World AIDS Day 2007- Time for a new approach in the United States: Developing Universal Health Care and Addressing Poverty

Hey folks it is 26 years into the epidemic and HIV/AIDS is still a huge problem in the United States. In all due respect to those men, women and children suffering and dying in Africa and elsewhere in the world- it is still a problem in this nation and it is simply not being addressed adequately. Much attention will rightfully be focused on the global epidemic and the horrendous toll it has taken in Africa on today’s World AIDS Day events.  It is my intention here to shine a bright light on our epidemic at home- while acknowledging that our efforts globally are also inadequate. 

 Increasingly HIV/AIDS is a disease of poverty in this nation and can only be adequately combated by addressing poverty. Increasingly people living with HIV/AIDS have a smorgasbord of heath issues that is exacerbated by the “graying” of the epidemic, the fact of decades of ingesting toxic anti retroviral medications, the need to address HIV/ AIDS as one component of overall health for many population and can only be adequately combated by addressing overall health care reform. HIV/AIDS cannot be adequately addressed without treating poverty and the broken nature of our national health care system.

HIV/AIDS has been with the world since 1981. My entire adult life has been informed by this epidemic- from the day I read a New York Times article on July 3, 1981 by Larwence Altman- “Rare Cancer Seen in 41 Homosexuals” when I was 23 years old. Now, I am 50 years old and I have been HIV positive for somewhere around 20 years and full blown AIDS for nearly 9 years.

Some things have changed but sadly many things have not changed. In the early days it was perceived as a “gay” disease and now in the United States impacts all populations with disproportionate impact on African American women, men who have sex with men- specifically young men of color.

Let’s look at a quick snapshot of HIV/AIDS in my city of San Francisco as well as nationally and globally. The statistics at all levels are sobering and are a clarion call that we must remain vigilant.

San Francisco
Today, San Francisco continues to have the nation’s highest per capita prevalence of cumulative AIDS cases, and AIDS remains the second leading cause of premature death in the city. The number of persons living with AIDS in San Francisco has increased by 43% over the last decade alone – a percentage that does include more rapidly escalating non-AIDS HIV cases Through December 31, 2006, a cumulative total of 26,991 cases of AIDS had been diagnosed in San Francisco, accounting for nearly 3% of all AIDS cases ever identified in the US (n=925,452) and nearly 20% of all AIDS cases diagnosed in California (n=139,019), despite the fact that San Francisco County contains only 2% of the state’s population.

In San Francisco- one out of every four gay men is HIV infected. One in every 37 residents of the city of San Francisco is living with HIV/AIDS (2,713 cases of HIV per 100,000). As of December 31, 2006, the incidence of persons living with AIDS per 100,000 in San Francisco County (1,292.1 per 100,000) was over five times that of Los Angeles County (217.1 per 100,000) and nearly double that of New York City (757.0 per 100,000).

USA
Here are the statistics for the USA according to the Kaiser Family Foundation:
Number of new HIV infections each year: 40,000
Number of people living with HIV/AIDS: 1.2 million, including more than 400,000 with AIDS
Number of deaths among people with AIDS in 2005: 17,011
Percent of people with HIV/AIDS not in care: 42%–59%
Percent of people infected with HIV who don’t know it: 25%

Globally
UNAIDS and the WHO indicate that between 2001 and 2007:
The number of people living with HIV/AIDS globally rose from 29 million in 2001 to 33.2 million in 2007, due to continuing new infections, people living longer with HIV, and general population growth;
The global prevalence rate (the percent of the population with HIV) leveled over this period at 0.8%;
Annual deaths increased from 1.7 million in 2001 to 2.1 million in 2007, but have declined in the last couple of years due in part to antiretroviral treatment scale up;
New HIV infections are believed to have peaked in the late 1990s, and declined between 2001 and 2007 from 3.2 million to 2.5 million. The decline is attributable to natural trends in the epidemic itself and to prevention efforts. Still, in 2007, there were more than 6,800 new HIV infections each day;2
Women represent half of all people living with HIV/AIDS, as they have since the mid-1990s;
HIV is among the leading causes of death worldwide and the number one cause of death in sub-Saharan Africa;
Most people with HIV are unaware that they are infected.

The world’s focus has shifted from the epidemic in the industrial world to the epidemic in the third world- specifically sub-Saharan Africa. It is appropriate to pour resources into the epidemic in Africa. But it is vital to address the epidemic at home as well.

President Bush has pledged billions of dollars to combat AIDS in Africa- that is commendable. But he has at best flat funded programs for HIV/AIDS and other health care issues and often he has slashed them. Most recently Congress added more funding for HIV/AIDS to the Labor/ Health/ Education bill but Mr. Bush vetoed it. Mr. Bush has also vetoed other health issues- most notably a needed expansion in the SCHIP program.

My message to Mr. Bush and his Republican friends in Congress and the Presidential candidates is that HIV/AIDS is still a very real problem in this nation.

I am supporting John Edwards for President for a variety of reasons- but a critical reason for my support is his platform on addressing HIV/AIDS at home and his emphasis on poverty as a critical issue for this country. Poverty is co-morbid with HIV/AIDS.

John Edwards was the first presidential candidate – Democratic or Republican – to take on the big insurance and drug companies and propose a plan for quality, affordable health care for every man, woman and child in America that offers everyone the option of a public plan. Today, John Edwards builds on his plan for true universal health care with specific proposals to lead the fight against HIV/AIDS at home and around the world. He will include a comprehensive new national strategy to fight HIV/AIDS, including:

Calling for universal access to HIV/AIDS medicine across the world, investing $50 billion over five years to meet that goal;

Changing the policies that protect big drug companies, at the expense of people dying of HIV/AIDS in developing countries.

Guaranteeing Treatment for Everyone with True Universal Health Care by 2012. People with HIV/AIDS who don’t have health insurance or who have inadequate insurance are significantly more likely to die from the disease. That’s the tragedy of the two health care systems in this country today – one for people who can afford the very best care and one for everyone else. True universal health care must be the foundation for a national HIV/AIDS strategy. Edwards’ plan will ensure every person in America living with HIV/AIDS gets the care they need, when they need it. His plan will also transform chronic care with a new patient-centered “medical home” approach where a primary care physician will make sure patients are getting effective treatment from a coordinated team, including palliative care. [Bhattacharya, 2003] Edwards supports the Early Treatment for HIV Act which will expand Medicaid to cover HIV-positive individuals in every state before they reach later stages of disability and AIDS. Currently, in most states, individuals must receive an AIDS diagnosis to receive services under Medicaid even though research shows that the sooner individuals living with HIV receive treatment the better the outcomes. [Porco et al., 2004]

In 2001, the CDC set a national goal of reducing the annual number of new infections in half by 2005, but the actual number of infections has barely budged. A 1998 presidential initiative set a goal of eliminating racial disparities in HIV/AIDS by 2010, but disparities are as bad today as they were then. Our disappointments can be explained in part by the failure to create a national strategy, backed by necessary funding and with clear and bold goals, specific action steps, real accountability and broad participation and buy-in from stakeholders both inside and outside of government. As president, Edwards will develop a National HIV/AIDS Strategy through an honest, comprehensive and fast-tracked process that involves stakeholders from the public and nonprofit sectors. The National Strategy will coordinate the various agencies within and outside of the Department of Health and Human Services (HHS) that affect HIV/AIDS policy. He will hold his HHS Secretary accountable for issuing an annual report on HIV/AIDS that charts progress towards our national goals, and he will appoint a strong director of the White House office of AIDS Policy to keep these issues visible at the highest levels of government. [CDC, 1999, 2001, 2007; HHS, 1998]

About two-thirds of all new HIV/AIDS cases are diagnosed in African Americans and Latinos. African Americans are infected at nearly 10 times the rate, and Latinos at more than three times the rate, of white Americans. A 2005 study of African-American men who have sex with men in selected cities found that almost half are infected with HIV, and 67 percent do not know they have the disease. Latina women are six times more likely than white women to have HIV/AIDS. Any serious effort to end the HIV/AIDS epidemic must begin in the African-American and Latino communities, including among the incarcerated population, and address their prevention and treatment needs. We must also continue to work intensively with important overlapping groups like gay men. [CDC, 2007; KFF, 2007]

Enacting true universal health care will ensure patients have access to care, but fully funding the Ryan White CARE Act will remain essential to ensure that culturally-competent care is available for the special needs of people living with HIV/AIDS. These programs include outpatient HIV early intervention services, support services like transportation, case management, substance abuse and mental health treatment, nutrition, family-centered care for children, access to clinical trials and delivery to hard-to-reach populations. Maintaining delivery of outreach and treatment services to the LGBT community, for example, is dependent on these programs. Edwards will also put an end to waiting lines for HIV drugs — for example, more than 300 people with HIV/AIDS are on a waiting list for medication in South Carolina – and increase funds for the Housing for People with AIDS (HOPWA) programs, only federal program that provides comprehensive, community-based housing for people with HIV/AIDS. [NASTAD, 2007]

Preventing HIV/AIDS with Scientifically-Proven Strategies, Not Political Ideology
The CDC has identified the three most reliable ways to prevent HIV/AIDS infections. Yet the Bush administration focuses on only one of them – abstinence. As president, Edwards will promotes all reliable prevention strategies, including comprehensive, age-appropriate sex education to ensure young people learn all the facts about preventing HIV/AIDS and harm-reduction programs that provide high-risk individuals with access to clean syringes. He will lift the ban on federal funding for needle exchange initiatives. In addition, Edwards will support community and public education that encourages testing. [CDC, Undated; Bush, 2005]

Mr. Edwards addresses another issue in his campaign that must be addressed- poverty. Trying to fight HIV/AIDS without addressing poverty is counterintuitive.

Without addressing HIV/AIDS as part of overall health reform- a critical issue for all Americans- not just those infected and at risk for HIV/AIDS, without addressing HIV/AIDS without addressing poverty, without addressing HIV/AIDS without addressing the larger issue of health disparities, and without addressing HIV/AIDS at home as well as globally- we will, I am afraid, be emptying the ocean with a teaspoon.