STATE LEGISLATORS: NCSL Meeting Discusses HIV/AIDS Challenges
"Changes and challenges," are what the HIV/AIDS epidemic is all about today, Dr. R. Scott Hitt, chair of the Presidential Advisory Council on HIV/AIDS, told state lawmakers Monday at the National Conference of State Legislatures' 3rd annual health care conference in San Diego, CA. Hitt said that "whatever you knew six months or a year ago is probably wrong today. Our treatments are changing rapidly, who is getting infected is changing. All we hear about in the press is that the death rate is coming down, but there's a lot of other activity." Mary Guiden, assistant editor of NCSL's State Health Notes, profiled the many challenges profiled by Hitt and the other panelists:
- The number of people living with AIDS is ever-increasing and as a result, policymakers have to look at HIV as a long-term illness.
- The number of women with AIDS is increasing.
- As first noted in 1995, HIV is becoming a rural disease, and the number of infected individuals is doubling in rural areas.
- HIV rates are rising among the nation's youth, communities of color and the heterosexual population.
- Steps have not been taken to address intravenous drug use. "Studies say needle exchange programs save lives and don't increase drug use," Hitt said, adding, "If they don't increase drug use, then why don't we do it?"
- Officials need to address HIV and AIDS in prisons, including prevention and condom use.
Hitt put prevention at the top of the "big public policy issue" list. It's "also the most frustrating policy for all of us," he said, as "we know what to do with prevention, but we don't do it. On a federal level, we just have our heads in the sand." A better approach, Hitt said, is "some kind of a coherent national strategy." As opposed to universal testing, Hitt suggested the implementation of a national testing and counseling plan, called the "KNOW YOUR STATUS CAMPAIGN." Similar to the Office of National Drug Control and Policy's "Just say no" campaign, the project would "let people know it's important to know their status."
Treatment & Notification
Hitt also briefly discussed expanding Medicaid to include HIV- positive individuals. "We have become a little hypocritical" because "we tell people they should get early treatment and then say you can't get it until you're disabled," he said, adding, "If you look at the cost per year of life saved, HIV treatment is a good deal." Pointing to the debates on names-based HIV reporting, Hitt said, "It is certainly important that we count the number of people who are HIV positive so we know where the trends are going." But "I'm amazed how much we're arguing about how we count everybody and how much time and effort the Centers for Disease Control and Prevention is putting into this issue. What I'd like to know is what we're doing with people once we count them." Panelist Shepherd Smith, president of the Institute for Youth Development, added that he supports HIV reporting. "One of the values of HIV reporting is partner notification. There is value to knowing whether your partner is infected," though "we have to find a balance between the need for a public health response and an individual's need for confidentiality," he said, adding, "Public health departments are impeccable when it comes to maintaining confidentiality." But panelist Leslie Wolfe, president of the Center for Women Policy Studies, said that when it comes to women and HIV, "state legislators can play a stupendous role in saving women's lives," asserting, "Every single AIDS policy has a gender dimension," and that partner notification is a "threat to women who are victims of domestic violence." She added, "We can't continue to pretend that there is no stigma" attached to HIV, because "we still know women who are fearful of what will happen if their family or community members know they have the disease." Wolfe concluded, "When it comes to HIV prevention for young women, we have failed. We need to stop sending the message to young women that we only care about them as potential reproducers" (Mary Guiden, Special to the Daily Report, 11/18).