‘We have an opportunity to close this chapter’: HHS official on ending the HIV epidemic

Dementia and Alzheimer’s disease and other chronic conditions are currently top-of-mind concerns for health care professionals in the U.S., but it’s critical that we keep children’s health in mind as well, says Admiral Brett P. Giroir, MD, the U.S. Department of Health and Human Services’ Assistant Secretary for Health.

“The big threat at the highest level is forgetting about children,” says Dr. Giroir, who’s also a pediatric critical care specialist. “Children always have to be at the forefront of our thoughts … the No. 1 thing I try to do in my position is to always make sure that children are part of the conversation.”

In his role, Dr. Giroir must assess all threats to public health, including infectious diseases such as HIV and Ebola. Dr. Giroir addressed DOs attending the AOA House of Delegates meeting last week. Following is an edited Q&A.

You said early diagnosis is essential to ending the HIV epidemic and that 80% of new HIV infections are transmitted from people who don’t know they have HIV or are not retained in treatment. How can DOs help in the battle for early diagnosis?

Osteopathic physicians have potentially a key role in aiding in ending the HIV epidemic. DOs really focus on primary care and holistic primary care. So being on the front line, they’re going to understand which patients are at risk and test them. We’ve got to do this at the primary care level and there’s nobody better to do that than osteopathic physicians.

Why is ending the HIV epidemic in the U.S. within 10 years a priority for this administration?

Ending the epidemic within 10 years is a priority because we can do it. I think that’s fundamentally what it is. HIV has cost 700,000 American lives. I was a young physician when this epidemic started. I lost many, many childhood patients. It’s really caused societal disruptions, tensions, stigma.

We have an opportunity to close this chapter in our history. Our administration is fully committed to this and we’re going to see it happen: a 75% reduction in new cases in five years.

How are you planning to reduce new cases so dramatically?

We’re going to implement the HIV program at the community level. Fifty percent of new cases occur in only 48 counties, Washington D.C. and San Juan. We’re going to focus on those areas.

We’ll be supporting the communities to get people into diagnosis and into care who have been very hard to bring into care. We’re going to support the Community Health Centers and the Ryan White program—those are really federal programs at the community level—to pay for that treatment and make sure they get into viral suppression. When they’re virally suppressed, they can no longer transmit HIV.

During the Ebola emergency, you directed the Texas Task Force on Infectious Disease Preparedness Response. What did that work entail? Is the U.S. prepared for an Ebola outbreak at this time?

Back in Texas, when we had the first Ebola case, the country was fairly unprepared to take care of an Ebola patient. The thought was that any community hospital could take care of an Ebola patient. That patient arrived at a very good community hospital in North Texas with outstanding rates and outstanding people and we had two transmissions.

It was really a recognition that Ebola is a special disease. Particularly in the U.S., where we can keep people alive for a long period of time with ICU care, the number of viral particles patients have goes up tremendously.

Since that time, we’ve realized that our infection control protocols were probably not right and we needed to change them. We now have a nationwide system of Ebola treatment units with all the supplies we need. We also have a vaccine that’s highly effective. In the Democratic Republic of Congo, where there’s an outbreak right now, we’ve vaccinated almost 150,000 people.

We can now protect health care workers very clearly against threats of Ebola, but also any other emerging disease, like SARS or MERS or Lassa fever. But just like with vaccines and measles, once we get control of it, we tend to become lax and forget about it. We need to keep the drumbeats going there. We always need to be prepared because Congo to Chicago is 20 hours away. It’s only one flight and you’re here. We do have an interconnected world and we are prepared for that.