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We will need proven policies, new resolve, and equity to make AIDS history

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Today we commemorate World AIDS Day in the aftermath of a presidential election that for many of us has raised more questions than answers about the future of equitable access to health care in this country. In a country that is both a leader in global HIV responses and home to more people living with HIV than any other industrialized country on earth, an assessment of where we stand will not only keep us from losing ground, but also give us common ground.

We see much to inspire and inform the work that lies ahead.  In San Francisco, where about 8,000 new HIV infections* were reported in 1982, only 302 persons were diagnosed with the virus in 2014. In contrast, the epidemic remains entrenched in the Southeastern United States where 52 percent of new HIV infections now occur. In Fulton County, Ga., where I care for patients with HIV, about 600 people become infected with the virus each year, and 200 HIV-infected patients died in 2014, many with AIDS-associated opportunistic infections invoking images of the 1980s. Sections of the AIDS quilt hang in our medical school lobby, not as a reminder of a bygone era, but as a testament to those whose lives are still slipping away because of barriers to basic health services that are yet to be overcome.

{mosads}We need to confront these disparities because HIV is a virus that thrives on disparities, whether defined by race, ethnicity, sexual orientation, or gender identity, our more heavily impacted populations are our minority populations. New infections are greatest where people are vulnerable – in poverty, with unstable housing, unemployment, and social marginalization, and independently and because of these factors, a lack of access to health care. Recognizing and responding to these realities have helped communities and countries make progress against their epidemics.

We know that opportunities and protections provided by the Affordable Care Act have offered 20 million Americans health insurance — millions for the first time —  and has played a central role in making preventive and primary care accessible to people who didn’t have it, including for HIV testing, treatment and care, and prevention services. When HIV-infected patients receive effective therapy, the risk of transmission falls nearly to zero, breaking the cycle of infection. 

We know that access to family planning and reproductive health services is integral to ending mother to child transmission of HIV.

We know that stigma, discrimination, and laws that punish and marginalize sexual minorities and people who inject drugs have fueled the epidemic. Embracing diversity is critical to fighting our American epidemic.  We must remain mindful of this, in light of the divisive and dismissive rhetoric that characterized the recent campaign. Addiction must be recognized as a disease. Expanding access to addiction treatment programs and to sterile syringes is essential to preventing HIV and hepatitis C transmissions among people who inject drugs. The vice president-elect saw this in Indiana when his authorization of syringe services brought a growing HIV epidemic under control.

We have made remarkable progress in the global HIV epidemic thanks to bipartisan support for the President’s Emergency Plan for AIDS Relief and the Global Fund leading to 18 million people on treatment, infections dropping by 35 percent, and deaths from HIV declining by 45 percent. This work is also far from done.

We must work together and across the political spectrum for solutions. Congress and the next Administration must avoid harmful disruptions in health coverage and lifesaving care. They must maintain strong federal support for the Medicaid program and for expansion, insurance premium as well as cost sharing assistance and minimum coverage standards that help support affordable access to prescription drugs, substance use and mental health services that have widened the landscape of care for people living with HIV. They must continue to provide leadership for global efforts to end the epidemic. And they need to do so in a legal, policy and political environment that respects the rights and dignity of all people.

They need to make optimal use of the resources we have, apply the lessons we have learned, and show humanity and vision for the way forward. 

Wendy Armstrong is chair of HIVMA, former co-Chair of the Fulton County Task Force On HIV/AIDS, and Professor of Medicine and Vice Chair of Education and Integration in the Department of Medicine at Emory University School of Medicine.

The views expressed by authors are their own and not the views of The Hill.


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