OKPOLICY.ORG
Shannon Hall is the Executive Director of Tulsa CARES, a social services agency for people living with HIV/AIDS.
World AIDS Day is December 1st: a day of remembrance for the millions who have lost their lives to the disease, a day to support those who are in its grasp, and a day to commemorate the advances we have made to manage it. Each year brings news of more progress and more hope. And yet, as we wait for medical breakthroughs, we have the power to stop its reach.
Though conditions on the ground are much different in the United States and other developed countries than those in other places like Africa, the methods can work anywhere. Treatment is prevention. This is a mantra to those working in the field of HIV/AIDS prevention, management, and care. It underlies our model of outreach and connection. But what does it mean?
The simplest fact to remember is: when HIV levels drop to “undetectable” amounts, the risk of transmitting the infection is reduced by 96 percent.
HIV levels (referred to as “viral loads”) in people who test positive are considered undetectable if the load drops below 40-75 copies in a blood sample. Viral loads are reduced to those levels by maintaining adherence to drugs designed to control HIV levels, called anti-retroviral treatments. Staying adherent to anti-retroviral treatments can lower the risk of transmitting the disease by 96 percent. (Anti-retroviral treatments should always be coupled with proper condom use.)
In addition, there are newer preemptive treatments for those who are HIV negative, called PrEP or Pre-Exposure Prophylaxis, and PEP, which stands for Post-Exposure Prophylaxis. Though neither is widely used and not 100 percent effective, they show there is continuing progress in the battle against HIV. So prevention sounds easy, doesn’t it? It’s not. But it is possible. Education in schools, in churches, and among families; testing; easily-obtainable anti-retroviral treatments and adherence to them; condom use, PrEP and PEP; and good decision making by all of us can all slow – or even stop – the spread of HIV in Oklahoma.
HIV/AIDS is expensive, not just to individuals and families, but to society: the CDC estimates the lifetime treatment cost at nearly $400,000. Oklahoma diagnosed 437 new cases in 2013. Total cost: $175 million. Oklahoma has over 5,000 persons living with HIV/AIDS. Total cost for the HIV/AIDS population in Oklahoma: $2 billion. Clearly, in addition to the compassion imperative, the economic justification to eradicate the disease is there.
So why don’t we fix it?
One word. Stigma.
Stigma is schools without comprehensive sex education. Stigma is limited access to treatment through health insurance. Stigma is fear of being tested. Stigma is rejection and fear from families and communities. Stigma is a convoluted, complex set of values, borne of ignorance and fear, currently costing Oklahoma over $2 billion. This total increases by a net $80 million per year.
That’s a lot to pay for misguided and uninformed opinions. But by changing our mindset, we can control the problem. By recognizing the realities of the disease in rational terms, we could see that it a treatable, chronic condition like diabetes or high blood pressure – deadly if ignored, manageable if attended to. The possibility of reducing the rates of HIV infection is much more plausible than lowering the occurrences of other chronic illnesses because we can respond case by case, track our results and reach out to at risk populations.
Education is the key to stigma reduction, but that takes dedication and resources – both of which are in short supply.
So, in the meantime, what do we do? We know that those living in poverty may have a 50 percent higher chance of contracting HIV than the general population and that if we want to control infections through treatment we need to orient the bulk of our efforts there.
To that end, we must lower the hurdles to treatment:
- All those who are living with HIV/AIDS, newly diagnosed or not, should be referred to care coordination professionals to help them navigate the health care and social services systems.
- Basic living needs like shelter, nutrition, support and counseling need to be a part of the treatment continuum. Adherence is difficult to maintain if you have issues with shelter, nutrition, isolation and mental health.
- Medical transportation must be easier to access, reliable and safe. Missing appointments with medical providers and service support can have devastating consequences because treatment must be strictly maintained.
But in the long run, the true path to eradication is education. Leaders in schools, communities, churches and social institutions must stop the politically expedient, ignorant and wasteful thought process behind the perpetuation of stigma. Fear and ignorance should not be a substitute for compassion, intelligence and courage.
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