Column: AIDS – 30 years into a 'treatable disease'

By David Webb – The Rare Reporter Three decades into the HIV/AIDS epidemic the future has never looked as promising for some who are infected with the virus and as bleak for others who will likely find themselves on the more unfortunate side of the spectrum of circumstances in the next decade. For older LGBT people, the threat of contracting a new HIV infection could not be more frightening in terms of the dire consequences related to health and aging and the cost and availability of medical care. Treatments for HIV infections have radically evolved since the early days when the side effects of medications such as AZT prolonged the lives of some HIV-infected individuals but often made them so sick they didn’t really care whether they lived or died. I witnessed several people choosing not to take the medications in earlier years because of how ill the side effects such as nausea and pain made them. Now, HIV-infected people often appear to be living life as fully, if not more fully, than many HIV-negative people, thanks to the development of anti-retroviral drugs in the 1990s. Although their healthy appearances belie the massive, complicated regimens of multiple, often-changing medications to sustain them, there is no doubt HIV-infected people are living longer and feeling better. Ongoing research by scientists around the world gives hope to the possibility there will someday be a vaccine to protect against HIV and possibly even eradicate it after infection. Just recently, it was reported that a man suffering from both leukemia and HIV who received a bone marrow stem cell transplant in Germany in 2007 is now HIV-negative. His bone marrow transplant reportedly came from a donor who was immune to HIV, an immunity that some scientists believe exists in about 1 percent of the Caucasian population. The downside of all this is the enormous cost of HIV treatments when they eventually become available to the public. The bone marrow transplant treatment is incredibly painful, dangerous and expensive so its widespread use is unlikely.

Billions are already being spent on the delivery of anti-HIV drug cocktails, and those costs are expected to spiral in the next decade to astronomical amounts. At the same time, all of the major countries in the world are struggling to remain solvent during the worst financial crisis of more than a half-century. Regardless of what medical treatments become available, the majority of people may not be able to afford them. Millions of people in the U.S. are unemployed and uninsured for health problems they face. The states and the federal government have long provided health care and other resources for HIV/AIDS patients, but crashing budgets are already placing limits on those programs. And it’s only going to get worse as governments struggle to make ends meet. Insurance premiums are rising so quickly in tandem with the rising cost of health care that many companies are struggling to provide benefits for employees. A decade ago, it was common for companies to pay for 100 percent of employees’ health insurance policies, but now it is more common for employers to require 20 percent payments of premiums by employees. In addition to government cuts, the amounts of money HIV service organizations have been able to raise from the charitable public is almost certainly going to decrease as well. People just don’t have as much income to share with less fortunate people. For older Americans looking to retire and anticipating the end of their job-afforded health insurance, the availability of medical care through the federal Medicare program is going to be more problematic, as it will be for younger people contracting new HIV infections. And even if an older American has abundant financial resources to access whatever medical care is available, the truth is that the drug cocktails that have prolonged the lives of younger people just don’t work as well for anyone over 50, according to scientific studies. It’s hard to believe that the 30th anniversary of the HIV epidemic observed this month was accompanied by a United Nations report that 30 million people have died from the disease, and that 7,000 new infections occur globally every day. What’s more, a Centers for Disease Control and Prevention study was released earlier in the month reporting that LGBT students are more likely than heterosexual classmates to engage in risky behavior like alcohol and drug use, which presumably could lead to unprotected sexual activity. In the United States, it is estimated that 40,000 new infections occur every year, many times to people who are unaware they have been infected. So three decades into the HIV epidemic, we find ourselves pretty much where we were in the beginning back in 1981 when we realized it was likely a blood-borne, sexually-transmitted disease in most cases. No matter how rich someone is or how old they are, an HIV infection is unaffordable in every way imaginable. Prevention of an infection is still the best answer for everyone.]]>