Giving Voice: Jeremy Turner

Transcript for Giving Voice: Jeremy Turner

Beckley: I’m Lindsey Beckley and this Giving Voice, from Talking Hoosier History.

In this installment of Giving Voice, I talk to Jeremy Turner, Director of the HIV/STD Viral Hepatitis Division of the Indiana State Department of Health. I first saw Mr. Turner speak at the dedication ceremony for the Ryan White state historical marker earlier this year, and his passion for HIV and AIDS treatment and prevention were apparent. So, when we were thinking about who would be able to give a more modern perspective on the topic, I knew Jeremy would be a great resource for us.

If you haven’t listened to the latest full episode – “Overcoming Stigma: Ryan White’s AIDs Education Advocacy,” I would encourage you to do so before listening to this interview, as it gives the historical context needed to better understand a lot of what Mr. Turner talks about here.

And now: Giving Voice.

[Talking Hoosier History Theme Music]

Turner: You know, it’s amazing to be here today, particularly during this time during the epidemic. I started working in HIV services fifteen years ago down in Evansville in Southern Indiana and it’s just great to be here at the State Department of Health during a time when we’re looking at ending the HIV epidemic.

Beckley: Absolutely. And that’s something that I definitely want to talk about ‘cause you had spoken at the Ryan White marker dedication and you had mentioned that and that really, kind of drew my attention. I was wondering if you could talk about, like, some of the concrete steps that we’re taking here in Indiana or across the nation that is going to meet that goal.

Turner: You know, Ryan White being from Indiana provided us a unique opportunity to have the spotlight shone on how HIV effects people here in the Midwest. And we’ve come a long ways since the early days of the epidemic. Our HIV system of treatment in Indiana was built by a network of community action groups, what we call “CAGS” now, many of whom are still in existence but grew up to be those HIV service agencies, those non-profit organizations, placed in regions across the state, who are providing care for folks living with HIV. Now, we know that keeping people engaged in care is one of the most important parts of ending the HIV epidemic. We’re so fortunate to be in a state where our state health commissioner, Dr. Chris Bucks, has embraced the ideology of “u equals u.” Undetectable equals untransmittable. And so we know when we provide good access to care and we can keep people living with HIV engaged in care, that that limits the viruses ability to transmit to other people. And we also know that we have this amazing prevention tool, this biomedical intervention called PrEP. It’s one pill a day and it is as effective at preventing HIV transition as the use of traditional prophylactics like condoms. And so with combining “undetectable equals untransmittable” with easy access to biomedical interventions, we see a path where we can end HIV. And so we have done our best here to work with our local organizations, our local health departments, our non-profit agencies to make sure that we are addressing not only the medical needs of our clients, but those social determinants of health that have prevented people in the past from being able to stay engaged in care. That’s keeping people housed. Keeping people fed. Getting access to mental health and substance use treatment facilities. All of those things combined are going to be what it takes to end the epidemic.

Beckley: I was – I was wondering how innovations like PrEP and other treatments have affected AIDS education – you know Ryan White was a big advocate of AIDS education – and I wonder if that’s changed the conversation around AIDS. You know, it’s not the death sentence it once was, so I was wondering how that has changed education.

Turner: Well, you know when we talk about education, we really have to take a very broad look at what that means. Because Prep being new and being something not everyone is familiar with, we have education not only to do with young folks and people who are at risk, but also our medical service providers about how to prescribe PrEP, about what the risks might be. So, we’re engaged in a variety of different levels, making sure that we’re not only touching the communities that we hope are going to initiate PrEP, but also working with our partners at the Midwest AIDS Training and Education Center who do a lot of provider education to get out there and—and instill a confidence in our family practice physicians and particularly providers in rural settings who may not have infectious disease specialty or may not be as familiar with providing infectious disease care, and getting them up to speed.

We have another great project called the HIV echo project and it is a format that allows providers – doctors, nurse practitioners – without an infectious disease specialty to essentially case conference with some of our leading providers in the state about how to provide care to those folks who are struggling with accessing those services in urban areas because they might live in remote rural parts of the state. And so, you know, it’s a really – ending the epidemic is not one component, but all of the components put together. And I really do think we’ve seen early progress. We’ve expanded a lot of Ryan White funded activities in Indiana and if we keep up the trajectory, I do believe that we will make it across the finish line by our goal date.

Beckley: And that’s 3030, correct?

Turner: Uh…

Beckley: Or, 2030.

Turner: 2030.

Beckley: I’m way in the future, I guess.

Turner: By 3030, I hope that we’ve ended all the epidemics.

Beckley: Well, we can make that the next goal, I suppose.

Turner: Right?

Beckley: So, in the episode, in the full episode of Talking Hoosier History, we talked about how Ryan White and Hamilton Heights used education specifically to combat the stigma surrounding an AIDS diagnosis. I was wondering if you could talk a little bit about the continuing stigma that is still around a diagnosis and how we might take steps towards combating that stigma.

Turner: Well, you know, one of the things that we can – almost goes without saying now – is that people with HIV can live long, happy, health lives. People who stay retained in care and who can maintain viral suppression, are going to have a normal life expectancy.

Beckley: Can you explain what viral suppression is?

Turner: Yea, uh – we know that if we can keep people’s viral loads to below what they call an undetectable level, doesn’t mean that the virus is completely gone from the body, but just means that the tests that we use, the sensitivity of it, there are fewer copies of HIV than can be detected. And we know that unfortunately once somebody has HIV that they will always have the virus for the rest of their lives, but we also know that the treatments that we have now, we can essentially keep HIV suppressed within the body to a level where people who get HIV can get diagnosed early will never progress to AIDS and that they will experience a normal life expectancy.

Beckley: And do you think that that is lessening the stigma surround being diagnosed?

Turner: I think that that does help. However, stigma doesn’t turn on a dime and so you know, we’re dealing with the concept of now getting out and saying “undetectable equals untransmittable.” The CDC has embraced this, and so you know, we want to make sure that we don’t let the fear of HIV keep people from getting tested. So, stigma looks a lot of different ways. And one of the things – one of our biggest barriers in ending the epidemic is making sure that everybody who has HIV knows their status. And we know that the majority – 90% of new transmission occurs among the 10-13% of people, that region in there, who don’t know their status. And so, one of the things that can be a barrier to being tested is the fear of discovering your status. And I know that that can sound kind of wonky but at the same time, people are afraid sometimes to go in and find out if they have HIV so it’s easier to do what I call the ostrich method of sticking your head in the ground, rather than confronting, and then addressing the issue.

But I do think that knowing that treatment is so much easier now, that there are resources out there to help people afford the care that they need, and that maintaining suppression means that you don’t have to worry about passing on HIV to someone else. I do think that all of those things are great. But, you know, we also have to deal with the stigma of being on a medication to prevent HIV. There is a lot of conversation in the community – particularly when Prep was first introduced, about, you know  – what are the implications of someone taking a pill every day in order to prevent a potential HIV infection? And so there was a lot of – and there continues to be, a lot of vibrant dialogue around what that means for us, but what I know and from my perspective, is that we want to keep people healthy. And if we can stop the spread of HIV, and if we can detect everyone who has HIV, and we can get them enrolled in the services that they need, that we can end it within this generation. But stigma has been a huge barrier and will continue to be. We are doing our best to come up with messaging and to provide education that will help eliminate that.

Beckley: It sounds like the education is shifting from teaching people what HIV is to teaching people about the treatments available and the preventatives available. It’s shifted in my lifetime from, well, everybody now is aware of the epidemic and has lived through part of it, or has at least, you know, the tail end here, hopefully. And now we’re all shifting to looking forward to how to end it. And that’s extremely hopeful and I can’t imagine that, you know, people who were living through the peak of it in the 80s and 90s would even imagine that we would be so close today.

Turner: Absolutely, but you know, one of the things that I have long been concerned about is that I don’t – we are remiss if we don’t acknowledge that HIV is still the same virus that has impacted so many people. More people in our country have died as a result of their HIV infection than all the soldiers who have fought in all the wars we’ve been engaged in and fallen in battle. And so when you think about it in that regard, over just a much shorter period in time, this is still the same virus. And we are only able to, you know, address it because of all the advancement we’ve made, but people who are late diagnosed can still experience some of those same health outcomes that we saw in the earlier days of the epidemic. So that’s why it’s important – if you’ve not been tested for HIV, that you utilize one of many services that are available across the state to find out your status. And if you continue to engage in risk behaviors, it’s important to get tested every six months so that you can stay on top of that and if an issue does arise and if you do come back positive for HIV, then you are referred quickly into care so that we can start that, the therapy process and make sure that we get people to viral suppression as quickly as possible.

Beckley: Great. Jeremy, could you tell our listeners where they can learn more about the HIV epidemic, and the steps we’re taking to end it and where they can go and get tested if they are needing to be tested?

Turner: Absolutely. Our state department of health website is a great resource for people. We also have a great network of service organizations around the state that we can, from ISDH here, help direct people to get them enrolled in care.

Beckley: Great, thank you. And thank you again for being on the show. We really appreciate you taking the time to talk to us.

Turner: I appreciate it. Thank you all.

[Music]

Once again, a big thanks to Jeremy Turner for sitting down to talk with us – he’s an incredibly busy man so I felt especially privileged to have the opportunity to take a bit of time to chat.

We’ll be back next month with another episode of Talking Hoosier History. In the meantime, follow the Indiana Historical Bureau on Facebook and Twitter for daily doses of Indiana History tidbits. Subscribe, rate, and review Talking Hoosier History wherever you get your podcasts.

Thanks for listening.