Category Archives: Commentary

NIH statement for World AIDS Day 2019

From the NIH

Ending the HIV Epidemic: A Plan for America aims to close this implementation gap. NIH-funded advances in effective HIV prevention, diagnosis, treatment and care are the foundation of this effort. In addition, expanded partnerships across HHS agencies, local community organizations, health departments, and other organizations will drive new research to determine optimal implementation of these advances. This type of research is called “implementation science,” and is essential to translate proven tools and techniques into strategies that can be adopted at the community level, particularly for communities most vulnerable to HIV.

Understanding what works to prevent and treat HIV at the community level is critical to the success of the Ending the HIV Epidemic plan. More than 50% of new HIV diagnoses in 2016 and 2017 occurred in just 50 geographic areas: 48 counties; Washington, D.C.; and San Juan, Puerto Rico. Seven states also have a disproportionate occurrence of HIV in rural areas. For its first five years, the new initiative will infuse new resources, expertise, and technology into communities in those key geographic areas.

However, communities are more than just geography. On World AIDS Day, we are reminded that Ending the HIV Epidemic must take place “Community by Community.” The people affected by HIV are a part of unique communities often shaped by differences in race, ethnicity, gender, culture, and socioeconomics. To reach people who have different needs, preferences, and choices, and ensure that HIV treatment and prevention tools can work in their lives, we must go beyond a “one-size-fits-all” approach.

Read the full statement on the NIH Website.

More evidence in support of needle exchange programs

In his State of the Union Address earlier this year, President Trump announced the laudable goal of eliminating HIV transmission by the year 2030. Needle exchange programs (also called Syringe Exchange Programs or SEPs) are a public health approach in use since the 1980s with a proven record of reducing the spread of HIV, hepatitis, and other blood-borne infectious diseases. I have presented much of the data supporting needle exchange programs here and, more recently, here. Now, new research reported in the Journal of Acquired Immune Deficiency Syndrome adds even more strength to the argument in favor of needle exchange programs.

Jeffrey A. Singer is a Senior Fellow at the Cato Institute and works in the the Department of Health Policy Studies

Because most of the averted cases would have received publicly funded health care, the study’s authors then translated averted cases into cost savings for the two cities.Using surveillance data of HIV diagnoses associated with intravenous drug use from Philadelphia and Baltimore, cities where needle exchange programs had been permitted since the early 1990s, their analysis concluded that more than 10,000 cases of HIV were averted in Philadelphia from the years 1993 to 2002, and nearly 1,900 cases were averted in Baltimore from 1995 to 2004.

The forecasts estimated an average of 1,059 HIV diagnoses in Philadelphia and 189 HIV diagnoses in Baltimore averted annually. Multiplying the lifetime costs of HIV treatment per person ($229,800) by the average number of diagnoses averted annually in both cities yields an estimated annual saving of $243.4 million for Philadelphia and $62.4 million for Baltimore. Considering diagnoses averted over the 10-year modeled period, the lifetime cost savings associated with averted HIV diagnoses stemming from policy change to support SEPs may be more than $2.4 billion and $624 million dollars for Philadelphia and Baltimore, respectively. Because SEPs are relatively inexpensive to operate, overall cost savings are substantial even when deducting program operational costs from the total amount.

Needle exchange programs have long been endorsed and encouraged by the Centers for Disease Control and Prevention, the Surgeon General of the United States, the World Health Organization, the American Public Health Association, and the American Medical Association. Nevertheless, needle exchange programs are legally permitted to operate in only 28 states and the District of Columbia. Drug paraphernalia laws make them illegal elsewhere.

Some critics argue that needle exchange programs “enable” or “endorse” intravenous drug use. Such moralizing is not appropriate in this context. Addiction is a behavioral disorder characterized by “compulsive use despite negative consequences.” Preventing organizations from providing an effective means of harm reduction to people with addiction who continue to use drugs is akin to denying insulin to diabetics who continue to make dangerous eating choices.

It is not unrealistic to set a 10-year goal for ending HIV transmission. Needle exchange programs are essential for that to happen.

Conversation about HIV is changing

By John-Manuel Andriote, author of Stonewall Strong

Let’s talk about drugs—specifically, drugs that keep HIV-positive gay men like me “undetectable,” and the drugs used in PrEP (pre-exposure prophylaxis) that, when taken daily, can prevent HIV-negative gay men (and others) from becoming infected.

John-Manuel Andriote

That’s essentially the theme for this year’s Gay Men’s HIV/AIDS Awareness Day—today, September 27—“The Conversation About HIV Is Changing: Talk Undetectable. Talk PrEP.”

But if we only talk about drugs to prevent and treat HIV, and don’t talk about the trauma behind gay men’s high-risk sexual and drug-use choices, we’ll see that same trauma continue to play out in our disproportionately high rates of crystal meth abuse, alcoholism, and other potentially harmful sexually transmitted infections besides HIV.

There is no question that today’s HIV drugs have dramatically changed the conversation about HIV. From the terrible illness and death that almost inevitably followed a positive HIV test 30 years ago, those of us living with the virus today can expect to live a virtually normal lifespan—so long as we adhere to treatment.

Read the full article.

Celebrating those who are aging with HIV

From the LA Blade
by Frank Gulli

I was living in the Castro in San Francisco in 1978 where optimism and liberation were in the air. Harvey Milk was an openly gay City Supervisor, gays and lesbians marched in the street for equal rights, and gay liberation was on display from Folsom Street to Golden Gate Park.

Frank Gulli

There was a real sense of belonging to a community. Our world shook when Harvey Milk and Mayor Moscone were assassinated by former Supervisor Dan White that year. Then it shook again when San Francisco became ground zero of the AIDS epidemic.

By 1985, the city was full of heartbreak and dying. My friends and I lived among it, terrified that we would be next. I was diagnosed with HIV that year, forever making 1985 a pivotal year.

Many of my friends who hadn’t been tested for HIV ended up in the ER at San Francisco General in respiratory failure. I was blindsided as an entire group of my friends and neighbors seemed to disappear overnight. There were no medical treatments, other than some antibiotics that seemed to prolong death for many.

For whatever reason, maybe by the grace of God, or good Italian food, I don’t know, I never got sick from HIV and I held on to hope for a better day. But my life and times would never be the same as it was back in 1978, before the shooting death of Harvey, when we felt liberated, before AIDS wiped out my entire phonebook.

Continue reading.

We won’t end the HIV epidemic until we help the most vulnerable

How do we reduce rates concentrated among black and Latino men who have sex with men? Or meet the needs of HIV-positive patients caught between insurance plans or places to live? To end the epidemic, we must start where we began — by focusing on those most affected, uniting advocacy efforts, pushing for a cross-sector response and focusing on the social determinants of health.

As someone who has spent the better part of my professional career as both an advocate and HIV public health expert, I’ve been reflecting on the decades-long fight for gay rights sparked by people who gathered together at Stonewall in 1969 to demand change for the LGBTQ+ community and put an end to years of discrimination. Not long after, the AIDS epidemic swept across the country, closely intertwining the movement for increased LGBTQ+ rights with the AIDS response. Gay rights groups were relentless in pushing for increased government attention and funding as thousands died from the disease. Activists organized “buyers clubs,” lobbied for faster FDA approval of promising drugs and countered the fear and discrimination people living with AIDS faced.

Read the full article.

Pride month includes HIV Long-Term Survivors Awareness Day

From the Human Rights Campaign

As we celebrate Pride Month, it is also important that we honor those in the LGBTQ community who are long-term survivors living with HIV. June 5 was chosen as HIV Long-Term Survivors Awareness Day to mark when the first case of AIDS was reported in the U.S. in 1981.

Long-time HIV survivor Elder Claude Bowen, M.Div

At the time, a person diagnosed with HIV or AIDS could expect to live only one to two years after that diagnosis. In the four decades since, more than 70 million people have been diagnosed with HIV worldwide and approximately 35 million people have died, according to the World Health Organization. People age 55 and older make up 26% of all Americans living with HIV, according to the Centers for Disease Control and Prevention.

In recent years, the LGBTQ community has benefited from biomedical interventions such as Pre-exposure prophylaxis (PrEP), a medication that prevents HIV when taken as prescribed. Yet, this medication is not always accessible to those most at risk for HIV, including Black and Latinx gay, bisexual and transgender people.

HRC spoke with three long-term survivors living with HIV to learn their stories.

See the interviews on the HRC Website.

HIV isn’t just a gay issue, it’s a ‘social justice issue’

From out.com...

Writer and activist George M. Johnson instructs us, on National Black HIV/AIDS Awareness Day, on the role we all play in the search for a cure.

BY TRE’VELL ANDERSON

George M. Johnson

The late activist and writer Joseph Beam once deemed the act of a Black man loving another Black man a “revolutionary act.” I imagine that doing so, while also living unapologetically with HIV, is doubly insurgent. But that’s perhaps the only way to describe the life and work of George M. Johnson. A writer, activist, and soon-to-be author, he’s committed to the work of toppling the patriarchy, challenging anti-Blackness, and confronting homophobia, transphobia, and HIV stigma wherever he sees it.

With over 40,000 Twitter followers and a much larger community that reads his words at Teen Vogue,Entertainment Tonight, The RootEbony, and countless others, Johnson is outspoken and defiantly visible as a Black gay man living with HIV, with which he was diagnosed at 25. Now, he’s set on being the resource he wishes he had when he was younger for other folks who are or might become HIV positive.

On National Black HIV/AIDS Awareness Day, Out spoke to Johnson about his activism, the state of HIV advocacy, and what those living with the virus and those not can do to combat stigma.

Read the full article/interview here.