AIDS, measles and educating the public

Moderated by Rick Badie

Today, a Fulton County medical director writes about the vigilance necessary to prevent and treat the AIDS virus. She wants to make Atlanta “greater than AIDS,” and outlines a new program in Fulton and DeKalb counties to inform and curb stigmas. Monday, the Georgia Department of Public Health announced the state’s first confirmed case of measles since 2012. A labor attorney offers guidelines for employers who may have to deal with the disease in workplaces.

Make Atlanta greater than AIDS

By Patrice Harris

Metropolitan Atlanta has the dubious distinction of having one of the highest rates of HIV/AIDS in America. That is unacceptable. We can do better. We must do better.

Advances in the treatment and prevention of HIV have reinvigorated hope that the end of AIDS is in sight. We now know that people with HIV, who are on ongoing antiretroviral treatment, not only can improve their own health, but can reduce the risk of spreading the disease to others by as much as 96 percent. That is a huge development.

Additionally, pre-exposure prophylaxis or PrEP — a once-daily pill available by prescription — is a highly effective, added option we now have to reduce the risk for those who are negative. When used correctly, PrEP is more than 90-percent effective protecting against HIV. Coupled with the use of condoms, which protect against HIV and many other sexually transmitted diseases, these are powerful tools at our disposal.

So what’s holding us back?

For one, many people in Atlanta and across the country are unaware of these game-changing developments. According to the Centers for Disease Control and Prevention, only 3 in 10 people with HIV in the U.S. have the virus “under control” through treatment. Fulton County fares better, with 4 of 10 having the virus under control.

And though HIV has touched so many lives, we are not talking about it — not with our families, friends, partners or even health-care providers. A recent survey from the Kaiser Family Foundation finds more than three in four Americans say HIV rarely, if ever, comes up in conversation. As a result, stigma and misperceptions persist. When it comes to HIV, too many people are still acting on fear, not knowledge.To close the information gap and reduce stigma, Fulton and DeKalb counties joined with the organization Greater Than AIDS to make Atlanta just that — “Greater than AIDS.” Media and community messages featuring local health care providers at the forefront of the HIV response will begin appearing this month to educate about prevention and treatment options available today. Future phases of the campaign will highlight the important role played by family and loved ones in the health and well-being of people with HIV.

A critical first step is that all Atlantans know their HIV status. So, we will also expand testing to get more people diagnosed and into care as quickly as possible. If you are HIV-positive, we can get you on treatments to keep you healthy and help prevent further transmission. And if you are HIV-negative, we can help you stay negative.

The Fulton County Board of Commissioners in December approved a resolution creating a task force on HIV/AIDS, reinforcing its long-standing policies to stem the transmission of the disease. Recommendations of these stakeholders and interested parties in the areas of prevention and treatment, public education, advocacy, housing and related issues are vital to all efforts to eradicate HIV/AIDS.

At the Fulton County Department of Health and Wellness, we are dedicated to providing information and services to the people of metro Atlanta. But we can’t do it alone. We need everyone involved. We need the faith community, businesses, community organizations — and you.

Whether you are HIV-positive or negative, we all have a role to play. Be informed. Talk with your loved ones. Know your status. And if you or someone you know is HIV-positive, support them in getting treatment and care. Together, we are “greater than AIDS.”

Patrice Harris is Fulton County director of health services.

Show concern for measles

By Howard Mavity

Georgians have learned that a child with measles has been admitted to Children’s Healthcare of Atlanta, a provider well-equipped to handle the case. Less clear is whether any unvaccinated persons were exposed as the child traveled through Georgia. Yet even if no additional cases are reported in this state, employers already are being bombarded with questions from concerned employees.

Employers might as well accept that infectious diseases will be an annual issue. In 2014, we dealt with Ebola and influenza. The current measles outbreak has introduced new concerns because the virus is hardier and more easily transmitted than the typical influenza. It can survive for two hours in the air or on surfaces. Employees may be infectious four days before and after presenting symptoms.

Each infectious disease outbreak prompts similar questions from employers: Can I require employees to get a vaccination? What are my responsibilities if an employee or customer exposes my employees? Can I tell an employee possibly exposed to an infectious disease to stay home?

How should Georgia employers respond to these questions? Are they even the right questions? Perhaps employers should first ask, “What can we do to prevent this illness before it generates personnel headaches?”

Society cannot yet eliminate all occasions of HIV, antibiotic-resistant staph, hepatitis or even TB, but we can eliminate almost all measles from the U.S. Employers have a vital role in this community effort, but they must address an uncomfortable area: employee personal responsibility. For legal and philosophical reasons, outside health care, employers are reluctant to require or even encourage vaccinations.

There are legal reasons employers in most settings should not mandate vaccinations, but there are few legal arguments against employers using wellness efforts and their internal communications programs to emphasize employees’ responsibility to co-workers and the public to obtain mandated vaccinations for themselves and their children.Employers should face anti-vaccination claims head-on by pointing out that all reliable research shows that, as in the case of any treatment, there are some risks with any vaccination, but they are minimal compared to the benefits. As long as the employer is repeating the established public health message, how can an employee prove the employer’s efforts violated the law?

Courts are loath to determine the validity of, or to override, religious objections. Outside of health care, it’s unclear whether an employer could overcome Americans with Disabilities Act, religious and other employee legal challenges to mandatory employee vaccinations. One would have to clearly show vaccinations were necessary to perform the essential functions of the job, or that not having a vaccination presented a direct threat to safety.

Employers must approach these decisions on a job-by-job basis. They should follow public health guidance in making decisions, including whether to ask an employee to stay home after an exposure.

Similarly, because of the easily transmittable nature of measles, public health officials are not recommending that employees be told the name of an infected coworker. That’s because there is little more an employee can do than to be alert to symptoms, so nothing is gained by identifying an individual. However, employers should understand that advising coworkers of a possible exposure, and the symptoms they should be aware of, raises few, if any, confidentiality concerns.

The best advice for companies is to remain calm and show concern for employees. Advise them you’re monitoring the situation. Regularly share useful public health advice and updates. Try to address employee concerns through education, before they become legal problems.

Howard Mavity is a partner at the Atlanta-based national labor and employment law firm Fisher & Phillips LLP.

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