November 16, 2009
photo credit: Karine Laval
Despite the fact that the mainstream media isn't focused on AIDS issues, France keeps plugging along, doing work that he thinks activists are neglecting. His most recent article Another Kind of AIDS Crisis in New York Magazine about the health complications of aging with HIV hit a nerve with readers.
The article is the first mainstream feature article focusing on the health issues people aging with HIV face. Three weeks after its publication, it still tops NYMag.com's list of most e-mailed articles.
France, a veteran writer and AIDS activist (and former Housing Works board member), said the story came about when he noticed his friends with HIV and AIDS developing a myriad of health problems, including memory loss, osteoporosis, stuttering, kidney failure and cancer.
"A friend of mine was diagnosed with cancer. He just thought he was a man with bad luck. Like another bus that came out of nowhere. It's exactly the same bus. It's not an ill-fated course through life," France said. "I wanted to look at these specific health complaints in context with one another and in progression of AIDS itself."
That friend, writer Joe Westmoreland, ended up featured in the story, along with Housing Works client Cesar Figueroa and a dozen other people with HIV or AIDS over 50.
France noted that while people with AIDS are living longer thanks to antiretrovirals, AIDS is still a death sentence, albeit one with an incubation period. "A person who seroconverts at age 20 has a life expectancy of age 60. That's a reduction of a third," France said. "That means there's still a problem. That means there's still fatalities."
Some studies suggest that in order to avoid cognitive decline, people with HIV should go on treatment as soon as possible. And while many doctors recommend this (and France's longtime friend Housing Works President and CEO Charles King advocates early treatment for HIV in general), France, said he's not sure early treatment is the answer because of the lack of long-term research about people with AIDS on medication.
"It's a trade-off," France said. "Before you can argue that everybody with HIV should be on medication, you have to find out what the impact of these drugs are."
France, a veteran of ACT UP New York, said he thinks he needs AIDS treatment activism to focus more on these issues and less on negotiating with drug companies.
"We need activism to lead this. Treatment activism has taken a whole new form in the last few years. Where's the pressure of looking at the treatment itself?" France said.
The aging and HIV problem will only get worse. Although there are 109,000 known cases of HIV and AIDS in New York City, France took a closer look at the numbers, including looking at other stats, such as estimates that a quarter of people are undiagnosed, and concluded that at least 144,000, if not more, New Yorkers actually have HIV. The Department of Health stands by its numbers.
France said he doesn't think the under-counting is deliberate but notes that the only way to tell for sure would be with universal testing. "You'd have to get rid of some of those issues of HIV exceptionalism and know the identities of people," France said.
France said whatever the headcount though, problems with HIV and aging are going to become more profound as people with AIDS continue to age. And by 2015, the average age of people living with AIDS in New York, the center of the epidemic, will be over 50. "It's a huge balloon of illness and medical need. Even for that 20 year old who seroconverts today, there will be assisted living and general life issues. The last ten years aren't going to be pretty ten years."
To read more of France's work check out davidfrance.com