“HIV has been a blessing in my life.”
Lola was a 48-year-old woman living in Denver when I interviewed her in 2002 about her HIV-positive diagnosis. She said the diagnosis improved her life in important ways; she had received income and housing support, nutritional assistance, health insurance, medication assistance and primary and infectious disease health care based on that diagnosis.
She said her sense of life’s purpose had changed, her basic needs were being met, and she found herself in a community of loving and fierce advocates who never stopped insisting on all the ways her life mattered. It was in this context that Lola regained her health.
Though she has since passed, in my 20 years of social policy research with vulnerable populations, Lola’s attitude still resonates. The seeming impossibility of her words prompt more questions about access to health resources and the successes of comprehensive HIV/AIDS health care.
Compared to the efficacy of vaccines on the global spread and death tolls of COVID-19, recent news of an HIV/AIDS vaccine is a failure, and far off in the future.
In early September, Johnson & Johnson and their partners announced that one of their highly anticipated HIV vaccines was not effective in preventing infection. Although Johnson & Johnson will continue with its Phase 3 study of a different vaccine and Moderna has begun its phase 1 human trials to test a vaccine targeting HIV differently, it will likely be 2024 before results for either are reported.
While a vaccine is still possible, millions of lives at stake may be saved the devastation of an HIV-positive diagnosis.
The recent National Gay Men’s HIV/AIDS Awareness Day points to the ongoing urgency of addressing the effects of a diagnosis. In 2020, there were 37.7 million people living with HIV worldwide. Although great strides in the global provision of antiretroviral therapy via programs such as the U.S. President’s Emergency Plan for AIDS Relief are available, 680,000 people died of HIV-related illnesses in 2020, according to UNAIDS.
In the U.S., the most recently published statistics report 1.2 million people living with HIV, approximately 65 percent of whom received at least some HIV care in 2019. In that same year, 15,815 HIV-positive people in the U.S. died.
Clearly, there is still a great deal of work to be done in adequately providing access to the most marginalized HIV-positive populations.
However, it is crucial to focus on how a comprehensive health programming approach can be improved and used to strengthen strategies to address widening and broader health disparities in the U.S.
The COVID-19 pandemic has brought into focus ways in which social injustice increases risk of ill-health, disease, and death. President Joe Biden’s proposed $3.5 trillion Human Infrastructure Bill would bolster federal initiatives to reduce health disparities, such as the National HIV/AIDS Strategic Plan and Healthy People 2030.
These initiatives expand access to Medicaid, increase home and community-based care spending, improve food systems, urban infrastructure and public housing conditions and create meaningful workforce opportunities targeted to underserved groups.
An HIV-positive diagnosis provides some with their primary — or sole — access to basic health resources. That is indeed a startling and unacceptable paradox.
As the world is necessarily preoccupied with controlling the pandemic that is COVID, it is also urgent for activists, allies, advocates and survivors of HIV/AIDS to push for not just an HIV/AIDS vaccine but for comprehensive health care.
For example, in the U.S., the Ryan White HIV/AIDS Program has addressed systemic barriers to health care faced in common by so many of our country’s poor and marginalized people. The program, now more than 30 years old, is designed to provide comprehensive health care to low-income people living with HIV/AIDS.
It includes programs to meet the needs of vulnerable populations who experience systemic barriers to health care, including racial and ethnic minorities, transgender individuals and people who struggle with addiction. In 2020, Ryan White care programs served more than 500,000 people and was funded at $2.3 billion. In the prior year, 88 percent of program clients were reported as virally suppressed, an essential part of keeping HIV-positive people healthy.
Treating the conditions of poverty and issues of housing, financial and food insecurity, childcare, transportation, addiction, and mental health as priorities of health care delivery comprises a system of HIV/AIDS care that offers proven pathways forward for improving health.
As the world copes with rising outbreaks and attempts to control the COVID-19 pandemic through vaccines and boosters, it is necessary to consider the lessons of the global HIV/AIDS pandemic as important to the nation’s blueprint to “build back better.”
Yes, an HIV/AIDS diagnosis can be a blessing if it leads to improved health outcomes and a call to action on better health access for all.
Alyson O’Daniel is an anthropologist and author of Holding On: African American Women Surviving HIV/AIDS.
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