“San Francisco has been incredibly successful in the fight for decreasing the transmission of HIV. In fact, they were able to decrease the rate of HIV transmission by 50% in three years” says Dr. MarkAlain Déry, DO, MPH, FACOI. “There is no doubt in my mind that New Orleans will do the same thing! Using simple public health interventions such as increasing the availability of PrEP and HIV testing, as well as test-and-treat strategies, we will replicate the success enjoyed by San Francisco.”
Dr. Déry is the Chief Innovation Officer for Access Health Louisiana, Medical Director of the Southeast Regional AIDS Education and Training Center (AETC) and founder of 102.3FM WHIV-LP, a radio station dedicated to raising awareness about HIV and other infectious diseases through music.
With World AIDS Day on December 1st, Dr. Déry reflects on his career and how much progress has been made in the fight against HIV. As a second-generation HIV clinician, Déry says he didn’t set out to treat people living with HIV.
“My father was an optometrist who found himself in the middle of the HIV epidemic in Los Angeles. He quickly learned how to diagnose and manage ocular complications associated with HIV and AIDS. I saw what people living with HIV had to go through back in those days. Treatment wasn’t as easy. Now, it’s just one pill once a day to bring down the HIV viral load and life expectancies are increasing! I never saw myself following in my father’s footsteps, but I too found myself in a historic epidemic, the 2014-2015 Ebola epidemic of West Africa. I worked for 4 months for the World Health Organization (WHO) as a clinical epidemiologist tracking down people with Ebola virus disease and their immediate contacts. When UNAIDS (the HIV subsidiary of the WHO) found out that I was an HIV specialist, they pulled me to help people living with HIV in Sierra Leone. Doctors fled the country while the nurses stayed to help. I wanted to make a difference in their lives. So, I guess I essentially did follow in my father’s footsteps after all.”
Dr. Déry has made it his mission to make 100% of people living with HIV in Louisiana get to undetectable HIV viral loads. When someone is diagnosed with HIV, their viral load is elevated. Infectious disease physicians work to get that viral load down so that the patient is in an undetectable state. This means that the viral load of HIV is so low that it is not detected on standard laboratory blood test. Furthermore, when HIV is undetectable , it cannot be passed onto their sexual partner. Hence, U=U: Undetectable equals Untransmittable.
In Louisiana, one in five people living with HIV do not know that they have HIV. The way to reduce that number is through testing. HIV INSTI tests are free and confidential at any Access Health Louisiana community health center location. You don’t even need an appointment to be tested. “Everyone 18 and older should be tested,” says Dr. Déry. “Teens 13-years-old and up don’t need parental permission in Louisiana to be tested.”
“There are four things that I do when testing a patient for HIV. First, I test them. If the result is positive, I assure them that life expectancy for a person who is HIV positive is the same as one who is negative if they maintain their daily medications. I then tell them that once they reach undetectable status (U=U) they will not transmit HIV to their intimate partner. Then, I do a same-day start and give them their first dose of medicine right there in the exam room. I hand them a bottle of water and a pill. The patient takes a sip of water and swallows the pill. Then, I ask them to hand me the bottle of water and I drink the rest of their water. The look on their face is like Wow! You just drank after me and I’m HIV positive. However, I want to impress upon my patients that you don’t get HIV just by drinking after someone and that despite their new “status” they are still the same person. Your quality of life doesn’t have to change, or the way people treat you. You are the same person only your status is different. I also tell them that no one should treat you any differently. Relatives shouldn’t serve you off a special set of plates or have you drink out of a designated cup or ostracize you.”
Knowing your status means that you can be proactive and stop the transmission of HIV. “We’ve come a long way in treating HIV since the 1980s.”
According to the website AIDSvu.org, there are an estimated 20,085 people living with HIV in Louisiana. Nearly 7,000 of those people (6,981) live in Orleans and Jefferson parishes. 75% of those are male. 25% are female. 65.4% are African-American, 26.4% Caucasian and 7% Hispanic/Latin.
When it comes to rates of HIV, New Orleans and Baton Rouge regularly rank in the top three cities nationwide. Louisiana is currently in the top five among the states. While tremendous strides have been made in detecting, diagnosing and treating HIV, there is still a lot of work to be done.
“I joined Access Health Louisiana because of the large reach they have throughout the state due to the number of clinics they operate,” says Dr. Déry. “We are fortunate to be Ryan White grant recipients which provides funding for us to help care for and treat people living with HIV. We’re able to offer case management services to help patients find housing, pay bills and buy medication. Unfortunately, a great number of patients diagnosed with HIV have social determinants which makes getting help challenging. Through Ryan White funding, provided by the Office of Health Policy, we are able to improve the quality of life for our clients.” Dr. Déry sees patients out of Access Health Louisiana’s Pythian Building location at 234 Loyola Avenue (near New Orleans City Hall). For appointments, call (504) 226-2976.