Fight Against HIV/AIDS Faces Setback Due to Global Recession
What do you call a crisis that has been going on for over two decades, has cost millions of people their lives, and yet manages to wax and wane in the press and always has budgetary problems? For the millions of people who are HIV positive the answer is the disease which may take their lives if they are unable to obtain antiretroviral medications.
While shortages of life saving antiretroviral medications may mean that millions in the developing world will lose their lives in the coming decade, many Americans believe that due to the Ryan White Act, such a disaster would not befall any American who is HIV positive.
This has been more or less true. When I was a medical student it was an often repeated mantra that HIV positive patients in the United States got the best medical care possible, or at least as good medical as some fancy health care plans. This is because a person who is HIV positive gets pretty much their entire medical care paid for by the government.
You shouldn’t be, many HIV patients don’t take their medication, or can’t stand the adverse effects and die of AIDS. And if that wasn’t enough of a problem, patients who are living longer with HIV are experiencing something similar to rapid aging. While many have described HIV as a treatable chronic disease, the reality is that even with treatment many patients develop HIV resistant strains and die of AIDS anyway.
However, as the Great Recession has affected governmental budgets and increased pushes for austerity measures, so to has health care budgets for HIV/AIDS patients been frozen. This is a problem because as HIV/AIDS patients live longer, the budgets for their care must expand to enroll a larger number of patients. However, some legislators want to remove money for the medical care of HIV/AIDS patients for diseases, such as diabetes, which are not strictly due to their HIV positive status. However, virtually every medical condition an HIV/AIDS patient has is affected by the HIV virus in one way or another. It sounds cruel to offer subsidized antiretroviral therapy and then not pay to go the extra yard to the touchdown by not paying for diabetes treatment.
Why Do HIV/AIDS Patients Get “Special Treatment”?
This may be a fair question to ask, and many are asking it with regards to funding for global health initiatives. However, a recent development in the study of patients on antiretroviral medications makes the care of the HIV positive patients important to society as a whole: HIV positive patients who are on retroviral therapy are much less likely to spread the virus to others due to suppression of viral levels in the blood. Is this a cure? No, but some experts believe that if everybody who was HIV positive was on antiretroviral medications then the HIV virus would be wiped out in less than a century.
This is why it make sense to treat all of the medical conditions that an HIV positive patient has. If an HIV positive patient with diabetes can’t get care for this condition, then this will likely affect their ability and desire to care for the HIV infection. This could lead to an increase in HIV strains resistant to medications, or a failure to comply with their therapy.
What is the Obama Administration doing?
Recently the AIDS Health Care Foundation, on July 8th 2010, released a statement which denounces the Obama administration’s modest increase in HIV/AIDS funding, only $25 million, as not being enough to treat all the HIV/AIDS patients in the United States. Already, there are HIV positive patients on waiting lists, and the longer they wait to get antiretroviral medications, the longer HIV will damage their bodies unchecked. New research and expert opinion is pushing infectious disease experts to begin antiretroviral therapy for HIV positive patients immediately when they first test positive. If anything, the treatment of HIV positive patients is likely to be ramped up significantly over the next decade due to this emerging consensus.
Why Hasn’t President Obama’s Health and Human Services Secretary increased funding for HIV/AIDS patients?
It seems that the approach that the White House is taking with regards to HIV/AIDS funding is that measures which are apparently more cost effective, such as preventing malaria and childhood diarrhea, in the developing world is more bang for the buck than increasing funding for HIV/AIDS patients. In the United States, care for an HIV/AIDS patient is approximately $10,000 per year.
In addition, politicians see funding for HIV/AIDS as increasingly taking up a larger percentage of the health care budget in the United States, and other countries, over the coming decades. A misguided approach would be to keep funding levels where they are or only increasing them slightly. In reality, increased funding of “test and treat” programs may prevent millions of HIV infections, thus it is both a life saving measure for the patient, and a public health measure which will benefit everyone.
However, because the science behind this new “test and treat” paradigm for HIV treatment is new, it is likely that the White House has not figured this into their budget calculations when deciding where to spend shrinking government resources. Is the Obama administration behind the times? I would say yes, at least in regards to funding for HIV/AIDS initiatives.