Why a Cure isn't enough

I decided I don’t’ quite have the time or energy, or inspiration to write a response to the entire article I mentioned yesterday.  How congress can end AIDS.

But I do have one thought, I have to disagree slightly with her last assessment, which is that The best thing we can do to end AIDS is to cure it.

I am not, by any stretch of the imagination, going to say that I don’t’ want lots of money and time and energy put into finding a cure, be it a Sterilizing Cure or a Functional Cure.  We need to be researching that with fervor, daily, without pause until we have found it!

But how, given the other premises of the article, can that be the BEST way to end AIDS?  Wouldn’t the BEST way, be to implement all the things he listed off that Congress, and Americans, can do? 

For those who didn’t do their reading (I would’ve made a GREAT professor/Teacher) or who forgot:

1.       The first thing we must do to end the global AIDS epidemic is to reframe the public perception of the disease.

2.       In short, the second things we must do to stop AIDS is to address the underlying drivers of the pandemic such as racism, homophobia, sexism and xenophobia.

3.       The third thing we must do to end AIDS is to formally research and actively address barriers to entry to-and retention in-clinical care.

4.       The fourth thing we must do to end AIDS is to make treatment more affordable.

5.       The fifth essential thing to do to end AIDS is to decriminalize it.

6.       Ending AIDS also requires that we get over our prudishness and be willing to talk non-hysterically about sex and injection drug use.

7.       The best way to ends AIDS is to cure it.

Her premises are as follows:

                Not enough people understand the reality of AIDS. (#1) We have to change the Pr presentation, in reality, HIV/AIDS is not “Just a manageable chronic disease that is survivable” because we aren’t able to link and retain people in treatment. Because disparities in income, race and sexuality prevent access to treatment. Because people have a stigma about it, and refuse to test or be treated for their HIV.  If this is the case now, suddenly having a cure for it will not simply end the crisis. 

How do we get people who can’t afford the treatment, or are afraid to access it, to suddenly and miraculously access the Cure?  It’s highly doubtful, to me, that this Cure will be a onetime pill, or shot in a clinic.  But even if it is, do we really believe the pharmaceutical companies are going to let it go for like20 bucks and a lollipop? 

Which brings me to the next issue, are we suddenly, with a cure, going to avoid all of the disparities in Race, Class etc and find a way to access the Cure for all HIV+ people?!  My thoughts are such that it is not going to happen this way. 

Obviously, assuming that this cure, is not a long-term treatment plan such as it is for Hepatitis C, the third issue might not be such a big deal. But at the end of the day, if it’s anything more than a single visit to a Doctor’s office we will have to continue to research ways to overcome barriers to link and retention of care for HIV+ people. 

So as not to be repetitive, the fourth issue we have to address will be the cost of this Cure. I am certain, but given the length of time Atripla and the like have been on the market, and the current Market price for it and others; This cure will not be easily affordable.  Now maybe if Ryan White and other Federal Programs are allowed to then pay for this Cure we might have a decent success rate, as it is a basic understanding that a Cure would not be an ongoing treatment plan unending, such as HIV Treatments (ARVs) are now.  Budgetary, this could make ti more affordable, but I’m seeing it as dubious, at best…

The fifth thing Regan Addresses is that we have to decriminalize it.  While I agree with her sentiment that this will be more likely to happen once we have a Cure for it, States in the US aren’t likely to suddenly an rapidly just change these laws. And with a broad misunderstanding, currently, of the reality of HIV and treatment, do we really think people will just get it then? Will the public and doctors, and patients, and law enforcement and policy making officials just wake up and say “oh I get it!” and the stigma will end? Because if the Stigma doesn’t’ end the criminalization won’t and as long as it is criminalized, people will be afraid to seek treatment, whether it’s a cure or not.

I am not saying we should not be fighting for a cure.

I would never say that. I would love nothing more than to know that my loved ones, friends and lovers, family and community members, and every stranger not eh street struggling with this would be able to be HIV Free one day, functionally or sterilely. But let us not be hasty about the realities, we will need to pursue ALL of the things Regan Hofmann lists in her article in order to truly end AIDS.  The cure is just a piece of the puzzle, and until we have it, let’s focus our energy on the pieces we do have, to complete the puzzle before a 45^th anniversary…