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December 1st, 2009
02:22 PM ET

The worst of the crisis may lie ahead

David Mixner
Author, Political Strategist

As the nation debates reforming our health care system, there is one topic I'm not hearing enough about – how the fight against HIV/AIDS will remain a national priority and how the prevention of such costly diseases such as this will become a foundational element of our health system.

Phenomenal progress has been made against HIV/AIDS since it first appeared in the United States a quarter-century ago. But this very progress has dulled our sense of urgency about preventing the disease and finding a cure. Today is World AIDS Day and we should take a moment to reflect on how we've made progress and why there is a bubbling fear that the worst of the crisis may lie ahead. To finally put a stop to the epidemic, we need to re-energize our commitment and pass smart health care reforms now.

A critical moment in the fight against HIV/AIDS occurred a decade ago, when powerful new protease inhibitor drugs showed remarkable effectiveness in treating the disease and raised hope that the epidemic's end was around the corner. Unfortunately, our progress led to overconfidence in science – a perception that the protease inhibitor regimen guarantees quality of life for people living with HIV/AIDS, and thus that contracting the disease is no longer a big deal.

Patients tell a different story. In this month's New York magazine, author David France reports on the disturbing health complications afflicting people on long-term HIV/AIDS treatment. Men and women in their 40s and 50s are experiencing premature aging, dementia, bone weakness, insulin resistance, and susceptibility to a range of cancers. According to France, in "one large-scale multi-city study, more than half of the HIV-positive population is suffering some form of cognitive impairment." The result is substantial deterioration in quality of life, memory loss and associated difficulty interacting with other people, genuine fear about whether men and women in their working prime can hold onto a job, and potentially shortened lives.

Scientists are trying to understand why people on anti-retroviral drug regimens are experiencing these ailments, but at the very least, it is no longer a foregone conclusion that protease inhibitors are a magic bullet.

But the burgeoning problems are not limited to people on treatments. We may soon learn that HIV infection is once again on a dramatic, even frightening rise. Why would that happen? As sad as it may be, we are seeing more careless behavior despite what is now widely known about how the disease is transmitted. The stigma of HIV/AIDS has subsided because people now can live longer, relatively normal lives with HIV.

Plus, with the progress we've made with retroviral drug regimens, people can once again live in the closet as an HIV-positive person. That means fewer people believe they know someone who is living with HIV, even though they most likely do. The CDC estimates that as many as 21% of the 1.1 million Americans living with HIV don't even know they're HIV-positive. The dynamic means they view the fight against the disease as less of an urgent priority. The disease is spreading at an alarming rate entirely under the radar.

We certainly don't want to re-stigmatize HIV/AIDS, but we do need to stop assuming that HIV/AIDS is just another chronic disease and get serious again about ending it. Affected communities – gay people, African Americans, doctors, drug companies, inner city support networks, faith communities, and others – need to honor the work already done and gear up to confront what may be the biggest challenge yet in this national and global health crisis.

Congress can play a pivotal role by passing health care reform with key provisions, including:

· Increasing the portability of insurance and killing preexisting condition requirements that force HIV-positive individuals to stay with the same insurance provider – and usually the same employer – to pay for expensive treatment regimens;

· Funding smart prevention efforts that will stop what I believe is now a silent but staggering rise in the transmission of the disease;

· Continuing to protect the patents and long-term data exclusivity of medical innovators so they remain incentivized to conduct research into innovative drugs and procedures to combat HIV/AIDS more precisely and with fewer debilitating side effects. That environment is the reason for our progress thus far, and it must be carefully cultivated.

These reforms need to be implemented this year. With more than 50,000 new infections in the United States annually – one every nine and a half minutes – AIDS continues to quietly devastate communities, particularly inner city and minority communities where quality health services are hard to come by. Any delay consigns more people to facing the indignity of this disease with limited resources and few options.

As recent evidence shows, we are nowhere near the end of this fight. AIDS is a nasty and adaptable adversary that preys on our complacency. It's time to reignite our nation's sense of urgency, recognize AIDS as the debilitating health crisis it continues to be, and commit ourselves to finally putting a stop to it.

Editor's Note: David Mixner is an author, political strategist and civil rights activist.

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Program Note: For more ways to make a difference, visit Impact Your World.

soundoff (3 Responses)
  1. Mike in NYC

    The recent decision to lift immigration restrictions on the HIV positive seemed to have been based partly on a CDC report stating that such immigrants, once admitted to the US, would not incur unmanageable health care costs. The medical problems seen among those on anti-retroviral therapy cast doubt on this conclusion.

    It's all about prevention; that is to say, avoidance of behaviors known to dramatically increase risk.

    December 1, 2009 at 3:13 pm |
  2. Joanne P.

    More publicity, such as this factual article is needed to keep the public on the "hot stove."

    December 1, 2009 at 12:29 pm |
  3. Tim Gibson

    The aware and the unaware, in sight and sound so to say. Some of us are aware each day when we look in the mirror, others are not.

    The long time ride on the HIV/AIDS train make for a weary traveler in unexplained ways that are real for those affected. Yet, the beat of the drum has grown faint in becoming, well, used to hearing it.

    December 1, 2009 at 12:09 pm |