International Policy Digest

Photo illustration by John Lyman
Health /18 Feb 2019

Complacency Has No Place in HIV/AIDS Treatment

Contrary to popular belief, the war on AIDS is not over. Considered one of the worst public health crises of the century, it claimed the lives of nearly 41,920 people at its height in 1993. By 1999, nearly 700,000 lives had been claimed by the virus.

With the invention of combination treatment plans and more in-depth scientific research, AIDS is no longer a death sentence. More people are getting tested, so fewer people are progressing to AIDS and dying from it. As a result, people began thinking the disease had completely been eradicated from the United States, but research statistics proved the opposite.

According to a report published in July 2018 by the World Health Organization, there are currently 36 million people living with the disease in the states alone and nearly one million people died from it last year. More importantly, infection rates are back up and are especially high within the African American and Latino LGBTQ community.

Even in today’s world, the disease and the necessary care are both still highly stigmatized. But what people fail to realize is the refusal to touch the disease inherently means a lack of security for those infected and a lack of quality care. Ignoring the problem and refusing to give quality care is what originally caused the epidemic and is what will most likely cause another one. The key to ending AIDS lies with heightened structural interventions, adequate funding of the Ryan White CARE Act and educational efforts to take away the stigma surrounding the disease.

Since the epidemic during the 1980s and 1990s, stigma has served as the primary barrier to universal access to treatment and support. According to Jonathan Mann, former head of the World Health Organization’s (WHO) Global Program on Acquired Immunodeficiency Syndrome, stigma was the “third epidemic.” He saw that “stigma, discrimination, blame, and denial.” were the harder aspects to address, but reducing them was vital in “preventing HIV transmission and mitigating the impacts of the disease on individuals, families, and communities.”

Research has shown that “fear of stigma and discrimination, which can also be linked to fear of violence, discourages people living with HIV from disclosing their status even to family members and sexual partners, and undermines their ability and willingness to access and adhere to treatment.”

In a project done by Horizons and USAID and the International Center for Research on Women, four specific types of stigma were identified:

  1. Inappropriate fear of contagion
  2. Negative judgments about people living with HIV
  3. Enacted stigma or discrimination
  4. Compounded stigma

The most common stigma-reduction interventions focus on changing attitudes, behavior, and knowledge on an individual level.

The second barrier to universal access to treatment and support is an administration unwilling to provide adequate funding for research and treatment. Nearly 20 years after the first epidemic, we are yet again facing an administration and a citizenry that are proving themselves unwilling to accommodate those in need. Because people are no longer dying in large numbers, many believe the war on AIDS is over and that there is no reason to keep funneling in money. This same feeling, along with intense homophobia, has also seeped back into our government.

The Trump administration, in the fiscal year of 2017-2018, proposed cuts in funding for HIV/AIDS research and funding. The administration proposed to cut CDC’s HIV prevention programs by $149 million, CDC’s STD prevention programs by $27 million, and eliminate Ryan White Program AIDS Education and Training Centers (AETC) and the Special Projects of National Significance (SPNS) programs. Trump also proposed to eliminate the Health and Human Services (HHS) Secretary’s Minority AIDS Initiative Fund, reduce funding for the Substance Abuse and Mental Health Services Administration’s (SAMHSA) Minority AIDS Initiative programs, and eliminate the Housing Opportunities for People with AIDS (HOPWA) program at Housing and Urban Development (HUD) by $26 million.

These severe budgets have the potential to cause extreme damage to the overall health of the country. If the overall goal is to reduce the current rising rates of infections and eventually eradicate the virus all together, then funding cannot be cut off. Reduced funding could lead to a severe spike in drug prices. As is, PrEP and PEP are costly for those with and without insurance. But without sufficient funding, the prices will go up more, making it harder for people to access them. Therefore, the best way to provide protection for those with the disease is by protecting the Ryan White CARE Act.

Enacted on Aug. 8th, 1990 by Congress, the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act is the largest federally funded program designed for those living with AIDS. The act was named after Ryan White, a teenager from Kokomo, Indiana, who contracted the virus from a tainted needle during treatment for his hemophilia.

The CARE Act provides those living with the virus with a comprehensive care framework, which includes primary medical care and support services. Most of the funds from the act are directed towards providing primary medical and support services to those who are uninsured and insured. But funds are also directed towards “technical assistance, clinical training, and the development of innovative models of care.”

There will indeed be a day where both viruses are gone and no one dies from them ever again. But the only way to get there is by paying attention to the alarmingly high rates of HIV and AIDs. Complacency has no place in the management of any disease, especially one that took the lives of nearly 700,000 people. Complacency is what caused the first epidemic, and could likely cause the next one. We need to be proactive in dealing with this virus and maintain pressure on the current administration to increase funding into research. Lastly, we need to increase awareness of the disease and launch educational programs to remove the stigma that surrounds it.