End of the Epidemic

End of the Epidemic

HIV/AIDS is  an epidemic that disproportionately affects  undocumented individuals in the United States. The lack of services, funding and social workers who are underpaid exacerbates this issue . Many  Hispanic families are still under the impression that HIV is a death sentence. There is a lack of awareness within this community regarding treatment options for HIV/AIDS and the resources available to them such as education sessions and group therapy. . Why can’t an undocumented person living with HIV/AIDS or a chronic illness obtain full health benefits like other people living in the United States?   The reasons why people are not receiving proper health benefits include stigma, (fear of?) deportation, lack of available benefits and poor understanding of the disease itself.

While HIV infections have increased throughout the years, many of the people around the globe do not know how these numbers are increasing and who is being affected by the virus. According to an article in HIV.org, “There are approximately 36.7 million people worldwide living with HIV/AIDS at the end of 2016. Of these, 2.1 million were children (<15 years old), an estimated 1.8 million individuals worldwide became newly infected with HIV in 2016 - about 5,000 were new infections per day. This includes 160,000 children (<15 years old)”  This would be a great example to show someone who does not know about data and facts of things happening around the world, because it is necessary for people to know the reality of this epidemic.

Undocumented individuals have become part of the statistics of HIV/AIDS cases in the United States. In an article done by PLoSOne.com, “Within the Hispanic population, immigrants, especially undocumented, may be particularly vulnerable to barriers to regular HIV care. Of 75 foreign-born Hispanic patients attending a public system in NYC, 69% were employed but 17% had health insurance.” The lack of health insurance coverage within this community likely precludes them from obtaining proper medical care which is vital in tackling this disease

Another barrier faced by undocumented immigrants with HIV is stigma which may be culturally related. The  Latino Commission on AIDS wrote in an article, “Some Hispanics/Latinos may avoid seeking testing, counseling or treatment if infected because of immigration status or fear of discrimination.”  It is clear that culture influences will affect the person in decision making when facing a situation as mentioned above and not seek for proper medical care or resources. It is important to ask questions and use available resources.

Another factor that affects the undocumented clients with HIV is the lack of benefits.  The uncertainty of not knowing where you will spend the night, where will you be living next, it could be very stressful for an individual. In an article by HIV.gov states,“The conditions in which people with HIV live, work, learn and play contribute to their ability to live healthy lives. With safe, decent and affordable housing, people with HIV are better able to access comprehensive health care and supportive services, get on HIV treatments, take their HIV medications consistently, and see their healthcare provider regularly.” This shows that if a client has better living conditions, their ability to get better physically and mentally will demonstrate by being adherent to their treatment.

Unfortunately, laws and rights have been deteriorated and modified to a level than clients have almost nothing to benefit from. In an article from L.A times it states, “Undocumented immigrants have limited access to health insurance and medical care, a fact the Affordable Care Act does little to change. Though it increases access to Medicaid and private health insurance, the law bars millions of undocumented immigrants, including an estimated 1 million Californians, from these programs.”  This shows that regardless of the little help the undocumented are getting there are tons of people still in need and not being taken care of.

Many Americans benefit from medical insurance covering them all without any kind of obstacles. Unfortunately to undocumented luck is not the same. In an article by Healthaffairs.org it states, “In the United States, undocumented immigrants have lower rates of health insurance coverage and medical service usage than U.S. Citizens or documented immigrants. Having medical insurance coverage whether private or through Medicaid significantly influences the actual utilization of healthcare services.”  This describes how the healthcare system in America only cares about their numbers and how to spend their budgets. They do not focus on the moral aspects of the undocumented people seeking for long term medical care.  

The next reason is deportation. Undocumented people are afraid of deportation because of the new Trump administration making random laws to punish those who are living in the USA and cannot access public assistance.  According to an article in poz.com, “Esther, a 70 year old woman, arrived in the United States in 1986. She came with her husband on a temporary visa when his business sent him abroad. Four years later, Esther learned that her husband had AIDS and that she had contracted HIV from him.  He died in 1992, leaving her in a country she wished to claim her home, but in a state of legal limbo - unsure she could get care without being sent back.” this shows the uncertainty of undocumented ill individuals who don’t know the future they might have in this country.

There are new laws that will charge through who are undocumented and receiving benefits.  This will affect clients with HIV who are scared to go back to their homes in other countries where they will not find the medical help they will need to have regularly.  In a journal posted by PMC National Institutes of Health they stated that, “Fear of deportation, whether real or imagined, was identified as a barrier in 65% of articles. Undocumented immigrants reported avoiding health care and waiting until health issues were critical to seek services because of their concerns of being reported to authorities.” This indicates the apprehension in which the undocumented clients have to get to this point of their lives to avoid medical services while being critically ill with the AIDS disease.  

Another reason that is probably one of the most powerful ones is Stigma.  In an article write by Avert: Global information and education on HIV/AIDS it states: “Stigma and discrimination also makes people vulnerable to HIV. Those most at risk to HIV (key affected populations) continue to face stigma and discrimination based on their actual or perceived health status, race, socioeconomic status, age, sex, sexual orientation or gender identity or other grounds.” This proves that Stigma has not gone away from our communities. It is still present and it is hurting many who are trying to seek for medical services; yet, they are afraid to be spotted at a medical facility and they return their homes.

If there was a way to count how many people in reality are being stigmatized and bullied because of their HIV status, the numbers would triple when it comes to real evidence. In another article from Avert: Global Information and Education on HIV/AIDS they wrote: “The People Living with HIV Stigma Index documents the experiences of people living with HIV. As of 2015, more than 70 countries were using the HIV Stigma Index, more than 1,400 people living with HIV had been trained as interviewers, and over 70,000 people with HIV have been interviewed. Findings from 50 countries, indicate that roughly one in every eight people living with HIV is being denied health services because of stigma and discrimination.” This shows only a certain portion of a study done.  What about the other people who are in silence because of stigma issues in their communities. Some even stopped going to their appointments because the way they were treated among medical facilities.

Words could be damaging when used the wrong way.  It could affect an individuals to the point of suicidal attempts, especially with a person diagnosed with HIV/AIDS. In a campaign article done by the Center of Disease Control it says: “HIV stigma and discrimination affect the emotional well-being and mental health of people with HIV. People with HIV often internalize the stigma they experience and begin to develop a negative self-image. They may fear they will be discriminated against or judged negatively if their HIV status is revealed.” This demonstrates that even high entities such as the CDC recognizes the seriousness of this situation and by doing national campaigns they are helping reduce the stigma among the people in the United States.

These were the reasons why people are not receiving proper health benefits. Lack of Information and Knowledge, Lack of Benefits, Stigma, and Deportation.  Now, putting that aside, there are couple of positive news that could help alleviate some of the factors already mentioned. According UNAIDS.org in a recent article it states:  “Three large studies of sexual HIV transmission among thousands of couples, one partner of which was living with HIV and the other was not, were undertaken between 2007 and 2016. In those studies, there was not a single case of sexual transmission of HIV from a virally suppressed person living with HIV to their HIV-negative partner. The Explainer cautions, however, that a person can only know whether he or she is virally suppressed by taking a viral load test.” This proves that a person living with HIV cannot infect someone else if the person is treatment adherent.  

Many lives have been transformed by this statement. The moral and future of those who were struggling with self-acceptation about their status has now changed. HIVplus Magazine stated in one of their articles: “After hundreds of other experts and HIV organizations have already signed on to a pledge that recognizes that people living with HIV whose treatment has brought their viral load to an undetectable level which is nearly half of all HIV-positive people in the U.S. do not transmit HIV to any other person, the Centers for Disease Control and Prevention has come out with the definitive statement on the subject.” This demonstrates that a person living with the virus will not infect another individual.  The Center for Disease Control has been very clear and made it an official statement. Who better to trust but those who have done years of research and have shown dedication and hours of labor such as Doctors and Scientist to stop the infection and make people’s lives happier.

The future of HIV/AIDS is now in control of those who know how to manage it. New York City and the city electives have come with a great plan to end the epidemic.  In an article by the New York Health Department it states: “On June 29, 2014, Governor Andrew M. Cuomo detailed a three-point plan to move us closer to the end of the AIDS epidemic in New York State. The goal is to reduce the number of new HIV infections to just 750 (from an estimated 3,000) by 2020 and achieve the first ever decrease in HIV prevalence in New York State.”  This shows the interest and dedication that people in power have shown for the people of New York. Avoiding new infections and making sure those living with the virus remain undetectable.

Another group of individuals added more information in their campaign to End the Epidemic.  The treatment Action group said in their article: “But ending the epidemic isn’t just about reducing new HIV infections. It is also an opportunity to end AIDS and improve health outcomes among people currently living with the virus. End of the Epidemic strategies therefore aim to maximize the number of individuals who learn their diagnosis as soon as possible after infection and are immediately linked to expert and culturally competent care and services, including state-of-the-art HIV treatment.”  This illustrates the importance of ending this epidemic and how people not just from New York but from the world can put in practice our model.

Unfortunately there are people who are not following treatment the way they are supposed to and they are infecting other individuals.  After interviewing two individuals about U=U at a non profit organization that works with clients with HIV, I have learned that not everyone is on the same page. Client A stated “I don’t care who comes to me to have sexual relations, if they know I am HIV positive they shouldn’t have sex with me. They are on their own risk” This shows how irresponsible this client is, knowing that he can destroy someone’s life, he prefers to keep it to himself and ignore what would happen next.

The fact that this is happening is really scary.  Client B stated “My whole deal with U=U looks very unreal to me, there is no way in hell that someone with HIV in their blood cannot infect someone else. It is dumb and stupid. I would have all the scientists and research Doctors working on this to be fired.” This shows the lack of education and understanding of the individual not accepting the reality of science and its advances.  Unfortunately this is the reality of many people. However, some individuals continue to work hard to make things better for the rest of the humanity.

In conclusion; No person, documented or undocumented should be denied for any benefit that will make a person’s life better. The lack of benefits can really interfere with an individual’s self-esteem, happiness, growth and unfortunately it can fall into a state of depression.  Undocumented people are being denied for services, some of them are uneducated about how the health system works, others are hesitant to seek treatment due to fear of judgement and many of them fear deportation due to government law changes. Overall, we all should be granted health benefits regardless of our legal status to make our lives healthier for a better future. HIV AIDS is not a death sentence anymore, the world needs to understand that every HIV infected person needs to be in treatment in order to live long lives on this earth. Let Stigma, Deportation, lack of benefits and lack of understanding become a thing of the past.

Work References:

Abadsidis, S. (2017). CDC Officially Admits People With HIV Who Are Undetectable Can’t Transmit HIV. Retrieved from https://www.hivplusmag.com/undetectable/2017/9/27/breaking-cdc-officially-recognizes-undetectableuntransmittable-hiv-prevention

CDC.gov. (2018). HIV Stigma Fact Sheet. Retrieved from https://www.cdc.gov/actagainstaids/pdf/campaigns/lsht/cdc-hiv-TogetherStigmaFactSheet.pdf

Davila, C. (2009). HIV And AIDS, Among Knowledge, Responsibility And Ignorance; A Study On Medical Students At The End Of Their First Universitary Year. Retrieved from https://www.nbci.nlm.nih.gov/pmc/articles/pmc5052504.

Department of Health. (2018). Ending the AIDS Epidemic in New York State. Retrieved from https://www.health.ny.gov/diseases/aids/ending_the_epidemic/

HIV.org. (year). Housing and Health:Why Is Stable Housing Important for people with HIV? Retrieved from https://hiv.gov/hiv-basics.living-well-with-hiv/taking-care-of-yourself/housing-and-health

Latino Commissioner on AIDS. (2016). Addressing Stigma Around HIV/AIDS In The Latino Community. Retrieved from http://www.latinoauds.org/news_detail.php?cat=pr&id=186

NYC Health. (2018). HIV Undetectable = Untransmittable (U=U). Retrieved from https://www.1.nyc.gov/site/doh/health/health-topics/hiv-u-u.page

Okulicz, J.F. (2013). Treatment Outcomes In Undocumented Hispanic Immigrants With HIV Infection. Retrieved from https://www.ncbi.nlm.nih.gov/articles/pmc3608625.

Popa, Mircea Loan, Gabriela Loredana Popa, Anda Mihai, Madalina Ocneanu, and A Diaconu. (2009). Journal of Medicine and Life: HIV and AIDS, among knowledge, responsibility and ignorance; a study on medical students at the end of their universitary year. Retrieved from https://www.ncbi.nlm.gov/pmc/articles/PMC5052504/

Ryan, B. (2011). Getting HIV Care Without Getting Deported: Treatment options and help are available for people with HIV-and without immigration papers. Retrieved from https://poz.com/article/illegal-Deportation-HIV-21243-6852

Treatment Action Group. (2018). What Does it Mean to “End the HIV.AIDS Epidemic”? Retrieved from https://www.treatmentactiongroup.org/ete/2

UNAIDS. (2018). Undetectable = Unstransmitable: Public Health and HIV Viral load suppression. Retrieved from http://www.unaids.org/en/resources/presscentre/featurestories/2018/july/undetectable-untransmittable

UNAIDS. (2018). Global HIV/AIDS Overview: The Global HIV/AIDS Epidemic. Retrieved from http://hiv.gov/federal-response/pepfar-global-aids/global-hiv-aids-overview

Two Individuals were interviewed and they did not want their names to be revealed in this research paper.