People are tired of AIDS.
Media coverage of World AIDS Day, which took place Dec. 1, was spotty at best. There are a lot of causes and concerns competing for our attention. But to give up on AIDS now, for whatever reason, would be tragic because after 30 years, we are making great progress.
We still don’t have a cure, but in 2011 life expectancy after a diagnosis of HIV has increased from 10.5 years in 1995 to 22.5 years in 2005. Last year, President Obama released the federal government’s first-ever National HIV/AIDS Strategy, which smartly insists on measurable outcomes in everything from rates of new diagnoses to viral loads of those in care. Here in Massachusetts, new diagnoses of HIV are down dramatically: 59 percent in the last decade, which has spared 4,085 people who otherwise would have become infected with HIV from untold suffering and will result in more than $1.6 billion in health care savings.
Clearly, we are at a tipping point toward success.
At the same time, gay and bisexual men continue to be hardest hit by the epidemic. They make up just two percent of the population, yet account for an astounding 61 percent of all new HIV infections. As a group, they are at least 44 times more likely to become HIV positive than the general population. And young black gay and bisexual men age 13 to 29 make up 27 percent of all new HIV infections and are the only population group whose rate of infection is increasing year over year. Meanwhile, an estimated 28 percent of transgender women are thought to be HIV positive.
Clearly, we still have our work cut out for us. But we’re running out of time.
Over three decades, AIDS service organizations have built a sophisticated model of care for HIV, one of the most complicated -- and expensive -- chronic diseases confronting the health care system today. These social supports, combined with ever-improving drug treatments that target the virus more efficiently and with fewer side effects, ensure better health care outcomes today than we’ve seen at any point during the last 30 years.
Our outreach to gay and bisexual men and transgender women best illustrates this. About one-third of the people we serve are gay, bisexual, or transgender. Not surprisingly, many of them are not comfortable seeking care in clinical settings. They may feel intimidated, they may have been treated insensitively in past visits to doctors’ offices or hospitals, or they may not be signed up for health insurance and don’t understand that they have a right to care.
They also have urgent needs for housing and food. Managing HIV might be third or fourth on their list of immediate priorities. After all, if you don’t have a place to sleep, it can be hard to keep track of your medicine. We help them find housing. We help them get food. We help them find jobs. We help them reduce their use of addictive drugs. We connect them with health care providers. And we track their progress, check in on them, make sure they’re keeping their appointments, and staying as healthy as they can. We keep them out of emergency rooms, and we keep them in care so their disease does not progress.
But funding for the outreach, education, and prevention work that’s been critical to our current success is drying up. In 2000, the state of Massachusetts spent nearly $52 million on HIV/AIDS. In 2012, it will spend $31.1 million. In 1990, Congress passed the Ryan White CARE Act, which has been the third-largest source of funding for AIDS care after Medicaid and Medicare. But with the passage of the Patient Protection and Affordable Care Act -- better known as the national health care reform law -- it’s uncertain whether Congress will reauthorize Ryan White in 2012, when the current Act expires. And the CDC just reduced our state’s HIV prevention budget significantly and put us on notice that the reductions will continue again next year.
But one thing we’ve learned in the last three decades is that spending on social services leads to a healthier community. The improved health care outcomes and reduced infection rates we are now seeing, particularly in Massachusetts, which is leading the nation, are not the outcome of medical care alone. Without critical community-based support services, many of those living with HIV will have to choose between paying their rent and picking up their medications.
Ending AIDS in our country is not just a medical solution -- it requires a community response. And it requires a commitment by our government representatives to see it to the end. Public officials need to take a longer term view and invest in strategies that work.
Our community is depending on it.
Rebecca Haag is the President & CEO of AIDS Action Committee of Massachusetts.