Posted by: Randy Allgaier | December 1, 2007

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).

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%

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.


  1. […] World AIDS Day 2007- Time for a new approach in the United States …By Randy AllgaierWithout 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 …The Alligator – […]

  2. Here’s a nice little posting on World AIDS Day, that seems to sum it all up/:
    enjoy…I did

  3. The #1 cause of injury, disability, and DEATH in America is, Health Care. More people die now from contact with the American Medical Health Care system than from any other cause of death. More than from Cancer, Heart disease, or Stroke. More than any other country in the world. Many times more than any other people in the world. This fact is a catastrophic indictment of the entire US Health Care System.

    Driven by greed. And a rush to profit. Thousands of Americans are killed, and injured daily in America. By compromised health care. Cutting corners. Over, and under treatments. And poisonings with all manor of toxic, poisonous pharmaceuticals. Especially the children. America only makes up 2-4% of the world population. But Americans buy, and consume 50% of all pharmaceuticals world wide.

    But the tide has turned. I can see it. Hear it. And feel it. The message is getting out. And taking hold about the fact that we have a very serious, and major health care crisis going on in America. Hurting everyone. Especially our precious little children. Rich, and poor alike. And most all Americans seem to understand now that “HR 676 Not For Profit Single Payer Universal National Health Care For All (Medicare For All)” is the way to go. Like all the other developed countries have done. I have seen numbers as high as 90% of Americans want government managed health care Now. Medicare for all. Like other developed countries have. And like older Americans have now.


    It’s NOW TIME to bring out the BIG GUNS!! The BIG GUNS!! are you. The American people. And anyone else that wants to help. From now until HR 676 is passed into law. I want every person to reach out and touch their fellow Americans every day if you can. I want you to take a phone book. And call at least one of your fellow Americans every day. And ask them to pickup the sword of HR 676 Single Payer Not For Profit Universal Health Care For All (Medicare For All).

    Call more than one each day if you can. And ask them to do the same as you are doing if they can. And also to put maximum pressure on their politicians to get HR 676 done. And to make sure their politicians support HR 676. Accept no substitute. HR 676 is a no-brainer. It’s the best way to go on health care. It’s the only moral, and ethical way to go. That is why every other developed country has done it. Most did it years ago.

    I know that many of you have been doing a fabulous job of spreading the word by talking it up with family, friends, and co-workers. And putting pressure on the politicians to get HR 676 done ASAP. The phone calls to your fellow Americans will increase the pressure. And grow the movement at an astonishing, and exponential rate. And I know many of you have been wanting to do something more to help. The phone calls to your fellow Americans is something you can do every day to help.

    Trust me. It will be something to see. But you have to keep the focus, and pressure on getting HR 676 passed pronto. They will try to distract you. With all manor of other crises, and catastrophes. And other plans. Don’t be distracted. HR 676 Single Payer Not For Profit Universal Health Care is the #1 concern of the American people. Thousands of Americans are dieing daily now. And you or your loved ones could be next.

    There is no good reason HR 676 cannot be passed into law well before the coming elections. Do not tolerate delays. If it is not passed before the coming elections. All America will know which politicians are on the side of the American people. And which are not when they vote. Well before the elections.

    Everyone can do this. Most of you are well informed about HR 676. This truly is one of those no-brainers. Be considerate of your fellow Americans when you call. But be comfortable about calling. These are your fellow Americans. Some will be receptive. And some will not be. Some maybe rude, and mean. Just thank them, and move on to the next. Most will be with you. And if you get a call from one of your fellow Americans about HR 676. Let them know you are already on board. And thank them for calling. Build them up. And keep them strong. They are fighting for all of us.

    I will try to make a second post with just a few of the reasons everyone with 2 working brain cells agrees HR 676 is the best way to go. But you can also look them up for your-self. And read some of the positive informed post on many of the message boards too.

    Lastly, I am sick and tired of hearing how the candidates, and politicians health care plans are going to protect, and preserve the private for profit health insurance companies that have been killing, and ripping off the American people. And now the politicians want to mandate (require) that every American has to support the private for profit insurance company’s that have been killing, and ripping you off. Or you will be fined, and PENALIZED. Thats right. PENALIZED. Ridiculous! The politicians really think you are all detached idiots. CASH COWS! To lead to the slaughter. Don’t put up with that.

    So get on it America. Get those phones going. Chat it up! Save some lives. You want all of America talking about HR 676 becoming law, Now! Before more die needlessly. Make it happen. And to my fellow cyber warriors. You have been doing great! I see it! Keep it up. 1 of 2 post…

    Below are a few reasons why “HR 676 Single Payer Not For Profit Universal Health Care For All (Medicare For All) is a no-brainer. And some reasons why private for profit health insurance is a stupid idea, and injuring, and killing you and your loved ones.

    Medicare cost 2-3% to administer. Private insurance cost 30% to administer.

    Under HR 676 everyone would be covered from birth to death. No co-pays. No-deductible. No out of pocket cost. Plus Dental. And Vision. For less cost than we pay now under private health insurance.

    With private insurance. You have 47 million Americans with no insurance.

    And 89 million Americans that had no insurance part of the time from 2006-2007.

    And over a 100 million that are under insured.

    18-30 thousand Americans that die each year from lack of health care.

    Health Care bills as the #1 cause of personal bankruptcy. And loss of homes.

    Under HR 676 health care is moral, and ethical.

    Private for profit insurance is immoral. And unethical.

    Profit is the primary motive of the private insurance companies.

    They make profit by charging needy, vulnerable, sick Americans as much as they can charge them.

    Then they make more profit by denying them care when they most need it. And are most vulnerable and unable to fight back. When they are sick. Or trying to recover from major illness.

    Yep! I know you are getting angry. I’m sorry. But I have to continue.

    Under HR 676: we will save 300 billion dollars in administrative cost each year.

    With private insurance: we spent more per capita on health care than any other country in the world. Over twice as much as most other developed country’s. Yet we have 47 million with no health care.

    We rank at the bottom in quality of health care #37.

    Americans have a shorter life expectancy than people from all other developed countries. We rank # 42 in life expectancy. Down from #1.

    For the first time in American history. The life expectancy of American children is less than that of their parents. American children are dieing at a record rate. And are in terrible health generally.

    People from other country’s enjoy a much higher level of general health than the best privately insured Americans.

    Americans are also shrinking. We used to be the tallest people in the world. Now we are down to # 10.

    People from other country’s never have to worry about going bankrupt, or loosing their homes over medical bills if they get sick.

    Maybe you should go take a break for a while before I go on. I know this must be upsetting. But this is just a small part of the sad truth about private health insurance that HR 676 can fix.

    Under HR 676: Health care will be based on need. Not on profit. And high standards, and quality will be enforced, and patients protected by the Government through a dedicated civil service. With the power, and resources to rain in abuses of patient care. Like they do with Medicare now.

    With private insurance: Medical care is base on ability to pay. And profit. Tens of thousands of patient are killed, and millions are injure, crippled, and mutilated each year under private for profit health care, and insurance.

    By insurance companies denying needed care to increase their profits.

    By hospitals cutting corners. And using the cheapest least experienced personnel, equipment, and standards they can get away with.

    By doctors that over treat, and under treat. Who injure, mutilate, and kill patients with unnecessary test, procedures, surgery, and invasive diagnostic test for profit. Who poison, kill, and injure millions of Americans with all manor of unnecessary pharmaceuticals for profit. Men, Women, Children, and babies.

    Americans makeup 2-4 % of the world population. But Americans buy, and consume 50% of all pharmaceuticals world wide. This is a monstrous evil. And immorality.

    And lastly, by politicians that take blood money from all these despicable groups and turn blind eye’s to this slaughter of the American people. And the slaughter of their own loved ones. And them-self.

    Well I could go on. And on. But I think this is enough to get you started making your daily phone calls to your fellow Americans to support HR 676. And to help them understand how important it is that each of them join the fight. And bring the MAXIMUM pressure to bear on all individuals, parties, and especially your politicians, and Representatives. To get HR 676 passed into law immediately.

    This is an emergency. America is in a crisis. More Americans have died from this health care crisis than have died in all the wars in US history. Do your best. Millions of Americans lives are counting on each of you. Including your own life. Remember, you are Americans. You know how to fight for your country when you have too. The whole world is in your blood. I’m with you.

    All the best… 2 of 2

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