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"Turning the Tide" is the theme of the 2012 International AIDS Conference, to be held July 22-27 in Washington, D.C. The conference’s return to U.S. soil after a 22-year absence was made possible by our country being one of the last to end its entry restrictions on people living with HIV, effective January 4, 2010.
The U.S. was also somewhat late-to-the-game as one of the last countries in the developed world to have a formal HIV/AIDS National Strategy (visit aids.gov to read it). But if recent claims by key U.S. government officials – including the President and the Secretary of State – can be counted on, there will be a renewed commitment to the eradication of HIV and care for those with HIV or AIDS.
On Nov. 8, 2011, U.S. Secretary of State Hillary Clinton made a commitment to the U.S., creating an “AIDS-Free Generation” when she said:
Our efforts have helped set the stage for the historic opportunity the world has today: to change the course of this pandemic and usher in an AIDS-free generation … where, first, virtually no children are born with the virus; second, as these children become teenagers and adults, they are at far lower risk of becoming infected than they would be today, thanks to a wide range of prevention tools; and third, if they do acquire HIV, they have access to treatment that helps them from developing AIDS and passing the virus on to others. Creating an AIDS-free generation has never been a policy priority for the United States government – until today.
The primary aim of “AIDS 2012” is to unite scientific and community health leaders from around the globe – those people charged with developing strategies and mobilizing support for the complex web of social, human rights, and political issues surrounding HIV/AIDS. As these leaders continue to translate new evidence into meaningful action, the world seems to have a shared goal of nothing short of a cure for AIDS and/or a vaccine for HIV.
Thirty-one years after the diagnosis of the first cases of AIDS, it sometimes seems that there are at least as many questions as answers when it comes to preventing HIV infection, how to provide the best possible care for those with HIV or AIDS, and who pays the tab for this monumental effort?
But one thing we know for certain – it’s no longer a question of treatment vs. prevention. A large clinical trial, funded by the National Institute of Allergy and Infectious Diseases and completed in 2011, found that patients with HIV are 96% less likely to pass on the infection if they are taking antiretroviral drugs.
“Quite simply, if we can link everyone who has the virus to proper medication and medical care, we can stop the spread of HIV,” says David Brinkman, CEO of Desert AIDS Project. “Finally, once and for all – in our lifetimes – it seems possible that we can stop the spread of new infections of HIV.”
Early treatment not only reduces transmission of HIV but can also protect HIV-positive people from opportunistic infections like TB. The study found that early AIDS treatment reduced the occurrence of TB infection by 84%. According to UNAIDS, expanding treatment and pairing it with other high impact interventions can avert more than seven million deaths and 12 million new infections by the year 2020. Combining this new evidence with recent economic modeling by the U.S. Center for Disease Control and Prevention (CDC,) we know that investing more in AIDS treatment and prevention now will not only reduce deaths, but will also reduce the cost of the AIDS response in the long run.
A terrible link with our nation’s capital
A report on HIV/AIDS recently released by the D.C. Department of Health found that 2.7% of the city’s population is living with HIV – far above the 1% the World Health Organization qualifies as a “generalized epidemic” – a statistic that is even a bit lower than the infection rate found in the service area for Desert AIDS Project. The CDC estimates there are as many as 240,000 of the 1.2 million Americans living with HIV who don’t know they are infected. The California Department of Public Health, Center for Infectious Diseases, Office of AIDS, estimates that 5,000 to 7,000 new infections occur in California each year. Of those, it’s estimated that there are 2,000 people living with HIV who don’t know it, right here in the Coachella Valley. In fact, it was recently reported that the Palm Springs area has the fourth-highest prevalence of HIV in all of California.
“That’s why D.A.P. has always been committed to free and confidential HIV testing,” said Brinkman. “We now have more than two dozen test sites locally, and we will continue growing that number as much as necessary to help get everyone tested.” Whatever an individual’s reason for not being tested and knowing their HIV status, it can become a literal life-or-death decision: almost 40% of people who test positive for HIV are diagnosed within just one year of developing full-blown AIDS, which often leads to a significant decline in health and quality-of-life. The majority of those who get an HIV test late in the course of their infection do so because they are already ill.
Fortunately, there is evidence that people who test HIV-positive take steps to keep others from being exposed to the virus. But studies show that people who do not know they are HIV-positive are more likely to engage in risk behaviors associated with HIV transmission. Because HIV testing linked to treatment can help to drastically reduce transmission of the virus, there is no question that routine testing is a highly cost-effective strategy. In fact, a 2006 study found the average lifetime cost of care from diagnosis for an HIV-infected adult is $618,900 over 24 years.
What’s the future of the AIDS epidemic among gay and bi men?
While some target populations are at higher risk than others, anyone can contract HIV, regardless of age, gender, race, ethnicity, sexual orientation, gender identity, or socio-economic circumstance. Even so, AIDS activists point out that HIV and AIDS continues to disproportionately impact gay men or men who have sex with men (MSM) in the U.S. and other countries. While the perception of AIDS as a “gay disease” has largely receded from the minds of most Americans, AIDS activists say they find themselves in the ironic position of having to remind Congress, state, and local governments that more resources and funding are needed for HIV prevention programs targeting gay and bisexual men.
According to the CDC, while MSM account for an estimated 2% of the U.S. population, more than half of all new HIV infections in the U.S. each year – 53% – occur among MSM. CDC data also shows that MSM make up nearly half of all people living with HIV in the U.S. – 48%. However, proposals for addressing HIV prevention among MSM in the National HIV/AIDS Strategy have been delayed, due to cutbacks for AIDS-related programs, not only at the federal level but by state and local governments as well.
Some even fear a return to the horrors of the AIDS epidemic of the 1980s, when friends and family members helplessly watched loved ones die, due to a lack of effective medical treatment. If the federal government fails to boost funding for the federal-state AIDS Drugs Assistance Program (ADAP), low-income people who rely on the program to provide the medications they need – could become casualties.
The health insurance reform laws that President Obama proposed and Congress passed two years ago – which many refer to as “Obamacare” – were expected to relieve the ADAP funding pressure on states when it takes effect in 2014. As this issue went to press, the U.S. Supreme Court had yet to rule on future of the Patient Protection and Affordable Care Act (ACA).
The ACA would prohibit insurers from denying coverage, dropping coverage when people get sick, or imposing limits on coverage. People living with HIV/AIDS have also often had issues with their medical needs exceeding the financial limits of whatever insurance coverage they might have. In addition, the ACA seeks to broaden Medicaid (known as MediCal, in California) eligibility to include individuals with income below 133% of the Federal Poverty Level – an annual income of about $14,000 based on the FPL of $10,800 – so that people with HIV wouldn’t have to wait for it to advance to a diagnosis of full-blown AIDS to be eligible.
After 28 years, D.A.P. is still committed to the fight
When Brinkman and other senior staffers at Desert AIDS Project attend “AIDS 2012,” they are hopeful for a brighter future – perhaps even for the beginning of the end of AIDS. “The continued support we get from our incredible donors and volunteers, who are so generous with their time, talents, and money, inspires us every day,” said Brinkman. “Knowing they have our backs, we continue to be inspired by the strength of those we serve in what we hope will be the final chapter of this devastating epidemic.”
This article was originally published HERE.