This week, thousands of HIV service providers, policymakers, advocates, and people with HIV will arrive in Las Vegas for the U.S. Conference on AIDS. As we enter the fourth decade of this disease in America, there are many reasons for us to be hopeful. Expanding HIV testing, ensuring early, consistent access to treatment, and establishing new efforts to prevent the spread of HIV, including pre-exposure prophylaxis (PrEP), have the potential to not only reduce HIV transmission, but could bring us closer to ending the epidemic.
Moreover, the Obama Administration has demonstrated an admirable commitment to effectively addressing the epidemic in the U.S. and beyond. Among the most crucial of those accomplishments was the passage of the Affordable Care Act (ACA), which has the potential to transform access to health and services for those at risk for HIV in the U.S.
There are distinct policy differences between Democrats and Republicans, including each party’s presidential candidate. The results of the November elections, not only for President but also for Congress, will have a profound impact on care and services for persons with and at risk for HIV. Indeed, with the ACA’s very existence, and funding for a host of domestic HIV programs hanging in the balance, people with HIV, and those who care about HIV prevention and care, cannot afford to sit out this election.
To explain how the ACA offers so many benefits for Americans with HIV, several misconceptions about HIV and AIDS first need to be addressed. First, HIV is not just a young person’s disease. As a campaign created by my organization, the AIDS Community Research Initiative of America (ACRIA), advises: “Age is Not a Condom.” Older people have sex and, just like others, are at risk for HIV unless they protect themselves. One in every six new HIV diagnoses is of an adult age 50 or older. And thanks to the antiretroviral drugs that have made HIV a manageable condition for many, those with HIV are living longer lives; indeed, many are likely to see old age. As a result, however, HIV is rarely the sole health condition that these men and women experience. In a study conducted by ACRIA, we found that these older adults, on average, manage three other illnesses in addition to HIV, which often includes bearing the accompanying medical costs.
Nor is HIV a disease largely confined to white gay men who can afford the medications they need. That's a stereotype that has eroded over the years, but remains too pervasive. When one looks at all ages and demographics, our current approach to delivering health care and services is not working for far too many people with HIV in this country. Americans with HIV are disproportionately likely to be unemployed or working in low-wage jobs—and in an employment-based insurance system, that means they are uninsured.