The situation in Mississippi sounds remarkably like the conditions in west Africa treating Ebola. Except the public health response is more vigorous and there are as yet no armed assaults on caregivers or their clinics. The cultural barriers in Mississippi are multiple and varied, depending on race, and with ignorance defended and promoted more vigorously. I would be most interested in seeing where the epidemic is most quickly brought under control. I'm betting on Africa.
2
I live in San Francisco. Yes, we voted to have the big businesses contribute to helping out with our homeless people situation. And you know what? The big businesses lawyerd up and are fighting tooth and nail not to do it. So don't hold us up as a shining example of what to do about HIV in the hard to reach community. We are failing at that as much as anywhere else.
4
@Nadia I think that you're being unfairly harsh in your assessment. Just because big businesses are fighting efforts to make them contribute their fair share of money doesn't mean that the outreach strategy is faulty.
1
The lingering effects of the Tuskeegee Experiment.
Abstinence-based sex education.
The down-low.
Religion.
Poverty.
Politics.
Fear.
What a Perfect Storm!
Here in Alabama people used to pride themselves that on national rankings Mississippi tended to be at the very bottom with Alabama just above. Looks like in at least one area the state outdoes us, and most other states for that matter.
Having dealt with this syndrome my whole life.
This would’ve been like when Dad promised my aunt to pay for the funeral of her husband in front of everybody.
Everyone said what a great guy he was. He stiffed them just like he always.
He got what he wanted. Nobody else did.
2
First off, I'm all for a cure for AIDS but this article was about Trump as well.
When I see a headline like this article this is what I think of....
Trump needs to be removed from office for crimes immediately. The criminal operations the Trump family have engaged in for decades was no secret.
This criminal as POTUS is unacceptable.
The whole investigation is going way to slow for me.
3
Even a broken clock is right twice a day, and if experts think Mr. Trump’s plan is sound then I’m all for it. Don’t let your (understandable) hatred of Mr. Trump keep you from supporting a workable solution to the problem.
5
There is no adult nowadays in the West who's having sex but hasn't heard of HIV and preventative measures. How many more limited resources must by wasted on people who are too reckless to protect themselves?
5
Apparently you didn’t read the article. Sex education is no longer taught in schools. In impoverished communities and communities where there are huge stigmas against same-sex sex, the educational approach has to be different. Very similar challenge SF discovered with lots of Hispanic men who came up from Mexico to work. They considered themselves straight but had sex on the sly with men. The messages about HIV and gay men didn’t reach them. It’s far more complex.
7
“H.I.V. is now a disease of poverty, and you can’t separate it from people’s other issues,” Mr. Sheehy said. “When you have schizophrenia and are homeless and use heroin to get to sleep and speed to wake up, H.I.V. is just one of your problems.”
If that was me I would only hope I’d want to die, please don’t prolong my suffering with a drug that will keep me alive a little longer to only to have to keep enduring more of the same.
1
The CDC has known about these regional pockets of HIV/AIDS for almost 20 years and they did not seek the funding to create programs on the scale that was needed.
I'm surprised the article doesn't mention heterosexual African American women in the Deep South. They also have extraordinarily high HIV rates, another group the CDC is aware of.
Our public health system should have started focusing on these populations 15 or 20 years ago. It's a national shame that the CDC knew these populations were suffering and didn't ask Congress for the funding it really needed to save people's lives. I focused on this issue in one of my grad school papers. I was astonished at the lack of action from our government.
Some of these regional HIV/AIDS hotspots have incidence rates similar to rates in some regions of the African continent. That's how neglected this health issue is in the U.S. It's that severe.
3
@Leah You make some good points. But, how do you know that the CDC didn't request funds? Just because it requests funds for a specific purposes doesn't mean that Congress went along.
But, we've also got to keep in mind the very decentralized nature of our public health system. The CDC is not in the business of providing long-term healthcare for chronic illnesses. That's where the states come in.
1
NEJM, the premier medical journal published the earliest studies on PrEP. PrEP's efficacy was impressive, the journal placarded the data, surely this is the 'brave new world. But PrEP is different than HIV treatment. PrEP is prevention, most of health care is to retain and treat people who have already been diagnosed. Fidelity of PrEP however, requires public health. Not surprisingly, NEJM did not envision, develop, nor imagine the implementation strategy for PrEP.
In the US, public health operates a scant 3% the budget of clinical medicine. We build high-tech hospitals and medical offices, but prevention is about something prosaic - outreach.
As the article describes, the people who need PrEP the most are mired in poverty, racism, bias, homelessness, and hopelessness - barriers of social determinants of health (SDH) for accessing and staying on PrEP. Instead of paying attention to barriers posed by SDH, the medical community often pejoratively stigmatize people who do not stay on regimen as 'non-compliant' - a code word for someone who does not 'really want to belong to our system, a system failure'. With that attitude, why would anyone want to pay us a visit?
Paul Farmer of Partners In Health has shown us that the best way to ensure community HIV treatment and prevention is, well, community engagement. Instead of building more hospitals, let us strengthen community health centres, outreach teams, and goto where people are living, to care and to love.
4
It is always good to hear of those people living in the south or midwest who struggle against odds to educate and benefit the people who live there. The blocks to health seem to be two: in the South, Christian hegemony over politics and education; in San Francisco and other urban areas, poverty and drug use.
In both areas, the meeting-point between government and the poor, the undocumented, and the drug users is the penal system. Legalizing and treating drug use and making it legal to be a person in the US would do a great deal towards helping eliminate this problem.
1
You can’t solve the problem until it is fully identified. This is a massive effort and let’s see if the government can work smarter and more effectively than prior administrations to stop more human suffering.
1
I hope they make progress trying to stop HIV. Unfortunately, Slashing funding to medicaid, medicare and the Ryan White program will make achieving that much more difficult. The Trump administration's proposed budget calls for huge cuts to those programs. If you really want to stop HIV, you have to strengthen public healthcare programs. The US pays some of the highest prices for HIV drugs in the world. It is also very unlikely this administration will address that.
25
The last line captures the singular reason the HIV epidemic has continued to run rampant among gay and bisexual men since it was first reported in 1981. That reason is the lack of political will—combined with the fact that the gay/bi men most affected have been treated as dispensable.
Add “poor” and “black” and multiply the sense that these American citizens somehow are not worthy of their country’s concern. Mississippi’s obvious negligence toward all its poorest, most vulnerable residents—amply evidenced in its willful resistance to expanding Medicaid in particular—demonstrates that the state’s political will is focused on keeping the state’s poor “in their place.”
If the state’s politics reflects its values, it’s obvious that racism and homophobia are alive and well—and will continue to keep Mississippi in poverty and its HIV epidemic festering.
6
@John-Manuel Andriote
Can we call something an epidemic when people willingly infect themselves? Everyone knows about condoms, and they're freely available. Just protect yourself.
3
The HIV epidemic has continued to run rampant because of irresponsible behavior by most of those infected, not by the lack of political will. It is difficult to feel sorry for them.
1
@John-Manuel Andriote
The real reason that HIV and other STDs run rampant is because men who have sex with men continue to engage in indiscriminate, unsafe sex. By all means, let’s get people tested and treated, but let’s not pretend that these men are passive, helpless victims.
2
This story was so interesting & very well-done. I hesitated to read it — but you digital folks kept online & Im glad to say I finally havein and read it.
So... What does this have to do with Trump? I'm quite unclear what makes this his initiative, as opposed to, I don't know, the health professionals who actually put this all together, who have been and will be doing all the work?
Funding? Trump gets credit for allocating funding? Surely, no other administration could hope for such an accomplishment as to pass a budget...
2
This is so partial. If Obama focused on curing AIDS, everyone would applaud.
9
He did....and you didn't applaud
18
@biglefty
PEPFAR was created by George Bush, even if Obama took a lot of credit for it. Bill Gates is also making a difference. Remind us of what specifically Obama did to curb the HIV epidemic.
1
@CP
Obama did. He also tried to support same sex marriage; he knew same sex couples. He was a constitutional scholar, and he didn't have a problem with granting legal rights to same sex married couples. Those rights are very important if one partner in a same sex marriage is hospitalized; or if a Will is in dispute. We need to stop forcing old norms on a new age. I can think of better things to worry about; for example, an incompetent President who appears to be nearly senile. Add McConnell who denied a sitting President the traditional right to appoint a respected moderate Superior Court Judge to the SC: Merrick Garland. Now we have four corporate shills on the Court: Alito, Thomas, Kavanaugh (who lied about his past history with Ken Starr, and denied a witnessed rape attempt on a young girl when he was in college); the witness is in RI and refuses to be deposed. Then we have Gorsuch who wrote an anti-employee Decision in the case of a truck driver caught in an ice storm. A right wing SC for decades unless Gorsuch can be challenged due to McConnell's suspect one-year hold on Obama's appointment of Merrick Garland.
1
I admire and applaud the work Open Arms is doing. But you wonder why Mississippi has to make everything so much harder for its citizens, gay and straight. The poorest state in the Union rejected Medicaid expansion? What ignoramus of a governor would want such a result when the people of his state need so much help? What exactly is he trying to prove? Governor Bryant should be ashamed of himself.
110
@Bob G.
Why does the poorest state in the Union reject Medicaid expansion? The short answer is institutional oppression. We're not the only state that upholds it, but as one of the poorest states in the country, its effects are widespread.
I'm a born and bred Mississippian. After thirty years out of the state I've recently returned to find that very little has changed where it needs to change most. The contrived neighborhood of "The District," the repaved streets on North State Street and new sidewalks in the Fondren neighborhood nudge the city into the twenty-first century, but they do nothing to change the institutional oppression so deeply rooted here.
Not all Mississippians are so unenlightened as our good ole boy governor, but sadly, the state is infatuated with tradition, and much of that tradition steeped is a lethal combination of religion, oppression and fear.
There could never be enough praise heaped on Dr. Meana and his staff at Open Arms Clinic. Not to be left out is Grace House, in Jackson, which provides housing for the homeless with HIV-AIDS. The people behind organizations like these shed a stark light on the "Christian" values of our governor and his cronies.
32
@Bob G. It is precisely because Mississippi is the poorest state in the country that it cannot afford to accept the expansion of Medicare. As progressive as ACA was, it did not offer a very progressive funding plan. There is no mechanism for the poorest states to pay nothing for the additional coverage while the richest states pay 20%. Every state must pay 10% of the cost (and there is no guarantee the feds will not push that percentage higher at some point).
Now consider that poor states have lots of poor people. So a larger percentage of Mississippi's populace would newly qualify relative to wealthier states making the relative cost for Mississippi even greater than for many other states. Mississippi simply cannot afford the near term cost even if having more citizens with health and financial stability might create long term benefits for the state.
We in wealthy states get on our soap boxes demanding companies provide full health, vacation and family leave benefits for even the most menial of jobs but we collectively are unwilling to fully cover the cost of expanded healthcare in states like Mississippi that just cannot afford something which such a major budget impact.
Of course if Bernie gets elected, everyone in Mississippi will have health care and be making at least $15 an hour via the federal government. And they will greatly appreciate how we northerners and you west coast folks signed up for those dramatic tax increases to make their transformation possible.
6
@Tifany Taxpayers in New York and some other states already subsidize Mississippi. New York receives about $0.86 from the federal government for every dollar that it sends, while Mississippi receives $2.19 for each dollar that it sends to Washington. Mississippi's tax burden is also about four percentage points below New York's, so it has room to raise revenue locally.
Virtually 100% of the expanded Medicaid spend would be paid to local hospitals and providers, boosting the economy and tax revenues. That's a great multiplier on the 10% that would have to be paid by the state.
If Mississippi and other conservative states had devoted as much effort to lobbying for improvements to ACA as they did to trying to kill it, they probably could have gotten the cost-sharing reduced even further for the poorest states.
30
George W. Bush did PEPFAR (Presidents Emergency Plan for AIDS Relief) in Africa. Trump will put an end to AIDS in America. We have the meds, the docs and president to do this.
6
@John - did you read the article? I’d be curious to hear how you think Trump will end AIDS in America. A lot of things would need to happen for that to be possible, most of which will require more funds for public health care services. Perhaps he’ll advocate for abstinence and prayer as the prevention and cure?
1
One thing I'm certain of, despite his pandering to the right wing zealots, I'm pretty convinced that he is NOT religious.. Oh yeah, "We'll pray for them," or "God will take care of Christians," just lip service. And he has the right wing religious vote. I'm going to assume they don't pray before they eat, other than maybe a Christmas service or something of the sort, they don't go to church either, except for the occasional photo op.
1
@Jen if you don’t try, it will never happen. It’s bold and will take a huge effort, but definitely a worthwhile and necessary endeavor.
This is similar to prior thinking about putting a man on the moon, running for President if you’re black or a woman or ongoing research to end cancer.
1
Does the Open Arms clinic accept donations?
12
Number 1 in number of new cases of aids is Washington DC. Number 2 in new cases is New York. Let’s pile on Mississippi and Alabama though.
4
Is that really the point? It’s heartbreaking no matter WHERE it is...And needs to be addressed!
11
AIDSVu has the number from 2016. New York State has approximately 19.5 million residents. And their rate of new infections in 2016 was 2,875. Mississippi has a population of 2.9 million. And the rate of new HIV infections in Mississippi in 2016 was 424. Their rate of infections per capita was essentially the same in 2016. The point is that rates are going down in the north and rates are going up in the south.
7
It seems to me he is taking a business like approach to dealing with this dreadful illness. He isn't doing it to create more government hierarchies he's using the money for the mission.
7
@Tony Francis The article doesn't explain where the money will be spent. But, it does point out that more than just medicine is needed. Mississippi, for instance, needs more staff.
A government bureaucracy isn't always a bad thing. The US didn't get to the moon by doling out some money to the Army, some to the Navy, and still more to various companies and telling them to figure out a way to do it. It empowered an existing agency with the resources and authority to get the job done. For HIV, we have the National Institutes of Health (NIH) that could take the lead if given the budget and authority.
9
Rejecting Medicaid in the poorest states does exactly that. The policy makers know exactly what the outcomes will be; the voters, I'm not so sure - not even the ones with heart disease, diabetes, onset of chronic diseases and the disabled who stand to lose the most. They often think it will only hurt "those people", and not them.
14
yet another distraction....
6
Trump does not want to end AIDS. That's just what he wants people to think. He also wants people to think that the sun came out during his inauguration speech, when it rained the entire time.
Just because he is president, is it actually required for the NYT to say, "Trump says...."?
You know full well he means almost none of what he says. What are the limits before you stop repeating his lies, Tweets, exaggerations, etc.? Is it endless?
9
I am one headline like this one away from cancelling my NYT subscription.
11
I don't know how you can lead with such a patently FALSE statement. Trump doesn't even know what HIV is. I didn't bother to read the article.
16
Many parasitic diseases alter the behavior of the their host and while I've only done a quick look for this phenomenon in HIV I did not find anything definitive but I wouldn't rule it out. The alterations are changes that ensure the transmission of the disease to another host, or to a place where the parasite can wait as in zoonotic diseases.
A professor of mine in population genetics mentioned the parasite that causes Chagas disease which often infected the family dog, he was from Argentina, so while the people in the family were clear of the disease they would get infected by the family pet through the kissing bug, which fed off the dog when humans were hard to bite.
Retroviruses don't have the same machinery as do tapeworms or flukes but that is no barrier to evolving new characteristics and HIV is a particularly insidious disease with a long incubation period.
A one-two approach may bring only a respite but universal health care in the US would do better, and of course a realistic approach to sex education in public schools along with universal health care could control all diseases better.
I just don't have any faith in Trump's approach as long as Republicans hand 1.5 trillion dollars to the wealthy but deny basic health, welfare, and housing to the vast majority of US citizens.
Then there's eliminating HIV around the globe. We eradicated measles once but it's back again. HIV isn't going away anytime soon especially with the republicans running things.
7
@lightscientist66
Measles are back due to anti-vaxers in the middle class-upper middle class nonsense derived from a debunked autism connection published by a British doctor who has lost his license to practice medicine. When children from the Philippines carried the virus to Disneyland the children affected were not vaccinated. This is an important issue: Measles can cause damage to hearing and eyesight. Some pediatricians and OB-GYN doctors will not allow unvaccinated children to sit in their waiting rooms. CA schools require vaccination certificates for public schools, no admission without a documented medical reason no vaccination document. Private schools have the same standards; my daughter had to have one for the French School in SF. She had to produce that record for entrance to UC.
2
Here is the additional, tragic fallout from egregious treatment of people of color through the ages in this country. I've heard it in other areas of public concern--people of color just don't trust what looks like a white person-based movement, government, business, etc. And it's ended up in some critically important areas that leaves people of color and other minorities along with them with horrible consequences. Unfortunately, I seem to relate at least a little (being white) when I hear that Trump wants to support something like this program elimination of AIDS. He certainly hasn't had a history of credibility! I'd still voice support for the people willing to engage in the program. In any case, I give Stevenson an immense amount of credit by putting a recognizable face on leadership, to enhance trust and involvement.
2
Put Pence in charge. He did a great job in Scott County, Indiana. HIV spread like wildfire thanks to his moral leadership.
26
We need to cure the disease of religion first. That kills more people than anything else.
35
So will we go to Mars before or after our leader cures AIDS?
3
Wow NYT, using lies in your headlines now. "Trump Plans to End the AIDS Epidemic."
We all know he has zero intention of formulating any thoughts or taking any steps necessary to make this anywhere close to a reality. Everything he says is the exact opposite of reality. Reality here is that "Trump has Zero Plans to End the AIDS Epidemic."
Stop treating our lying president with respect and trust - two things he has obliterated in his presidency.
16
Good grief, regardless of the possible merit of any Trump initiative the NYT will always find a way to apply negative spin ... A not far fetched hypothetical: Trump discovers cure for all cancer, but implementation was delayed for several weeks due to administration in - fighting over who gets the credit ... ( I'm a Hillary voter by the way ).
6
Is Jared in charge?
8
It will be a Herculean task to eradicate HIV and AIDS in Mississippi. The article outlined it beautifully. Healthcare in any form is not a priority of this governor or legislature. The last budget slashed funds and closed many of the health department offices. Medicaid was not expanded under the ACA, so that prevents many from any kind of medical care. As far as sex is concerned, there's plenty of that in Mississippi. Sex is okay, but you had better not talk about it. Fundamentalist taboos and lack of education will keep Mississippians in their not so blissful ignorance for generations to come.
16
It's obvious that someone is spreading a "Tuskeegee Experiment" alarm to intimidate the generally uninformed black gays in Mississippi. If these young men had some smarts, they would take the initiative and find out the facts about a program that could save their lives.
3
I think you underestimate how profoundly the Tuskeegee experiments have hurt trust in the medical establishment among African-Americans, even well educated ones.
It was a horrific crime, and the consequences are ongoing
7
@Martin
No excuses. We don't all live in or near Tuskegee, and the doctors from that time are long gone.
While Trump’s motives are suspect, since during his presidency he has created only a path of destruction, and we all know the driving force of anything he does is to get adulation... I believe in giving credit when credit is due, and so if this will be a sincere effort, with actions taken, thank you.
Color me skeptical of the Trump Inc. Administration's motivation here.
6
Thanks again for taking an inspired initiative to help one of the most at-risk demographics in our country, and spinning it into another blinding, relentless attack on our President.
4
I read the entire article top to bottom and did not see one single word of attack toward Trump. Did you read the article?
2
@Steve Hanegan Apparently if an article isn't full of praise, it is considered an attack.
Sounds like big pharma offered outsize PAC contributions for 2020 if the bill to spend billions on H.I.V drugs will get approved.
6
@Tumiwisi
Do some research and see what scientists recommend, not politicians. A treated patient whose HIV is under control reduces dramatically the chances of transmission, notwithstanding that left untreated., people with HIV die. Are you suggesting to let people die? Saving money is not a sound strategy, it is bad for individuals and also the whole population. And the more infected, the more money spent on drugs, so why not trying to nip in the bud? It is cheaper in the long run, it has been proven - nothing to do with lobbying
1
More funding for public educationvand healthcare will help to dispel ignorance and improve people's lots in life in general - and I agree that paying people to be confidentially treated and take their meds is worthwhile in poverty-stricken areas.
5
These stories, common to this publication, are big on pathos but low on statistics. How many people are we talking about here? Over what geographic area? What time period? What’s their percentage of the population? Etc.
3
@Paco
The article, a newspaper article, did not have that purpose. You should find a technical article to read if you want technical information.
1
@Paco
Who cares? HIV-Aids is a killing disease. There is no reason to promote a cost-benefit analysis to a medical/health issue. We didn't do that with cancer from smoking; we treated the ill, and we forced cigarette manufacturers to put warnings on their packaging. We also launched Congressional Hearings, and educational programs. I smoked until I got pneumonia and had to stop. I wore a patch for 6 months, and chewed Nicotine gum after that. My airways were permanently impaired, even though my lungs healed.
The biggest problem with health issues, whether this one, or opioid addiction, is the nature of the human animal that is in denial about all truth related to health. I come from a long line of doctors over 3 generations, and one learns the reality of how people operate when it comes to stress, honesty, etc. Females used to try to abort with coat hangers, men never went in right away when they had an STD, and young gay men over a decade ago, decided that if there were drugs to keep AIDS as a chronic disease, there was no reason to use a condom. I mean, we have 60% of the population that is overweight, and obese. Does anyone really believe that humans are mature enough to take good care of their health? Not really! We are failing as individuals first of all, and as a society in general in our arrogance, self indulgence, immaturity, and expectations of the government to fix our ways. It can't be done, and if it could be, it would of happened decades ago, as we have poured money, and programs into all of it, and it has only become worse, actually.
5
@MaryKayKlassen We're not going to change human nature. If we're going to be successful, human nature has to be anticipated and, if necessary, worked around.
2
Trump doesn’t really want to end AIDS. What does he care? It’s just another grandiose lie.
6
No country has yet figured out a way to get males to simply use condoms.
19
@Maggie here, here!
1
@Maggie
Condoms fail 17% of the time when used as directed.
But good to know you are prepared to blame male victims in particular.
1
Condoms work well when used properly. Key word, properly. It is not blaming the victim to observe that the choice to not use a prevention measure is a problem.
1
Am I the only one that thinks if Obama proposed this, the NYT would be throwing him a parade? Trump proposes a very noble moonshot, and the NYT scrambles to frame it as ignorantly misguided. Sigh....
6
@JJ He's proposing a "moonshot", but funding a model rocket. That's hardly a reason to throw him a parade.
Kennedy's moon program had an ambitious target date, with a budget and infrastructure commensurate with the challenge.
8
Under Obama, the CDC did propose this. Trump's "moonshot" is simply a rebranding of an already existing CDC and WHO proposal called Getting To Zero. Getting To Zero has existed in some form since at least 2014, and has been discussed by community leaders and public health officials for longer. Without any new funding, this is just an attempt to present old ideas as new ones, and take credit for the work of previous administrations.
13
@JJ Looks like you didn't read the article either. It's not about Trump at all. It's about the depth of the challenge in some parts of the country.
10
Who keeps stating the US is the greatest country in the world? The same people who are going to pray a disease away? If we could just take religion out of every issue this country might just evolve a little.
17
I don't know, maybe it's just me, but I think it's hard to end AIDS and other diseases if the know-nothing president goes about it by proposing to slash the NIH's budget. But, what do I know--I only had NIH grants for 21 years while at academic medical centers and then worked at the NIH for 10 more years...
25
@porterjo
No. You see, now that NIH is out of the picture, Capitalism will NOW come to save the day with new an innovative programs that will be funded by the $billions of profits Big Pharma already made off the really sick and the no-bargaining GOP Medicare policies. Just you wait. It is coming any day now. The Conservatives have promised this will happen, as it is part of their Trickle Down programs which Americans vote for decade after decade.
6
Ten years in prison in Mississippi if you know your HIV status and infect someone else?
That is certainly NOT going to encourage someone to get tested; that is huge negative incentive! Public health folks in MS. need to talk to the state legislators and revoke that stupid law.
9
And I highly doubt the law has done anything to curb infection rates; in fact, I’d put money on it. It’s just a way for ultra-conservative legislators to pat themselves on the back.
10
@Mary
There has to be a legal remedy for the victim and for society when some sociopath creep is so degenerate that they *purposefully* force a death sentence on a vulnerable victim, who then unknowingly can pass that on to another victim.
6
@Maggie If you click on the link included in the article, it is clear that a major flaw with the law is that it becomes a "He Said, He Said" about whether the HIV status was communicated. Since an absolute defense is lack of knowledge of HIV status, there's a real incentive not to get tested until recurring symptoms develop, often years after infection.
Since the Mississippi legislators don't seem to otherwise care about HIV/AIDS patients, I have to agree with @38-year-old-guy that this law was passed simply to make it appear that they were doing something, anything -- short of actually allocating resources -- to solve the problem.
5
Many years ago when traveling around the world, I went on a safari in Tanzania. While staying in Arusha. Tanzania at a small place that had small window less cabins about 12 x 12 feet and no running water or lights past 10 PM, I decided to have a beer that was part of this place. When I went in I was the only white person in the place. Went up to the bar to get my beer and a young man also gathering up bottles of beer said, buy as many as U want to drink because they always run out. I asked if I could join his 2 friends at their small table and he said yes. Well not many of U will see how beautiful these young Masai ladies are but they are a combination of African, Indian and Arab as these people have been trading together for hundreds of years. There were several tables of these young women and the guy who invited me over said, "Prostitutes all clapped up." Arusha is on the road connecting Ruwanda with Dar Es Alam and would later be labeled the aids highway cause that is how it spread to the world. A few days later I wanted to go to Zanzibar and was told that took a yellow fever shot which are worthless but if you vaccine info does not include this shot - you will be fined and thrown into jail. Walked to the small clinic providing these shots for a small price. Walked in and the morgue door was standing and piled into the room were dead bodies in cheap white muslin and the smell was horrid. That did it for me - they called aids slim's disease then.
2
Good.
Glad to see some one in Washington will actually tackle a real life challenge that affects so many Americans and their families.
Will it be as easy as waving a magic wand? no.
It will require a lot of work and cooperation by every one involved.
I am glad to see this is happening.
3
Ha. I expect Trump just says what he says no matter how ridiculous he sounds to people with brains. Of course his base will believe him. The GOP will back him. Maybe he can cure cancer, leukemia, alzheimer's disease, and old age. Facts don't matter to Trump since he says everyone else is lying and the facts aren't true. No scientific research is involved with the Trump approach. As long as he says it, he thinks it's true.
It's only a matter or time for him to declare that when he said he would cure aids means he didn't mean he would actually cure aids.
6
@Louise It won't be long before someone in the White House will tell us "that's just the way Trump talks" and proceed to give us a different, watered-down explanation of the program that will eventually disappear into the ether.
3
If he wants to make a difference, he should fully fund Planned Parenthood. When Pence closed them down in some Indiana counties the HIV numbers spiked.
37
@Joe Barnett
Men can buy condoms at the local drug store. Or order off Amazon.
1
@Maggie Many Planned Parenthood offices can prescribe PrEP and provide counseling on its usage. They also do HIV/STD testing. PP is about more than birth control.
10
@Maggie Here in Seattle, they are free. There is always a basket at my pharmacist's and I see them at the doctor's waiting room and even at a couple of foodbanks. One foodbank even offers instructions on how to use one:)
4
What a mess... I hope they find a program that works. In the mean time, I have absolutely no sympathy for the guys on the “down low” who are infecting the women they’re with... where’s the “me too” tweets?
9
Maybe Trump will redeem himself and agree to have his border wall money (or the money he intended to unilaterally divert for construction of the border wall) spent instead on creating a "wall" against spread of the HIV virus. Heck, he can even claim that that was the "wall" he had in mind all along. That's fine with me.
51
Are we sure Trump wants to end AIDS? Or does he just want to act like he cares about black people before the 2020 general election?
49
@I’ve Got Questions
Yes, I thought the same. Particularly when he came out in favor of prison sentence reform. In my opinion, it comes down to shaving off a little of the AA support for Democrats. He's too dumb to have thought of this strategy himself [another example, his Supreme Court picks].
5
Sorry, "Trump *plans* to End the AIDS Epidemic" as your headline? Show me where among his and his party's platform it includes plans to end the AIDS epidemic. Seems to me that gutting social services and healthcare spending, especially in the GOP-controlled states where these "hot spots" exist, is completely antithetical to that goal – yet this is exactly what the GOP supports.
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@Shaun As usual, the program is meant as a distraction to divert our attention from, as you point out, all the other healthcare cuts that he's making. He'll point to this program as proof of his compassion and his base will nod knowingly.
4
"President Trump’s plan to end America’s epidemic of H.I.V., the virus that causes AIDS, within 10 years is not going to succeed easily in places like this.""
Number 1, he has no plan. For anything.
Number 2, he doesn't care about anything but his ego, nevermind the sick.
So stop writing as if he does. It's annoying. And it's silly.
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HIV is the cause of AIDS. Infections due to HIV can be prevented from causing AIDS in HIV positive persons by timely medical intervention with Highly Active antiretroviral therapy (HAART). Of course the biggest challenges to the eradication of AIDS is to prevent HIV infection in the first place.
The administration has to focus on a multipronged approach. Education on safe sex and compliance has to be part of public school curriculum as early as is appropriate. Sharing syringes has to be replaced with providing sterile syringes to prevent IV drug users from spreading the disease. Medicaid spending which currently runs at one billion dollars every day has to cover affordable treatment of HIV infected persons. The focus has to be on eliminating and treating HIV infection and not on how a person in America was infected.
Also the current guidelines are treating patients well before the immune cell count (CD4 count) drops below 200 but well above 350 that could be changed to initiating treatment as soon as infection is detected or as a prophylactic means soon after the exposure to HIV infection is suspected. For example after a needle stick exposure to anti-HIV treatment is recommended for a month and in order to ensure that a child born to HIV infected mother does not get infected, the mother is treated with anti-HIV treatment.
Millions have been spent on a HIV vaccine and we are still don't have it. Education and safe sex compliance is the best vaccine for now..
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@Girish Kotwal
"The administration has to focus ..."
Good luck.
14
@Girish Kotwal and let's not forget the role of PrEP (pre-exposure prophylaxis) in preventing infections before they even happen. we have to spend money on that, too.
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@Susan Watson
Amen.
3
Someone doesn't have to be a party boy to get infected. the woman in the story, for example, who found out she was infected after discovering her husband in bed with another man So we should wait for her to get infected first - then we can treat her? Why not solve the problem at the source?
When I was younger, I dated a guy for a long time that I suspected was bi. I was exclusive but never quite sure about him. I felt like an "acceptable" companion when he had to attend a work related social event. We were more friends than anything else. Eventually, we stopped pretending to date but remained friends. We're old now, both senior citizens. He never married, still alone, no kids, suffering from a terminal illness but sketchy on exactly what it is. I often wonder if he's infected but just too ashamed to tell me. I just thank God I didn't get infected.
Yes everyone should have access to health care and drugs. Instead of focusing of building or "finishing" the wall in Trump's lingo, they could do something meaningful.
But for Trump it's just a speaking point that sounds good. He doesn't care about delivering. I don't remember much about his pre-election talks, but the one that sticks in my mind is his "oh yeah, we're going to have great health care for everybody" talk. He knew then he was lying and hadn't given health care a thought, beyond how to dismantle it.
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@Ann
"So we should wait for her to get infected first - then we can treat her? Why not solve the problem at the source?"
That's an interesting question. How could that be prevented at the "source"? On the surface, she wouldn't appear to be in an at-risk category, so she wouldn't be prescribed PrEP even in the most sophisticated health systems. Advocating routine condom use by married/committed couples wouldn't gain much traction.
Or, does it require a cultural change so that men with an attraction to other males don't feel family or societal pressure to marry or have girlfriends as a "beards"? Men don't suddenly a same-sex attraction in their 30's and 40's. They've had it all along and suppressed it.
I have a feeling that you've asked a question that does not have an easy answer.
7
@Barry Short it's not her that should be on prep. it was her husband who should have been. he's obviously at risk, and i am sure he knew he was at risk and would most likely qualify for prep.
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@greg
It is amazing and appalling that HIV and Aids remain such a big medical issue. Use condoms, and if you are a drug user use a sterile syringe. Why should an already inadequate Medicaid system be burdened by two preventable diseases? We all learned about smoking and cancer. Drug users, gay men, and bi-husbands can learn how to protect themselves. More community education would be worth the expense. We have sick children; we have sick old people without adequate insurance beyond Medicare. Now, we are obliged to pay for HIV/Aids because those infected never learned how to use a condom or a sterile syringe? I'm not buying it. If you are old enough to have random sex, or to use a syringe for your drugs, you are old enough to protect yourself.
2
As someone who works in the field, I'd take much more comfort in the president's Get to Zero Pledge if Trump hadn't fired the remaining members of the Presidential Advisory Council on HIV/AIDS with no warning or explanation, if his administration wasn't redirecting crucial Ryan White CARE Act dollars to pay for putting immigrant children in cages or changed the Medicaid Part D rules to make it harder for people living with HIV to get the medication they need to survive, and if his vice president hadn't previously expressed a desire to divert HIV prevention and treatment funding to fund harmful and debunked gay conversion "therapy" facilities.
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@Kara. Thanks for the information. Trump does so many foul things it's hard to keep up with them.
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@Kara As someone who just attended the most recent PACHA meeting last week, take some solace that it’s been reinstated (albeit with different, but still capable, leadership).
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@Kara
When Mike Pence was governor of Indiana, the public health people identified an epidemic of about 100 IV drug users. Pence's response was incompetent. The epidemic of IVDU turned into an epidemic of about 100 HCV infections, and then about 100 HIV infections.
They had needle exchange programs that went through the checklist of policies that had been demonstrated to guarantee failure -- requiring photo IDs, limiting exchanges to 1-for-1, etc.
It was literally a textbook case of how to turn an IVDU epidemic into an HCV and AIDS epidemic (if you're teaching a course). Pence's health commissioner wrote articles in (I think) JAMA and NEJM ostensibly describing his program'S success, but there were letters to the editor challenging him. His lame defense is worth reading as an educational exercise.
BTW, Mississippi has ZERO needle exchange programs. https://www.detoxlocal.com/needle-exchanges/mississippi/
Science magazine had a section about the science behind the psychology of persuasion; for example, how does a doctor persuade patients who refuse to vaccinate their children? The answer: they had some general advice, like using your authority as a doctor, but you have to recognize when it's hopeless and stop wasting your time (!)
Google Carl Zimmer's article on Lysenko and tell me if you see any similarities.
Most of the big public health problems are political problems, not medical problems. There's something wrong with America.
15
I've had first hand experiencing doing HIV testing and now I focus on quality assurance. Trump has no idea how to end the epidemic. The HIV/AIDS advisory council quit in his administration. He's taken money from Ryan White, that funds services with those living with HIV, to fund his wall and imprison immigrants. He's further stigmatized those vulnerable to HIV with his transgender ban and other policies that hurt LGBTQ ppl. Furthermore, most people access HIV medication using medicaid since Ryan White is a payer of last resort. With the administrations cuts these people will find it harder to take their medication. Lastly, like the article mentions we need wrap around services. No one is gonna take their medication if they are dealing with homelessness or food insecurity. We need a holistic approach. Unfortunately this administration doesn't get it.
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@al
Why do transgender individuals get lumped in with gay and lesbian individuals? I really don’t get it. Frankly it ends up looking like an effort to keep homosexuality from the mainstream and a bargaining chip following the Supreme Court rulings. Just saying.
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@Lloyd Christmas
"Why do transgender individuals get lumped in with gay and lesbian individuals? "
Because there's a certain amount of crossover between the communities. Being homosexual and being trans aren't two separate, exclusive categories.
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@LG
Forgive me, but they do actually seem like two separate exclusive categories. Such that by lumping them together under an umbrella acronym seems to do a disservice to both communities by distorting their meaning. This is my impression. So I suppose I am looking for someone to explain the crossover between the two communities.
6
Let's look at the facts. Safe sex will have a 100% chance of preventing AIDS. This is a proven solution.
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@Pepperman - Condoms break so your safe sex 100% isn't accurate but yes, safe sex is important and should be taught. Unfortunately Republicans are solidly against teaching people about safe sex.
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Condoms fail.
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@Blue Jay
They have a -chance- at failing, which isn't the same as a flat failure. Just because a proven safety measure could fail doesn't mean you shouldn't use it because they tend to only break when you don't use them correctly. Or when you assume that every condom is the same when that's not the case - for instance, there's special condoms designed for anal sex, so...
13
Serious question: why are transgender individuals in the same ‘category’ as gay and lesbian individuals? I really don’t get it.
Because they are frequently mistaken for one another?
Until recently, didn’t everyone assume a man dressed as a woman (who ultimately became a woman surgically and/or chemically) was a gay man, because “she” was attracted to men?
Does anyone believe that Trump who picked the most homophobic politician in America to be his Vice President really wants to end AIDS? Do you really think the Republican Party which is deeply hostile to both the LGBT Community and the African American is going to get behind this? Last time I checked the bigoted Southern Evangelicals that make up the base of the party view AIDS as some kind of divine retribution and I doubt any of those racists shed a tear when a black gay man dies.
My guess is that this whole initiative was cooked up by the President’s vapid shoe designer daughter in an effort to burnish her brand.
Pathetic that the Times is falling for this ruse. Shame of the Times for giving any legitimacy to Trump and his thieving Family.
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What a brilliant idea Louisiana. I'd gladly pay more taxes to pay people to take their HIV medicine.
4
As someone who is actually *in* Louisiana, let me ring in with enthusiastic endorsement of the concept. You did note that compliance with medication can significantly reduce or eliminate transmitting the disease to someone else, right?
8
It seems these days that no social need or problem can be discussed without it deteriorating into a "hate-Trump-love-Trump" emotional shouting match. Not once in this article is there any mention of making condoms available at cost as a preventive for spreading AIDS or any other STD.
3
@Penseur The article did mention condoms. It mentioned how many didn't even know how to put them on correctly. They asked guys to put one on a vegetable. Many did not know how. Some used their mouth to open it, which can cause it to disintegrate, others didn't know to check the expiration date. Distribution is great, but they need education as well on how to use them
2
@Penseur
Low-cost condoms probably weren't mentioned because cost isn't generally a barrier to their use. Many gay bars (although not as many as a few years ago) make them freely available. Even at retail, they can run less than a dollar each.
The problem is education and culture. The article mentioned that one advocate was escorted off a junior college campus when he attempted to give condoms away. Abstinence-based programs don't provide the necessary information for effective use. For some reason, southern adults seem to think that the idea of sex would never occur to teens if they don't hear about it in a sex education class.
3
@Ann: Missed that. Thanks for bringing it to my attention. Seems amazing that people might not know that. I grew up in a blue-collar mill town, and even boys of 10 or 11 knew about such things -- not that we had any occasion to need them.
1
A more accurate headline would read "Trump says he wants to end AIDS".
Because after the last 3 years I'm surprised journalists would just state things he says as fact, when he has such a long proven history of lying about most of the things he talks about.
14
The venerable New York Times should re-label itself The New Race Times. Here are groups who are above reproach: blacks, LGBTQ, Hispanics, transgendered people.(and especially black gays).Always at fault: white males (those dastardly devils). It's become not only predictable but laughable.
11
@Dennis - I'm so white I'm almost blue but I'm so tired of hearing white people whining.
Take a look at almost every section of this newspaper, particularly the financial section and you will see that it's white men who are predominantly in charge.
14
Who do you think is to blame?
4
@Dennis In what way are white males being denigrated in this article? And why do you think that minority & LGBTQ populations deserve criticism? This article discusses a health crisis, compounded not only by lack of access to medication but by cultural attitudes. This crisis is occurring within specific demographics - gay black men. I'm not going to launch a discussion of white supremacy or the patriarchy here. But the defensiveness of white men is certainly telling.
18
Interesting that the health care epidemic chosen by the Narcissist-in-Chief to combat relates to a sexually transmittable disease.
6
I'm all for AIDs sufferers getting the meds they need, but what about every other American who needs meds and can't afford them? Why only AIDs sufferers?
3
@Cornflower Rhys
Because this is an article about AIDS. No one said other Americans can't afford meds for other things. Go find the myriad of other articles about diabetes, breast cancer and heart disease if you are so inclined.
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@Cornflower Rhys Are you serious? This is an article specifically about AIDs. There are plenty of articles about plenty of meds and aspects of healthcare in this country... ?!
15
@Cornflower Rhys: Could it be that HIV is contagious & diabetes, asthma, gout, cancer, isn’t?
7
Trump doesn't plan to do anything about this. One of his handlers told him to make an empty promise, he did and that's the end of it.
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PrEP may be effective, but it can apparently cost up to $2,000 a month. In a country where people are dying because they can't afford insulin, why should the taxpayers pay that much for people who can't or won't take responsibility for their sexual health? PrEP should be given to sex workers and partners of infected people, not party boys.
3
@Kathryn McDonald - Interesting comparison. Quite a few people with diabetes have it because they ate poorly and refused to exercise. Not much responsibility going on there.
17
How old are you? You sound those same folks who were shouting very similar to what you’ve chosen to disrupt the conversation about HIV/AIDS since the 1980’s when the epidemic was killing off thousands and thousands of infected people.
Shame on you!
YOU, do not get to pick and choose who gets financial medical help from OUR GOVERNMENT!
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@Kathryn McDonald
I would say your comments lack understanding about HIV & PrEP, but I believe it goes much deeper. Next time you're at Cheesecake Factory, Olive Garden, or McDonald's take a look around "for people who can't or won't take responsibility" for their burgeoning waist lines.
8
It is pretty simple, don't do those things that can get you AIDS and then few new cases will happen. This is about treatment not prevention.
3
Not only can I not think of any Trump supporter who would want to solve this, but I dare you find 5 of them who even think it’s a problem.
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So this war on aids will also be accomplished by stigmatizing LGBTQ individuals and restricting their rights, and de- funding planned parenthood and other low income access to medical care?
I'm not sure I understand.
Susan Grant MD
19
Take it out of tthe defense budget — the price of one plane would fund all the needed clinics for a decade
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@true patriot
Take it out of the Wall, for which money is earmarked that serves no useful purpose.
12
@true patriot Yes. My father worked for the defense industry as an engineer. One mediocre fighter jet in the 1990s costed $35 million. That number has probably gone up since then.
3
The intersection between HIV/AIDS and culture is incredibly difficult to unwind. Things seem very simple on a spreadsheet but you're dealing with an enigma wrapped in enigmas. I once wrote a research paper on the subject. The context was HIV prelavency and prevention in Sub-Saharan Africa. Lesotho specifically. My study was a rather depressing mix of economic impacts and anthropology.
The short story goes: Most men in Lesotho go to South Africa as migrant laborers, typically in mines. Their remittances support most of the Lesotho cash economy. The Basotho women manage local affairs largely independent of the men with family farms and water exports to South African agriculture. The men, during periods of long absence in male dominated communities, commonly develop extra-marital relationships and often with men. It's not prostitution. Even homosexual partners would not describe themselves as gay or homosexual either. They have wives at home and they do go home occasionally.
Take this population and try to teach them how to use a condom. Not once but all the time, every time. Things get complicated quick. I haven't even gotten to religion, education, taboo, and postmortem multipliers yet either. Female sex trafficking in Lesotho basically wouldn't exist without AIDS. There are entire communities of orphans with few if any living adult relatives. You are in for a serious roller coaster when you start tackling these issues.
So too with HIV/AIDS among certain US populations...
12
No, Trump does not "plan to end the AIDS epidemic." Trump just wants attention, and that's what you're doing with that headline
57
Thank you so much for this article.
1
But if it happened to occur under his disintegrating administration’s “reign,” how much credit would 45 and cronies claim. During those few, fleeting moments between discovery and implementation anyway. Pathetic
2
What could possibly explain a sudden interest in fighting AIDS? Do Kim Kardashian or Jared have a friend affected?
7
It'll be hard in Indiana also, where some Pence policies upended the AIDS fight and caused an epidemic of STDs to reemerge.
The GOP has become incoherent.
They are destroying our institutions, along with us and the nation.
It began with Reagan's 'The government is the problem' statement. The GOP took it and ran with it as a prophesy they would fulfill!
Now they have their ultimate weapon at the head of the charge in the form of Trump.
7
Trump's new gag rule on Title X aims to shut down healthcare providers who serve low-income and uninsured people -- providers who offer affordable testing and treatment for HIV and other sexually transmitted infections.
Just saying.
10
And as Republican state and federal politicians work to gut the ACA and Medicare and their own states social services, Trump the conman in chief is now all about eliminating HIV and AIDS? What a joke.
How cruel, hypocritical and morally bankrupt the Republican Party is.
Shameful and disgraceful -
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@Steven Remember when the GOP and its "amen corner" called AIDS "God's judgment on gays"? That's not a deity worth worshipping, let along printing on toilet paper.
This is more GOP Goebbeldeguck to cover its true intention: Make America White Again. It's your typical lies covering GOP genocidal intent (Romney's "47%" comment).
7
Trump doesn't truly want to end the AIDS epidemic. He's just paying lip service to the idea as a way to try to make himself sound good.
75
What Trump promises: everything
What Trump delivers: tax and regulation cuts that only benefit the rich
Don't hold your breath waiting for Trump to deliver on his promises
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