Moderated by Rick Badie
In our lead column, medical experts entrenched in the AIDS battle stress the importance of HIV testing as a first step toward curbing the disease. And, with Year Three of open enrollment for health exchanges underway, an advocate writes about her nonprofit’s efforts to sign up immigrant populations for care. Finally, the third essay outlines a national initiative to improve the health of our community and beyond.
Take steps to control HIV/AIDS
By James W. Curran, Gerald Schochetman
Recently, the World Health Organization (WHO) issued new HIV treatment and prevention guidelines that encourage anyone with HIV to begin antiretroviral therapy immediately after diagnosis. Previous guidelines recommended waiting to treat HIV-infected people until their immune systems show signs of illness. The guidelines also recommend that people at substantial risk of infection take a daily dose of oral pre-exposure prophylaxis (PrEP), which can help reduce the risk of acquiring HIV infection when taken regularly.
These revisions bring us a step closer to controlling HIV/AIDS.
But before someone can seek treatment, they need to know whether they have HIV or not. HIV testing can be lifesaving, and it is a vital first step in prevention and proper treatment.
It has been more than 30 years since we began working together at the Centers for Disease Control and Prevention (CDC) in Atlanta to wage a war against HIV and AIDS. Since then, we have witnessed tremendous advances in prevention, testing and treatment. Yet, despite all of the progress, we continue to face new challenges, frustrations and a continual need for more action. While we agree the WHO’s new guidelines are a powerful step to eliminating this disease, more can be done.
To support the WHO’s early treatment mission, we must first prioritize HIV testing. More than 1.2 million people in the United States are living with HIV, but almost 1 in 8 don’t know that they have it. Atlanta is ranked No. 5 among cities in the United States when it comes to the rate of new HIV diagnoses. What is disconcerting is that by the time people are diagnosed in Atlanta, almost one-third (29.4 percent) have advanced to clinical AIDS.
In order to know whether someone has recently contracted HIV, people must make sure they are being tested with methods that are able to detect the HIV virus soon after infection. Last year, the CDC recommended that laboratories use the latest HIV testing technology to better identify early cases. Called fourth-generation tests, or HIV Combo, these tests can screen for both antibodies to the virus and antigens (a protein of HIV), and can detect HIV infection earlier than older antibody-only tests.
HIV Combo tests are available in the United States, but despite the CDC’s recommendation, many U.S. testing facilities are not using the latest testing technology, including some in Atlanta. The new WHO guidelines could have enormous impact on those infected and those at high risk in the U.S. and globally, but in order to be effective, it is important to place a strong emphasis on testing.
After more than 30 years on the front lines of the war against HIV, we now know so much more than when we started. Scientific breakthroughs have saved and prolonged the lives of millions in the U.S. and throughout the world. While our mission is not yet complete, we know that by getting the right information about HIV status at the right time, we can turn the tide against the disease.
So, do your part. Talk to your doctor, get tested, and learn about treatment options at the earliest stage possible.
Dr. James W. Curran is dean of public health for the Rollins School of Public Health at Emory University and co-director at the Emory Center for AIDS Research.Dr. Gerald Schochetman is senior director of diagnostic research for Abbott, a global healthcare firm.
Health care benefits all of Atlanta
With open enrollment beginning this week, the Center for Pan Asian Community Services has been preparing to help clients obtain coverage through the Health Insurance Marketplace. CPACS specializes in working with immigrant and refugee communities, particularly the Asian and Latino populations. For the last two years, dedicated staffs have provided in-language enrollment and education with the goal of increased access to health care.
Before the Affordable Care Act, according to 2010 Census data, 25 percent of the area’s Asian population had no health coverage, with Koreans being highly uninsured at 41 percent; for Latinos, the uninsured rate was 46 percent. At the time, about 19 percent of the overall metro population lacked coverage. The uninsured had little to no access to adequate health care. Many utilized emergency rooms for their basic health care needs.
CPACS took on the challenge of educating and enrolling the uninsured with the organization’s mission in mind: To promote self-sufficiency and equity to immigrants, refugees and the underprivileged. It held outreach and education sessions about the changing health law; provided in-language enrollment to clients in more than 15 languages, and helped newly enrolled clients learn how to use health insurance.
CPACS assisted hundreds with the marketplace over the last two open enrollments. Clients had a variety of backgrounds, but all understood the importance of being insured. Our staff enrolled small business owners and their families who would not have been able to afford health insurance otherwise; faith leaders, including small church pastors and Buddhist monks, and immigrants who had multiple part-time jobs that offered no health coverage.
Clients came to us for enrollment assistance since many lacked the language and computer skills to comfortably navigate Healthcare.gov. The marketplace offers only English and Spanish websites. Many clients had limited English proficiency but were fluent in other languages such as Korean and Chinese. Some lacked literacy in their native language and needed assistance interpreting the application and different plan options. Many had limited computer skills and little access to the Internet. Some even needed email accounts created just to start an application.
We learned clients needed not only health coverage, but guidance on how to access care. Many immigrants and refugees come from countries with different health care systems or very limited access to medical care. The concept of health insurance and terminology such as “deductible” and “co-insurance” were confusing and daunting when clients were choosing plans and trying to use their coverage. Individuals would forego or drop coverage and pay the fine for going uninsured, since they were so uncertain how use their coverage.
Unfortunately, a significant number of clients sat through appointments and were unable to qualify or afford health insurance. Many individuals fell into the Medicaid gap: Their incomes were too low to qualify for health coverage on the marketplace and too high to qualify for Medicaid. Additionally, other clients’ incomes were eligible for marketplace coverage but unable to afford the premiums.
Though progress has been made, navigators and assisters continue to work with immigrants and refugees to meet their unique needs. Education and resources are essential. During open enrollment, individual guidance is vital to help enrollees understand their options and successfully enroll in a plan that will give them sufficient and quality care. When all communities have access to quality health care, all of Atlanta will benefit.
Sarah Brechin is the AmeriCorps VISTA program coordinator for the Center for Pan Asian Community Services Inc.
Focus on health, not sickness
William E. Hauser Jr.
Here at Humana, we’re partnering with doctors and other health care providers so that, together, we make it easy for people to achieve their best health. The current health care system is too complex and not exactly easy to navigate.
To demonstrate our commitment to the communities we serve, we know we need to measure our progress. So earlier this year, we announced a 2020 goal: “To improve the health of the communities we serve 20 percent by 2020 because we make it easy for people to achieve their best health.” We’re now working to achieve that goal in communities across the country and with the nearly 50,000 associates who work at Humana. It’s what inspires us in the work we do each day.
Is it an ambitious goal?
Yes, but one that we believe is achievable if we work together with partners here in Atlanta and in communities across the country. It’s also imperative when you consider the alarming growth rate of serious health conditions, such as diabetes. In its 2012 report, The Centers for Disease Control and Prevention reported that 9.8 percent of Georgia’s adult population had been diagnosed with diabetes. That same report stated one-third of U.S. adults have pre-diabetes, although awareness of this risk condition remains low.
By collaborating with doctors, for instance, to deliver an integrated, holistic approach to health that focuses on preventive care, reducing disease progression and encouraging health choices, we are well-positioned to help people have more healthy days than ever before.
In fact, “healthy days” have a lot to do with how we are going to measure our progress over the next five years. The Healthy Days measurement – developed by the CDC – features a quick survey that asks people four simple questions to rate their recent days of physical health and mental health and has been well validated for measuring population health.
So we are using it.
We also believe that encouraging people to invest in health and well-being works. In Georgia, we already have close to 412,000 people participating in HumanaVitality, our wellness program that helps people stay motivated to reach their fitness goals and earn rewards for healthy behaviors. And, when we hosted a free, “Rock ‘n’ Roll Tune-Up Series 5K” at Centennial Olympic Park in September, the event filled up well in advance — 2,500 Atlantans participated.
We know that improving the health of the communities we serve by 20 percent by 2020 is a bold goal – but we believe it’s attainable. Over the next five years, Humana is committed to working to meet that goal while greatly improving our entire health-care system in the process. It’s time to stop focusing all the attention on treating sickness – and start focusing on improving health.
Dr. William E. Hauser Jr., is Humana’s regional medical director for senior products in Georgia, South and North Carolina.