Health Care

Florida has the third-highest rate of new HIV diagnoses. The CDC wants to fix that.

As home to one of the nation’s highest rates of new HIV diagnoses, South Florida will receive help from the federal government to raise awareness of the virus that causes AIDS and to ultimately reduce new infections as part of President Donald Trump’s national plan to end the epidemic.

Meeting with local researchers, doctors, healthcare system executives and elected officials at Miami’s Jackson Memorial Hospital on Monday, Dr. Robert Redfield, director of the Centers for Disease Control and Prevention, said the federal government wants to emphasize innovation and combat stigma about HIV.

“The president’s initiative to reduce new HIV infections by 75 percent in the next five years and 90 percent in the next 10 years is not an aspirational initiative,” Redfield said during a news conference after the meeting. “It’s a very pragmatic initiative.”

More than 115,000 people in Florida live with HIV, about 12.5 percent of all cases in the United States. But about 15 percent of those individuals, or roughly 19,200 people are not aware of their status and therefore not receiving care, according to the CDC.

Florida had the nation’s third-highest rate of new HIV diagnoses in 2017 with more than 4,800 new cases identified. Only Washington, D.C., and Georgia were higher. More than 40,000 new cases of HIV are diagnosed in the United States each year, Redfield said.

Seven Florida counties rank among a list of 50 jurisdictions, including Washington, D.C., and San Juan, Puerto Rico, with the highest number of new HIV diagnoses, making them all eligible to receive expertise, technology and financial resources from the CDC. The Florida counties targeted for CDC support are Miami-Dade, Broward, Palm Beach, Orange, Pinellas, Hillsborough and Duval.

In 2018, the CDC awarded Florida’s health department and community organizations more than $43 million for HIV prevention, including testing, diagnosis and connecting them to medical care, such as Pre-exposure prophylaxis or PrEP, a pill that can prevent transmission of the virus to those at high risk for HIV.

Lt. Gov. Jeanette Núñez said HIV remains a public health threat in Florida, and that the state has developed surveillance, education, prevention, counseling, testing and treatment programs to combat spread of the virus.

“We need to continue to address this to make sure that we’re looking at the root causes,” she said, “making sure we’re addressing the various social and economic issues that are putting people at greater risk for contracting HIV.”

CDC Director Dr. Robert Redfield was in Miami to meet with state and local health officials to discuss the national plan to end HIV in America. Carlos A. Migoya, president and CEO of Jackson Health System, and Jeanette Núñez, lieutenant governor of Florida, joined Redfield during a news conference on Monday, June 17, 2019, at Jackson Memorial Hospital. Emily Michot

Only certain bodily fluids — blood, semen, breast milk and vaginal fluids — from a person who has HIV can transmit the virus, which is spread primarily through unprotected sex, sharing contaminated needles and syringes, and from an HIV-positive mother to her child during pregnancy, labor, delivery or breastfeeding, though medical interventions have reduced the rate of mother-to-child transmissions.

One of the most innovative programs for preventing HIV in Florida has been the IDEA Exchange in Miami-Dade, the state’s only legal needle exchange, where drug users can turn in used syringes for clean ones to avoid sharing blood-borne diseases.

This year, the Florida Legislature approved Senate Bill 366, legislation modeled after IDEA Exchange that would allow for the creation of other needle exchanges throughout Florida. However, the bill prohibits exchange programs from using state, county or city funds. Instead, they are to be funded through private grants and donations. The bill has been sent to Gov. Ron DeSantis for ratification.

Núñez said she did not know whether the bill would prohibit needle exchange programs from receiving federal funding through the CDC, though the program has succeeded on many levels.

“All the data that we’ve seen in the pilot program that was initiated here in Miami-Dade County is positive,” she said. “We’ve seen increased access for counseling and treatment. We’ve seen cost savings that have been significant. So the governor will continue to evaluate that bill.”

One of the greatest challenges for HIV-positive individuals in Miami-Dade is accessing care.

The University of Miami Health System and Jackson Health System, Miami-Dade’s taxpayer-owned public hospital network, provides care to about 3,000 patients a year, said Jackson CEO Carlos Migoya, who was among a group of local health officials attending Monday’s meeting.

Migoya said that about 43 percent of those patients have no health insurance and 32 percent receive Medicaid, the public health insurance program for some low-income and disabled Floridians.

“That means 75 percent of those people have no insurance or are under insured, which means that most [hospitals and clinics] will not take care of these people,” he said.

Of the HIV-positive patients receiving care through UHealth/Jackson, Migoya said, nine out of 10 are diagnosed at community clinics and emergency rooms. Of those patients, he said, 92 percent are able to reduce the virus in their blood to undetectable levels through medication within 73 days of beginning treatment.

But not enough HIV-positive individuals and those at greatest risk for contracting the virus are receiving the treatment they need to reduce transmission. Redfield said fewer than 20 percent of individuals who would benefit from PrEP are receiving the medication.

“We have to figure out a way to get that done,” he said.

If state, local and federal health leaders succeed in increasing awareness of HIV among those who have the virus, then the rates of new diagnoses are likely to rise significantly during the next few years before infection rates begin to drop, Redfield said.

He said those individuals will be key to helping public health agencies learn how to reach others.

“We need them to teach public health leaders what didn’t work for them,” Redfield said.

Redfield added that among the most effective programs he has seen for reducing HIV infections are mobile healthcare units that reach people where they live rather than waiting for infected individuals to seek out care at hospitals and clinics. He also praised approaches that increase referrals for PrEP through counseling and other means that do not require a visit to a doctor’s office or clinic.

He also stressed that public health leaders and healthcare providers alone cannot achieve the CDC’s goals of reducing HIV infections. He said society must change the way it sees HIV and stop stigmatizing the disease and those who are infected.

“Too many people still see it as a moral failing,” he said. “It’s not. It’s a chronic relapsing medical condition and society needs to embrace it as such.”

This article has been updated to correct the description of Pre-exposure prophylaxis or PrEP, a pill that can prevent transmission of the virus to those at high risk for HIV.

Daniel Chang covers health care for the Miami Herald, where he works to untangle the often irrational world of health insurance, hospitals and health policy for readers.