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"The End of the Beginning": Thoughts on Poverty and HIV

By Gary Bell

July 21, 2010

With yesterday's release of the CDC's report on the relationship between poverty and HIV, and another study on morbidity and mortality released by the University of California, Day Three of the International AIDS Conference of 2010 began on a more somber note. To be blunt: It's about Poverty, stupid.

While the CDC's report demonstrated a clear link between HIV infection and poverty in urban centers, the UC report focused on dramatically heightened mortality rates of 'disadvantaged' (read: poor black folks) who have been linked to care and started on state of the art antiretroviral therapy -- rates that were in excess of third world countries. None of the deceased patients ever received viral suppression, despite robust supportive and case management services to help them. In short, even getting low income minorities into care is, as Winston Churchill would say (and I paraphrase); 'is not the end, is not the beginning of the end, but the end of the beginning.'

Many of us have been impacted in many ways by the global financial recession. We probably know people who have lost their jobs or perhaps even their homes. We are all pinching pennies to make ends meet. But, nowhere may the effects of the recession be felt more greatly than in HIV prevention and care. Think about it: if we have more minorities falling into poverty, or becoming more entrenched in it, then we may see greater HIV infection rates in those urban areas where most of them (and us) live. Moreover, even if we link them into care, how will we ensure that they stay in care and take their medication?

So many of us have become comfortable thinking about HIV disease as a chronic, manageable condition, much like diabetes. But we all know black folks, probably in our families, who have 'sugar' (what some of our seasoned citizens call diabetes) and who slide up to the table and eat those greasy chicken wings or smack on that sweet potato pie. And we watch those same folks lose their vision, or even some toes, because of uncontrolled diabetes. However, with HIV, they may lose a lot more than some toes. Moreover, unlike most other 'chronic conditions like diabetes,' HIV is transmissible.

So the reality of my work, (which I am never unrealistic about), hit a little harder today. It also reminds me that the US National Strategy on HIV/AIDS will require unprecedented coordination and cooperation by not just HHS, the CDC and SAMSHA, but from other agencies that (should) focus on the poor such as HUD and the Departments of Labor and Education. With drop out rates of 50% in Philly and unemployment rates in the black community more than double the national rate, we must do more to address poverty in order to have an impact on health disparities, especially with HIV.

Goodbye from Vienna. Will be in touch tomorrow!

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