Certainly, since the advent of protease inhibitors and the real progress in antiretroviral medication, the ability to treat HIV infection and slow down the progression to serious illness and death is very real. However, the disparity in being able to reap the benefits to the treatment advances is also very real in the United States, and certainly when one looks at the global epidemic. Health care is still very much a privilege and not a right, so a person’s socio-economic status affects the degree to which he or she has access to the medications. There are racial disparities in health care which make the ability to take advantage of the medications an issue of race. So, the disparities that we have in our society continue to play out in the AIDS epidemic.
I learned of my HIV infection in October of ’89 and enjoyed an asymptomatic period until 2 years ago. How and why I got sick is a mystery to both my doctor and I, but the fact is that I contracted PCP. That’s the definition of AIDS, so I moved from being asymptomatic HIV-positive to AIDS. And that also meant that I needed to start taking medications. Taking the drugs represented a sort of a Rubicon of illness that frightened me. I guess it was easier than I thought it would be. We always project a catastrophe, and when the reality comes around, it’s often not as bad as we thought it would be. I was very fearful that I would miss my regimen’s schedule, and with ARV, you have to adhere to the schedule. I’m amazed at myself at how disciplined I’ve been at taking my medications.
I’ve been in a committed monogamous relationship for 5 years. My partner, who had AIDS, died in ’95. After the death of my partner I was getting back into the dating world after a relationship of 11 years. One of the things that shocked me was the degree to which safer sex was not necessarily a given. More often than not I had to bring up the issue, and that kind of surprised me, that things could easily have progressed without the issue coming up.
People are living longer. I just assumed that I would be dead by the time I was 50. So geriatric care and HIV care are going to have to be more blended. It’s going to be an increasing population, but we have to look at the issues. How is HIV going to increasingly affect Medicare? When more and more people who are HIV-positive are eligible? And as people get older that’s going to be more and more of a burden.