Better Not To Get HIV In America

Last night saw the premiere of the HBO version of Larry Kramer’s The Normal Heart. It focuses on the very beginning of the epidemic. But in some ways, the American AIDS experience remains as different from the rest of the developed world now as it was back then. The world is transformed medically, of course, but the deeper pathologies of the American healthcare system have sustained more infections than in any other advanced country.

As Michael Hobbes explains in a must-read, America’s decentralized and haphazard patchwork of care is part of the problem:

In the United Kingdom and Germany, if you test positive for HIV, you’ll immediately be referred to an HIV clinic for tests to measure how much of the virus is in your blood and how well your immune system is holding up. Three-quarters of Brits diagnosed with HIV get to this next stage of care within two weeks, and 97 percent make it within three months.

This is not just some nationwide codification of English politeness. Clinics that provide testing are required to get HIV-positive people to the next round of tests or they don’t get fully reimbursed. If you screen positive and skip your viral-load test, you’ll get a call from the clinic asking why you didn’t show up. Some testing centers will walk you straight to the hospital to make an appointment.

In the United States, only 65 percent of people with HIV get linked to a hospital or clinic within three months. A survey in Philadelphia published in 2010 found that the median time between diagnosis and treatment was eight months. The effect of the wait can be devastating. A 2008 study found that gay men who had full-blown AIDS before they were diagnosed were 75 percent more likely to die within three years, even if they got on treatment. For people whose viral load is high and T-cell count is low, getting on HAART is like putting on sunscreen after they’ve already been at the beach for two hours.

(The above chart taken for an accompanying article)