Shannon Southall remembers it was 10:30 on an April morning nearly 25 years ago when her life screeched off its path.
It was 1992, and she was the first person her doctor had ever diagnosed with HIV. Southall, who was infected by her cheating fiance, had only asked for the blood test as a routine follow-up after she was poked with a needle during her work as a medical assistant.
Southall, now 52 and director of a Denver advocacy organization for people living with HIV and AIDS, was diagnosed early, began a drug regimen almost immediately and reached “viral suppression” in 1997, meaning there was no detectable virus in her blood. She is the model patient, one who has accomplished all three goals set by the international health community to end the AIDS epidemic by 2030.
To get there, Denver — along with many other cities across the world — pledged to meet three measures by 2020: 90 percent of people with HIV know they have it, 90 percent of those diagnosed are receiving care and 90 percent of those in care have, thanks to medication, no detectable virus in their blood.
Denver is two-thirds of the way there, officially reaching a 90 percent diagnosis rate earlier this year and, this fall, achieving the “viral suppression” benchmark.
The toughest measure for Colorado has been getting 90 percent of people diagnosed with HIV into medical care, said Dr. Sarah Rowan, director of HIV and viral hepatitis prevention at Denver Public Health. Everyone living with HIV should see a doctor at least once a year, and many patients need multiple visits. Yet only about 75 percent of Denver residents with HIV showed up at a medical appointment within the past year, according to data from Denver Public Health.
Beginning in 2017, public health officials will intensify efforts to track patients who haven’t been to the doctor and call them.
The city’s Department of Environmental Health plans to attack that health measure as aggressively as it has the first two, with what Mayor Michael Hancock calls “one of the most comprehensive networks supporting people living with HIV.” The department’s “office of HIV resources” distributes $7.9 million in federal funding, much of it for prevention and treatment programs at Children’s Hospital, Denver Public Health, and the University of Colorado Hospital.
The medical centers have ramped up testing, diagnosis and financial help to cover prescription costs.
Denver Public Health offers free or low-cost testing weekly at the LGBT Community Center, the downtown nonprofit HeyDenver, the Denver Swim Club and the Midtowne Spa, all popular hangouts among gay men, the most at-risk population along with people who have sex with multiple partners. People ages 25-29, who grew up in an age when HIV infection is a chronic, manageable condition rather than a deadly diagnosis, comprise another high-risk group.
The majority of those whose test results are positive are linked to a clinic within 30 days.
About 1,800 people with HIV are patients at the University of Colorado infectious disease clinic, where pharmacy manager Jasjit Gill helps them get free or reduced-cost medication through the state’s AIDS drug assistance program. The once-a-day pill to treat people with HIV costs about $3,000 per month, although Medicaid government insurance covers most of the cost of the prescription.
About half of the pharmacy’s patients are receiving state assistance for prescription costs. Some of them are homeless, which makes it hard for staff to follow up with them. “The hardest part is getting people to show up here,” Gill said. “How do they even put down an address?”
Out of all patients with HIV who visited a doctor or clinic within the past year, 90 percent were in viral suppression — part three of the three-step international goal. That means medication to suppress the virus was reduced so that it is not detectable through a simple blood test, although an antibody test still would detect antibodies. Patients in viral suppression do not progress to AIDS and the possibility of disease transmission is dramatically reduced.
Public funding also goes toward marketing campaigns, including one called “Denver Brings It Up.” The ads, mostly on gay-dating websites, encourage testing and offer information on PREP, a daily pill that can prevent HIV infection.
The first case of AIDS in Colorado was diagnosed in 1982, and since then, 19,100 people have been diagnosed with HIV. More than 6,000 have died. An estimated 12,900 Coloradans are now living with HIV.
Nationally, the number of new HIV cases fell 19 percent from 2005 to 2014. An estimated 14 percent of people with HIV in the United States do not know they have it, compared with 10 percent in Denver. The percentage is derived by estimating the prevalence of the disease and subtracting the number of diagnosed cases.
The 2020 goal is a step toward ending the AIDS epidemic by 2030, a worldwide effort led by the United Nations. In logistical terms, the end of the epidemic means new HIV cases are rare, and when they occur, they do not progress to AIDS. “They will go on and live long, healthy lives,” Rowan said.
Southall’s life took an abrupt “right instead of taking a left” the day her doctor told her she had HIV. At 26 years old, she drove straight to her family in Greeley. Although they were supportive, for years they washed her dishes separate from their own and were concerned about showering after her, and one brother-in-law refused to let her see his children. A new boyfriend freaked out when he learned she had the virus. “All that stigma, thrown at me by my own family,” she said.
Southall got married six years ago, and because the virus in her blood is suppressed, her husband has not been infected. Her first drug regimen required her setting an alarm to take medication at 3 a.m., one of 20 pills each day. Now she takes just three.
The diagnosis also led to a new career. Southall founded and then ran the Women’s Lighthouse Project for 13 years, helping women with HIV find medical care. Now she heads Rocky Mountain Cares, which works on prevention, education and medical-care management for people living with HIV.
Besides the 90-90-90 international goals, Southall’s organization is working to eliminate stigma and the perception that someone who asks for an HIV test has been “sleeping around or using drugs,” she said.
“This is a health issue, not a behavior issue,” Southall said. “It should be part of a regular test at the doctor if you are single and sexually active. The biggest barrier to that is the stigma that comes along with having to ask for an HIV test because you’ve ‘done something.'”
