July 13, 2012
Photo courtesy of Getty Images.
"I think we are at a turning point," said Dr. Anthony Fauci, Chief of the National Institute of Health, this week of the epidemic, as he geared up for the International AIDS Conference in Washington D.C. He is referring to new studies demonstrating that getting people with HIV into treatment ASAP, before their CD4 count takes a hit and their viral load is high, can not only help a person's health, but also cut the chance of infecting another by 96%. The early treatment approach counters past policies of waiting to put people on meds until their immune system is severely weekend or they are sick. He says the studies have "striking, sometimes breathtaking results."
Of course many obstacles remain to translating those results into the AIDS-free generation the Obama administration has stated it is striving, amidst funding cuts and a non-supportive Congress, to provide, not least of which is the cost of treatment and getting people access to it, which Fauci concedes is indeed "a daunting challenge." In the U.S. treatment costs $15,000 a year and rising, a prohibitive expense for those without quality care, which even with the passage of the Affordable Care Act may still remain allusive for many low income individuals, especially in states that opt out of expanding Medicaid coverage. In developing countries it can cost as little as $400 annually and the UN hopes to double the number in treatment to 15 of the 35 million HIV positive people globally by 2015.
Another obstacle is of course that since the beginning of the epidemic fighting AIDS has meant confronting society's inequalities and fighting for human rights. No pill can be a panacea when stigma, discrimination, lack of funding for health care, invisible populations, and policies that focus on criminalizing drug use and mass incarceration and attacking instead of supporting women persist. Five years ago women overtook men as the majority of those living with the virus globally and in the U.S., after MSMs, African American women are the most affected population. "Something in the world's current response to HIV has left women, especially women of color, behind, and now we're seeing the consequences of our blind spots," said Serra Sippel, President of the Center for Health and Gender Equality, yesterday in the Huffington Post. "We can't afford to be myopic in our responses anymore. We have to focus on the whole package, or we're willingly putting an entire generation of women at risk."
And as AIDS in America increasing impacts poor people and minorities more than the rest of the country, it grows increasing scarce on front pages and in the front of people's minds. Recent polls show that only 20% of Americans, including 16% of African Americans and 4% of whites, consider contracting HIV a real risk, and only 57% of American adults report having been tested even once in their lifetime. However, new infections continue to mount, especially in those under 29, and 1 in 5 infected people remain unaware of their status. "Maps tell the story," said Amy Nunn, a Brown professor beginning a testing campaign Philadelphia. "It's not just what you do, it's also where you live. There's just a higher chance that you will come into contact with the virus," she said of people living in hard hit neighborhoods, like wards 7 and 8 in D.C., among the city's lowest income areas, where an HIV rate of 8% rivals those in Sub-Saharan African countries. "We've become complacent about HIV in America, and it's a real tragedy because hundreds of thousands of people in our own country aren't getting the care they need," said Chris Collins of amFAR, The Foundation for AIDS Research. The medical advances may indeed be breathtaking. We need the sound policies that can do the same for their real world affect.