HIV/AIDS in South America

Transcription

Every year, more than 13,000 people die of AIDs in America. You know how many die in Germany, or Britain, or France? Less than 250. The entire EU, with a population 1 and a half times larger than America’s, had fewer than 1,000 deaths from AIDS last year. It’s like this everywhere you look. Pick any statistic, in any year, and America’s HIV numbers are digits worse than any other developed country, even when you control for population. So why is the AIDS epidemic so much worse in America? Yes, it’s partly Reagan’s fault. But it's also ours. Let me explain. OK, let’s start with the easy reason: AIDS arrived in America before any other developed country. The virus originated in Central Africa in the 1950s. A few isolated cases made it to the US and Europe, but it never really spread. AIDS really began to take hold in Haiti, in the 1970s, taken there by workers who went back and forth to Zaire. Haiti was a popular vacation spot with Americans at the time. Gay Americans got it from Haitians, and brought it back home. This is when the virus as we know it starts to appear. It caught fire in gay communities in New York, San Francisco and LA, and spread from there to blood donors, drug users and the rest of the country. And that’s also how it got to Europe. Genetic tests on the virus have shown that it arrived in Europe from America, not from Africa. We didn’t get it that much earlier than they did, but for an invisible virus, that sits dormant for 10 years before it gives you symptoms, a little head start goes a long way. The second explanation is a little more speculative: Americans move around more than Europeans. It’s easy! Our country is big, and we all speak the same language. American gay communities were more concentrated than European ones and, crucially, Americans had higher rates of intravenous drug use. Before the virus even had a name or a test, it was spreading through our cities faster than anywhere else in the world. OK, here’s where it gets political. When the AIDS epidemic arrived in Europe, most countries immediately instituted needle exchanges. The idea was harm reduction: No one liked that bunches of people were shooting up heroin, but stopping the disease meant giving them a safe, clean place to do it. By the 90s, the UK was giving out 25 million free syringes every year. In Germany, you could get free needles at vending machines. America did the opposite. We were right in the middle of the drug war, and to people living in inner cities, where drug use was the highest, it seemed insane to give people the implements to use them. For decades, the US refused to provide any federal funds for needle exchanges, or even to pay for research into whether they worked. In most states, you couldn't even have a needle on you. By 1996, America had 37 times more drug users with HIV than the UK. Here’s a graph of AIDS deaths since the beginning of the epidemic. See how they fall in Britain, Germany and the US, all at the same time? That’s anti-retroviral therapy. Medication that prevents people from dying of AIDS, and makes them much less likely to infect other people. But this graph isn’t just deaths, it’s death rates. Even with a much larger population, Americans are still more likely to die of AIDS than in other developed countries. That’s because preventing AIDS deaths means getting people onto treatment early, before the virus damages their immune system beyond repair. Europe does really well on this. If you test positive for HIV in Britain, someone will walk you from the testing clinic straight to the hospital to get treatment. In America, you’re on your own. It’s like this after you’re diagnosed too. For treatment to be effective, you need to take it at least 90 percent of the time you’re supposed to. In America, that can mean thousands of dollars a year. If you lose your job, or move to a different state, it can be hard to stay on treatment. These little disincentives, they add up. Nearly half the people with HIV in Britain and Germany are on treatment. Only one-quarter of Americans are. And it’s not just that our health care system is inconvenient. In the last 20 years, the AIDS epidemic has migrated to the populations who are the least able to access it. AIDS used to be an epidemic of gay people, concentrated in major cities. It is now an epidemic of poor people, and ethnic minorities, and concentrated in the South. Here, I’m gonna leave this up for a second because I feel like it’s a big deal. After the introduction of HIV treatment, mortality rates among white people plummeted. Black men with HIV are more likely to die now than white men were before HIV treatment was invented. So what does all this add up to? It’s too easy to say that Europeans have socialized medicine, and that’s why AIDS has been less severe there. By the time treatment became available, America had more new infections every year than Germany or the UK had in total. Managing an epidemic at that scale would have required a huge investment. But it’s an investment we haven’t made. Since the epidemic began, three times more Americans than Europeans have died of AIDS. As the disease has drifted farther and farther from our coasts, and our cities, and our affluent, it has started to look like every other disease in America. And maybe that’s why we stopped paying attention.