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Doni: It's not a topic that dominates the news these days.

In fact, the rate of HIV AIDS has significantly declined in recent years.

Even so, it remains an issue of great importance globally.

More than 39 million people are living with this illness.

1.5 million of those are children.

There were 1.3 million new infections in 2022.

Disparities in the rate of infection are more pronounced than ever.

So what do we doing in Lucas County to stay ahead of this disease?

Donna Fox, HIV and STI manager for the Toledo Lucas County Health Department, is with us to discuss this issue.

I'm Doni Miller, and this is to the point.

As always, you can connect with us on our social media pages.

You can email me at doni _miller@wgte.org and for this episode and any others that you'd like to go back and see, should you have missed one?

You can go to WGTE/to the point.

Welcome, welcome, welcome.

Today we are having a discussion that is so important.

It might be a little uncomfortable for some of you out there, but hang in there.

You're going to learn a lot of stuff about two issues that are still very much with us today.

We're going to talk to Donna Fox about HIV AIDS and what Toledo, Louis County Health Department is doing to stay ahead of this disease.

It's important to know that the numbers are declining, but it is still a major global issue.

We're also going to talk about the rise in an STD that we thought was gone.

We will talk about that as well with Ms.. Fox.

So please, please stay with us.

So we as I mentioned in the opening, there's not a lot of discussion about HIV AIDS anymore.

Should there be?

Donna: Absolutely.

We need to continue talking about HIV because HIV is a treatable infection, but it's an infection that's going to last a lifetime.

So the prevention of it is very important from the health of the individual and as well from a community standpoint, is if you want to look at costs, that's the cost of treatment.

So we want to continue to focus on it.

We we do a tremendous job here in the region.

We've got tremendous resources available to us.

And so HIV can be prevented.

Doni: What's our status in this region?

Are we doing well?

Are we doing better?

Could we do.

Donna: Better?

We absolutely can do better because there are so many great prevention methods out there now to prevent HIV.

So I'll give you the real stat.

The real stat is last year we had 31 cases in northwest Ohio.

We encompass and for this responsibility we take an eight county region.

So we're in northwest Ohio.

So that was down over 30% over the previous year, which is tremendous.

And the reason that we're able to be so successful in our community is because you have the opportunity to prevent it.

First of all, condoms are available and you have to talk about condom and condom use.

Doni: Every single item is still free at the health department.

Donna: Condoms are still free at the health department.

We have them in the lobby.

Just walk in, grab a bag.

You don't have to ask for them.

You don't have to text anybody.

You don't have to speak to the person.

Come in, take a bag out of the lobby.

So we do make them available for free because that's prevention for you, prevention for our community.

There's also medication you can take called prep pre-exposure prophylaxis for HIV.

Doni: So I'm really glad you brought that up because that was one of my questions.

How available is Prep and would you explain to folks why Prep really is.

Donna: So practice of the pill that you take daily?

It's not anything you have to commit to for a lifetime.

The beautiful thing is you take it, you have to take it daily, but take it for a life stage.

So while you're while you're having behaviors that would put you at risk, you want to be on prep.

It's a daily pill is see, a doctor is prescribed to you, and then you're followed up and the doctor follows you closely every quarter.

Make sure that you have no new infections of STDs or HIV because, of course, the goal is to keep that is to maintain them.

But they're also great programs that insurances cover it.

But if you are not insured, there are other programs that we can help you get on to help pay for for prep.

Doni: You know, I read a stat that said that only 25% of folks who are eligible for Prep are using Prep.

Why would that be?

Donna: Prep is a commitment.

You know, taking a pill every day is a commitment, but it's a commitment that allows you to prevent a lifetime of taking a day of taking pills.

And this is about your good health.

So nobody's trying to tell people what to do.

We're trying to help prevent infection for people and let them live a healthy, long life.

Doni: Right.

Right.

Is up.

Can we talk for a moment about the behaviors and the symptoms and the way that it spreads?

The illness spreads.

Donna: So HIV spreads through bodily fluids.

So but not.

Doni: Not.

Donna: Kissing.

Doni: Not not.

Donna: Hugging.

Doni: Right.

Donna: Not sharing utensils.

Right.

So we're talking we're generally talking sex.

We're also talking shared details for those who are who are opiate users or needle users.

That's a factor.

So those individuals should be tested and they're eligible for prep.

Doni: Do you think we're missing that population?

I always wonder about that.

That that population of needle users.

Donna: Well, we're we're looking at the health department and in our region that we have a syringe services program called Northwest Ohio syringe services that goes out in the community.

And they can actually test for HIV and syphilis, as well as provide clean syringes.

So that's kind of a side topic.

But yeah, absolutely, they're eligible for prep and that we can help them.

The health department has a great clinic Our website Lucas County Health dot com also has a site on it that allows you to find other providers in our community that can provide prep.

We're not the only ones that do it.

Doni: Sure, sure, sure.

And so we talked a bit about behaviors, symptoms that people should be looking for, because I think it's really important that people understand that at the end of the day, their health is their own responsibility.

Nobody's coming to save you.

You know, you have to take care of your take care of your health yourself, so yourself.

But oftentimes we push symptoms away.

What should we be looking for?

Donna: With HIV, it can actually present in several ways.

So it can really be a matter of just not feeling well.

So that's that's really.

Just a general.

Donna: So you do need to be ten.

You do need to be tested.

Often what's going to put you at risk is having condoms as sex.

Multiple partners, anonymous partners, or even honestly.

The reality is that sometimes people think they're in monogamous relationships and they're not.

And that can be a factor.

Doni: Yeah.

So do you still encourage the discussion of previous partners in new relationships?

Do you still discuss that?

Do you still recommend that?

Donna: There's no reason you wouldn't want to know for yourself and for your partner, and both know that you're both in a good place?

You wouldn't Of course you would want to know that.

Doni: Sure.

Donna: So HIV is preventable with condoms and with prep, there's great access to it in our community.

And so if you're somebody whose behaviors are putting them at risk right now, then Prep is an option.

But but condoms are an option, too.

Doni: Sure.

Sure.

You know what I was really stunned at actually was the rate of disparity in the disease.

It's any idea other than, you know, it's what we typically see in black and brown populations when it comes to many health issues.

The disparities are amazing, but eight times as often in black males, four times as often in Latino in the Latino community.

What is that all about?

Donna: The numbers in our region matched just just exactly what you said.

They do align with that often.

Right now, HIV is because it's transmitted sexually.

And a lot of times this and it's transmitted through rips and tears in the body.

So a lot of times the white men who have sex with men have sex.

There tends to be more opportunity for the infection.

Doni: You mean because of anal sex predominantly?

Donna: That's correct.

So so because of that, you see it.

So then the population stays contained.

Now, being on prep, perhaps there's a stigma to being on prep.

So you want to be somebody who says, I'm going to take my health in my own hands.

There's no reason that it needs to be in the black and brown communities, predominantly, disparately.

There's no reason for that whatsoever, except that that there is, you know, some acceptance of being bisexual.

And those issues need to be.

People just need to take their health in their own hands, as you said.

Doni: So you think there's an accepted answer of being bisexual in black and brown communities?

Donna: I think there's less of an acceptance.

Doni: Less of an acceptance.

Yes.

Yes, I would I would agree with that.

In fact, in in those two communities particularly, there's a really strong pushback against being bisexual.

But there's also a major stigma, I think, in those communities about accessing health care for issues that are considered pretty personal and not personal.

Donna: I mean, you can't get around that, that this is a personal topic.

And we do ask very personal questions, but we ask them for the sake of getting the best health care possible.

And one thing that we talk about is just having a provider that you're confident with.

We do have multiple providers.

The health department is actually an extremely judgmental, free place.

Doni: I would agree with that.

Donna: And for full of kind individuals.

Doni: Right.

Donna: And so this is what we do and we do it very well.

And we have great providers and we can help you access care.

Doni: You are absolutely right about that.

I'm so glad that you raised that, because people have got to understand that when they get sick, it the the domino effect includes those people that love you, those people that you love, and and such a large part of the community.

So you almost have an obligation in this case to find out what your status is.

Donna: That's that's right.

That's a really great point.

So we believe in testing.

We believe in treating.

But most of all, even prevention.

Doni: Yeah.

And we would want people to know that this remains a major issue, a major point of concern here.

Donna: You know, 31 individuals last year.

No, that's not a huge number in the scheme of our population, however.

Doni: Yeah.

Yeah.

Donna: It's a lifetime of illness that can be prevented.

Doni: Right.

That's a really good point.

And you know what I always think of mean?

We only have a few seconds left here, but what I always think of is that no matter the number it has, it has the potential to expand exponentially.

Donna: Absolutely.

Just like we do in public health, Right.

We contain the infection and we work to help the community for the better.

So that's what we're here to do.

But we really want people to be healthy.

Doni: Absolutely.

So in this last few seconds, if people are concerned about getting tested or they want more information, they should just call the health department.

Donna: They can call the health department, they can go to Lucas County Health dot com.

They can request an appointment directly from our website or just give us a call and make an appointment.

Doni: Great.

Thank you so much.

Would you stay with me because we want to talk about an alarming increase in an STD that we thought we had under control.

Donna: That's true.

Doni: Stay with me.

We'll be back in just a moment.

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Doni: Welcome back.

You can connect with us on our social media pages, but you know that.

You can also email me at doni _miller@wgte.org.

And as always, if you'd like to see this episode again or if there's some others that you've missed, please you can find those at wgte.org/to that point, don't hesitate to check us out there.

If you were not with us during the first segment, I would like to reintroduce Donna Fox.

Donna is from the Health Department.

She's the HIV and STI manager there.

An amazing conversation about the management of HIV AIDS.

Thank you so much for that information.

Something that has become almost a larger or conversation and in so many ways, an astounding conversation because we thought we had this steady undercurrent roll.

It sounds like we're not winning this war right now.

We're talking about syphilis.

Donna: There's a lot to be said about syphilis.

So, you know, this is one of those you gotta buckle up when you're ready to listen to it.

But syphilis has increase in dramatic rates.

We have not seen anything like this since the 1950s.

my gosh.

So I. I can't even dig out those numbers, to be perfectly honest.

But I can tell you that if you if you see the chart, which you see in 2011, we had 19 cases of syphilis in our region, northwest Ohio, eight counties.

Last year, in 2023, we had 186 cases.

It went like this.

Wow.

Now, the reality is that we were at 86 cases in 2020 after COVID people didn't get into care.

The infection spread and the cases, number of cases more than doubled.

And we ended up at our highest ever last year with 186 cases, which is just, as you said, astounding.

Doni: Astounding.

Do.

Is there a lack of education around how syphilis is spread around getting treatment?

What do you what do you attribute this to?

Donna: The reality is people have sex and they have unprotected sex.

And now the syphilis has a foothold, if you will, in the community.

It's spreading.

And the reality is that it can still go back to prevention efforts of using condoms to be prevented.

So we encourage, encourage condom use.

We talk about condoms about it.

But that's the bottom line to syphilis.

But the problem with syphilis is syphilis is called the great imitator.

Syphilis can look like a rash on your on the palms of your hands and feet.

Syphilis can start with a painless, short sore that they call a Shanker.

But it can.

It can be in an area you can see.

Such as?

Such as your penis.

But it can also be in areas of the body where you've had sex that it's not seen.

And because it's painless, you may not know that it's there.

So you're most infect during that time.

So if you're having a partner or multiple partners, you could be spreading it and not knowing it.

And that's that's a real problem.

So the sooner we can identify a new infection, the sooner we can contain it as a community and try to bring this this rise under control again.

Doni: Pregnant women are at specific risk.

Donna: They absolutely are.

Because if a woman has syphilis and delivers a baby, the baby can be born with syphilis.

The baby can be born with birth defects or the baby can be stillborn.

The baby can die shortly after birth.

And we've seen that there is a 300% rise in congenital syphilis in just the last four years.

So from 2028 to 2022 is our 2018 excuse me.

So there's a huge number.

We had three cases last year, but that's three babies that were affected with one with one dying.

And this is preventable.

So if you're pregnant, you will you should be tested in your first trimester or your first prenatal appointment.

So you should be.

But we are also encouraging at 28 to 32 weeks of pregnancy, because if a mother is treated for syphilis at least 30 days before the baby is born, the baby can be born without syphilis.

So the baby can be born without that health impact.

So that's what that's what we really want to encourage.

And we kind of encourage it for everyone because unfortunately, people think they're in a monogamous relationship and they may not be.

Doni: What are the most common ways that you're finding at the health department that syphilis is spread?

Donna: I mean, syphilis is spread sexually, is spread through vaginal, anal and oral sex.

So you can get it orally as well.

So use a condom.

Doni: So are there symptoms that that pregnancy that happened during pregnancy that might indicate that the mom has syphilis?

I mean.

Donna: No more than you would.

Doni: Know more.

Donna: No, for anybody else's.

And as I'm looking for a saw, as in looking for that rash, as in getting tested because syphilis will go away, you might see the sore and the first it can occur in the first week of the first three months after you've encountered the infection.

Right.

So it could be 1 to 3 months before you see any symptoms, but then the symptoms can go away on their own.

But the virus is still in your body.

So unless you're treated for syphilis, which syphilis can be treated, that's a great thing.

Syphilis can be treated.

Doni: Is it more of is treatment more effective at one point than another earlier?

Donna: No, no.

But the best thing about being treated early is that we can treat partners, we can treat yourself, we can contain the virus, and that's when you're most infectious.

So we want people tested and treated as early as possible.

Doni: And not treating it can result in the death of a newborn.

Donna: Not treating if you're pregnant can death can result in the death of the newborn, but syphilis is serious.

Well, we've got a billboard that says that syphilis is serious because syphilis can lead to hearing loss, brain damage.

It can lead to death in the long run.

So it you don't want to ignore it.

You know, I get that That's an easy thing to do.

I get that, especially when your symptoms go away.

But if you've been sexually active, condom less sex, multiple partners, partners you don't know, you would want to be tested.

Doni: Testing at the health Department.

Donna: Testing at the health Department.

Testing at your doctor.

I'm glad you brought up testing because people will say, test me for everything and they'll pay for all STDs.

Maybe they'll even go to an urgent care clinic or the urgent or emergency department People do that.

But if you haven't been tested for blood, you have not been tested for syphilis.

So that's really important to know, because if you've if you've been swab and you've been tested or you've paid in a cup, that's not enough to test for syphilis.

So you have to be tested by blood.

That's really important for people to know that for themselves and to make sure that if a provider saying, I tested you for everything because they didn't test for blood, they didn't ask for syphilis.

Doni: Is testing for syphilis require.

It's not required when you're pregnant.

It's not one of the is it?

Donna: It is a CDC recommendation that you're tested and you get it several times after it's a first trimester or first prenatal appointment.

However, not everyone receives prenatal care.

Doni: That's right.

Donna: That's right.

And again, that's why honestly, that's why this shows importance, because because we're all influencers.

So if you have somebody in your life who's pregnant, make sure they're getting prenatal care, make sure they're getting tested for syphilis.

If you have others in your life that you can influence in a positive way, share the information.

You know, be a great personal influencer.

Doni: That's such a good point, especially because the because of the lack of how do I put this, the we see significant numbers in Louis County of young women, young black women, predominantly not engaging in prenatal care.

Donna: That's a fact, right?

Doni: That's a fact.

It's unfortunate, but it's absolutely a fact.

And in fact, those numbers went up over last last year, over the year before.

So there are people out there who need to hear what you're saying because they're not engaged in the health care system and they're pregnant.

Donna: That's right.

So, I mean, that's what we want to encourage.

And of course, there are lots of programs in our community to help people engage in care.

From several agencies there, our community health workers that work out, especially in the in the black and brown communities to help ensure that women have the care they need.

They have up there aligned with the resources that they need to make sure that they've got the best health about the outcomes for themselves and their child.

Doni: Absolutely.

And again, the health department and I will say this again for you.

I've worked with them a lot on a lot of different projects, and they are one of the most nonjudgmental institutions I have ever, ever worked with.

And that's critical.

You guys do a great job.

I get that.

Great kudos to to Shannon and your new person coming in because people need to know that they can go in and it's okay.

It's okay to say, please test me for HIV.

Please test me for syphilis and whatever other STD might be out there.

Donna: Well, absolutely.

Doni: And they can pick up free condoms and.

Donna: They can do that.

They can do that.

They can do that because the health department's a great place with a whole wealth of information and great, knowledgeable, caring people.

But talking about syphilis and STIs in general, you want to people need to understand that there are that you need to be tested in more than one place.

So peeing in a cup urine alone will not detect all STDs.

That's what we say.

So if you're a guy, especially, you come in and I can totally understand the logic of you're thinking I'm peeing in the cup, they're testing it, it's through my body.

It's good, right?

If he's had oral or anal sex, you should be tested there as well.

Right.

Because the infection can live there and maybe not be as treated.

So there's we call it three site testing.

Extra genital testing is a medical term for it, but it's important for people to advocate for themselves and for doctors to not be afraid to ask the hard questions.

Doni: Right.

Right.

And I actually think that it's an issue that those folks who are in the business of providing health care need to advocate more strongly for.

We should be requiring testing in in the first trimester.

It's a CDC recommendation.

But as you know, and as other people who are watching would know, it's a recommendation.

We would do so much better if we required that testing.

Donna: We do.

And that's what's great about this show is people learning what they need to be asking about.

Can go ahead and advocate for yourself.

Doni: Advocate for yourself.

You are amazing.

Thank you so much for joining us today.

Thanks so much for joining us.

And we'll see you next time.

On to the Point.

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