World is Still At Risk of AIDS

By SAM URETSKY

In an editorial published in the New England Journal of Medicine on Dec. 1, World AIDS Day, Dr. Thomas R. Frieden, the director of the Centers for Disease Control and Prevention, and Dr. Jonathan Mermin, the agency’s chief of AIDS prevention warned that the United States, and ultimately the world, is still at risk of losing the war on AIDS. After listing the advances in detection and treatment that have been made over the past decade, they warn, “Despite this progress, most people living with HIV infection in the United States are not receiving antiretroviral treatment (ART); notification of partners of infected people remains the exception rather than the norm; and several high-risk behaviors have become more common.”

In their conclusions they wrote “ Momentum has been generated by the recently updated National HIV/AIDS Strategy, which includes a goal of viral-load suppression in 80% of people with diagnosed infection, an executive order to improve the continuum of care, increased access to health insurance coverage through the Affordable Care Act, and a global focus on detection, treatment, and viral-load suppression.” The challenge is that there is a latency period between infection and what is sometimes referred to as “full blown AIDS” and during this interval the patient is infected and can transmit the infection, but is completely asymptomatic. HIV infection leads to damage to the immune system, but there are no outward indications until the immune system is so compromised so that one or more of 20 opportunistic infections develop. The length of the latent period varies with the strain of virus and extent of viral exposure. During this period, diagnosis of HIV infection depends on laboratory tests. The tests are readily available and the rapid test, commonly used for screening, can provide results in about half an hour. Wider use of these tests could identify more carriers and, through education, reduce the spread of the disease. What’s needed then is universal access to health care.

While the authors of the editorial credit the Affordable Care Act with facilitating detection of HIV infections, they are too politically savvy to mention that many of the uninsured live in states that refused to expand Medicaid under the ACA. According to the Kaiser Family Foundation “Uninsured rates vary by state and by region, with individuals living in the South and West the most likely to be uninsured ... The ten states with the highest uninsured rates in 2014 were all in the South and West. This variation reflects different economic conditions, state expansion status, availability of employer-based coverage, and demographics.” This again is a polite reference to the fact that red states refused to expand Medicaid, even with the Federal government paying at first all and then most of the costs.

Beyond that, a study in the Russell Sage Foundation Journal of the Social Sciences v1 #1, 11.15) reported that roughly 5% of the United States population is living in deep poverty, with incomes below 50% of the poverty level. While the authors provide additional estimates based on the availability of safety net services there are, by definition, no statistics on the number of people who are not being counted.

Similarly. 17 states do not have needle exchange programs which reduce the spread of HIV among intravenous drug abusers. According to the Centers for Disease Control and Prevention (CDC) at the end of 2010, the South accounted for 45% of the estimated 33,015 new AIDS diagnoses in the 50 states and the District of Columbia, followed by the Northeast (24%), the West (19%), and the Midwest (13%). The list of states without needle exchange programs includes Alabama, Kentucky, Mississippi, South Carolina, Texas and the Virginias.

Right now HIV infections can largely be controlled with multi-drug combinations, and in 2012 the FDA approved Truvada® (tenofovir/emtricitabine) for pre-exposure prophylaxis for HIV-infected people who engage in high risk behaviors. There is still no vaccine, and no cure. There is still a great need for education and early detection.

Mary Fisher, speaking at the 1992 Republican National convention, said it best: “AIDS virus is not a political creature. It does not care whether you are Democrat or Republican; it does not ask whether you are black or white, male or female, gay or straight, young or old. H.I.V. asks only one thing of those it attacks: Are you human? ... Because people with H.I.V. have not entered some alien state of being. They are human. They have not earned cruelty, and they do not deserve meanness.”

There are things we could do, that would benefit us all. And we should. All of us should.

Sam Uretsky is a writer and pharmacist living on Long Island, N.Y. Email sdu01@outlook.com.

From The Progressive Populist, January 1-15, 2016

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