World AIDS Day is a time to remember those we’ve lost, celebrate the advancements we’ve made in the fight against HIV/AIDS, and acknowledge and take action to break through the remaining hurdles to end the epidemic once and for all. HIV stigma and discrimination are among the most significant challenges.
This year, World AIDS Day falls amid continued actions by Congress and the Trump administration that, if successful, would undermine America’s access to health care. The recently proposed tax bill will cut taxes for large corporations and the extremely wealthy at the expense of millions of hard-working Americans. The repeal of the individual mandate will lead to sky-high premiums, and the bill threatens safety net programs such as Medicaid. As a result of the ACA and Medicaid expansion, Medicaid coverage for HIV-positive people rose from 36 percent in 2012 to 42 percent in 2014. People with chronic conditions like HIV count on Medicaid for health insurance. It enables them to lead healthier, more productive lives and greatly reduces the chance of transmission, which gets us closer to ending AIDS as an epidemic.
Now more than ever, we must mobilize to preserve and increase health care access, especially for those communities that face the greatest barriers, and we must encourage our leaders to better understand the HIV epidemic and reject HIV/AIDS stigma.
Thanks to decades of advocacy and medical advancements, HIV is a manageable chronic condition. Just last month, the Centers for Disease Control and Prevention (CDC) confirmed that a person living with HIV who has an undetectable viral load cannot transmit the virus to others. We now know that Undetectable equals Untransmittable (U=U). In New York City, the number of new HIV infections has dropped from 5,902 in 2001 to 2,493 in 2015. Despite these achievements, however, stigma and bias around HIV, addiction, and other public health crises persist.
The long history of ignorance and indifference to HIV in U.S. politics began with President Ronald Reagan’s silence and inaction, which contributed to HIV growing into an epidemic that cost millions of dollars and hundreds of thousands of American lives. Mike Huckabee made a comment back in 1992 that people living with HIV should be quarantined. When he was Governor of Indiana, Vice President Mike Pence’s negligence in addressing opioid use contributed to an HIV outbreak in the state. Recently, Georgia state representative and physician Dr. Betty Price suggested a “quarantine” for people living with HIV as a solution to ending the HIV epidemic.
When public figures talk about HIV in ways that are inaccurate and demeaning, they have the power and influence to shape public perception in a misleading and damaging way. Research shows that stigma seriously undermines HIV prevention efforts. It stops people from learning about HIV prevention tools like pre-exposure prophylaxis (PrEP), delays the diagnosis of HIV, and discourages people from seeking treatment. Stigma and discrimination can also cause denial of treatment, even for those who do seek help. One out of every eight people living with HIV is denied health services due to stigma and discrimination, according to data from The People Living with HIV Stigma Index.
A 2015 survey in Georgia, which has the fifth-highest number of HIV diagnoses in the country, found that 30 percent of respondents believe or are not sure whether HIV can be passed by sharing a drinking glass, and more than one in five say toilet seats or swimming pools are a means of transmission. According to the recently updated National HIV/AIDS Strategy for the United States, the percentage of the American public that hold misconceptions about HIV transmission has barely changed since 1987. Among the factors that contribute to this lack of progress are the statements from public figures that use people living with HIV as a scapegoat to distract from the important issues, like access to health care.
Political leaders at all levels of government can and must be proponents of change for people living with HIV. Ending the AIDS epidemic should be a bipartisan cause. Preventing just one new HIV infection can save upwards of half a million dollars in estimated lifetime medical costs, which are typically paid for by taxpayer dollars. At Amida Care, New York’s largest Special Needs Health Plan (SNP) for people with chronic conditions such as HIV, 78 percent of our HIV-positive members have viral loads that are undetectable, meaning that they require significantly less costly care. This saved New York State more than $115 million between 2008 and 2015. An AIDS-free generation is within our reach – but it won’t happen unless we dispel the myths surrounding HIV/AIDS once and for all and promote more widespread advocacy for increased access to testing and treatment.
On World AIDS Day, we celebrate those that have supported the HIV advocacy community since the beginning of the epidemic, while recognizing that our work to end deeply-held stigma is far from over. Instead of shaming and blaming people with chronic conditions, we urge all our political leaders to focus on what really matters – helping every American access quality, competent health care.