As the HIV epidemic seemed to spiral out of control in the United States in the early 1990s, Dr. Robert Redfield led the military’s efforts to prevent further infections.
Earlier this year, the Trump administration cited Redfield’s long experience as a virologist in naming him director of the Centers for Disease Control and Prevention.
Redfield, 67, assumed office in March after facing some criticism over his past support for mandatory HIV testing for military recruits.
As Redfield spoke to the National Association of County and City Health Officials' annual conference in New Orleans this week, a new epidemic, of opioid-related deaths, looms large.
“This is the public health crisis of our time,” Redfield said in an interview Thursday. “It’s a serious crisis that obviously is going to take a lot of innovation and effort to bring to its knees.”
Redfield said he spent much of his time in Louisiana meeting with state and local health officials to discuss the opioid crisis and HIV/AIDS. He also visited the CrescentCare health clinic to learn about its success in reaching new patients with PrEP, an HIV prophylactic.
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Opioids have claimed an increasing number of lives in New Orleans and Baton Rouge in the past few years. Last year a majority of the 111 overdose deaths in East Baton Rouge Parish were opioid-related, and 76 percent of the 219 accidental drug-related deaths in New Orleans involved opioids.
And while the HIV/AIDS crisis has largely faded from the headlines, Louisiana still maintains the nation’s second-highest rate of new HIV infections.
Redfield said one of the similarities he sees between the two epidemics is that in the early days of HIV/AIDS treatment, few cities had a full suite of services — not just medical treatment but also social support services.
“We don’t have the tools we need right now. It wasn’t just the treatments we didn’t have when the AIDS epidemic started. Initially, we didn’t have the care systems to actually provide it,” he said.
Redfield is confident that in the long run, science will provide answers to the opioid crisis in the form of new treatments, which he hopes will also prove helpful in combating other addictions like gambling.
In the short term, he supports medication-assisted treatments like methadone and buprenorphine. Studies have shown them to be effective in reducing opioid abuse, but they remain controversial in some circles because they also contain narcotics.
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“Clearly, whether it’s methadone or buprenorphine, there’s clear evidence that these products have an impact on illicit opioid use,” he said. “This is a medical condition; it’s not a moral failure.”
Redfield said he worries that the increasing number of opioid deaths could threaten progress on his life’s work of reducing the incidence of HIV/AIDS.
Increasingly, states are adopting a goal of “getting to zero” — eliminating all new HIV infections — by making sure everyone with the disease reduces their viral load through treatment, and by having everyone at risk of infection take PrEP.
"Obviously, the opioid epidemic threatens that, because when people are high on opioids, they may not be taking PrEP," Redfield said.
Nevertheless, a state like New Hampshire has managed to bring its number of new HIV infections under 30 in a year while struggling with opioid deaths.
"That tells you that they got an opioid epidemic up there, but they got people with HIV treated, and they got people at risk for HIV — largely fairly well educated, gay, Caucasian men — they’re on PREP. That’s what we need to do here," he said.
Southern states still lag in adopting PrEP, as do African-Americans who are at risk. Still, Redfield said he was impressed with CrescentCare’s success at signing up new patients to take the prophylactic, which reduces the risk of contracting HIV by more than 90 percent when taken daily.
“CrescentCare has over 1,000 people on PrEP right now. That’s actually a major accomplishment,” he said. “The more we accelerate that, the more rapid this epidemic will get closer to zero. But I have no question New Orleans can do it.”