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Why We Can't Forget about HIV/AIDS in Health-Care Reform

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Over the past few months, two issues have dominated the debate over how to reform our nation's ailing health-care system: reducing costs and expanding access to quality, affordable coverage for every American. For long-time advocates of universal care like me, the discussion is an encouraging sign that we're closer than ever before in our history to achieving this goal. But in the midst of all the finger pointing and political jockeying, one issue has been largely overlooked -- winning the war against HIV and AIDS.

This issue is personal for me. I've lost close to 300 close friends to this disease, have given eulogies at funerals for 90 people under the age of 40 and know many more who are fighting everyday. Most painfully, my nearest and dearest have been lost. I will never see them again.

While scientists are making remarkable strides in reducing HIV/AIDS-related deaths through antiretroviral drugs (ARVs) and biologics, progress has masked the persistence of the disease. The urgency to find a cure has diminished because many people see it as a manageable condition such as high cholesterol or diabetes. We must be certain given these changing circumstances that complacency doesn't undermine our fight against HIV/AIDS.

The HIV/AIDS epidemic is far from over. Just look at the recent studies.

According to the Kaiser Family Foundation, only 17 percent of 18-29 year-olds are "very concerned" about HIV infection. The share of people who view HIV/AIDS as the most important health threat facing America "declined precipitously" in the last three years. Perhaps most alarming, one-quarter of people surveyed believe an AIDS vaccine already exists.

Despite recent medical progress -- including the identification of antibodies that could open new pathways toward a vaccine -- we're still years away from that goal. And while ARVs are extending lives, it's still an ongoing struggle for people undergoing treatment. In many ways, living on ARVs is akin to enduring chemotherapy, with regular sickness and constant fatigue.

We must treat HIV/AIDS as the public health emergency it continues to be. More than 500,000 Americans have died from the disease. An estimated 1.1 million Americans are living with HIV - and as many as 250,000 may not even know it yet.

With the health-care debate resuming in Washington, Congress and the Obama administration must make HIV/AIDS a cornerstone of comprehensive reform by embracing three equally important measures: expanding access to treatment, prohibiting insurance companies from discriminating against people with HIV/AIDS and supporting research to find better treatments and eventually, a vaccine and cure.

First, expanding access to treatment needs to go hand in hand with covering the uninsured. A study by Stanford University and the RAND Corporation found that expanding public insurance coverage for uninsured people with HIV/AIDS could reduce annual death rates by 66 percent. Access to private insurance would produce even better results. The study's author stated it bluntly: "Expanding insurance for HIV patients clearly can save lives."

It also saves money. While the cost of ARVs is expensive, the cost of inadequate treatment is even higher. A 2006 report in the Journal of Acquired Immune Deficiency Syndromes calculated that HIV/AIDS costs the U.S. $36.4 billion a year, mainly in lost productivity. Access to treatment that keeps people healthy can reduce that figure substantially.

Second, because insurance is essential to receiving treatment, insurance companies should not be allowed to drop anyone from coverage after diagnosis or deny people coverage because of their HIV status. Those who are trying to remain healthy with HIV/AIDS are in the most vulnerable period of their lives; that's no time to leave them without access to care.

Americans with HIV/AIDS also need to be able to choose their doctor and hospital, not have providers excluded by insurance plans trying to keep AIDS patients off their rolls. Treating HIV/AIDS is a lifelong commitment that demands strict adherence to drug protocols, consistent care, and a trusting relationship with health care providers.

Third, we must continue to develop new treatments and work toward a cure within the next decade. Government support for scientific research is key, as is keeping private funds flowing into effective treatment and prevention. Getting a traditional pharmaceutical to the market can cost a billion dollars or more. Newer, more tailored and targeted drugs called biologics are even more complex and expensive. Simple economics dictates that companies and venture funds will invest more in products that can generate a sufficient return.

In July, a coalition of HIV/AIDS advocacy organizations called on the Senate Committee on Health, Education, Labor, and Pensions - then chaired by the late Senator Ted Kennedy - to provide a 12-year period of data exclusivity for biologics, so that companies have an incentive to invest in innovation. The Committee included that standard to ensure that researchers and innovators continue to develop effective drugs to treat the world's most pressing medical challenges, such as HIV/AIDS. There are currently 29 HIV/AIDS vaccines in development, all of which by definition are biologics.

For nearly three decades, too many people have died and millions more are living with HIV/AIDS' painful realities. Stated simply, it is far from over. As Congress and the president work toward an agreement on health care reform this year, ending HIV/AIDS must be an urgent policy priority. By expanding access to treatment, ensuring coverage for those who are sick and spurring new research into treatments and a cure, we can reignite our commitment to eradicating this devastating disease once and for all.

David Mixner is an author, political strategist and civil rights activist. Once named by Newsweek as the most powerful gay man in America, David has been a highly regarded leader in American politics and international human rights for over 40 years. He writes the blog http://www.davidmixner.com