Eliminating these counseling and treatment programs seems like a nonsensical strategy, given the large (and frighteningly increasing) number of people affected by HIV in the minority community and the low number of those people now represented in the health care system--not to mention the time pressures under which doctors and nurses must already work. When was the last time your primary care doctor had time to discuss your sexual behavior? Or even asked you about it?
The CDC claims that given its limited resources, it must redirect funds to states with the highest concentration of HIV infections. But if the goal is to save billions of dollars in health care expenditures, then we should be investing in programs that keep people healthy. In Massachusetts, the state's long-term investment in finding ways to reduce the transmission of HIV resulted in a 60 percent drop in new diagnoses from 1998 to 2008. All of which will save the state more than $1.6 billion in health care costs.
In 2008 and 2009, I worked closely with a coalition of AIDS service organizations to help the Obama administration develop its National HIV/AIDS Strategy. That strategy, which marked the first time that any presidential administration had created a national plan to end the domestic AIDS epidemic, called for accountability and measurable outcomes. That's exactly what Massachusetts has been delivering. Our funding strategies demand results: a reduction in new infections, which saves health care costs and lets us direct scarce dollars to care for those who are already HIV-positive.
The Atlanta-based policy advisors for the CDC should spend some time in Massachusetts learning from our success, so they can replicate it in states where the transmission of HIV has stubbornly risen year after year, and where health outcomes for those with HIV/AIDS is poor. They would find that we do three things extremely well:
• Provide early access to health care. Fifteen years ago, Massachusetts provided health-care eligibility to low-income people living with HIV, which meant they had access to the care and treatment needed to manage their disease and reduce the long-term effects of the infection. Most states still provide access to care and treatment under their Medicaid plans only to those with full-blown AIDS. So even if the states test people at risk, they can't treat them until they become very sick--which costs taxpayers millions of dollars in unnecessary health care costs. Six years ago, Massachusetts adopted health care reform and covered lower-income citizens through MassHealth. Others are covered under private insurance plans. Being in treatment and taking medications ensures low viral loads and significantly reduces the chances of passing on the infection to sexual partners.
• Create community-based social support networks. In Massachusetts, health care for HIV and AIDS has been tightly integrated into the state's network of community-based social service providers, who provide housing assistance, mental health counseling, nutritional support, substance abuse counseling, and peer support programs to those at risk for or infected with HIV--all of which help keep people on their medication regime and in control of their chronic disease.