In the 30 years since HIV/AIDS exploded into public consciousness in the 1980s, considerable progress has been made. Rates of infection and death related to HIV/AIDS have declined to well below peak levels—the number of new diagnoses each year are less than half of what they were. However, rates of infection have plateaued rather than continuing to decline, and discrepancies across class and race indicate that much work remains to be done.
HIV, or human immunodeficiency virus, is a virus that causes acquired immunodeficiency syndrome, or AIDS—a progressive failure of the immune system that disables the body’s ability to fight off infection and cancers. HIV can be transmitted via unprotected sexual contact, unsafe injection drug use, contaminated blood transfusion and in utero. According to the Oklahoma State Department of Health (OSDH), at the end of 2012, an estimated 5,127 people in Oklahoma were living with HIV/AIDS in Oklahoma. Of these, 2,654 (51.8 percent) were HIV cases and 2,473 (48.2 percent) were AIDS cases. OSDH notes that, “Over the last five years, there has been an overall upward trend in newly diagnosed HIV/AIDS cases in Oklahoma from 341 HIV/AIDS cases in 2008 to 388 cases in 2012, a 13.8 percent increase.”
Those diagnosed in 2012 were disproportionately likely to be Black and male – despite comprising seven percent of the state’s population, Black Oklahomans constituted one-quarter of newly diagnosed cases (which is to say 99 people). White Oklahomans accounted for 205 cases (52.8 percent). New cases were also typically male (81.7 percent against 18.3 percent). HIV is typically a disease of poverty, tied to food insecurity and substance abuse, and researchers have also linked HIV transmission with populations experiencing high rates of incarceration—which is to say, Black men.
Death rates are similarly racialized. OSDH reports that in 2012, the death rate due to HIV/AIDS and related complications among Black Oklahomans was nearly triple the death rate of white Oklahomans. While medication can suppress progression of the disease into full-blown AIDS, the treatment regimen is both complicated and costly, requiring several doses of several different medications every day. The Kaiser Family Foundation estimates that only one in four of those infected with HIV nationwide are following the treatment regimen closely enough to suppress the virus. Currently about 30 percent of those infected with HIV are uninsured, compared to about 15 percent in the general population – and people of color are far more likely to be uninsured than their white peers.
Nonetheless, with treatment, HIV/AIDS is manageable. More people are living with HIV than ever before, and the Affordable Care Act contains provisions aimed at helping Americans with HIV/AIDS lead healthy, productive lives. The Pew Charitable Trust says that the Affordable Care Act will have “a huge impact” on people with HIV/AIDS, eliminating many barriers that have kept people with HIV/AIDS from accessing care. Pre-reform healthcare in America typically tied insurance to employment, meaning that the unemployed were often left without affordable coverage. Furthermore, exclusions on pre-existing conditions and lifetime or annual coverage caps often still prevented those with HIV/AIDS from insurance coverage. Thus Medicaid expansion is a “top priority” for HIV/AIDS advocates. However, Medicaid expansion is not going forward in Oklahoma, blocking a large number of Oklahomans with HIV/AIDS from affordable, accessible care.
Furthermore, an estimated 18 percent of people nationwide with HIV are unaware that they are infected. More accessible testing and awareness that HIV is a relevant and deadly disease are needed to curb transmission rates. RAIN Oklahoma lists a variety of free and low-cost testing options in Oklahoma, along with a variety of support services, and Greater Than offers information for those with HIV/AIDS signing up for health insurance.
The New York Times recently called HIV a “a disease of the middle-aged,” as a disease that was once considered a swift death sentence has increasingly become a condition one can live with for decades. However, these gains require maintenance going forward. In the short term, Medicaid expansion and greater access to and awareness of testing services would help those who are already infected learn their status and access affordable healthcare quickly. But HIV is a disease whose transmission is compounded by poverty and incarceration, and until that is addressed, HIV will continue to be concentrated within some of our most vulnerable populations.