Sunday, July 12, 2009

Charles King: Obama No Friend to HIV Community

Housing Works President and CEO Charles King recently was asked to speak at the Philadelphia Prevention and Outreach Summit. He was supposed to speak on homelessness and HIV/AIDS prevention, but instead gave a spirited speech on AIDS Advocacy in the Obama Era. It's a great speech, full of thought provoking ideas, pie-in-the-sky advocacy, and more than a little pointed sarcasm directed at the Obama administration and a seemingly lack of serious commitment to addressing HIV/AIDS treatment and prevention in this country. Reportedly, while reaction to the speech was overwhelmingly positive, he did receive a smattering of hisses and boos, and a handful of people walked out midway through. I've snipped out his discussion of the four point plan issued by the Campaign to End AIDS as well as what he says about HIV/AIDS stigma and its root cause: Homophobia and an asinine refusal to talk as adults about sex.

"So let’s take a look at some of the things we really ought to be doing if we really want to end the AIDS epidemic. Five years ago, the Campaign to End AIDS distilled it down to four simple things:

Provide treatment, services and care, including housing, to every single HIV-positive person who needs it;

Implement prevention strategies that follow science and not ideology;

Ramp up research, not just for a cure or vaccine, but also for innovative prevention strategies such as vaginal and anal microbicides; and

End stigma against people living with AIDS and HIV.

Since C2EA developed this four-point platform, the research has advanced on several fronts. First, there have been a number of important studies released on the impact of early treatment. Two studies, released in the last 60 days, indicate that initiation of ARVs among people infected with HIV before the t-cells decline below 500 copies reduces mortality by more than 90 percent. This begs for a new standard of care that would require providers to offer HIV medications as soon as one is diagnosed. Yet that is not the standard anywhere in the United States or anywhere else in the world, notwithstanding a recommendation to that effect last summer by the US Section of the International AIDS Society. In the long run, implementation of this standard would save billions of dollars in treatment cost by prevention of opportunistic infections, but in the short term, it would make ADAP waiting lists soar. So we have yet to see advocates even begin to call for it.

Besides, without real health care reform, not some tinkering at the edges, we are still left in a situation where some 50 percent of people infected with HIV have no primary care provider…that’s in the United States, still, even after the economic crisis, the richest country in the history of the world.

As for services, they continue to be rationed, not along some rational mechanism, but most irrationally based on formulas that were developed nearly two decades ago. But how many people do we hear calling for rethinking Ryan White, perhaps along the lines of an entitlement such as was recommended by the Academy of Medicine report several years ago? No, all of AIDS Inc. has climbed on the band wagon for at least a three year reauthorization that would keep the same inequitable distribution of resources because we are all afraid of what we might lose if we made the legislation actually work for people living with the virus instead of the grantees and providers of services."

"Want to get more people tested? End stigma. And I am not just talking about stigma about HIV. I am talking about homophobia. I am talking about stigma about drug use. I am talking about our prudishness about SEX! How many women in American go every year faithfully putting their feet in the stirrups for their annual pap smear without ever being told that it’s a test for a sexually transmitted disease, much less being asked by the gynecologist about their sex life or having it suggested that they should have an anal pap smear too, because some 50 percent of American women have had anal sex, and that’s not counting finger play. Hey, guys, I’m not just talking to the gay men now, you ever had anyone stick a finger in your ass? Did anyone ever suggest to you that you might ought to have an anal pap smear for HPV, which just happens to be a precursor to rectal cancer in men and women?

I’ve got no problem with universal HIV testing every year or six months if the insurance companies want to pay for it, but how about if we just trained medical professionals to have honest conversations with their patients about sex and drug use and then offered the test where indicated? We could then use the money we save the insurance companies to make universal offerings of voluntary testing not just in prison, but in pre-arraignment detention centers, in mental health programs, in shelters for homeless people, in low income communities with high addiction rates and to men who are hooking up with other men. You get my drift."

Read the entire speech here.

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