When one thinks of HIV and AIDS today, what often comes to mind are images of the 1980s, when the disease took a devastating toll on gay men.
In the course of the past 30 years, much has changed. With advanced medications, people with HIV can live relatively healthy lives if they have access to health care and proper drugs.
But there are still 50,000 new infections every year in the United States, a third of them among teens and young adults. Of the 1.2 million people living with HIV in this country, many of them do not know it, and most of them are not receiving care and treatment.
With the correct policy decisions in Washington, D.C., and in state capitals, we can change that. We can turn the tide together and actually see an end to AIDS. This weekend, the International AIDS Conference returns to the United States after 22 years. AIDS 2012, with its theme “Turning the Tide Together,” will attract more than 25,000 delegates to discuss new research and policy priorities. Front and center will be the Obama administration’s National HIV/AIDS Strategy, which seeks to reduce the number of new infections, improve access to care and reduce health disparities on a disease that has mostly affected gay men, African-Americans and the poor.
Better prevention will require increased resources, which the administration has proposed. Unfortunately, Congress has not met the president’s requests. Instead, it has cut funding for school HIV health education by 25 percent. What’s more, Congress banned funding for needle exchange programs that are proved to reduce the spread of HIV, and then went ahead and revived failed abstinence-only-until-marriage programs.
Of the 1.2 million people living with HIV in this country, 18 percent, or more than 200,000 people, do not know they are HIV-positive. Testing is the only way to learn of one’s HIV status, and is therefore the necessary first step to get people linked to care and treatment. The Centers for Disease Control and Prevention is carrying out campaigns to remind people to get tested and to encourage doctors to test patients for HIV as part of their routine medical care. And earlier this month, the Food and Drug Administration approved the first ever at-home rapid HIV test.
Screening for HIV, and getting HIV-positive people on medications, has proved to be beneficial not only to the individuals’ health but to society as a whole. Recent research shows that treatment outcomes are better the sooner an HIV-positive person starts medication. But according to the CDC, only 36 percent of HIV-positive people are on AIDS medications.
Implementation of the 2010 health care law, and maintaining Medicaid, Medicare and the Ryan White Program, which provide health care to low-income people with HIV, are all critical to ensuring that people with HIV receive treatment.
The Ryan White Program and its AIDS Drug Assistance Program has experienced unprecedented client growth. This resulted in long wait lists for medications until the Obama administration provided emergency funding. The president has proposed a $100 million increase in ADAP next year, $65 million of that increase was approved earlier this year by the Senate. However, it remains to be seen what the House will do. With mandatory cuts of more than 8 percent on the horizon for nondefense discretionary programs, which include HIV treatment and prevention programs, the fight against this epidemic is in jeopardy.
But there is hope. As health care reform is implemented, many of the barriers that have prevented people with HIV from accessing private insurance will disappear. HIV-positive people will qualify to receive private insurance through the exchanges, and if they are very poor they can access Medicaid.
Yet there are some in Congress who want to repeal the 2010 law. These same Members are trying to deny funding to implement the law. It is time to stop the political bickering and move to full implementation — in Washington and throughout the states.
Perhaps the most positive development for people with HIV contained in the law is the Medicaid expansion. More than a dozen governors have already announced they will deny this health coverage to their low-income citizens. If this truly is the case, these governors will be turning their backs on their most vulnerable constituents and putting politics over policy.
Because there still is no cure or vaccine for HIV, the only way to end the epidemic is through prevention and treatment. While the ultimate responsibility rests with the individual, federal and state policies will play a large role in determining whether we will turn the tide together on AIDS, or whether this preventable disease will continue to plague our nation.
Carl Schmid is deputy executive director of the AIDS Institute.