September 18, 2012
The line "If you build it they will come" worked for Kevin Costner in the movie Field of Dreams, but it definitely does not work for people living with HIV/AIDS or in public health. The health care system we need won't get built until we show up and demand it.
America's health care system has long been a source of shame. The U.S. is the only industrialized country that does not guarantee health coverage for all its citizens. But through a combination of programs, such as Medicaid and the Ryan White CARE Act, we've actually built the foundation for a system of care for people living with HIV -- although it's not always easy to access and it's easier for some to access than it is for others. Only about one in four people with HIV in this country are now receiving the care they need. Neither the government nor private industry are going to invest in the infrastructure necessary to end the epidemic if the AIDS community doesn't demand it.
People living with HIV have to start showing up, start asking for treatment, start putting pressure on policymakers to support policies that expand the treatment infrastructure, and we have to start utilizing and maximizing the resources already available.
We know what antiretroviral treatments can do for people living with HIV/AIDS. HIV therapies are more effective and easier to take than ever before. The pill burden is as low as it can get and the side effects are fewer and milder. And in most cases the treatments are cheaper than they've been in the past. Yet, too many people are intimidated by the medical system, too many still believe that a positive HIV test is a death sentence, and too many people believe that HIV treatment requires fistfuls of pills every day with horrible side effects. No matter how good the treatments are and no matter what treatment advancements we make, health services aren't meaningful unless they are actually used.
We need massive investments in community education, in HIV science and treatment literacy programs. We need an army of peer patient navigators that link individuals to the care they need.
People living with HIV/AIDS also need to assume greater responsibility. We need to communicate that investing in the public-health infrastructure is not charity. Based on what we know about treatment as prevention, investing in the public-health infrastructure not only helps PLWHA, it helps folks who do not have HIV. The adage "an ounce of prevention is worth a pound of cure" has never been truer than in this area. If we get people on treatment now and early in their disease, we save a huge amount of money that we won't have to spend in emergency rooms and end-stage care. And we make money in gained workforce productivity. It's the right thing to do for people living with HIV, and it's the right thing to do to help people who don't have the disease not get the disease. It's also cost effective.
Please join the Black AIDS Institute as we travel around the country in partnership with local AIDS organizations and health departments to host Post-Conference updates, where we share the latest science and other information from AIDS 2012 and continue this conversation. We look forward to seeing our friends in Los Angeles and Philadelphia next week. Please come out and let's continue this conversation there.
Next week we'll talk about integrating biomedical and behavioral prevention and treatment interventions.
Yours in the struggle,