February 4, 2011

Serious issues, but false alarms.  

One of the editors of Poz Magazine, Regan Hofmann, posted a column at Huffington Post yesterday raising the alarm about the AIDS Drug Assistance Program (ADAP) funding crisis, and her disappointment in President Obama for not prominently mentioning HIV/AIDS in his State of the Union speech the prior week.  In her writing, she talks about how the Republican-led House of Representatives wants to cut funding that will only increase the already-growing waiting-list for ADAP.  While I share her concerns about the funding problems and that it is important that we do all we can to keep treatment affordable and accessible, I personally find it difficult to get worked up into a shrill for two main reasons.

First, this does not strike me as a crisis in the context of other crises that are unforeseen and unexpected.  This is a story that has been unfolding for over a decade.  AIDS organizations had been taking false comfort in the notion that transmissions had leveled off (at first estimates of 40,000 new cases a year, but re-assessed at close to 56,000/year).  Each year, regardless of the real number, these were real people who would need treatment, but the writing has been on the wall for a decade that public funding was only going to get tighter, starting with the high-tech bubble-burst in 2000, and going through the after-effects of the 9/11 attacks, costly wars, housing crises, financial collapses, etc.  As I've written here, this is all compounded by the fact that "AIDS, Inc" has continued to dither with arcane policies and practices.  Why isn't there any strong AIDS-leadership voice asking where HIV/AIDS efforts may have gone wrong, and what can we learn to do better in the future?  Instead, all we see is "blame Obama/others and give us more money".

Second, Hofmann and others have cited studies that show that, despite the high-cost of treatment, it is more cost-effective than the costs of taking care of people as they progress to AIDS, get sick and die.  What's missing from this is that treatment does not extend life forever.  The fact is that, under almost all conditions, as people enter their final days there are exorbitant healthcare costs.  If we are going to use the economic argument for treatment, shouldn't we be honest and admit we are just delaying the days when the high-cost end-of-life treatments are incurred.  It is the rare fortunate person who is laughing one minute and is dead the next; most of us will more likely see lots of tubes, procedures and treatment those last 3-6 months.  If I have learned anything through this journey with HIV/AIDS it's this: nothing is life-saving, only life-extending, and any campaign that talks about life-saving measures is a marketing ploy that denies the inevitable and doesn't allow for a good discussion.  Hofmann ends her column by saying that she hopes we can show the world that in American we won't let you die when we can save your life".  It's a false promise - we can't play God.  We can only hope to extend life.

I can easily get behind arguments for public health, and that we need to do all we can so that children born in the next decade won't have to deal with HIV/AIDS as they enter adulthood.  Many of the arguments that I see, however, are ego-driven.  Isn't it time we stop demanding that the politicians somehow see through the crap when it looks to me like it's too often AIDS organizations that have been shoveling it?  These issues are too serious for shrill blame and false promises.