How Baltimore Is "Moving Forward" on HIV/AIDS

Today we mark a monumental achievement in our ongoing fight against the scourge of HIV/AIDS. For three decades now, HIV has been a long-standing and significant health problem in Baltimore, with terrible consequences. Countless people from all walks of life have died from HIV/AIDS. More than 13,000 people—two percent of the City’s population—are living with HIV.

In addition to the physical and emotional tolls the virus takes on its victims, the costs to our society are staggering. Everyone reading this, I’m sure, has been touched by this epidemic in some form or fashion. Through various programs and initiatives—the City has made tremendous progress in getting more people tested for HIV, getting more HIV positive people into care, and helping those with HIV live longer, healthier lives.

Now, on the eve of World AIDS Day, I’m pleased to report Baltimore has a new, aggressive plan to dramatically reduce new HIV infections, expand treatment, better coordinate services and make a significant improvement to the status of the HIV/AIDS crisis in Baltimore. On Tuesday, Mayor Stephanie Rawlings-Blake unveiled our new strategic report on HIV, “Moving Forward”. The strategy will help us better engage non-profit and community partners in our efforts educate residents and improve the lives of those who are HIV-positive.

The report was prepared by the Baltimore City Commission on HIV/AIDS.  It adopts specific, measurable goals in four key areas and outlines a variety of strategic initiatives to achieve those goals in an accelerated timeframe.

1.      Reduce new HIV infections by 25% in Baltimore City by 2015

2.      Increase access and improve health outcomes by facilitating earlier, more continuous, and more comprehensive care

3.      Reduce HIV-related health disparities by focusing resources and coordinated services on the most at-risk populations

4.      Achieve a more collaborative City response by creating effective linkages between services providers, advocacy organizations, and community-based models

The measurable goals and specific strategic initiatives outlined for each of the key goals are designed to drive aggressive and fundamental changes, yet are calibrated to be realistically achievable by 2015. I’m especially pleased that our vision aligns with the new National HIV/AIDS Strategy, as well as the ambitious goals we’ve set for improving the health of Baltimore residents through our Healthy Baltimore 2015 agenda.

Reducing HIV disparities is of particular concern in Baltimore. Eighty-seven percent of new HIV infections are among African-Americans, who only represent 64% of Baltimore’s population. This is one of the City’s most glaring health disparities. As referenced in the Strategy, 44 percent of the city population from 10 zip codes represented 60% of new HIV cases. These same zip codes have high rates of STDs, poverty and crime, along with higher rates of other poverty-related health problems, like cardiovascular disease and diabetes.

The Health Department, working in concert with our partners at the state and in the community, is working hard to address these needs. We provided more than 45,000 HIV tests in calendar year 2010. Through these efforts we identified 283 people who were previously unaware of their positive HIV status. Additionally, we operate two STD clinics that provide in excess of 30,000 patient visits per year, and offer HIV testing to all patients who register. Lastly, we are preparing a social marketing campaign in collaboration with Maryland Institute College of Art aimed at increasing awareness and testing among African-American MSM, the group that is currently experiencing the highest rate of HIV transmission.

Our focus is to ensure that patients who test positive make it all the way from receiving their results, through notification of their sex and needle-sharing partners, to being linked to HIV primary care.  As leaders of these efforts, we have a responsibility to hold ourselves and each other accountable to achieving measurable results

It is important to realize that the report provides critical guidelines for dramatically reducing HIV/AIDS in Baltimore, but reaching the target goals that have been established cannot be achieved unless communities and individuals also make effective prevention and treatment of HIV/AIDS a priority.

This strategy is our path forward. I’m counting on all of you to help us put this strategy into action. Let’s show the world that Baltimore is aware, that Baltimore cares, and that Baltimore is committed to stopping the spread of HIV.

Meeting People Where They Are: The Needle Exchange Program

The best outcomes in public health often happen when we meet people where they are.

Our NEP staff - Chris Serio-Chapman, Derrick Hunt and Lamont Clark.

At 10 a.m. this morning, I witnessed a part of life that many of us shy away from.  I spent time observing the work Health Department staff do within our harm reduction program.  Within the confines of a small camper on a street corner in Southwest Baltimore, two staff members attended to drug injecting users exchanging dirty needles for clean ones.  There was a steady stream of clients – men, women, young, old, black and white.  Some were regulars who chatted for a bit and then went about their day, while others were in and out in less than five minutes.

 

One of the clients, a woman just a year older than me, shared she had ongoing liver disease, diabetes and MRSA.  She also shared symptoms that made us suspect her diabetes was not under control and we convinced her to follow up with her clinic.  Another young lady listed a bunch of STI’s she had been treated for and was concerned she might have HIV.  We were testing her for HIV on the spot.

Our Needle Exchange Program (NEP) is the cornerstone of BCHD’s Ha­­­rm Reduction Program. NEP is an evidenced-based intervention program that provides clean needles to injection drug users in return for used syringes, which are discarded. The purpose of the program is to reduce the frequency of infections passed through the use of unclean needles, infections that include HIV and hepatitis C. 

The time I spent on the van gave me a more personal glimpse of the ravages of drug abuse in our city.  Our program, run by Chris Serio-Chapman and her staff, is the only confidential needle exchange program in the country.  The success of the program has been documented: when the program began in 1994, it is estimated that approximately 650 incident cases of HIV in Baltimore were caused by injection drug use, representing 60.3% of reported HIV.  Sixteen years later, the number of new HIV infections caused by injection drug use dropped to 177 new cases per year, representing a 29.5% decrease in the proportion of new HIV diagnoses caused by injection drug use.

One of the many reasons we’ve been successful is the attention paid to doing things that are evidence-based and evaluating the work we do to make sure we’re getting the outcomes that will best improve the lives of the people we serve.  An even more important reason is the dedicated staff that we have.  In addition to Chris, I got to talk with Derrick Hunt and Lamont Clark about their experience with the program and how we could help people on the road to recovery. 

I also had the pleasure of observing the skill with which they were able to engage individual clients by meeting them where they were. NEP has been extremely successful in this regard, currently operating at 17 locations around the city. Since 1994, more than 9 million clean syringes have been distributed to clients, and more than 10 million contaminated needles have been properly destroyed since it was started.

For more information about Baltimore’s needle exchange program, including our location sites and times, please see our website. For the latest NEP updates, be sure to “like” their Facebook page.

Take Care, Baltimore.

Pushing the envelope

April is STI Awareness month and this year’s emphasis is on the importance of getting young people tested. Focusing efforts on youth and young adults is important because they are more likely to engage in high risk sexual behavior. Additionally, the consequences to them of untreated STI’s can have long lasting effects such as infertility. 

Testing and treating individuals for STI’s in the age of the internet has become a hybrid of good old-fashioned public health practice and digital sleuthing.

For some people, the internet has become a means for arranging shorter term, often anonymous and often unsafe sexual encounters. This practice has added a new and challenging obstacle to our work of intervening in the spread of sexually transmitted infections. Everyday, public health staff in Baltimore and throughout the country interview people diagnosed with HIV, syphilis, or other STIs to provide appropriate education about STIs and to ensure that the person has medical care. We also reach out to their sex partners so they can get appropriate and timely medical care.

Until recently, a typical scenario when public health staff asked the patient about his or her sex partner(s) would be “I met him/her on the internet. We agreed that we would meet at an agreed to location in 45 minutes.” When asked how that person can be contacted, the patient typically says “I only know his/her screen name: ‘#1hotbodi’”. Prior to this month, that was typically the end of the public health intervention.

Now, however, the Baltimore City Health Department and the Maryland Department of Health and Mental Hygiene’s Infectious Disease and Environmental Health Administration are implementing internet partner services (IPS) to intervene in the spread of sexually transmitted diseases. Working with a nationally recognized consultant and three of the most heavily utilized “hook-up” sites in Baltimore and Maryland, we’ve developed a program to maximize the number of sexual partners we treat. The joint effort is critical because oftentimes persons like those described above have no idea where the person they meet lives. Close coordination between the city, the state, the counties and even other states is essential to reducing our rates of STI’s and HIV.

The program has been in effect four weeks and already we’ve been able to reach people exposed to an STI or HIV from places as far away as New York and are enthusiastic about the new program’s potential to intervene in the spread of disease.