We can legally control HIV through science, health-care access and stigma elimination

We can legally control HIV through science, health-care access and stigma elimination
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With one word recently, Georgia state Rep. Betty Price (R) brought back memories of a desperate time when, in the absence of scientific answers to an emerging HIV pandemic, fear guided policies, fed stigma, hobbled evidence-based responses, and served as a lasting lesson of how not to respond to a public health threat.

“I don’t want to say the ‘quarantine’ word,” Rep. Price said, after asking what could “legally” be done to stop the spread of the virus through her state’s most vulnerable communities, “but I guess I just did.”

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Subsequently, the legislator, who is also a physician, walked back her question, saying her intention was “to light a fire under all of us with responsibility in the public health arena ... to ensure that all our fellow citizens with HIV will receive and adhere to a treatment regimen that will enhance their quality of life and protect the health of the public.”

 

As physicians providing care to patients with HIV in Georgia, and involved in guiding HIV policy and practice locally and nationally, we appreciate her remarks distancing herself from a damaging and ineffective approach to modern disease control. But it is important to note that although we now know how to stop HIV transmission through access to antiretroviral therapy for those with HIV and preventive therapy for those at greatest risk, we are missing many opportunities to do so.

With reliable access to comprehensive medical care and antiretroviral drugs, persons with HIV can stay healthy and keep the virus suppressed, thus allowing them to live a near normal lifespan and eliminating the risk of transmitting HIV to others. This has led some of the poorest countries around the world with some of the highest rates of HIV infection to reverse the trajectories of their epidemics and guided states and local jurisdictions’ strategies to end AIDS, including Fulton County, Ga., where we live and practice medicine.

But nationally, according to the U.S. Centers for Disease Control and Prevention, just 62 percent of people living with HIV in the United States have received any HIV medical care, and only 49 percent are receiving treatment consistently and effectively enough to achieve viral suppression.

The reasons for this are strewn across our health-care landscape. HIV thrives on inequities, and people with limited resources face a maze of structural hurdles to accessing health-care coverage and services, from complex and differing eligibility requirements and recertification processes to a lack of HIV providers, pharmacies and transportation within their communities to inadequate housing and food. But we can do more to level the playing field.

The federally funded Ryan White Program provides support systems and medical care for people living with the virus, and in 2015, 83.4 percent of those receiving care and treatment at clinical sites funded by the Ryan White Program were virally suppressed, a percentage that continues to increase. Expanding the capacity of the Ryan White Program through federal and local dollars is cost-effective.

The Medicaid program opens access to health-care coverage to more than 40 percent of all people living with HIV in care. But 19 states, including Georgia, have not adopted Medicaid expansion, keeping primary preventive care, and essential services out of reach for many Americans living with HIV. Stabilization of the non-group health insurance markets or ACA Marketplaces also will prevent potentially devastating loss of coverage for the tens of thousands of people with HIV who have come to rely on it.

Robust federal funding for the CDC’s HIV, viral hepatitis, STD and TB division can help states and jurisdictions develop targeted local interventions.

Finally, stigma and its associated discriminatory policies and laws create barriers between people and services. Georgia and some 33 other states have HIV-specific felony laws and three additional states have HIV-specific misdemeanor laws, creating a powerful disincentive to learning one’s status and obtaining care while doing nothing to curtail HIV infections. Any discussion of quarantine magnifies stigma, jeopardizing both individual and public health.

Progress toward preventing new HIV infections while enhancing, and extending, the lives of people living with the virus has been dramatic. We need to make more progress. We invite Rep. Price to work with us to turn Georgia, now an epicenter of the epidemic, into a national model for ending the impacts of HIV and the deadly vestiges of stigma.  

Melanie Thompson, MD, is a chair at the HIV Medicine Association (HIVMA) and a principal investigator at the AIDS Research Consortium of Atlanta. Wendy S. Armstrong, MD, is the immediate past chair at HIVMA and professor of medicine at Emory University School of Medicine. Carlos del Rio, MD, is the past chair of the HIVMA and a professor of medicine and global health at Emory University.