July 25, 2012
AIDS in 2012: The founder and executive director of the Black AIDS Institute tells Joanne Silberner that the AIDS epidemic can be combated by making policy choices based on science and by ensuring that the health law's essential benefits package provides for both HIV/AIDS treatment and prevention. A transcript follows.
Joanne Silberner: Your group, the Black AIDS Institute, issued a report calling for policies aimed at stemming the epidemic of HIV among black gay men. How big an epidemic is it?
Phill Wilson: The Black AIDS institute, in partnership with the National Black Gay Advocacy Coalition and the Black Research Group released a report recently that looked at the AIDS epidemic among black gay men in America. What we found that among black gay men in America we really have the worst epidemic of any epidemic. Now black gay men in America may be the most vulnerable population on the planet with regard to HIV. We see prevalence as high as 46 percent in this population and we see incidents over the last three years as high as nearly 50 percent as well. This is a level of epidemic that is number one generalized as opposed to concentrated. The U.S. basically has a concentrated epidemic. But within those concentrated population we have a generalized epidemic. The other thing we discovered among black gay men in America is that black gay men are at risk for HIV infection at every age, starting with a 1 in 4 chance of being infected at the age of 25, rising up to nearly a 60 percent chance by the time a black gay man reaches the age of 40.
Joanne Silberner: What kind of policies have allowed this to happen, or what kind of lack of policies have allowed this to happen?
Phill Wilson: Well, you know, we are where we are in regards to the AIDS epidemic and black America in general, or the AIDS epidemic among black gay men specifically on two fronts. First of all, it's really, really important to point out that we are much better off than we were a decade ago, and certainly two decades ago. But sadly, the advances that we've made have not benefitted all populations equally. One of the populations that has suffered is the black community. But when we look at some of the challenges we've had policy-wise -- things like not paying attention to the science. For example, we know that syringe exchange programs work, they reduce HIV infection and they don't raise drug use, and yet there's been a federal ban on funds for needle exchange programs. We briefly lifted the ban and then the ban was reinstated. That costs lives. People are getting infected and people are going to die because that's bad policy. For a decade, we were doing abstinence only programs, denying young people the benefits of comprehensive sex education and AIDS education. Again, that costs lives. We have to do better.
Joanne Silberner: Will the Affordable Care Act make a difference?
Phill Wilson: The Affordable Care Act is going to be a critical benefit to people living with HIV on a number of fronts. Number one: the elimination of preexisting conditions; the elimination of lifetime and annual caps; the fact that you can't lose your health insurance because you get sick or because your care costs too much. Given the number, the rising cases of HIV among young people, the fact that young people can stay on their parent's health care up to the age of 26 is also important. But the secret is going to be in the essential benefits package. We need to make sure that the essential benefits package actually responds to the needs of the people living with HIV. So what does that mean? It means annual physicals. It means an HIV test with every physical. For people who are at higher risk, they should be tested twice a year. It means annual viral loads for people with HIV, and it means comprehensive coverage of ARVs both for treatment and prevention.
Joanne Silberner: And what would you say to people who say the money's not there?
Phill Wilson: Well, you know the truth of the matter is that it really is not a question of money as a matter of a question of will. We're going to pay for this one way or another. We are either going to pay for this now, or were going to pay for it later, by the way of lives or actually dollars. For every averted infection, we save thousands and thousands of dollars. So we really don't have a choice, but to actually take this on now. And if we take it on now, not only do we save lives, not only do we contribute to our economy with people being able to work and live healthy lives and continue to pay taxes, but we also delay having to care for people who then get sick.
Joanne Silberner: And there's a threat to Medicaid in some states -- how do you think that's going to play out?
Phill Wilson: I think that we really have to look at our systems at large. Health care reform alone is probably not going to get us there. One of the challenges that we have is that Medicaid is not being applied evenly around the country. I think that over time, once we see the benefits of getting people onto care and treatment, the benefits of treatment as prevention and reducing viral load and therefore reducing new infections, I think that we will make room for more resources to do different things.
Joanne Silberner: And the states that are threatening to not accept Medicaid money because of the new rules under the Affordable Care Act. Where do you think that's going to go?
Phill Wilson: We do see a number of governors who are playing politics with our health and with our lives. I'm hoping that people will put pressure on our leaders to do the right thing. It's absolutely outrageous that we have governors around this country who are saying that they are not going to accept the resources that are going to be made available to their citizens because they want to create political posturing. And I think that that's absolutely obscene.
Joanne Silberner: Last question: Any particular state or local initiatives that have really made a difference, that really should be a model?
Phill Wilson: I think that there are a number of model programs out there that are working to make a difference. In California, there's a program called Bienestar, that's servicing Latino organizations, that's marrying education with science and advocacy. Here in Washington D.C., there's an organization called the Community Education Group that's figured out how to get a 90 percent linkage rate for the people they test. When you test positive with this organization they virtually guarantee that you get linked to care. They either personally accompany you to care or they provide financial incentives to care.
The Black Treatment Advocates Network, which is a project that the Black AIDS Institute is running. One of the things we have to do is marry the science -- we know that the science works, we know that treatment is prevention, we know that prep work -- but we need to marry that with the community, we have to take the science to the community, so we're creating an army of peer/patient navigators. We help people maneuver through the system, to get them into care, to help them stay into care, to drive down the viral load, and that's going to be the road to ending the AIDS epidemic.
Joanne Silberner: Thanks very much for stopping by.
Phill Wilson: You're welcome.
This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.