Commentary Sexual Health

Getting to Zero on HIV and AIDS Means Investing in Supportive Services

Alison Yager

This year, the theme of World AIDS Day is "Getting to Zero: Zero New HIV Infections. Zero Discrimination and Zero AIDS Related Deaths." In order to get to zero, we must be clear that now is not the time to cut back on essential services, even in the face of fiscal austerity.

New York, NY (December 1, 2011) Today is World AIDS Day, a time to recognize those who live with HIV, to honor those who’ve died, and to come together in the fight against HIV/AIDS. This year’s theme is “Getting to Zero: Zero New HIV Infections. Zero Discrimination and Zero AIDS Related Deaths.” In order to get to zero, all of the tools in our prevention and care toolbox must be fully deployed. In the face of fiscal austerity, we must be clear that now is not the time to cut back on essential services.

A major study released this year taught us that early initiation of treatment not only improves health outcomes for individuals living with HIV, but also that it reduces transmission by almost 100 percent. But these outcomes depend on consistent care and treatment. Many barriers make this challenging to achieve, but poverty is elemental in the disruption of care and treatment.

Poverty and its manifestations are essentially destabilizing, with very real consequences for the health of a person living with HIV. Poor people are more likely to experience homelessness and food insecurity. Homeless or marginally housed individuals are more likely to delay treatment, less likely to have regular access to care, less likely to receive optimal drug therapy, and less likely to adhere to their medication than are stably housed individuals—all of which increase the individual’s viral load and decrease health outcomes. According to one study of people living with HIV and AIDS (PLWHA), more than one-third went without care or postponed care due to lack of transportation or another competing need. Further, more than 10 percent of female HIV patients report having foregone care to pay for basic necessities, while 7 percent report having gone without food or other basic necessities in order to pay for the cost of their medical treatment. And poor women face unique challenges. Data analysis from the HIV Cost and Services Utilization Study demonstrate that women are 70 percent more likely than men to delay care because of competing caregiver responsibilities. We cannot afford to ignore these dramatic figures.

If we truly hope to keep people in care, we must ensure that they have the supportive services they need to remain connected to care, and to access care as needed.  Social services, such as case management, supportive housing, and legal services that help people stay housed, access nutritious food, and access quality medical treatment, are critical to connecting people to treatment and care, and supporting the most vulnerable people living with and at risk for HIV/AIDS. And supportive services are known to improve health outcomes.

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Case management, for example, increases the likelihood that recently diagnosed patients will seek medical treatment, and one study found that 78 percent of all PLWHA enrolled in case-management programs were linked to HIV medical care within 6 months of enrollment, representing a 30 percent increase over those without case-management services. A 2004 study reports that women with a history of sexual violence who received social services were 150% more likely to reduce risky sexual behaviors, and were more likely to adhere to their medication than women who did not receive services.

Poor people living with HIV and AIDS are making difficult choices about how to allocate precious, limited resources: time, money, and energy. Supportive services make it possible for many PLWHA to better attend to their own health, and the health of their families, while navigating the rigors of poverty. Cuts to supportive services for PLWHA will be universally devastating, but they will especially hurt women and the children and others for whom they care. It is abundantly clear that supportive services improve health outcomes which in turn saves money now and in the future. Preservation of these services is sound economic policy, and sound health policy– for the health of individuals and families, and the public health.

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