By Grayson Meckfessel

“It’s no surprise that New Orleans has the third highest rate of new HIV infections in the U.S. Still, for all the challenges, Dery says there are some early signs of hope… ‘I think we could get to a point where we are reaching zero new infections. The question is not if but when’” (Park, 2016).

In the fall of 2016, infectious disease expert Dr. MarkAlain Dery was interviewed by Alice Park from TIME magazine for his work in establishing the T-Cell Clinic, now known as the Total Health Clinic. The article highlighted Dr. Dery’s philanthropic pursuits toward battling the HIV epidemic along with his atypical lifestyle. Founded by Dr. Dery in 2011, the clinic’s mission is to provide barrier-free treatment for individuals living with or exposed to HIV. Located within the Ruth Fertel Tulane Community Health Center on North Broad Street in Mid-City, the clinic has grown and changed over the years. Nurse Practitioner of adolescent medicine Eddie Bonin explains “There are now three clinics in that building… there’s total health, which is infectious disease… then there’s the adolescent and young adult health clinic, my clinic, which is for ages like 13-26… then there’s the STD clinic.” Together they offer an array of reproductive health services that serve the Tulane and New Orleans community alike.

Six years later, New Orleans has made remarkable progress, ranking 9th in per capita HIV infections among US metropolitan areas as reported in a 2022 quarterly report from the Louisiana Department of Health. This improvement stands as a testament to the professionals who have dedicated their careers to transforming a once-fatal disease into a manageable, chronic condition. “At one time, New Orleans and Baton Rouge had the highest rates per capita of HIV in the country,” Bonin continues, “we still have very high syphilis rates, same with gonorrhea and chlamydia. These things kind of all go together….” Bonin points to the fact that comprehensive and accessible sexual health services, along with community engagement and education, have played a crucial role in the reduction of HIV and other sexually transmitted diseases. However, even with medical advancements, an insidious obstacle remains, stigma.

Perhaps the underlying reason for HIV’s persistence, in particular, can be traced back to deep-seated societal perceptions surrounding the disease. “I think it’s probably societal stigma, that’s really the only thing I can think of, which in particular affects MSMs [men who have sex with men] of color and transgender women” (Bonin). When individuals are deterred from seeking testing or treatment, progress is inevitably hindered. Furthermore, the lack of open conversations about HIV and its transmission risks may contribute to a pervasive sense of fear and misunderstanding. It is this intangible aspect that Dr. Dery sought to address through the Total Health Clinic. “The last goal [of the clinic] is the hardest to quantify: to eliminate stigma around HIV and discrimination against those who have it” (Park, 2016). By fostering an environment that encourages open dialogue and support, the clinic aims to break down the barriers that have historically impeded progress in combating HIV.

 Isabel Gretschel, a junior at Tulane studying cell & molecular biology and public health, underscores the importance of the clinic by recounting the story of a close friend who turned to the services at Ruth Fertel following a high-risk HIV exposure. “My friend is in the LGBT community and had a scare and was freaking out because [they] didn’t know what to do… in the end, they chose the clinic because it was free,” Bonin emphasizes that not only is the HIV testing free, but the clinic also offers confidential billing for any services provided to ensure privacy. “Basically, if you have a clinic visit and you use your insurance, it’s a possibility your parents get an ‘explanation of benefits’, which… tells you what happened at that visit as far as testing goes. Some people choose to have confidential billing because they don’t want to have anyone know they went to that clinic.” Gretschel corroborates the impact that confidential HIV testing can have on closeted individuals. “The issue wasn’t even about money… having a medical bill for the HIV test showing up at [their] parents’ house would have basically been a forced coming-out.” Gretschel’s point touches on a broader issue; the ongoing prevalence of HIV is not due to a lack of medical innovation, but rather the psychological, physical, and financial disparities that enable the disease to keep spreading.

It’s important to recognize that a possible explanation for this stigma comes from the populations which HIV disproportionately impacts, such as the LGBTQIA+ community as well as racial and ethnic minorities. Bonin explains, “The highest rates of HIV in New Orleans are with MSMs of color and transgender women. So there’s a concerted effort here to get those people on preventative HIV medication if they’re willing.” According to the Louisiana Department of Health report, 57% of new HIV diagnoses in Louisiana were among gay, bisexual, and other men who have sex with men. Additionally, 65% of newly diagnosed cases were among African Americans. Considering that African Americans comprise only 32% of Louisiana’s population, this discrepancy highlights the role social structures play in contributing to higher infection rates within these groups. “There are a lot of organizations out there that are actively trying to reduce the risk but there’s still a lot of men of color who don’t seek testing for whatever reason… And with transgender women, a large number of them are in the sex industry and they are at risk that way…So there’s a whole lot of combinations for why people end up getting HIV.” Bonin adds, “I think nationally this holds true, but for New Orleans, that’s kind of where we are seeing the numbers.” Irrespective of the underlying causes, the clinics’ approach to dismantling barriers is essential in enhancing public health.

In addition to the rapid HIV testing, the center provides a myriad of testing and treatment for all things reproductive health-related. “We provide HIV testing, STD testing, STD treatment, contraceptive care (so birth control pills, IUDs, contraceptive implants, injections, so any form of contraception), PEP and PrEP, and gender-affirming care… we’re kind of a one-stop shop for everyone to get anything they need.” Bonin furthers that increased awareness on Tulane’s campus would have substantial benefits to people who may not feel comfortable going to the on-campus health center. Moreover, increased awareness could also help destigmatize conversations around reproductive health and contribute to a more informed student body. “My goal is to get more than just HIV testing information out there because HIV testing goes with STD testing and contraception, so hopefully this [article] will help students know they have a place to go.” Although the services provided at the Ruth Fertel Community Center have undoubtedly grown over the years, challenges remain. In particular, combating the persistent stigma and misinformation around reproductive health is crucial in order to foster a more inclusive and health-conscious community.

 “I think one of the big problems, for one reason or another, is that people don’t know about [the clinic] and what it has to offer,” reports Sophia Mattson, a member of Tulane’s SAPHE (Sexual Aggression Peer Hotline & Education). “And since it’s something that only a minority of people would use, it’s not heavily advertised… Whether you get HIV from intercourse, a needle, blood, I think the hurdles of fighting the disease are really made by society.” Mattson’s observation brings attention back to the pervasiveness of stigma as a barrier to care. Bonin substantiates her perspective adding, “I don’t think the clinics are well known. And that’s one of the problems we’re having. We need to get our services out there. I wish we were better known on [Tulane’s Uptown] campus because we’re probably a great fit for a lot of students. The problem has been that we haven’t been able to advertise and part of the problem is that during the COVID pandemic, people got out of the habit of going to the clinic…” In light of these challenges, the clinics’ efforts to provide accessible and affordable HIV prevention measures become all the more critical.

One vital aspect of the clinics’ services includes the provision of PEP and PrEP, both of which play a significant role in preventing HIV transmission. PEP is an emergency HIV suppressant that, according to the CDC, should be taken within 72 hours of high-risk exposure to HIV and must be continued for 28 days. “Twenty-one hundred dollars! That’s how much 30 pills of PEP cost,” Gretschel explains, emphasizing that without insurance, these medications are unaffordable for anyone who is not extremely wealthy. “I mean…that was for the post-exposure drug. You can imagine… the cost of PrEP and buying a new bottle of pills each month.”  PrEP, the preventative HIV medication, significantly reduces the chances of contracting the virus when taken in advance of exposure risk events. Gretschel adds that the staff at the center were able to waive the cost of PEP for her friend through Gilead, a medication assistance program aimed at reducing out-of-pocket expenses and ultimately providing treatment to those who need it but cannot afford it.

As medical innovations such as PEP and PrEP continue to advance, one might wonder why rates of HIV and STDs remain high. Bonin offers an insightful, explanation for this issue. “Let’s talk about STDs in general. In the beginning, it was condoms, condoms, condoms… Then when more therapies were developed to treat HIV, they figured out that if you got someone to [an] undetectable [level of the virus] then they couldn’t transmit it… With the advent of PrEP we were giving more people medications to prevent HIV, but people feel that they can have sex without condoms, so they’re getting other STDs and those rates are going up.” In other words, as HIV is no longer viewed as a death sentence for many individuals, they feel more at ease engaging in unprotected sex. Consequently, this behavior leads to an increase in the rates of other STDs. “The problem is then people are having unprotected sex with people who have HIV but don’t know it.”

The CDC reports that nearly one in five individuals infected with HIV are unaware they carry the virus. Taking into account the number of people who could potentially be infected by someone unaware of their own status, the critical need for widespread testing becomes evident. Bonin elucidates the government’s improved measures aimed at identifying HIV-positive individuals more effectively. “What has changed over the years is that now we don’t need to get consent to do an HIV test… in the past, people had to consent to having an HIV test done. Now we don’t need consent, we just do it. It’s part of routine care. You would do an HIV test like you would do a diabetes test or checking cholesterol… So more people are getting tested which means we can identify them earlier.” This shift in testing policies not only streamlines the process but also helps to normalize HIV testing as part of routine healthcare. The integration of HIV testing into regular medical check-ups can encourage individuals to seek testing and reduce the stigma associated with it. By testing as many people as possible, those who are unaware of their status can be identified, receive treatment, and ultimately prevent the infection from spreading to others. This proactive approach to testing is crucial in the ongoing fight against HIV and its impact on affected communities.

“We are particularly motivated… by all the social determinants that keep HIV rates high… I see us as the underdogs,” Dery affirms. Twelve years since the Total Health Clinic’s opening, the Ruth Fertel Center has made remarkable strides in providing a community in need with the essential resources they deserve. Their tireless prevention, education, and awareness efforts have undoubtedly saved lives and mitigated the spread of HIV and other STDs. In doing so, they offer hope in an era of news saturated with tragedy and pain. The center’s immeasurable contribution to public health serves as a testament to the power of perseverance, dedication, and kindness in the face of adversity.