Where's the Treatment?

Secretary of State Hillary Clinton gave quite a feel-good speech on November 8, complete with the news that Ellen DeGeneres was selected to be the Special Envoy for Global AIDS Awareness. I guess that’s so we can laugh through our tears.

Mrs. Clinton went through the litany of AIDS history, noted the successes of medical science, urged us to work towards the goal of “an AIDS-free generation.” In fact she said, “If we take a comprehensive view of our approach to the pandemic, treatment doesn't take away from prevention. It adds to it," she said. "So let's end the old debate over treatment versus prevention and embrace treatment as prevention."

Only one problem there. As I write this, there are 6,489 people on ADAP waiting lists in 12 states, other states have made their eligibility requirements harder to meet, formularies have been cut down, and despite the fantasy-world attitude of complacency about all the wonders that PPACA is supposed to bring, there are increasing numbers of uninsured and underinsured who can’t afford the co-pays, deductibles or co-insurance necessary to have access to the care and treatment they need, but who make “too much” to qualify for Ryan White or ADAP or Medicaid.

The Secretary of State is concerned with the global pandemic, understandably. And the fact that billions of dollars have been channeled to resource-poor countries via PEPFAR doesn’t quiet criticism of our failure to live up to the promises Bush made when PEPFAR was first instituted and which Obama pledged to extend, nor should it.

Of course, the United States must be a good global neighbor in helping those countries to fight the pandemic. But the fact is that new infection rates among African American MSM in the South are nearing those of sub-Saharan Africa. Is it unreasonable to expect that our leaders would choose to fund the care and treatment of our own people?

The National HIV/AIDS Strategy—the focus of much discussion and hard work in the HIV community—lays out specific goals in terms of testing and identifying those people who are HIV-positive and don’t know it. A boatload of money, time, and effort has gone into devising innovative strategies to reach high-risk populations. The science cannot be denied, as Clinton pointed out. Treatment IS prevention. But the question no one seems to be asking is this: if we can’t even provide medical care and treatment to the people we know are HIV-positive NOW, how the hell are we going to provide it for the tens of thousands we’re supposed to get tested and “linked to care?”

No one is asking, but I’ll tell you—single-payer healthcare. No more ADAP. No more Ryan White core medical care. No more Medicaid. No more disparities between races, socioeconomic levels, geographical regions. No more bankruptcies and suicides due to medical debt. No more T-cell-destroying stress over how to pay the doctor bills.

But just like the “public option” that fell by the wayside during the health care reform “debate,” precious few in the HIV community are standing up and advocating for single-payer, though it is undoubtedly the only way to end the inequity and greed of our current system.

I’m not HIV-positive, but I have my own basket of medical issues, as well as the love I have for my HIV-positive friends, that make this an extremely personal fight for me. So if you come to USCA, you’ll see me wearing my DUH (Demonstration for Universal Healthcare) button; standing in the back of the room with a big yellow sign during sessions relating to health care; passing out my fact sheets in the halls. If you aren’t willing to trust that the Patient Protection & Affordable Care Act actually WILL be enacted by a Congress that wants to destroy it and you’ve been inspired by the hundreds of Occupy protests around the country, come join me. As those early ACT UP guys proved, as the 99% are proving, we can create social change if we stick together.