Few health facilities in America have done more in the fight against HIV and Aids than Grady Health’s Ponce De Leon Centre.

At this Atlanta clinic, staff counsel people about getting tested for HIV, perform the test, talk about the consequences of the result, and, if necessary, arrange for people to receive treatment immediately. Sometimes – far too often – they are present as patients die.

An HIV-positive diagnosis is no longer a death sentence. Effective drugs mean people can with HIV can lead normal or even extraordinary lives.

But that requires people getting tested, acknowledging they have the virus, and taking the medicine to manage it. For some people, that is too much.

Doctors at Grady say that each year they lose around 100 patients to Aids-related illnesses. The figure is horrifying; in London, a city of 10 million people, 42 such deaths were recorded in 2017, and 51 in 2016.

And as the doctors at Grady point out, those deaths were at just one of several hospitals in the city of Atlanta, which has a population of just 500,000.

“The numbers alone are certainly astonishing. For 2016 and 2017, a single hospital in the Atlanta area, we have lost over 100 individuals a year. Mostly young people,” says Jonathan Colasanti, an assistant professor of medicine in infectious diseases.

“The tragedy is not only do they tend to die very painful, drawn-out physical deaths, but the tougher thing for me to watch, is the emotional aspect,” says Colasanti. “The number of people that we watch die alone, with no one in the room with them, surrounded by no family, is one of the greatest tragedies of our time.”

He adds: “That’s not everybody. Thankfully there are moments of peace at the end, and surrounded by loving families. That number of 100 is tragic in and of itself. But that is one hospital.”

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Experts say that a gay black man in the United States has a one in two chance of being diagnosed with HIV. In Atlanta, it is even worse, with those odds perhaps closer to 60 per cent. There are many reasons for this, but racism, homophobia, poverty and lack of education about HIV are all contributors.

The doctors at Grady seek not only to work as physicians, but as educators working to overcome the ignorance and stigma that lead some people to avoid taking medicine, rather than admit they have the virus. Others will decide to forgo the drugs because they do not want their family to know.

“For some, looking at those pills is a daily reminder of their illness,” says Colasanti.

The Grady clinic, which is associated with Emory University School of Medicine, is one of the projects supported by the Elton John AIDS Foundation, a charity being supported by The Independent and Evening Standard.

Independent campaign with the Elton John AIDS Foundation Show all 10 1 /10 Independent campaign with the Elton John AIDS Foundation Independent campaign with the Elton John AIDS Foundation Sir Elton John and Evgeny Lebedev The Independent has launched it's Christmas charity appeal for essential HIV testing around the world with the Elton John AIDS Foundation. Funds raised will pay for those at risk to be able to get tested, and will make sure they have access to the treatment they need. Sir Elton John and Evgeny Lebedev with their HIV test swabs at the Ponce Centre in Atlanta Jeremy Selwyn Independent campaign with the Elton John AIDS Foundation Elton John and Andrew Williams Andrew Williams had never heard of the word HIV when he tested positive. It was his mother who had forced him to go to the doctor where he got the diagnosis that he thought was a death sentence. At that time he was in a wheelchair. It was the unbearable itching of his back that finally got him to get medical help but, he discovered, he not only had HIV but diabetes, high blood pressure and kidney disease. That was two years ago. This week, as the 31-year-old joined Sir Elton John and Evening Standard and The Independent owner Evgeny Lebedev in Atlanta to witness the revolutionary new breakthroughs against the disease at the city’s Grady Ponce De Leon Centre, there was no need for a wheelchair. Nor, he now knew, was there any need for fear Jeremy Selwyn Independent campaign with the Elton John AIDS Foundation Evgeny Lebedev and Andrew Williams Within two months of starting the latest antiretroviral drugs, the virus in his body had become undetectable in his blood. Not only is he now healthy, partly due to the drugs and partly due to the healthy lifestyle adopted for his other illnesses, but he can virtually not pass the infection to other people. He feels, he says, “reborn”. “I have a reason to live,” he explained, “and that is to help people who were like me – and to show you’re going to be OK.” Jeremy Selwyn Independent campaign with the Elton John AIDS Foundation It was a message so stark in its optimism that it reduced Sir Elton to tears. He knows first-hand the realities of what, in the past, an HIV diagnosis can mean. When he started his Elton John AIDS Foundation in the US in 1992, it was because his friends were dying and he wanted to do what he could, anything that he could, to help. “When we set up the Elton John AIDS Foundation we were delivering meals to people’s doors,” he said. “[The stigma meant] they would not go outside. We have come a long way.” Jeremy Selwyn Independent campaign with the Elton John AIDS Foundation But part of the reason for his tears was not only happiness at Andrew’s story. It was also the knowledge that, despite all the advances that have been made, the fight is far from won – indeed, in some parts of the world, things are getting worse. Sir Elton John with everyone at the Ponce Centre in Atlanta Jeremy Selwyn Independent campaign with the Elton John AIDS Foundation It is why he and Mr Lebedev had come to Atlanta to mark the first day of our Christmas Appeal, for that city, sadly, is one place where the situation is not only getting worse but, as those at the centre made clear, dramatically so. Jeremy Selwyn Independent campaign with the Elton John AIDS Foundation Sir Elton John with Vic Mensa at the Ponce Centre Jeremy Selwyn Independent campaign with the Elton John AIDS Foundation Sir Elton John with his HIV test swab In Atlanta, one of America’s richest cities and the home of such international corporate giants as Coca-Cola and CNN, if you are a gay black man in 2018 then, unbelievably, you still have a one in two chance of being diagnosed as HIV positive during your lifetime. Jeremy Selwyn Independent campaign with the Elton John AIDS Foundation Elton John with the mayor of Atlanta, Keisha Lance Bottoms Jeremy Selwyn Independent campaign with the Elton John AIDS Foundation Elton John talks at the Ponce Centre Jeremy Selwyn

Recently, Sir Elton and Evgeny Lebedev, owner of the newspapers, visited Atlanta, to meet doctors, community workers and survivors. They also got tested for HIV to show how quick the process could be and to encourage others to do so.

In a joint statement, they said: “As we write, 37 million people globally are living with HIV. Last year alone, 1.8 million people contracted the virus and 940,000 died of an Aids-related illness. This need not happen.

“Today’s medicines not only enable those living with HIV to have full and fulfilling lives, but also ensure they cannot pass the virus on to others,” they added.

Wendy Armstrong, professor of medicine at Emory, carried out the tests on the two special visitors.

She says a tester has to be confident in what they are doing, comfortable about talking to the patient and ready with a plan of action for treatment if the result is positive. “The second you hear that you’re HIV positive, you may not hear anything else.”

Armstrong says there are a number of reasons why the American south has HIV infection rates comparable to several countries in southern Africa, while much of the nation has looked away, perhaps believing the disease was defeated in the 1990s.

One was the enduring stigma associated with the virus among some communities. Among some African Americans there is still understandable suspicion, she says, of the medical community, following scandals such as the Tuskegee syphilis experiment, in which poor African American men from Alabama were refused treatment for the disease, even though the use of penicillin was known to be effective.

“One cannot ignore in the south the legacy of racism and the remaining structural racism that affects our institutions,” she says.