Monday, August 11, 2014

HIV and Corporate Profit: Recognizing the needs of a Community

Jesus withdrew in a boat to a deserted place by himself. But when the crowds heard it, they followed him on foot from the towns. When he went ashore, he saw a great crowd; and he had compassion for them and cured their sick. When it was evening, the disciples came to him and said, "This is a deserted place, and the hour is now late; send the crowds away so that they may go into the villages and buy food for themselves." Jesus said to them, "They need not go away; you give them something to eat." They replied, "We have nothing here but five loaves and two fish." And he said, "Bring them here to me." Then he ordered the crowds to sit down on the grass. Taking the five loaves and the two fish, he looked up to heaven, and blessed and broke the loaves, and gave them to the disciples, and the disciples gave them to the crowds. And all ate and were filled; and they took up what was left over of the broken pieces, twelve baskets full. And those who ate were about five thousand men, besides women and children.
––Matthew 14:13–21, Lection for Proper 13A [August 3, 2014]

When I first moved to Boston in September of 2011 (some nine months after my diagnosis with HIV), I was not yet on an anti-retroviral medication. To be quite candid, I was afraid to start treatment. Despite the incredible reduction of side-effects caused by anti-retroviral treatment, I was weary of the cost. Starting an HIV medication can be something of a life-long commitment; in order for it to work the most effectively, total (or near total) adherence (that is, taking the medication every day, as prescribed) is requisite. Ceasing treatment often runs the risk of viral mutation and, therefore, resistance to medications. This was a proverbial plunge for which I was not ready.

Once established with a local HIV specialist, however, a medication was prescribed to me. My previous doctor in New York City had leaned on an older model of care. His stance was to wait to begin an anti-retroviral regimen until a patient's CD4 (or T-cell) count had dropped below about 300 (a count of 200 or fewer usually indicates the on-set of AIDS). This meant that, in theory, I could have gone many, many years without beginning medication, depending on my body's ability to handle the virus. My provider in Boston, however, introduced me to the notion of "Treatment as Prevention," a now standard approach to HIV care.

Treatment as Prevention relies on the now clinically verifiable notion that, in order to slow or even prevent the spread of HIV, a patient who is sero-positive should adhere to a medication so that the patient's viral load is suppressed to undetectable levels (or, what is called "undetectable viral load"). Studies have shown that HIV-positive patients who adhere to medication and maintain an undetectable viral load are exponentially less likely to transmit the virus (one researcher has even been quoted saying that the chances are reduced to near zero percent).

With this knowledge in hand, I accepted my provider's orders and began treatment. The results were almost instantaneous: within a month my viral load was reduced from 20,000 copies per unit to completely undetectable levels. As a result, my CD4 count rose, and my last blood panel showed them hovering just over 850––a high, healthy CD4 count for anyone, positive or negative. I, like so many others, now live with the reassurance that it is almost impossible for me to transmit the virus, especially when other precautions are taken. My adherence to anti-retroviral treatment is a safe-guard to the community, as well as myself.

This was the good news. The bad news, however, revealed itself when I needed to find away to pay for treatment. When I started taking medication in October of 2011, I had to rely on student insurance. While I am now fortunate enough to have coverage through MassHealth, the Commonwealth of Massachusetts public insurance, I did not qualify for it in 2011 because the university had enrolled me with Aetna. This presented a major problem. Not only did Aetna not adequately cover my doctor visits or blood work, they maintained a $2,000 yearly cap for medications. That might sound like a reasonable cap, but a 30-day supply of Atripla (the anti-retroviral medication prescribed to me) costs just over $2,000.

I'll repeat that: a 30-day supply of Atripla costs just over $2,000. I was (and continue to be) fortunate enough to live in an area of the U.S. where there are many resources for someone living with HIV. Although it was, by no means, an easy feat to get my medication covered during the first year, thanks to the incredible medical social workers in Boston I now have full coverage. This, however, is not the case universally, both at home and abroad. Treatment can be hard to come by, and this often prevents those living with HIV from receiving adequate access to medicine--medicine which not only allows patient to live longer, but also prevents the spread of HIV.

We will never live in a post-HIV/AIDS epoch unless this changes. Until there is a vaccine or a cure, Treatment as Prevention is the only sustainable model that benefits both the HIV-positive and HIV-negative communities. At a certain point, we have to ask ourselves (especially as communities of faith) how much longer we can allow the corporate profit made off of those living with HIV to outweigh the imperative that anti-retroviral therapy be made readily and affordably available to all, for the sake of all. Medications do not simply save individual lives; they save communities.

"Loaves and Fishes Mosaic"
Used under Creative Commons License.
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The Gospel pericope cited above serves as a cornerstone of this imperative. In this enacted parable (the historicity of which is not my purpose here), Jesus gives his disciples a command –– he gives us a command: "You go and feed them." The responsibility here is not Jesus’; it is ours. The necessary resources are already abundant by God's good grace, and we simply have to recognize that. But, in recognizing this abundance, we are also forced to ask where this abundance frequently ends up. Does it end up serving the good of the community, or does it end up in the hands of a few? The responsibility is ours.

Let's take Jesus at his word in this parable: "You go and feed them."

Sean R. Glenn is Integrity's Diocesan Organizer for Massachusetts. He is a composer and conductor of sacred choral music, and holds a Masters in Theological Studies from Boston University and a Master of Arts in Music from the Aaron Copland School at Queens College. His home on the web is

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