An audio version of this story Nearly $9 million in three years. That’s about how much Fulton County failed to spend in federal HIV prevention funds in the past three years. WABE broke the story in June and has since discovered Dr. Patrice Harris, director of the Fulton County Health Department, blocked at least one Centers for Disease Control and Prevention effort to intervene on its behalf.

Getting To This Point The Fulton County Health Department has received nearly $28 million to stem Atlanta’s high incidence of HIV/AIDS. The reason? Atlanta has the fifth highest rate of new HIV infection diagnoses among U.S. cities, a statistic HIV advocates and health officials say proves we’re in the midst of a crisis.

“We see the steady drumbeat of new HIV infections without any sign of diminishing over time,” said Dr. Melanie Thompson of the AIDS Research Consortium of Atlanta.

That’s why in 2012 the CDC refocused prevention efforts on cities where HIV rates were exploding. So far, the shift has meant more than $28 million coming to help Fulton County fight the epidemic here.

But in June of that year — just six months into the five-year grant cycle — the CDC raised a red flag about Fulton County’s bureaucratic red tape. According to documents obtained by WABE, the CDC believed the problem could drastically slow, or even stop, HIV prevention money from getting into a community that desperately needed it.

Despite the CDC’s concerns, which were repeated in several biannual reviews, Fulton County’s top officials remained unaware.

According to multiple sources and internal CDC documents obtained by WABE, that’s because the director of the Fulton County Health Department kept the CDC away from county commissioners.

“I do remember email communications or phone communications” related to the incident, Harris told WABE during an interview last Friday. She also remembers turning down the request.

But a June 2014 interoffice CDC email paints her answer differently. It reads, in part, that Harris “made very clear that we are not to contact the board of commissioners for any reason.”

Harris said it made more sense to follow protocol and “build a case” for making the changes.

“I knew the CDC wanted to be helpful,” Harris said. “But I felt the best way to handle that was to go through the chain of accountability.”

Harris also worried the Fulton commission might think she put the CDC up to the meeting.

“Certainly, if I had to do it all over again, I would be more aggressive,” Harris noted. “But hindsight is always 20/20.”

(Following WABE’s Aug. 14th interview, Dr. Harris followed up with a written statement, as well as a copy of the health department’s guidance on working together.)

Unsympathetic Ears

Thompson of the AIDS Research Consortium of Atlanta doesn’t give Harris such an easy pass. Thompson points out that people’s health — maybe even their lives —were at stake.

“It makes me angry, actually,” Thompson said. “Many of us have spent decades here trying to impact this epidemic.”

When WABE shared its findings with Fulton Commission Chairman John Eaves, he became equally upset. He said he was unaware of the attempt and that he found Harris’ efforts to keep the commission out of the loop “incredibly disconcerting.”

Eaves also questioned why the CDC needed to ask the health department’s director for permission to talk to the board.

Dr. Eugene McCray, head of the CDC’s Center for HIV Prevention, said doing so without Harris’ permission would cross the boundaries of the agencies’ cooperative agreement.

“Our goal is to work with [local health departments] and provide them with the information we think they need,” McCray said. But it’s up to the local health department to act.

And in this case, Fulton County didn’t.

But it’s not the only time the county health department balked at CDC help.

Project managers with the CDC noticed Fulton County’s struggles were becoming chronic, so they offered the county “direct assistance.” That’s when the CDC embeds one of its own staffers at the local health department level.

A CDC staffer with direct knowledge said Fulton’s health department never responded. When WABE asked Harris about the offer, she said she didn’t recall the scenario. A former Fulton County health department employee, who was present for initial discussions, confirmed the offer; however, that person couldn’t recall why the county didn’t follow through. The source tells WABE Harris would have to sign off on such a proposal, which did not happen. It’s not clear, however, who bears responsibility.

Despite all this, Harris hopes the missteps won’t overshadow the many good things the county health department has achieved in the fight against HIV.

“There have been some successes,” Harris said. She even uses the HIV prevention spending issue as an example. After three years of problems, she said the county is now on track to spend all of its HIV prevention funding. And, Harris notes, the health department is meeting more quality benchmarks.

In December, Harris will step down as director of the Fulton County Health Department. She said she wants more time to devote to new endeavors, including her position as chair-elect of the American Medical Association.

Harris denies the recent, negative spotlight on her has anything to do with the decision.

But whether Harris goes out on a high note largely depends on the results of a county audit, which is expected to be released soon.