January 22, 2013
The second of a two-part series about the stories to keep your eyes on during 2013. Go here to read part 1.
Last year we saw a number of medical advances designed to stem the HIV/AIDS epidemic:
But those advances won't make a difference if the people they're designed to help don't know about them or have access to them. If the latest treatments are going to be effective, the HIV/AIDS community must demand them.
What to watch for: HIV Post-Conference Updates conducted by the Black AIDS Institute have provided opportunities for information from AIDS 2012 to make its way to different parts of the country. Conversations about essential health benefits and how the Affordable Care Act will be implemented present an opportunity for members of the HIV/AIDS community to make sure their needs aren't overlooked. The ability of communities to mobilize and demand treatment will determine whether we actually realize the end of the epidemic that is finally within reach.
It was a good year for supporters of gay marriage. Four states showed their approval of gay marriage in the 2012 election. Voters in Maine, Maryland and Washington approved same-sex marriage, marking the first time that gay marriage had prevailed in a general election. Minnesota voters defeated a constitutional amendment that would have banned same-sex marriage in that state.
What to watch for: Challenges remain for the gay-marriage movement. Among them: The constitutionality of the Defense of Marriage Act (DOMA), a federal law that defines marriage as between a man and a woman and limits the federal benefits that same-sex couples can enjoy. The Supreme Court announced that it would hear arguments next year on DOMA, as well as the constitutionality of California's Proposition 8, which bans same-sex marriage.
Treatment as prevention is key to ending the HIV/AIDS epidemic. Not only do PLWHA live longer and healthier when they receive treatment early, but they are less likely to transmit HIV to others when taking ARVs. But there are leaks in the treatment cascade -- specifically, PLWHA who are not receiving care. In order for treatment as prevention to be effective, we must plug those leaks or increase the number of PLWHA who are linked to and retained in care.
What to watch for: The treatment cascade provides a visual way to track the number of PLWHA who are actually receiving treatment. Community-based organizations and patient-navigation services must develop new ways to get PLWHA linked to care and keep them there. As the Affordable Care Act increases the number of people eligible for health insurance under Medicaid, the HIV/AIDS community must also figure out how to make sure people use that insurance. By seeing where the leaks in the cascade are, health-care officials can track the effectiveness of methods to get more people into treatment.
The focus on treatment as prevention and the increasing use of biomedical tools to fight the HIV/AIDS epidemic means that Black AIDS organizations that have focused on behavioral interventions only are in danger of extinction. The National HIV/AIDS Strategy has redefined the way that funding is allotted for HIV/AIDS prevention, care and treatment. As a result, organizations that perform only one task, such as testing, may find that they'll no longer be financially supported as more focus is placed on addressing the entire continuum of HIV/AIDS prevention, care and treatment. If organizations are to survive, they must develop a scientific expertise or figure out a way to deliver health-care services.
What to watch for: Unfortunately, some Black AIDS organizations will close. Some may consolidate or find ways to work together in a changing health-care system. Community organizations should look for ways to adapt their business models and increase their knowledge of the science of HIV through training sessions, such as those offered by the Black Treatment Advocates Network, a network of HIV/AIDS advocates working to spread knowledge about the science of HIV.
The ability to safely disclose one's HIV status is crucial to physical and emotional health. Not only does sharing one's HIV status combat stigma and show that PLWHA can live full and happy lives, but it also forces people to acknowledge that PLWHA need and deserve essential services to remain healthy. The 48th Presidential Advisory Council on HIV/AIDS (PACHA) took a major step in creating a safe environment for disclosure by unanimously voting to adopt a safe and voluntary disclosure resolution. The Black AIDS Institute is also urging PLWHA to "come out" with their status.
What to watch for: If efforts to get people to reveal their status are successful, we'll have fewer people avoiding treatment because of shame and more people accounted for when policyholders determine what the HIV/AIDS community needs. "We can't make the case for the Affordable Care Act, the essential health benefit package, expanding Medicaid, building new clinics and creating incentives for doctors in the rural South if we can't prove that real people need those services," says Black AIDS Institute President and Chief Executive Officer Phill Wilson.
Tamara E. Holmes is a Washington, D.C.-based journalist who writes frequently about health and wellness.