On June 27 we will mark National HIV Testing Day, a federally designated event that has been observed annually on this date since 1995. It is a meaningful one for those of us who work at Mazzoni Center, since HIV testing, counseling, medical care and supportive services have been a core element of our history and organizational purpose for decades, and continue to be a central focus of our day-to-day work.
There can be no question that tremendous advances have been made in the treatment of HIV/AIDS, and in the projected health outcomes for individuals who test positive for the virus. This can be credited to prevention initiatives, public health and education campaigns, advances in research and treatment, the introduction of retroviral medications and the 2012 FDA approval of the preventive use of Truvada, more commonly known as “PrEP,” which has been found to be up to 99-percent effective in preventing HIV infection when taken as prescribed on a daily basis.
The announcement made earlier this month that the federal government has changed its official website and leading source of information about HIV from “aids.gov” to “hiv.gov” is just one indicator of how much things have changed in recent years.
“Today, lifesaving antiretroviral therapies allow those living with HIV to enjoy longer, healthier lives — an outcome that once seemed unattainable,” said Anthony S. Fauci, M.D., director of the National Institute of Allergy and Infectious Diseases, in a press release noting the change. Fauci added that the website’s name change “appropriately reflects our evolution in transforming the pandemic, even as work remains to bring about an end to HIV.”
It also reflects the fact that Internet users are far more likely to search for information using the term “HIV” these days than the word “AIDS.”
Much progress, but far from equally shared
Jonathan Mermin, M.D., M.P.H., director of Centers for Disease Control’s National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, observed: “The number of annual HIV infections in the U.S. fell 18 percent between 2008-14, but progress has not been the same for all communities.”
This month, I find myself reflecting on two recent articles that underscore how much work remains to be done — and how tenuous these advances may be, if the current administration fails to recognize the urgency and moral imperative of supporting some of the most marginalized populations in the U.S., who are also among those at the highest risk for HIV infection: specifically, young gay and bisexual men of color and transgender women of color.
If you haven’t read “America’s Hidden HIV Epidemic” by Linda Villarosa, which appeared in the New York Times Sunday Magazine June 6, I would urge you to look it up. I found it to be a heartbreaking and well-reported account of the many factors, and failures, that have contributed to alarming rates of HIV/AIDS infection among black men who have sex with men (MSM) in the Southern United States.
Villarosa concluded that “35 years of neglect, compounded by poverty and inadequate local health-care infrastructure, have left too many black gay and bisexual men falling through a series of safety nets.”
The Times piece vividly underscored that there are still significant disparities that exist around HIV/AIDS and race, and they have devastating consequences — not just in the South but around the country.
Also on my mind is a June 16 opinion piece in Newsweek, authored by Scott A. Schoettes, counsel and HIV Project director at Lambda Legal, detailing why Schoettes and five of his colleagues were resigning from the Presidential Advisory Council on HIV/AIDS (PACHA) this month.
“Because we do not believe the Trump administration is listening to — or cares — about the communities we serve as members of PACHA, we have decided it is time to step down,” Schoettes wrote.
Among the reasons Schoettes cited for taking this dramatic step were the removal of the Office of National AIDS Policy website, which happened the day President Trump took office (and has not changed as of this writing). The president’s failure to appoint a leader for the White House Office of National AIDS Policy is an even more critical point, he argued.
It’s not simply that the current administration has failed to prioritize the fight against HIV/AIDS and its causes, but also that they have actively promoted policies that threaten the advances and evidence-based policies that are already in place — and they insist on repealing and replacing the Affordable Care Act, and eliminating funding for programs critical to the health and well-being of low- and middle-income Americans.
The changes to Medicaid outlined in the American Health Care Act — such as defunding Medicaid expansion, imposing limits on benefits an individual could receive and/or funding the program through block grants to states — “would be particularly devastating for people living with HIV,” Schoettes noted, given that more than 40 percent of people with HIV receive care through Medicaid.
It’s clear that, in order to effectively reduce and ultimately eliminate HIV infection in the United States, and specifically to reach the populations that are most heavily impacted, we must be willing to acknowledge and address the multiple factors that contribute to higher risk: including poverty, restricted health-care access, unemployment, lack of education, social stigma and the institutional racism that underlies many of these issues.
We can’t afford to turn back the momentum and the gains that have been made, nor can we ignore the stark disparities that exist around HIV/AIDS in the United States today. And while the issues outlined above may seem overwhelming, there are many ways that each of us can make a difference.
It could mean making your voice heard by contacting an elected official about proposed health-care reform, showing up at a rally for trans women of color, taking a friend to get tested for HIV or spreading the word about PrEP and programs that allow many people to access it free of charge. In honor of National HIV Testing Day, make a pledge to move things forward in your own way.
Mazzoni Center offers an array of HIV care and services, including medical care and supportive services for people regardless of insurance status, free rapid-testing services, as well as navigation services for people interested in learning more about PrEP. On June 27, Mazzoni will offer HIV testing from 9 a.m.-9 p.m. at the Washington West Project, 1201 Locust St.