December 14th, 2011
05:00 AM ET

Opinion: To stop AIDS in America, fight discrimination first

Editor's note: Dr. Paul Curtis Bellman is a physician in private practice in New York City and with New York Presbyterian Hospital.

By Dr. Paul Curtis Bellman, Special to CNN

(CNN) - As a physician who has been on the front lines of the HIV/AIDS epidemic since its beginning in 1981, I have taken care of thousands of HIV/AIDS patients. I believe that the key to stopping the epidemic now depends upon zeroing in on HIV/AIDS discrimination and stopping it cold.

The Centers for Disease Control and Prevention reported in August that the number of new HIV infections is stabilizing at 50,000 per year, but there is an “alarming increase among young, black gay and bisexual men.”

In fact, there’s a scandalous surge in new cases among blacks and Latinos - men and women - and young men who have sex with men. The CDC reported young, black men who have sex with men is the “only subpopulation to experience a sustained increase” between 2006 and 2009.

It affects women, too. The CDC recently estimated the risk of black women contracting HIV was 15 times greater than for white women. For Hispanic women, it was three times higher.

In America, the battle against HIV/AIDS is at a pivotal moment. The current administration has developed a national AIDS strategy that has laudable goals like increasing access to care. However, this is not ambitious enough in an era in which testing and treatment holds the promise to halt new infections. There are groundbreaking opportunities for change, opportunities we ought to seize.

Extraordinary progress in treatment means I can treat almost every single HIV-positive person in my medical practice with reasonably safe medications and ensure their long-term health and quality of life.

But few Americans, including medical professionals, know how effective state-of-the art HIV treatment is today. When an HIV-positive person is diagnosed and effectively treated, he or she can achieve an undetectable viral load. This reduction is so dramatic that HIV-positive persons on effective treatment might never transmit HIV. In one recent study, there was a 96% reduction in HIV transmission from an HIV-positive partner to an HIV-negative partner when the positive partner was on medication.

But, the medical capability is failing to adequately impact prevention. Many don't even know that they’re HIV-positive. A CDC report showed one in five HIV-positive U.S. residents are unaware of their infection status and half fail to receive routine medical care.

Many patients still incorrectly assume that an HIV diagnosis means AIDS, and even imminent death. The reality is that AIDS only develops when an HIV diagnosis or treatment is delayed. Yet because of HIV discrimination, many choose not to know and not to let any one else know.

The stigma of HIV diagnosis brings loss of status, discrimination, economic disadvantage and even imprisonment. One African-American patient told me HIV is just one more excuse for a black man to be sent to jail. One of my Latino patients was fearful that getting tested and getting treated with expensive medications might somehow get back to his employer. I reassured him that this was unlikely because of confidentiality laws. Sure enough, he was fired after his employer made a remark about how expensive his insurance coverage had become.

Just recently, an academically qualified 13-year-old student was denied admission to a prestigious boarding school in Pennsylvania for the sole reason that he is HIV positive. The school's representatives cited fears that, although they encourage abstinence, he might sexually infect other students. The story was widely reported by the media, but it's a lesser-known fact that the boy is African-American.

Although the school's position is rightly regarded as preposterous by medical professionals and public health officials, it reflects a level of ignorance that fosters widespread discrimination and stigma. The fact is that this boy - who knows his status and is on effective treatment - is absolutely not a danger to anyone else. Nor are the hundreds of thousands of HIV-positive Americans, black or white, gay or straight, man or woman, who know their status and are on effective therapy.

But many HIV-positive people, especially minorities and women, lack access to proper medical care. To make things worse for America's low income HIV-positive population, eligibility for public assistance to pay for HIV/AIDS medications is usually only available once AIDS has developed. Our system lets people spread HIV, often unwittingly, as a matter of policy.

Due to all these factors, many black and Latino HIV-positive people first enter the health care system with complications of advanced AIDS. Delayed diagnosis and treatment leads to disability and a more complex set of chronic health care needs. This is a costly public health tragedy of the highest proportions, all the more so because it is preventable.

In July, the World AIDS conference is coming to Washington, D.C., one of the epicenters of the epidemic. The U.S. capital has the highest HIV rate in the country - the infection rate is the equivalent of that in of the Ivory Coast or Congo, according to 2009 estimates from UNAIDS.

The D.C. conference is a historic opportunity to advance HIV/AIDS prevention and treatment, one that couldn’t have taken place before – until last year, HIV-positive non-citizens weren’t allowed into the United States. African-Americans and Latinos need to be on the top of the agenda.

As a physician who has worked with a diverse patient community, I know that the essential component to eliminating new HIV infections and new AIDS cases is testing and treatment.

We need a medical leadership that fights for education and access to intelligent prevention and care. We need to be more vocal and effective advocates for the vulnerable black and Latino populations and young men who have sex with men at high risk for new HIV infections and preventable AIDS complications. We need to go forward with programs that by improving access to health care will save so much in lives and for our economy as healthy HIV positive individuals contribute much to society in the workplace.

We need to fight against the discrimination that fuels the epidemic and educate, empower and partner with the affected communities. We have been silent about this unfolding tragedy and we now have the ability to stop it.

The opinions expressed in this commentary are solely those of Paul Curtis Bellman

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Filed under: Black in America • Ethnicity • Health • Race • Sexual orientation • Social justice • What we think
soundoff (14 Responses)
  1. promotion in yahoo

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    January 23, 2012 at 5:41 am | Report abuse |
  2. Jose

    Discrimination has nothing to do with AIDS. Only stupid people or careless people get aids.

    December 16, 2011 at 2:48 pm | Report abuse |
    • scotty501

      @Jose Mean while, back in reality, the 13 year okd child is not stupid or careless. You are ignorant and cruel. Most of the comments on here are from uneducated people. The FACTS: the financial impact of HIV on the health care system is NOT even in the top five chronic conditions. So instead of judging innocent children look at your own families BMI, smoking, diabetes etc. Just because fat is common in the US doesnt make it less costly. Next time you pay the extra 25 cents to super size you meal remember the cost to the US.

      December 16, 2011 at 4:23 pm | Report abuse |
    • Bruce

      Jose I agree 110%. Discrimination has nothing to do with this. Its not like only certain classes or backgrounds have received the message about condoms and IV needles. Hell you can get both for free if you wanted to. The increase of HIV in blacks and latinos has nothing to do with discrimination and the more you pander to the victim philosophy the more you empower them to blame someone other than their own carelessness and stupidity.

      December 19, 2011 at 3:19 pm | Report abuse |
  3. Jeton Ademaj

    this comments section is itself a perfect illustration of the kind of stigma that makes it far harder to convince people to go get tested...and harder to keep HIV+ people on their meds with the regularity needed for it to be effective. now is the time for governments to commit both to "Test and Treat" and research towards a Cure. test *everyone*, offer effective medication and adherence support to everyone infected, and push forward toward the Cure that has now (finally) proven to be scientifically feasible. the consensus in the medical and scientific communities is that, over the long-term, this is actually the lea$t expen$ive of all possible responses.

    none of that will be possible when people like richard and dirtydog publicly bask in their own malevolent sanctimony without public rebuke...of course, they are the tip of a populist/know-nothing iceberg. notice that no one has actually addressed the point of the Dr. Bellman's op-ed and the accompanying video clip? Stigma is proven to spread HIV more efficiently than any supposed moral deficiency.

    bravo to Dr. Bellman. it's time for many more doctors and scientists to step up and plainly state the same long-known and long-proven truths.

    for the bigots out there, keep in mind that celebrating or ignoring the deaths of others has a way of getting back to you. microbes like to mutate, after all...there's that pesky Evolution again! the longer the people of the world turn away from HIV as a disease that "only undesirables get", the larger the pool of HIV virus grows and the greater the chances that it mutates into something that could wipe us all out. read Richard Preston's "The Hot Zone" for a very chilling account of how that almost happened in 1989 in Reston, Virginia when the most lethal strain of Ebola known (Ebola Zaire) suddenly mutated into an *airborne* virus and wiped out a facility full of chimpanzees. LUCKILY, that new strain (Ebola Reston) only affected chimps. we all dodged a bullet there, but we all have a fairly limited supply of Luck.

    quarantine is not viable. genocide threatens us all in every version. the only solution is stopping the spread, and that can't happen without ending the stigma. bigots of every stripe, get over yourselves already. you may tell yourself you're responding to a threat, but when you spread mindless hate, YOU are the actual threat...to everyone.

    December 16, 2011 at 11:01 am | Report abuse |
  4. dot

    we had the ability to stop this mess in the '80s, but our government thought it could sweep it under the rug and it would go away. which is exactly what they are doing today. i heard they have a vaccine for malaria. its a bad disease,but it doesnt spread like hiv/aids, but they are working tirelessly to "cure" it, and no word yet on an aids vaccine.

    December 16, 2011 at 9:11 am | Report abuse |
  5. Robo G

    Good to hear the medicine is so good that gay men don't even have to bother to wear condoms anymore. Or worry about "accidently" killing anybody. Since the worst that can happen is that the HIV recipients will get it too. Plus employers should be happy too about how HIV employees are more productive than employees with full-blown AIDS. And not as great a spike to everyone's insurance costs either. So everyone can celebrate.

    December 15, 2011 at 5:19 pm | Report abuse |
  6. teresa, ohio

    : ( wow, my very logical and insightful post didnt get put thru.... i used the "s" word ( se cks)

    find out why that group of young men is doing it with anybody and everybody without a care for their own
    health. Its not discrimination keeping them from seeking treatment.

    December 15, 2011 at 3:39 pm | Report abuse |
  7. dirtydog1776

    While there is discrimination against people with AIDS, the main problem is people making bad choices in their life styles and then expecting someone else to assume the consequences of their actions.

    The gay community, along with other groups, long engaged in risky behavior. When an AIDS epidemic began, there was weeping and wailing, and rending of garments over how evil people and the government were because not enough money was spent on AIDS research.

    Start with people making good choices.

    December 15, 2011 at 9:20 am | Report abuse |
  8. whosurdaddy

    Normal people don't get AIDS.

    December 15, 2011 at 4:33 am | Report abuse |
  9. Peter Griffin

    Oh my god, who the hell cares?

    December 15, 2011 at 1:38 am | Report abuse |
  10. Richard

    Fact is, there is no shame anymore. People (aside from innocents who received tainted blood) acquire the disease through known pathways they can avoid. If they are stigmatized, they've earned as least part of that.

    December 14, 2011 at 11:16 pm | Report abuse |


    December 14, 2011 at 4:27 pm | Report abuse |
  12. gene fedorko

    because of stigma, distrust, fear, many people victimize themselves and others in terms of HIV, and are shut down about the issue. no wonder, as people can be marginalized by family, friends, employers, etc. few people acknowledge the fact that if one has an undetectable viral load, chances of transmission are next to zero, which further thickens the blanket of secrecy wrapped around these issues.

    December 14, 2011 at 1:54 pm | Report abuse |