspicion, she says, of the medical community, following scandals such as the Tuskegee syphilis experiment, in which poor African American men from Alabama were refused treatment for the disease, even though the use of penicillin was known to be effective.
“One cannot ignore in the south the legacy of racism and the remaining structural racism that affects our institutions,” she says.
“That might be how far patients have to travel to get to a clinic, how welcome they feel in that clinic. It’s that milieu that disadvantages our minority populations in accessing treatment.”
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