Atlanta is ranked No. 5* among U.S. cities when it comes to the rate of new diagnoses of HIV.
Experts say that's because routine HIV testing is not offered in the places where most people get their health care. By the time patients are diagnosed in Atlanta, almost one-third have advanced to clinical AIDS.
Since starting a routine testing program in 2013, Grady Hospital has seen an average of 1 percent of their emergency room patients test positive for HIV. Often, that's as many as two or three new diagnoses in a day.
“This is something that keeps me awake at night in Atlanta," Dr. Abigail Hankin-Wei said.
She runs Grady’s FOCUS HIV testing program. It’s the only emergency department in the city that offers a HIV test to every patient regardless of why they came in.
“When we diagnose patients with HIV, the first time we are telling them they’ve been infected with HIV, we know that among our patients at Grady, nearly half of them have AIDS the day we diagnose them," said Hankin-Wei.
There are at least 50 places you can get tested in the Atlanta area.
“Despite that, there are patients who aren’t going to get those tests. And they aren’t going for a decade," Hankin-Wei said.
It takes about eight to 10 years for untreated HIV to advance to clinical AIDS. Across Georgia, about a third of the people who find out they’re positive fall into this category of late diagnosis.
“Diagnosing people to get people on treatment is our best method to prevent further transmission," Wendy Armstrong, the director of the Ponce de Leon Center, an AIDS care facility in Atlanta, said.
Effective treatment can make the risk of HIV transmission almost non-existent, Armstrong said. But nationally, according to the CDC, an estimated 14 percent of people with HIV or AIDS do not know they’re infected.
“Our massive group out there who are not tested are folks out there who often don’t have primary care physicians because they’re young, and there’s not a need for that and no insurance if they they did wish to have a primary care physician," Armstrong said.
There are plenty of other reasons people don’t get tested. Experts say stigma, extreme poverty, fear of a positive diagnosis, transportation even. People might think they’re not at risk because they’re in a monogamous relationship.
For all these reasons and more, in 2006, the CDC recommended routine HIV testing. That means offer the test anywhere people get health care.
Almost a decade later, Grady’s Emergency Department is the only one in Atlanta to follow that recommendation. The funding comes from pharmaceutical giant Gilead.
Georgia’s Department of Public Health relies mostly on federal money to combat HIV.
“The needs for funding of health care in general are not keeping up with the demands that the various disease that we’re facing are placing on society," Dr. Pat O'Neal, the director of health protection at the state Health Department, said.
When it comes to state money, really no agency one gets what they need or ask for, he said.
“We’re competing with all the issues Georgia has, for example, with education, for the same pie of funds that the education community does," O'Neal said.
He's been practicing medicine long enough to see HIV diagnoses go from a death sentence to a treatable condition, so he’s hopeful. But others say the pace of progress in Georgia is glacial.
Dazon Dixon Diallo is the president of Sister Love, a community-based AIDS treatment and advocacy group in Atlanta.
“We shouldn’t even be talking about AIDS anymore these days, and yet we still are," Diallo said.
“It’s not acceptable to have a zero line item for HIV prevention ... It’s unacceptable to not have expanded Medicaid to include HIV testing. It’s not acceptable to have any health department in the state of Georgia that’s currently not trained, equipped and implementing rapid testing ... You want me to go on? It’s just a lot," she said.
Other states with HIV hotspots have pushed for more aggressive testing initiatives.
“New York has made a priority of the funding of HIV and health care is quite a bit different than a number of states in the south including Georgia," Catherine Hanssens with the Center for HIV Law and Policy in New York, said.
There, the state passed a law in 2010 requiring doctors to offer the test to patients in all health care settings. In Washington D.C., you can get a rapid HIV test at the DMV.
Ideally, Hanssens said, people should not need to be tested for HIV in emergency rooms. That’s kind of the end result of a broken public health system.
"Frankly if someone is in a medical emergency or they present with a gunshot wound or a knife wound that is probably the very worst and last time that you would ever offer an HIV test," Hanssens said.
But in Atlanta, that’s where we’re at. On overnight shifts at the emergency department Dr. Hankin-Wei sees a steady stream of patients suffering with non-existent immune systems because of untreated HIV.
“Those patients, we have failed. I want to be clear. We: physicians, lawmakers, public health professionals," Hankin-Wei said.
She said in the ZIP code around Grady, 8 percent of the population are living with HIV or AIDS. Georgia can do better, said Hankin-Wei, and making routine HIV testing part of health care is the first step.
*CORRECTION: A previous version of this story indicated that Atlanta is ranked No. 1 among U.S. cities for new diagnoses of HIV. That was based on 2012 data available when original reporting was compiled, but recently-released 2013 data from the CDC ranks Atlanta as No. 5 in the country.