An open letter to Dr.. Elizabeth M. Clark (Price), M.D.

Published 23, Oct, 2017
Author // T.J. Miller

T.J. Miller invites Dr. Elizabeth M. Clark to an open dialogue to bring her (and Georgia) up to speed on HIV.

An open letter to Dr.. Elizabeth M. Clark (Price), M.D.

Dr. Clark,

I choose to address you using this name, as this is the name that you are licensed under by the State of Georgia in the United States of America under the auspices of the Composite State Board of Medical Examiners under medical license #024915 first issued on June 14, 1983 which expires on August 31, 2019. Besides being a board certified Anesthesiologist who trained at McGill University (Class of 1980) in Montreal, Quebec Canada, you also are a Georgia State Legislator from their 48th Legislative District and the wife of former United States Health and Human Services Secretary Dr. Tom Price, himself a physician and Orthopedic Surgeon. Science and Medicine are something not unfamiliar to you.

In a story first reported by Regina Willis at Project Q Atlanta on October 20, 2017, Dr. Clark, you inquire about the feasibility of quarantining HIV patients as a method of curtailing the spread of HIV in your state. You also lament at the great costs that your state government is currently outlaying on the current HIV treatment and prevention model. You also further on in the article are interested in a tracking system and are quoted as saying that in the early years the high death rate of HIV patients was a much more effective method of controlling the spread of HIV. Just so that there is no confusion, let me publish the salient quotes from your questions, as published in the article from Project Q Atlanta. The entire hearing that you made these statements at is on video, just so fact checking can occur.

“My thinking sometimes goes in strange directions, but before you proceed if you wouldn’t mind commenting on the surveillance of partners, tracking of contacts, that sort of thing. What are we legally able to do," Price said.

"And I don’t want to say the quarantine word, but I guess I just said it. Is there ability, since I would guess that public dollars are expended heavily in prophylaxis and treatment of this condition. So we have a public interest in curtailing the spread. What would you advise or are there any methods legally that we could do that would curtail the spread,” Price added.

“It seems to me it’s almost frightening the number of people who are living that are potentially carriers, well they are carriers, with the potential to spread, whereas in the past they died more readily and then at that point they are not posing a risk. So we’ve got a huge population posing a risk if they are not in treatment,” Price said later (sic).

Dr. Clark, you are correct. The number of individuals who are infected with HIV who are undiagnosed, not on effective treatment, and stigmatized is absolutely shameful. It is thinking such as a quarantine, increased death rates or even worse yet the article published in the October 21, 2017 Atlanta Journal Constitution newspaper that holds the HIV policies of CUBA as a solution to in fact be the WORST examples of how to deal with HIV and sound policies to manage and treat the illness. Obviously you have not read the Dear Colleague letter recently released by the U.S. Centers for Disease Control (located right in your own backyard in Atlanta) from September 27, 2017. Here is a copy of that letter:

National Gay Men's HIV/AIDS Awareness Day

Dear Colleague,

September 27, 2017

Today is National Gay Men’s HIV/AIDS Awareness Day. On this day, we join together in taking actions to prevent HIV among gay and bisexual men and ensure that all gay and bisexual men living with HIV get the care they need to stay healthy. Gay and bisexual men are severely affected by HIV. More than 26,000 gay and bisexual men received an HIV diagnosis in 2015, representing two-thirds of all new diagnoses in the United States, and diagnoses increased among Hispanic/Latino gay and bisexual men from 2010 to 2014.

However, recent trends suggest that prevention efforts are slowing the spread of HIV among some gay and bisexual men. From 2010 to 2014, HIV diagnoses fell among white gay and bisexual men and remained stable among African American gay and bisexual men after years of increases.

Scientific advances have shown that antiretroviral therapy (ART) preserves the health of people living with HIV. We also have strong evidence of the prevention effectiveness of ART. When ART results in viral suppression, defined as less than 200 copies/ml or undetectable levels, it prevents sexual HIV transmission. Across three different studies, including thousands of couples and many thousand acts of sex without a condom or pre-exposure prophylaxis (PrEP), no HIV transmissions to an HIV-negative partner were observed when the HIV-positive person was virally suppressed. This means that people who take ART daily as prescribed and achieve and maintain an undetectable viral load have effectively no risk of sexually transmitting the virus to an HIV-negative partner.

However, according to a recent Morbidity and Mortality Weekly Report, too many gay and bisexual men living with HIV are not getting the care and treatment they need. Among gay and bisexual men living with diagnosed HIV, 61% have achieved viral suppression, more than in previous years, but well short of where we want to be. More work is needed to close this gap and to address the barriers that make it more difficult for some gay and bisexual men, including African American and Hispanic/Latino men, to get HIV care and treatment. For example, socioeconomic factors such as lower income and educational levels and cultural factors such as stigma and discrimination may affect whether some gay and bisexual men seek and are able to receive HIV treatment and prevention services.

Some of the Centers for Disease Control and Prevention’s (CDC) activities to reduce new HIV infections among gay and bisexual men, increase testing, improve treatment outcomes, and reduce HIV-related disparities include:

Funding health departments and community-based organizations (CBOs) to support HIV prevention services for gay and bisexual men. For example, under current cooperative agreements, CDC has awarded at least $330 million per year to health departments for HIV prevention among the most affected populations and is awarding nearly $11 million per year to CBOs to provide HIV testing to young gay and bisexual men of color and transgender youth of color.

Supporting biomedical approaches to HIV prevention such as PrEP and post-exposure prophylaxis (PEP).

Supporting projects to identify promising prevention strategies, such as Project PrIDE (PrEP, Implementation, Data to Care, and Evaluation), which is helping health departments implement PrEP and Data to Care demonstration projects for gay and bisexual men of color.

Providing gay and bisexual men with HIV prevention and treatment messages through Act Against AIDS. For example, Doing It, which encourages all adults to get tested for HIV, includes many resources for gay and bisexual men. Start Talking. Stop HIV. helps gay and bisexual men communicate about HIV prevention, and HIV Treatment Works provides resources to help people live well with HIV.

CDC encourages public and private stakeholders to implement interventions that increase retention in HIV care and viral suppression. In addition, partners such as health departments, CBOs, and others can help address stigma and discrimination—using the resources of the Act Against AIDS campaign Let’s Stop HIV Together, for example—and extend the reach of their HIV prevention and testing services that focus on gay and bisexual men. Learn more about how CDC can support your prevention programs.

Thank you for your contributions to HIV prevention efforts for gay and bisexual men. With your help, we have made tremendous strides over the decades. And while there is still much work to do, today we have powerful prevention and treatment tools that can dramatically reduce HIV infections among gay and bisexual men and move us closer to a future free of HIV.

Sincerely,

Jonathan H. Mermin, M.D., MPH

RADM and Assistant Surgeon General, USPHS

Director

National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention

Centers for Disease Control and Prevention

www.cdc.gov/nchhstp

Eugene McCray, MD

Director

Division of HIV/AIDS Prevention

National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention

Centers for Disease Control and Prevention

www.cdc.gov/hiv

*******

Dr. Clark. I have been involved in healthcare since the mid 1980’s. I have been involved in HIV healthcare since 1987. I have been an advocate for the HIV community since that time and I also have been HIV+ myself since 2003. My brothers and sisters fighting HIV are my EQUAL- HIV knows no age, no race, no country, and no gender. The purpose of my open letter to you is simple. I would like to invite you to an open dialogue. I know that I am not a constituent of yours, but if I or any of the groups that I am affiliated with or know leadership at can offer assistance, then I would like to make that offer. Perhaps if you sat down with experts who have best practices from around the country, or looked at programs that have worked in other countries you could bring Georgia out of the lower performing category (5th highest in new HIV cases in all of the U.S.) and become a leader.

Individuals on effective HIV treatment cannot spread HIV Dr. Clark. 10 Years of studies have proven this, and the CDC has endorsed this scientific fact just this past summer, after over 400 other agencies worldwide lead by the Prevention Access Campaign (PAC). We need to get MORE individuals into treatment. We need to erase barriers to care. We need to destroy the biases, stigma, shame and pressures that are preventing everyone from being tested, having open, honest conversations about HIV, STI’s and treatment. If we can get all of the untreated individuals on to effective treatment, we can see this illness mostly die out within a generation. That is a statistical fact Dr. Clark. No vaccine needed. No magic potion, no miracle cure…..just using the tools that we have available today. Please, be a part of the solution, rather than a barrier to good health.

TJ Miller, BSN, MSN

About the Author

T.J. Miller

T.J. Miller

T.J. Miller was diagnosed with HIV in early 1993, an event which he describes as one of the greatest gifts that life has ever given to him, because it forced him to re-evaluate his life and make positive, life affirming changes.  Born in the Albany, N.Y. area, T.J. has been involved in health care since his late teens when he went to work with his local ambulance service. He then went on to become an instructor for the American Red Cross, twice being named instructor of the year by his students and peers.  T.J. holds a bachelors degree in nursing from the SUNY Empire State College and a masters degree in nursing education from The Ohio State University and has worked in health care for over 30 years. Early on in the AIDS crisis, T.J. worked in 2 of the busiest dedicated inpatient AIDS Treatment Centers in N.Y. State, one of which covered a 25 county referral territory from the Canadian border with NY to just south of Kingston N.Y.  He also worked at St. Vincent’s Hospital in NYC in their AIDS care inpatient unit.  TJ has continued his work with AIDS services organizations all over the country while working as a travelling nurse providing staffing solutions and nursing education.

In his free time, T.J. loves to play piano/keyboards, is an avid cook, loves to remodel old homes, garden and enjoys travelling to new places. He currently lives in Columbus, Ohio. 

T.J. can be found on Facebook at http://www.facebook.com/tj.miller.165