Cherokee Nation partnership tackles HIV epidemic

In the United States, 50 percent of new HIV infections occur in 48 counties distinct counties, Washington D.C., and seven states, Oklahoma. San Juan, Puerto Rico also has high rates of HIV infections.

The federal government has set a goal of ending the HIV epidemic, and it's receiving the help of Cherokee Nation, as the tribe and Indian Health Services are launching a new HIV pilot project, "Ending the HIV Epidemic: A Plan for America."

Cherokee Nation was selected for a few reasons, according to Dr. Jorge Mera, chief infectious disease control doctor for the tribe. The first is because Oklahoma was identified as one of the seven states with a major HIV problem. The other states include Alabama, Arkansas, Kentucky, Mississippi, Missouri, and South Carolina.

"They [the states] harbor half of all new infections when you consider the United States as a whole," said Mera.

Within the past few years, Native Americans communities in the U.S. have seen a 58 percent increase in new cases of HIV. So Oklahoma's large Native American population is another reason the Cherokee Nation was selected.

"The third reason is because we have a good track record of Hepatitis C elimination," said Mera. "Cherokee Nation was the first one to start a Hepatitis C elimination program three years ago, almost four now. We've been doing a lot of good work. We haven't eliminated it yet. We still have a long ways to go, but we've been pretty successful in our intervention."

The project provides an opportunity to implement procedures that can help other communities eliminate the HIV epidemic. IHS Principal Deputy Director Rear Adm. Michael D. Weahkee said the project will help people get educated, tested and treated.

"The Indian Health Service's goal is to ensure access to quality health services for American Indians and Alaska Natives living with HIV and those at risk of contracting HIV," said Weahkee. "To achieve this goal, IHS is using innovative tools, such as telehealth, and implementing a strategic public health approach."

The pilot program is based on four pillars: test, treat, prevent and respond. The first pillar is to test everyone between ages 13 and 65 at least once in their lifetime. The second pillar is to treat those who are infected.

"So if you treat the ones who are infected, you protect other people, because they cannot transmit it," said Mera.

The third pillar is to project those who are at high risk of acquiring the infection. Mera said the individuals with the highest risk of becoming infected with HIV are men who have sex with other men, people who do not use condom, those who have multiple partners, and people who inject drugs.

"That fourth pillar [respond] is more on the [Centers for Disease Control and Prevention] line of work, because what happens is that when we have patients who are HIV-positive, we test the virus for resistance," said Mera. "That involves molecular testing the virus and that information is sent to the CDC from all parts of the United States. They analyze that with specific software and they can determine if in any of the area of the country they are seeing viruses that are related, and it could mean an outbreak."

Within the pilot project, the Cherokee Nation has several other programs in mind. One is to devise a way to increase its screening.

"So right now, we have screened in Cherokee Nation about 35 percent of the population that's ages 13 through 65," said Mera. "And we are going to deploy certain interventions to see if we can increase that screening rate to much higher levels."

Part of the one-year project is to test the feasibility of the HIV intervention, and then it will start collecting data.

"I am not sure if in one year we'll be able to get enough date to have big results, but at least we'll get a good glimpse of, was the intervention feasible to deploy?" said Mera. "And then we'll probably be able to collect some data that will give us a hint if it's working or not, but that will take a little bit more time, to really get robust information."

Cherokee Nation Health Services also wants to expand PrEp, which is pre-exposure prophylaxis services. PrEP is the administration of medication to people who are at high risk of contracting HIV. Currently, PrEP is offered at Hastings Hospital, where patients can receive the prevention medication Truvada. However, Mera said they want to expand that service to most, if not all, Cherokee Nation clinics.

"You take one pill a day, and if you take it consistently, like anything in medicine, treatments work if you take the pill," he said. "That's a barrier in itself, but if patients take the pill every day, they decrease the risk of getting an HIV infection by 90 percent, sexually. If it's people who are injecting drugs, it could decrease the risk of them getting HIV through drug use by 70 percent."

The HIV virus used to be mentioned in the news frequently, but education and coverage of the infection has declined over the years. Mera said the disease is not like it was 30 years ago, "which was a death sentence," but it's still a problem that can be prevented, and "if we do everything correctly, there's a potential to eliminate the infection."

"Fourteen percent of the individuals who are HIV-infected in the United States do not know they are infected, and they are responsible for 50 percent of the transmission of the disease," said Mera. "That's why it's so important to screen everybody and to detect the ones who are infected that don't even know they're infected."

Oftentimes, providers are so busy taking care of other medical needs they can forget to recommend the test during short visit. That's why Mera said it's important that patients remind their doctors to get screened for HIV. He also said those who have contracted HIV can live a "practically normal life" as long as they're under medical care.

"Nobody should die of HIV today in the U.S., because there's treatment for everybody, and it's a pity," said Mera. "That's why we want to work to close to that gap."

Get help

Cherokee Nation will soon have a 1-800 phone number to call with more questions about the HIV project and how to get to get screened. For now, more information can be found by calling Hastings Hospital at 918-453-3100 and asking for the specialty infection disease clinic.

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