HJAR May/Jun 2023

PUBLIC HEALTH AND MEDICINE We have a bold goal, and that’s to end new HIV infections, 90% of them, by 2030. To do this, we need to be looking at the communi- ties with the highest rates and looking at the most at-risk populations, diagnosing, hav- ing treatment readily available. In treating, we make sure we are reaching those viral suppression levels, so people aren’t trans- mitting. And I always think that this is one of those really great things to where treat- ment is prevention. This does prevent future infections. And then certainly responding when we have outbreaks oftentimes related to injection drug use. One example was in Scott County, Indi- ana. Many of you’ll probably remem- ber that HIV outbreak; I think it was 2015. After that, we were able to institute the first legal syringe service program in that area. What they found was after it was in place, the county had less than expected cases of newHIV, and they saw decreases in hepati- tis C cases. They also saw that of the more than 1300 participants, they had over 11,000 visits or linkages to treatment. In addition, about 2,500 doses of Naloxone were given, and 600 were reported to be used. Again, when you think about the syndemic and all the ways that you’re able to impact multiple aspects of health, I thought that was really powerful. Those of you that know me know that my background was really in violence pre- vention. I think healthcare providers have such an important role in the community — in hospitals, in schools, in homes. One of the most simple things we can do is a trauma-informed approach in patient care. If somebody comes in, I’m not just cutting their clothes off with trauma shears, I’m tell- ing themwhat’s going to happen with them. I am not retriggering or making their expe- rience worse. I’m trying to approach them in an unbiased way to really explain what we are doing and then offer them resources afterward. There are also things like hospital-based violence intervention programs like “Caught in the Crossfire.” This is a peer interven- tion that was started in California, where it links clients with trauma-informed care, but also resources — sometimes it’s school- ing or job support. They found that 98% of the clients were not rehospitalized for any violence-related injuries, and 90% who’d come from a juvenile justice system were not rearrested. “SafeER Teens” is something we’ve been funding. It’s being done in Michigan right now, and it uses motivational interview- ing skill building, such as conflict resolu- tion, with teens who come into the ER after a violent assault. It also uses cool things like cell phones to provide text messaging and GPS tracking. If you’re going to an area to where you might have a violent conflict, it reminds you that that’s one of the things that you’ve talked about. What they have found is that this has caused reductions in perpetration, in victimization of peer vio- lence, alcohol use, as well as increased self- efficacy in avoiding fighting. We can also talk about safe storage of firearms. When we talk about childhood injuries as well as suicide prevention, stor- ing a firearm in the house safely is very important to do. There’s an intervention called “Emergency Department Counseling onAccess to Lethal Means”(ED CALM). We funded the evaluation of this and in it, found that among parents who went through this when a youth would present pro suicidal attempt, 100% reported guns were locked up post intervention. Again, that’s just talk- ing with people about the importance of this and giving them the tools that they need. I do think together we can make such a difference. We have opportunities at so many touchpoints in a person’s life and in various aspects of the community to do so. Some of the successes that we have seen over the years are when you look at things like viral hepatitis, 750,000Americans have been treated with hep C medications in the past decade. Similarly, we are now seeing that for children, our MMR vaccine cov- erage is now exceeding the 90% target again for over a decade, really having those impacts. I led the first opioid prescribing guideline at CDC. We’ve now seen a 40% decrease in high MME prescriptions. We’re also seeing a decrease in deaths from anti- biotic resistance from safer stewardship — about a 28% decrease since 2013 — and we’re seeing HIV deaths in the U.S. have dropped by about 50% in teens and up. I just want to thank all of you for having me here today. n “I do think together we can make such a difference. We have opportunities at somany touchpoints in a person’s life and in various aspects of the community to do so.”