Could Massachusetts stop — not just reduce but actually stop — the spread of HIV and new cases of AIDS?
Some activists say that with a little more money and a targeted plan, the end of AIDS is within reach here.
“It’s possible for us to end the AIDS epidemic in Massachusetts,” said Rebecca Haag, president and CEO of the AIDS Action Committee of Massachusetts. “This came on our watch and I believe we should put an end to it.”
You may be shaking your head and asking, “Really?”
Well, Haag says, think about this figure: 657. That’s the total number of new HIV cases reported to the state Department of Public Health in 2011. Compare that with the many hundreds of Massachusetts residents who were dying of AIDS every year from the mid-1980s through the mid-1990s.
In 1994, the worst year, 1,156 died. Overall, nearly 13,000 Massachusetts residents died of the disease, and more than 18,000 are now living with it.
But recent years have seen major progress.
“In Massachusetts, we have been successful in dramatically reducing new incidence of HIV infection and are approaching levels that start to look like an unsustainable epidemic, over the long term,” said Kevin Cranston, who directs the Bureau of Infectious Disease at the Department of Public Health.
When might there be so few new cases that HIV dies out? Cranston says it’s hard to predict, in part because Massachusetts is down to the hardest-to-reach cases. Most of them are young gay men in poor city neighborhoods.
Like Frank. When his dad found out he was gay, he was kicked out of the house. Frank, who’s 21, turned to prostitution.
“I would sell myself for food. I would sell myself for a place to sleep. It makes you feel gross,” he said. “That’s why I stopped. It made me feel really gross. I’d have to get drunk in order to have sex. I won’t do it again.”
Frank’s solution, for now, is to stop having sex. His last HIV test was negative and he plans to keep it that way.
Frank had the test at a drop-in program in Cambridge called Youth on Fire. He says the meals, showers and counseling are his backbone, but Frank is still just barely getting by. If Frank had a stable life, with a doctor and health insurance, there’s a pill he could take every day to prevent HIV. But he doesn’t. If Frank got the virus, there’s another daily pill that would virtually ensure he didn’t pass it to someone else. But would he take it?
Prevention and treatment have come a long way, says Kenneth Mayer, Medical Research Director at Fenway Health.
“But each of these approaches does involve resources and does involve the buy-in of individuals,” Mayer said.
Frank would have to be tested regularly, check in at a clinic regularly, and he’d have to be prepared to take a pill every day for the rest of his life, “Because if people take it erratically, one can create resistant virus,” Mayer explained. “Which will make it harder to treat later and we don’t want that to happen.”
Mayer, who treated the first cases of AIDS in Boston in the early 1980s, says Massachusetts will have to put a lot of support for people like Frank in place if it hopes to end the AIDS epidemic.
The Department of Public Health is finalizing a statewide plan. Haag has one of her own.
“First of all, we need to test every sexually active person in Massachusetts,” Haag suggested. “We’re not that far away from oral tests being available in drug stores.”
Haag’s plan also includes making sure everyone at risk can get and afford their medicine, has stable housing, community support and on-going education. The cost? About $150 million a year, Haag estimates — double the $75 million the state currently spends on HIV/AIDS services.
“That investment has significant long-term payoffs in terms of reducing health care costs,” Haag said. “And that’s what everyone is talking about right now. HIV is a place we can demonstrate that works.”
Haag estimates the state has saved $2.4 billion since 2000 by reducing new cases of HIV. (See the chart below.) That may sound high, but the CDC estimates that lifetime medical costs for each case of AIDS are over $379,000.
Activists typically look to the government for extra money. But in Massachusetts, everyone is supposed to be shifting money to prevention, to keep people from getting sick and cut health care spending. So would hospitals, doctors and health insurers join forces to help end HIV and AIDS?
“I think the [health insurance] plans would be very willing to work with those stakeholders if it meant that in the end we were going to eradicate that and save a lot of money in the long run,” said Lora Pellegrini, president of the Massachusetts Association of Health Plans. “But there are huge anti-trust considerations about how we would structure that.”
Massachusetts does not have the lowest rate of new HIV cases in the country – that’s Vermont, with only 9 in 2011.
But its rate is low — compare it to Florida, with 5,124. It may not happen tomorrow, but for Massachusetts residents who recall the epidemic’s terrible, tragic peak, the very fact that advocates and officials can now envision the end of AIDS here is breathtaking.