Fitzsimon File

Monday marks the 20^th World AIDS Day and much has changed since 1988 in the battle against the disease around the world and in North Carolina.  Until just a few years ago, the state's HIV/AIDS policies were an embarrassment in the medical and public health world.

The state was barely spending anything at all on education and prevention initiatives, while denying lifesaving medication to thousands of poor people living with HIV/AIDS. The state banned participation in the AIDS Drug Assistance Program by anyone who earned more than 125 percent of the federal poverty level—$13,000 a year, roughly what the medication costs.

It was the strictest eligibility limit in the nation. One prominent state lawmakers explained his opposition to changing it by saying that he didn't want to do anything for "those people."  But tireless advocates inside and outside state government never gave up and three years ago convinced lawmakers to raise eligibility limits to 250 of the federal poverty level, providing access to the lifesaving drugs to thousands of people who couldn't afford it.

This past summer the limit was raised again, to 300 percent of the federal poverty standard, which is the national average.

Improvements in funding for education and prevention programs have been less dramatic and despite a successful campaign to encourage people to be tested for HIV, the state's funding of prevention programs is still inadequate.

Just over 1,900 people were infected with HIV in North Carolina last year and 62 percent of them are African-American, almost three times the percentage of African-Americans in the state's general population.  A report last summer from The Black AIDS Institute criticized the federal government for its lack of efforts to fight the disease among African-Americans, pointing out that there are more Black Americans infected with HIV than in many of the countries targeted by the Bush Administration for anti-AIDS programs.  The state has also been reluctant to target the racial disparity in the epidemic.

People still die from AIDS, though thanks to a cocktail of medications, an AIDS diagnosis is no longer a certain death sentence. That presents new challenges for long term care of people infected with HIV and makes prevention efforts more difficult, as some people no longer take the disease as seriously as they should.

The attitudes of some leaders in North Carolina continue to stand in the way of many prevention efforts, most notably a clean needle exchange program for IV drug users. Legislation to allow local need exchange programs fails in every session of the General Assembly, despite evidence that it reduces infections among drug users and their unknowing partners.

The opposition to clean needle programs is both political and philosophical. Religious conservatives object on moral grounds, as if there is no morality in saving lives, and Democratic legislative leaders are afraid of the possible political consequences of appearing to endorse illegal drug use.

A national battle continues in Washington over directing more federal funding AIDS funding to Southern states like North Carolina, where infections rates are higher than in many urban areas in the Northeast, the traditional center of the war on HIV/AIDS.

Ultimately, HIV/AIDS is a heath care issue, just like cancer, heart disease, and diabetes, and demands specific programs to prevent infections and to care for people already infected. The disease has morphed from one that primarily affects gay white males to one that now disproportionately affects the African-American community, which may explain why it has faded from the headlines in recent years.

The stigma about HIV/AIDS also remains alive and well in many circles and now mixes with crass political considerations to prevent the next major steps in battle the epidemic that still devastates lives in North Carolina on the 2008 World AIDS Day.

Let's hope this anniversary prompts state lawmakers and the incoming Perdue Administration to take another look at the state's policies on HIV/AIDS and put politics aside and start thinking more of the people whose lives can be saved.

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This entry was posted on Monday, December 1st, 2008 at 3:52 pm and is filed under Fitzsimon File. You can follow any responses to this entry through the RSS 2.0 feed.