BREAKING THE SILO – BENDING THE CURVE.

This is the year to end rationalizations and isolationism and break out of the silo.

  • The number of new HIV infections in Ohio has gone up over the past ten years.
  • The national conversation about HIV and AIDS has become muted.
  • The age group most impacted by new infections is the younger generation.
  • An HIV positive status has been criminalized for almost two decades.
  • HIV positive Ohioans now have full access to Marketplace and Medicaid managed care plans.
  • Community viral suppression will reduce the rate of new infections.

Let’s put those in perspective. HIV has been in a silo since the start of the epidemic in the 1980s. The Ryan White Care Act was enacted by Congress in 1990 to provide a safety net for individuals living with HIV or AIDS primarily because these persons had no other sources of care or support. For as long as the virus has been around, society spoke about HIV/AIDS separately from other diseases in general, as though it was something to keep apart, and keep isolated. Culturally we became so specialized, so focused on the havoc the human immunodeficiency virus can bring, that we missed the bigger picture.

The advent of highly active antiretroviral therapies changed HIV/AIDS from being a fatal disease to being a chronic disease. It also had a different effect of muting the conversation about the seriousness of the HIV and its impact on the lives of those who contract the virus; isolating both the disease and those with it even further.

The result is not surprising. Society maintained the HIV/AIDS silo, and because of that, the national number of new infections annually has stagnated at 50,000 over the past few years. When it comes to new infections, you don’t want to see stability, you want to see a decline. Individuals under the age of twenty didn’t experience the height of the epidemic in the mid-1980s until the mid-1990s and the muted dialog only served to place the younger generations at greater risk. They are now the age group with the highest rate of new HIV infections, accounting for one in four.

2014 was a watershed moment not only for all Ohioans regardless of HIV status. For the first time in history HIV positive Ohioans can now be covered by some form of insurance with Essential Health Benefits (EHB) whether through employer sponsored insurance, Medicare, Medicaid, or the Marketplace. Access to coordinated comprehensive integrated care means greater opportunities to reduce community viral load and reduce new HIV infections.

2015 will be another watershed year—a year of breaking the silo.

  • We will move forward and recognize that HIV is a disease—not a crime.
  • We will work to fully integrate HIV treatment into mainstream health care.
  • We will promote prevention interventions including pre-exposure phrophylaxis (PrEP).
  • We will work to ensure persons with HIV have fully integrated and equal access to housing and employment.
  • We will promote State Health Education Standards.
  • We will reinitiate the dialog about HIV and AIDS with the public at large.

So, here’s the thing, and there’s really no getting around it. If we’re going to really commit to ending the HIV epidemic, we need to break the silo.

On HIV Criminalization

Last week the Director of the Ohio AIDS Coalition launched the first volley in a fight to end an historical anathema to the public health strategy to end the HIV epidemic.  Few people know this, but there are sections of our criminal code that make conduct of HIV positive persons a felony.  Loitering for example is a misdemeanor…  unless a person has tested positive for HIV, then it is a felony subject to imprisonment for years.  The natural reaction to this law is to not get tested, because if you haven’t been tested you can’t be convicted of a felony.  These laws were written in the mid 1990’s, a time of fear and a time when effective treatment for HIV was just becoming available.  Times have changed folks.

So here’s the thing, and there’s no getting around it.  A viral infection that can’t be transmitted by walking around or standing around (aka loitering) isn’t deserving of a two-year prison term.  Further, if someone is on antiretroviral medication, they can get their virus to an undetectable level, and are 96% less likely to be able to infect others.  Laws like these discourage people from getting tested for HIV, they discourage people from getting into treatment to suppress the HIV virus, and only create opportunity for passing HIV to other people.

Legislation from the seat of fear is never a public good.  The time of treating people with HIV as serious criminals, rather than encouraging people to get tested and access treatment and reach viral suppression, needs to end.  The Ohio AIDS Coalition is working to end that.

Read the letter here