HIV Treatment *IS* HIV Prevention

There's an interesting twist to the news that HIV+ people on anti-retroviral medication have surprisingly low chances of passing the virus on to their sexual partners in this weekend's New York Times column by Charles Blow.

Blow makes the point that the AIDS Drug Assistance Program (ADAP) has been a victim of both state and federal budget cutting and points out the long-term fiscal irresponsibility of such actions.

According to data from the ADAP Advocacy Association: as of last week, the number of people on ADAP waiting lists had risen to 7,873; between April 2009 and April 2011, 14 states reduced the number and types of drugs they would pay for. A number of states have stiffened financial eligibility requirements, capped enrollment or removed some people already enrolled. Other states are considering doing so.


This is particularly problematic since the National ADAP Monitoring Project’s annual report, released in March, showed that those most dependent on the program are some of society’s most vulnerable. About a third of all people diagnosed with AIDS are enrolled in ADAPs, three-quarters of them had incomes of less than 200 percent of the national poverty level, 61 percent were uninsured, and 55 percent were black or Hispanic.


But as the recession put more patients in need, federal and state aid didn’t keep track. From 2007 to 2010, the number of people using ADAPs jumped by a third, but federal and state funds specifically appropriated for it grew by just 3 percent and 18 percent, respectively.


Not only is it morally reprehensible to restrict or deny life-saving drugs to those who need them (talk about death panels), it is a colossal miscalculation of public health policy, not to mention fiscally irresponsible.


The new findings should help change a paradigm that’s badly in need of changing. Treatment benefits the healthy as well as the sick. It not only prolongs and improves the lives of those who are H.I.V.-positive, but also is a prophylactic for those who aren’t. Everyone wins.


It’s time to expand ADAPs, not diminish them.

It's just amazing how we spend health care dollars in this country. It simply is not rational to be cutting funds for  prevention of any disease, especially when prevention is always cheaper than treatment. In the case of HIV, treatment can also improve prevention of future infections so it should be a no-brainer to increase, not decrease such expenditures. Unless you live in Mississippi, of course.

46% of Mississippi Republicans Oppose Interracial Marriage

The blogosphere is buzzing with the results of a Public Policy Polling poll of Mississippi Republicans showing that a plurality (46%) think interracial marriage should be illegal while only 40% think it should be legal. For information purposes, all laws banning interracial marriage were struck down by a unanimous Supreme Court in the 1967 landmark case Loving v. Virginia.

The self-evident fact that most Mississippi Republicans are bigits is not surprising, what is really interesting is the analysis of which Presidential candidates the Republicans who think "miscegenation" should be illegal support. 

The American Prospect bog TAPPED has the analysis:

We asked voters on this poll whether they think interracial marriage should be legal or illegal- 46% of Mississippi Republicans said it should be illegal to just 40% who think it should be legal. For the most part there aren't any huge divides in how voters view the candidates or who they support for the nomination based on their attitudes about interracial marriage but there are a few exceptions. 

Palin's net favorability with folks who think interracial marriage should be illegal (+55 at 74/19) is 17 points higher than it is with folks who think interracial marriage should be legal (+38 at 64/26.) Meanwhile Romney's favorability numbers see the opposite trend. He's at +23 (53/30) with voters who think interracial marriage should be legal but 19 points worse at +4 (44/40) with those who think it should be illegal.

It's worth noting those 46 percent of Mississippi Republicans who oppose interracial marriage -- and think it should be illegal -- are in the small minority of whites nationwide who oppose race mixin'. According to a 2007 Gallup poll, 75 percent of whites approve of interracial marriages (or at least, those between blacks and whites). That number jumps up to 85 percent for whites between the ages of 18

I would love to see polling of Republicans nationwide on interracial marriage and whether public accommodations (schools, parks, buses, etc) should be racially segregated. But I bet they wouldn't really tell the pollster what they think.

Human Rights Watch Issues Report On Mississippi(!)

The state of Mississippi has long been an embarrassment to the rest of the country, but now the international non-governmental organization (NGO) Human Rights Watch has made it official by issuing a report detailing and decrying the way the state deals with people who are either LGBT or have HIV or both.

From the Executive Summary of "Rights At Risk":

Throughout Mississippi, people living with HIV, their advocates, health providers and public officials describe an extreme stigma surrounding HIV that is, for many, more frightening than the disease itself. Human Rights Watch found that Mississippi laws and policies promote prejudice and discrimination against those vulnerable, and perceived to be vulnerable, to HIV, thereby contributing to the problem. Numerous legal provisions, including constitutional amendments, discriminate against homosexuals and state sex education laws marginalize lesbian, gay, bisexual, and transgender (LGBT) youth. In Mississippi, the criminal law penalizes those with HIV for failing to disclose their positive status, an approach that public health experts deem likely to undermine, rather than promote, the public health.

Mississippi’s sex education policies also play a harmful role in the state’s HIV epidemic. The state has the highest rates of sexually transmitted disease (STD) and teen pregnancy in the nation and alarming rates of HIV infection among young black men who have sex with men (MSM). Yet Mississippi’s legislature remains stubbornly committed to failed messages of abstinence in sex education, ignoring evidence that such approaches have little effect on reducing HIV or STD transmission. Despite the fact that students in Mississippi are having sex earlier than in any other state, the state suppresses information about condom use and effectiveness in sex education, denying youth access to accurate and relevant health information that can prevent HIV infection.

The sex education curricula in Mississippi also mandates negative messages about “homosexual activities,” creating hostile school environments for LGBT youth and interfering with their right to health. Combined with other state laws that discriminate against homosexuals, Mississippi promotes a culture of homophobia that, according to state public health officials, endangers the health of gay, bisexual, and other men who have sex with men by keeping them away from HIV testing and treatment services.

The HIV/AIDS epidemic in the Southern US has been particularly devastating for minority communities.Nowhere is the dramatic racial impact of the epidemic more apparent than in the state of Mississippi, where African-Americans are only 37.5 percent of the population, but comprise 76 percent of those newly infected with HIV. Mississippi’s failure to embrace evidence-based approaches in the face of increasing health threats to minority populations conflicts with fundamental principles of human rights.

An alarming rise in HIV infection among young black men who have sex with men recently prompted an investigation by federal and state health authorities, who recommended implementation of comprehensive sex education at an early age in order to increase awareness of risk and to promote condom use as a proven method of prevention. These recommendations have been utterly ignored in the public schools despite evidence that once infected these young men are unlikely to access adequate health care. Similarly, though African-American women have the second-highest HIV infection rate in the state, Mississippi’s “Just Wait” abstinence campaign does not provide evidence-based HIV prevention education to this very vulnerable population.

The factors identified in this report are not the only contributors to the HIV epidemic in Mississippi, an impoverished state with poor rates of overall health, education, and development. Stigma and discrimination, fueled by community attitudes, religious beliefs, and other societal forces are also contributing factors. But government action plays a significant role, and the harmful policies highlighted here undermine efforts to combat the HIV/AIDS epidemic and disregard national and international guidelines on best practices for effective management of the disease. These policies combine to create a high-risk environment where it is difficult for many people to avoid HIV infection and to access life-saving treatment and support. If there is to be meaningful progress in access to HIV services, Mississippi’s obligation to protect public health and human rights should be the immediate focus of both federal and state governments.

Hat/tip to Todd Heywood's reporting on this report at the Michigan Messenger.