By Hilary Beard
— With politicians, public health experts and epidemiologists announcing that the United States is at the beginning of ending the AIDS epidemic and that we will soon usher in an AIDS-free generation of youths, each World AIDS Day, on Dec. 1, takes on increasingly special significance, especially for African-Americans.
Because the nation's HIV/AIDS epidemic is unfolding disproportionately in black communities, black America has the most to gain by ending it. Getting there requires that more HIV-positive people are diagnosed (currently, almost 20 percent of black people with HIV don't know it) and then linked to care, retained in care and prescribed HIV-fighting medications (called anti-retrovirals). Ultimately, they also must get their virus under control (viral suppression), a sequence called the HIV care continuum, or HIV treatment cascade.
Although African-Americans are more likely to get tested than whites, once they do test positive, many don't get the health care they need. And a mere 21 percent of black people who have been diagnosed with HIV have their virus under control, fewer than whites and Latinos. That is critical, because people whose virus is suppressed both protect their own immune systems and are 96 percent less likely to transmit HIV to others, meaning that treatment is also prevention.
Each step along the HIV care continuum involves going to the doctor. But while black people make up 13 percent of the population, 19 percent of us don't have health insurance, and scores of Americans — of all backgrounds — have health insurance policies that don't offer prescription coverage or aren't worth the paper they're printed on. This remains a serious problem, considering that HIV meds can easily cost upward of $12,000 per year.
The Patient Protection and Affordable Care Act (ACA) addresses many of these problems, bringing us closer to ending America's HIV/AIDS epidemic. Here's how:
1. Requiring that all Americans have health insurance increases the odds that the roughly 240,000 Americans who don't know that they have the virus will get tested for HIV and diagnosed, receive appropriate care and treatment and reach viral suppression.
2. Young adults under age 26 can already be covered on a parent's health insurance policy, including those who have HIV. Black teens and young adults ages 13 to 24 represent 57 percent of new infections in that age demographic.
3. The ACA prohibits health insurance companies from discriminating against people with pre-existing conditions, including HIV/AIDS, and from kicking people off their plans or raising their rates astronomically if they get sick. Such practices had prevented many people with HIV from accessing both the care and prescription medications they need-meds that help reduce the black community's viral load.
4. The ACA requires that all health insurance be of good quality. So from hospitalization to maternity care to mental-health services, the new health-care law establishes a minimum set of 10 essential health benefits that all insurance policies must offer, including prescription benefits that include lifesaving HIV drugs.
5. The ACA eliminates annual and lifetime caps on health insurance coverage, which is particularly important with HIV, which can be tremendously expensive to treat.
6. Expanding Medicaid to cover people often labeled the "working poor" disproportionately benefits African-Americans and other people of color, who are overrepresented among the un- and underinsured, according to a July 2013 Kaiser Family Foundation report. Unfortunately, many governors have refused to expand Medicaid, and nearly 60 percent of uninsured black people with incomes below the new Medicaid-expansion limit live in states not expanding Medicaid at this time. They are disproportionately located in the South, where the HIV epidemic is worst.
To learn more about how health-care reform affects people with HIV, visit Greater Than AIDS' "Obamacare and You" website at http://greaterthan.org.
Hilary Beard is co-author of "Health First! The Black Woman's Wellness Guide" and has led the Black AIDS Institute's volunteer journalists to the International AIDS Conference in Washington and Vienna.