Cherokee Nation combats HIV with prevention, treatment program
Cherokee Nation Health Services Infectious Disease Director Dr. Jorge Mera, right, and nurse practitioner Whitney Essex present at the 66th Presidential Advisory Council on HIV/AIDS meeting in February to discuss the tribe’s plan on how to combat and prevent HIV in the CN. COURTESY
TAHLEQUAH – During President Donald Trump’s State of the Union address in February, he announced a goal to stop the spread of HIV in the United States within a 10-year period. Part of the plan was to target seven states with the highest rates of the infection, which includes Oklahoma.
Since September, Cherokee Nation health officials have worked to address the Oklahoma HIV epidemic by setting up ways to screen for HIV and create a prevention plan using $1.5 million of Indian Health Services funding awarded as part of the President’s Ending the HIV Epidemic initiative.
“Oklahoma is one of the seven states in the United States with the highest incidences of HIV, with new cases coming up of HIV in relation to its population,” Dr. Jorge Mera, CN Health Services Infectious Diseases director, said. “Also, Oklahoma has a lot of Native Americans and HIV in Native Americans has increased by around 50 percent from 2010 to 2016. So Oklahoma is a hotspot for us because, first, we see Natives in Cherokee Nation, and second, the state in general has a high rate of HIV.”
HIV, or human immunodeficiency virus, attacks certain white blood cells called CD4, which are cells that fight infections and tumors. If HIV compromises CD4 cells, it weakens or destroys the cells and the body cannot defend itself against certain infections and tumors, Mera said.
He said the plan is to reduce HIV cases by 90% in 10 years by diagnosing, treating, prevention and response, with a focus on the first three steps.
“One is to diagnose those individuals who have it and don’t know they have it,” he said. “The second is to put them on treatment because when you treat someone who has HIV…they do not transmit the virus to other people anymore. Prevention is basically education on sexual behavior. The fourth is to do surveillance and respond to outbreaks or epidemics. That’s more of a state health department and CDC (Centers for Disease Control) role and us in the clinic individually.”
Mera said the CDC recommends everyone between the ages of 13 and 64 be tested at least once. So far about 35% of the 114,000 patients ages 13-64 who come to the CN for health care have had HIV testing.
Currently, between 60 and 70 patients are being treated for HIV in the CN.
Mera said all CN clinics are LGBTQ+ and two-spirit friendly facilities. “So if you belong to that community and you have questions about your health care, if even beyond HIV testing, feel free to come to us.”
He also said testing can be performed at all CN health facilities. “If you are positive for HIV the treatment…makes you lead practically a normal life if you see your provider every three months and take the medication as instructed.”
Treatment includes taking an anti-viral medication, Mera said. “If you have HIV and you’re on treatment and your virus is not detected in blood even if you have sex without a condom, which is not recommended, you do not transmit the infection to someone else.”
Prevention includes education on sexual behavior, condom use and, if qualified, taking Pre-Exposure Prophylaxis, which has been used by Health Services the past few years.
“You take one pill a day, and if you get exposed to HIV, you reduce the risk of acquiring HIV,” Mera said. “For example, if you have multiple sexual partners and you’re not using condoms consistently, if you take this pill once a day you can prevent 90 percent of the infection.”
PrEP, as it is commonly referred to, also reduces the risk for those who inject drugs and share syringes. “But if you take this pill once a day and you have to share equipment (syringes), which we don’t recommend at all, it decreases your chances of acquiring HIV by 70 percent,” Mera said.
If left untreated, most individuals could develop AIDS five to six years after being diagnosed with HIV, and if left untreated, could have a lifespan of one to two years after an AIDS diagnoses, Mera said.
Mera and CN nurse practitioner Whitney Essex presented at the 2020 Presidential Advisory Council on HIV/AIDS meeting in February on the CN’s plans to combat HIV.
Essex said one goal they would like to achieve is placing more people on PrEP to help remove the stigma associated with HIV and what it means to be on the medication.
“Take it as a positive because if someone wants to be on PrEP it means that they’re being pro-active in their health, that they’re wanting to prevent themselves from getting sick,” she said. “PrEP is a positive thing. It’s not something that we do to enable people or encourage risky behavior but to decrease the chances of behaviors affecting someone’s health in a negative way.”
For information, call 1-844-PREP-STI from 8 a.m. to 5 p.m. Monday to Friday or text 918-570-9119.