Advocates: End Of AIDS In Mass. Within Reach

Frank, a 21-year-old homeless man, takes in Cambridge Commons. (Photo: Martha Bebinger/WBUR)

Frank, a 21-year-old homeless man, on his favorite Cambridge Commons bench. (Martha Bebinger/WBUR)

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.

Source: AIDS Action Coalition

Source: AIDS Action Coalition

 

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  • john labella

    Two aspects of this discussion that I rarely see advertised: 1. you already have to be a member of the gay community to access this information about PEP and PREP. We. need bilboards and advertisements on Main Stream TV and magazines so that people who haven’t yet acknowledged to themselves what they are can also have access to that information. 2. the Department of Public Health has never adequately advertised the existence of prep which means that many people who are exposed are never given the tools to protect themselves.this is been the case since the very beginning, and I wonder if its budgetary. Puritanism, or an attempt to avoid controversy with religious groups. or if it goes to the governor’s office. We also need a president who will go on national TV and say when you’re having sex with another man I want you to always use a condom, in much the same way the president would speak on issues such as toxic shock syndrome or a swine flu scare. and we’d also need that President to go on TV and talk about the very direct connection between HIV infection and the fact that people aren’t allowed to safely form relationships and are certainly not given much support for being in a relationship. True, not everyone needs and wants to be in a marriage but a lot of people do and it would certainly lower infection rates. Finally, the President of the United States needs to go on TV and denounce the black church as a group for its dysfunctional and suicidal response to homo sex.the fact is most people are not capable of living a heroically honest life without social supports.and we need every social support we can think of. well that’s more than two issues, isn’t it? Oops

    • Joe Beckmann

      Blaming blacks ain’t a new tactic. Why not blame the real culprits: AIDS Service Organizations who are so addicted to public funding? This is a lot more immediate – and accountable – than a last-term President! Much like Rebecca Haag’s estimate of twice what she has already mis-spent in prevention this year! Why, once again, do we not track the NEW INFECTIONS, and, rather, subsume them all under “new cases?”

      Or, perhaps, WBUR wants more money to promote AIDS Action in public service promotions!?

  • joe.beckmann@gmail.com

    Rebecca Haag is about ten years too late. In truth, with Pre-Exposure Prophylaxis (PrEP) and Post-Exposure Prophylaxis, we would have reduced the number of “new cases” even more dramatically, and we’ve known about both for a very long time indeed. (Most medical professionals take anti-virals for a week to a month after they’ve been exposed to the virus, and, since the beginning of the epidemic, very, very few ever get sick.)

    Even more than PrEP and PEP, however, we know that treatment IS prevention, as they say in Vancouver, and that continued compliance with treatment, once tested and diagnosed, makes it very difficult (still possible, but more than 90% safer) to transmit the virus. And, because in Massachusetts – unique in the United States until later this year – an insurer can’t drop you if you are HIV+ on a test, we have very high rates of testing.

    Even more than PrEP and PEP and treatment, however, Ms. Haag – and Kevin Cranston – continue to hide the real data on HIV infections: how many of those “new cases” are also “new infections.” Because HIV is often late in symptoms, MOST of those “new cases” were first infected two to five years ago. And all the state would have to do is analyze viral loads to see how rapidly those “new infections” have declined – mostly due to treatment.

    The hideous truth is that the epidemic might have ended years ago if AIDS Action weren’t addicted to funding condoms. Perhaps the worst possible consequence of gay rights is today’s racist, class based infection rate, and the collusion between caregivers and policy makers.

  • Meg

    I couldn’t help but be put off by the angle of this article focusing on gay people with HIV. Considering the hurtful stigmas of the 80′s being that gay men were thought of as disease carriers, the use of language like “gay cancer” in this bit really concerns me…