When it comes to HIV, the greatest risk to uninfected American women is their male sexual partners, according to a report released last November by the national Centers for Disease Control (CDC). At-risk men are more likely to be intravenous drug users or men who have sex with men -- activities they often hide from their wives, girlfriends or sex partners.
New Orleans, like other cities, has recently seen an increase in young, gay men who are HIV-positive. Last week, Gambit Weekly interviewed HIV-positive women, whose numbers likewise are growing. Last year, they comprised one-third of the 350 New Orleanians newly diagnosed with HIV. That's a big change from a decade ago, when women typically made up less than 10 percent of new cases.
Thanks to modern prescription drugs, HIV-positive people can lead full lives, working and taking care of their families. But HIV complications take many forms. Last week, proposed budget cuts included Charity Hospital's HIV Out-Patient (HOP) clinic, which currently provides ongoing care to about 3,000 local HIV patients. This is senseless. Without the care provided by HOP, these same patients will become ill and later enter Charity -- through the emergency room.
Early detection and care can't be over-emphasized -- but current Medicaid policies don't reflect this reality. Currently, HIV-positive people can't receive Medicaid coverage until they're officially ruled disabled. In order to be declared disabled, they must have an AIDS diagnosis for two years. The Early Treatment for HIV Act, a federal bill introduced this past session, would make HIV-positive people eligible for Medicaid upon diagnosis. They would thus receive treatment before their health deteriorates to the most costly phase of the illness.
Congress should pass this or similar legislation -- quickly.
Education and prevention are the surest ways to address HIV's growing human and financial costs. On an individual level, this means either condoms or abstinence. Often, especially for married or long-term couples, abstinence is not practical. But, if one partner insists on condom use, the other may question the motive or simply refuse. Prevention experts have learned that teaching "condom negotiation" promotes more consistent condom use. This is a step forward.
On another front, politics stands in the way of progress. Last year, the CDC deleted any mention of condoms on its Web site, and replaced it only after a major controversy ensued. Here in Louisiana, politics also threatens the state's free-condom program. This past legislative session, the program was finally funded after much criticism from opponents who said that condom giveaways encourage sex. But a recent Office of Public Health analysis found that when Louisiana cuts back its no-cost condom distribution, condom use declines and disease rates increase. When the state steps up distribution, condom use increases and disease rates drop. Critics of the program should consider that one averted case of HIV means less human suffering -- and up to $10,000 less in annual medication costs alone.
The nation's loudest voice for prevention is the CDC, which in April announced new guidelines. Anyone entering a doctor's office, the CDC stated, should routinely be tested for HIV, almost like a blood-pressure test. Adequate counseling and services should be in place for infected people. Current prenatal protocols provide a good example of how this can work. A decade ago, an HIV-positive pregnant woman had a one-in-four chance of passing the virus to her baby. HIV tests now are part of routine prenatal care, and women who are HIV-positive take the drug AZT, which has reduced perinatal -- mother to child -- transmission in Louisiana to the current 1-in-20 rate.
But the April guidelines also narrow CDC's focus -- to people already infected. Certainly, reaching HIV-positive people is crucial, but uninfected people should also be targeted. "If you put all the responsibility ... on people who are already infected, you unrealistically create the expectation -- for others -- that you don't have anything to worry about anymore," says Terje Anderson, head of the Washington D.C.-based National Association of People with AIDS.
Everyone shares responsibility for prevention. Likewise, everyone must share responsibility for making America more livable for people with HIV. "One of the things that we still have to account for is the tremendous amount of stigma, of shame, of social isolation that people experience," Anderson says.
Last week, 34-year-old Erica Hutchinson told Gambit Weekly that she can't always be honest about her HIV status. "You can't be open to a lot of people because of their ignorance about the disease," she says. No one should have to hide in his or her own community. Medication and help can come from policymakers, but understanding and compassion can only come from family, friends and neighbors.