A Disease Entrenched in Poverty

It can cost upward of $2000/month to treat HIV/AIDS-infected patients into a reasonable and productive life. For those with access to reasonable medical care, it is an affordable treatment option. For those who cannot afford the treatment and are otherwise not covered by a government healthcare program, the infection can be a death sentence. The federal government recently announced grandiose plans to stop this epidemic, but it often precisely the federal government (with lots of help from conservative states) that insures that such achievable goals will simply not happen. 

Anything that curtails the expansion of Medicaid, makes knowingly having HIV/AIDS and having sex a felony, allows state Affordable Care Act healthcare exchanges to issue “skinny” insurance plans that just do not cover this infection, or impose preconditions/work requirements impacts lower income communities’ access to needed healthcare. Since HIV/AIDS is disproportionately spread within the lowest income sectors, states with the greatest resistance to social programs for impoverished constituents also have disproportionately higher rates of untreated HIV/AIDS victims, particularly red states with significant urban centers. The red-state Southeast has become this nation’s most serious HIV/AIDS problem area. 

The stigma of HIV/AIDS is a challenge to conservative Southern values where even the notion of approving availabilities for clean needles for drug addicts, often HIV/AIDS sufferers, have to be approved by red state legislators. An easy prevention effort. You can guess what those legislators feel about appropriating money for that.

Like so many promises made by the Trump administration, the pledge to eradicate HIV/AID is long on slogans but short of funded solutions. “In his State of the Union address earlier this month, President Trump announced a plan to halt the transmission of HIV in the U.S. by 2030. But clinics face a knot of obstacles to meeting that target. The problems are most severe in the Southeast, currently the epicenter of the nation’s HIV epidemic.

“‘We have the technology, we have the expertise, to prevent HIV and allow those who unfortunately contract it to live healthy and productive lives,’ said Nicole Roebuck, executive director of AID Atlanta, an agency that has provided HIV/AIDS-related services and care since 1982. ‘But the funding is never enough, and the stigma in the South is still a debilitating factor, especially for people of color.’

“The number of new HIV infections across the United States dropped from about 130,000 in 1985 to 50,000 in 2010, and has plateaued at around 40,000 in recent years. Among intravenous drug users, the infection rate has jumped from 6% to 10% since 2015.

“While the nation’s first cases of AIDS were documented in San Francisco, Los Angeles and New York City in the early 1980s, Southern states now make up 52% of new HIV diagnoses — up from 44% in 2014. Miami ranks as the nation’s top metro area for the rate of new HIV diagnoses, followed by Orlando, Fla., Atlanta, New Orleans and Baton Rouge, La.

“Healthcare advocates say the structural and political challenges to combating HIV/AIDS are greater in the rural South, where public transportation systems are lacking and schools are less likely to educate students on prevention options.

“Laws that criminalize HIV exposure in more than 25 states also may make people reluctant to get tested. In Louisiana, for example, a person living with HIV who knows his or her status and intentionally exposes another through sexual contact can face 10 years in prison.

“If the Trump administration is serious about eliminating HIV, many experts say, it must increase federal funding for prevention measures and reverse several key areas of its healthcare policy, such as efforts to gut the federal Affordable Care Act, oppose the expansion of Medicaid and push abstinence-only sex education.

“‘Trump’s war on the Affordable Care Act, his policies that would make it harder for people to get on or to stay on Medicaid, work against the first step in controlling the epidemic,’ said Gregg Gonsalves, assistant professor of epidemiology of microbial diseases at Yale School of Public Health… ‘If you look at the map of HIV rates and pull up another map of Medicaid expansion states, guess what?’ he added. ‘Many of the states that didn’t extend Medicaid or [that] put work requirements into place are the states that are struggling with HIV.’

“Carolyn McAllaster, a law professor at Duke University and director of its Southern HIV/AIDS Strategy Initiative, said she was thrilled to see officials home in on rural pockets of the Deep South, which traditionally have seen little funding… Still, she said, any plan to end HIV has to involve providing comprehensive, equitable healthcare. ‘If we don’t expand Medicaid in our Southern states, it’s going to be very difficult to eradicate HIV,’ she said.

“Stopping the virus’ spread should be achievable, the vast majority of experts agree, because treatment exists: People diagnosed with HIV can undergo antiretroviral therapy that lowers the amount of the virus they carry to almost zero and prevents transmission to partners. People who do not have HIV, but are at substantial risk of contracting it, can prevent infection by taking a daily pill — a practice known as pre-exposure prophylaxis, or PrEP. [see the above map from the Kaiser Family Foundation]

“But only about half of HIV-positive people in the U.S. are receiving antiretroviral treatment. And PrEP is expensive… Many diagnosed with HIV or those considered at risk face barriers — low wages, limited transportation options, unstable housing — that compound the challenges of getting care.

“‘HIV is an epidemic that is entrenched in poverty and inequality,’ said Dr. Melanie Thompson, principal investigator at the AIDS Research Consortium of Atlanta. ‘You cannot separate the inequalities — the racism, the homophobia, the transphobia — from this epidemic. It drives the epidemic.’…

“‘People who inject drugs — that’s where the emerging challenge is,’ [says Dr. Hansel Tookes of the University of Miami’s Miller School of Medicine]. ‘But the South lags behind.’... Ultimately, many care providers say social stigma remains the trickiest hurdle to ending the HIV epidemic… ‘We’re still not talking about sex in Mississippi,’ said Deja Abdul-Haqq, director of organizational development at My Brother’s Keeper in Jackson, which founded the first LGBTQ heath center in the state… ‘We’re not talking about it in the Legislature, we’re not talking about it in the schools, and we’re not talking about it in the church,’ she said. ‘In order to talk about HIV, you have to talk about sex.’” Los Angeles Times, February 17^th.

Increasingly, in a GOP-dominated political scene, money for social programs, expanded medical care and care for the poorest in the land has been cut back, with threats for further cuts to help reduce the deficit created with the 2018 tax cut for the wealthiest Americans and pay for a wall that a minority of right-wing Americans believe is necessary.

              I’m Peter Dekom, and I remember when Americans were once touted as people with the biggest and most generous hearts on earth… but that was a while ago.