December 1st was World AIDS Day. Since 1988, it has been a day to reflect on those we have lost to the disease, support those who are currently living with it, and educate each other about HIV/AIDS infection, prevention, and treatment options. Sponsored by the World Health Organization, which has a goal to “end AIDS by 2030,” World AIDS Day also serves as an important yearly check-in that helps measure how far we’ve come and how far we still have to go in fighting the global pandemic. Each year, the WHO chooses a different “theme” for World AIDS Day. This year’s theme is “communities make the difference”. Visit their website to learn more about the 2019 campaign.
CANNABIS AND AIDS: THE ROOTS OF THE COMPASSIONATE CARE MOVEMENT
Since the early years of the AIDS epidemic here in the United States, cannabis has played a crucial role in providing palliative care to HIV/AIDS patients, as well as helping to extend their lives post-diagnosis. It was the AIDS crisis that jump-started the Medical Marijuana movement in California (also known as the Compassionate Care movement), which in turn paved the way for Medical Marijuana programs in states across the country, many of which have gone on to decriminalize and form their own legalized, regulated recreational markets.
We have many people to thank for legalized cannabis, but AIDS patients and their growers and caretakers are at the top of the list. Because the stigma of being diagnosed was so great in the early years of the epidemic, patients and their caretakers often had to fend for themselves post-diagnosis. Cannabis can relieve many of the painful side-effects of the disease, and can significantly aid in appetite stimulation, which can be crucial as many AIDS patients die of chronic wasting--an inability to eat and keep nutrition in their bodies. It was a powerful medicine, and, lo and behold, could be grown and distributed to patients for little to no cost. It was a no-brainer: Cannabis quickly became a vital medicine very early on in the epidemic. Many studies have gone on to show that utilizing cannabis both improved the morbidity and mortality rates among those early patients; that is to say, their quality of life was increased, and their lives extended.
HOW FAR WE’VE COME
Today, patients who have HIV/AIDS and have access to medical care can live long, healthy lives. For those patients, HIV/AIDS is not a terminal illness so much as a chronic disease. With the help of Antiretroviral Therapies, patients can now get their viral load down to what’s known as an “undetectable” number. If someone’s viral load is undetectable, the disease is untransmissible, meaning someone who is on the right treatment regimen can safely have sex with partners who do not have the disease without the risk of transmission (RW Eisinger et. al, 2019)! In addition, new developments in pharmaceuticals have brought us Pre-exposure Prophylaxis (PrEP), which is a class of drugs designed for people without the disease, but who have risk factors associated with contraction. PrEP drugs lower the risk of infection by 92-99% if taken correctly and consistently--a miracle of modern science that seemed impossible not even 20 years ago.
In general, we are far better off as a global community, 30 years after the initial outbreak. From the World Health Organization Website:
“From 2000-2018, new HIV infections worldwide fell by 37% and HIV-related deaths fell by 45%, and by 2018, about 79% of HIV+ folks knew their status, 62% of them were receiving ART, and 53% had achieved viral load suppression and were declared “undetectable” with no risk of infecting others.”
“In 2000, HIV/AIDS was the 7th leading cause of death worldwide. By 2016 it was no longer in the top ten.”
In just 30 years, we’ve gone from HIV/AIDS being a death sentence with no hope in sight, to being a serious global health issue that can be managed with the right funding, outreach, and advocacy.
HOW FAR WE HAVE LEFT TO GO
Of course, not everyone has access to these life-saving treatment options, even in “developed countries” like the United States, where black southerners are over three times more likely to contract and die from the disease than other United States citizens (yes, right now, in 2019). In fact, the United States is currently in yet another AIDS epidemic, with the majority of new contractions occurring in the Southeast. In 2017, 52% of new HIV diagnoses in the US were in the South (see chart below). The majority of these patients are poor, black, and have low access to healthcare. Even those that do have access have a deep distrust of doctors and government, a sentiment understandably leftover from the Tuskegee Experiments (if you aren't familiar with the experiments, you can read about Tuskegee here).
Even in the midst of the initial epidemic, the United States suffered more diagnoses and deaths than any other “developed country,” by large amounts. There were many factors for this, including things like how our marginalized communities band together in tight groups (for example, gay men in San Francisco), which made transmission quick and easy, and how our puritanical society and conservative government dragged their heels and refused to address the epidemic until it had reached massive, undeniable proportions. It took activist groups like ACT UP, and “sympathetic” cases like Ryan White (a teenager who contracted the disease from a blood transfusion and not through unprotected “deviant” sex or intravenous drug use) to draw enough attention to the epidemic that the Federal Government and United States’ healthcare system finally began to respond.
The biggest difference between the United States’ response to the crisis and other “developed countries” like the UK or Germany, was that those countries almost immediately adopted needle exchange programs. Needle Exchange programs are the fastest, most effective way to prevent new outbreaks of the disease which occur from intravenous drug use. Despite overwhelming evidence for this, which we’ve had for decades, the United States time and time again refuses to adopt these programs.
Up until 2016, the federal government withheld any and all federal funding for any such programs that do exist. In 2016, the federal government agreed to release some funding to organizations that support needle exchange programs, but they do not currently allow that funding to actually purchase sterile needles. Today, needle exchange is mostly a state’s rights issue and so some states, including Oregon, have programs that do operate almost entirely with state & county funding (see the Multnomah County Health Department’s needle exchange calendar here). Even those states, however, have limited resources and cannot operate on the levels required to quell epidemic outbreaks.
Race and class are the two biggest factors in an HIV/AIDS patient’s diagnosis, potential treatment, and ultimate survival here in the United States. Fueled in large part by our broken, privatized healthcare system in addition to our massive income inequality problems, the rates of HIV infection are “10 times higher among people who earn $10,000 or less per year compared to people who earn $50,000 or more per year.” (From CDC.gov - National HIV Behavioral Surveillance (NHBS), 2006-2007)
THE CURRENT STATE OF HIV/AIDS IN PORTLAND, OREGON
Portland itself is in the midst of an HIV/AIDS epidemic, being fueled in large part by our houselessness problem. Intravenous drug users who are also houseless are more likely to have to share or re-use needles, and have very little access to testing and post-diagnoses care. The Oregonian is currently doing an in-depth, multi-part investigation into this issue, which should be required reading for all Oregonians. From part one of their investigation:
“The virus has historically targeted marginalized communities, devastating an entire generation of gay men in the U.S. in the 1980s and ‘90s, and later taking hold in communities of color. But in the past few years, the outbreak has surged among intravenous drug users who are – or who soon become -- homeless, and their sexual partners.”
You can read The Oregonian’s reporting for free online: part one here, and part two here.
SO WHAT DOES THE FUTURE HOLD?
Without a doubt, if we want to end AIDS, we must end the War on Drugs. Intravenous Drug users are people who deserve compassion and care, not criminalization and demonization. Robust efforts must be made to advocate and care for the most marginalized populations among us--”key populations” as they are known in public health circles--if we want to end this disease’s stronghold. We are all too familiar with how Regan-era drug policies have continued to harm our communities in regards to cannabis. From ridiculously high incarceration rates of black and brown “offenders” (cannabis users), to the campaigns that set out for years to demonize and stigmatize the use of our favorite plant. Cannabis activists fought (and continue to fight) very hard for our right to use it legally, and now we must expand our efforts to include decriminalizing and de-stigmatizing other forms of drug use. Yes, cannabis can be powerful medicine, and is therefore very different than “hard” drug use. However, when we center people, the reasons people use cannabis and the reasons people use “hard” drugs are often the same. People who use “hard” drugs are hurting, and deserve care and resources that can help them stop using--and protection while they still are. Until intravenous drug use and opiate addiction is tackled head-on, using compassionate and decriminalized tactics, we will continue to see vulnerable populations being lost to preventable HIV/AIDS deaths. From The Drug Policy Alliance’s Deputy State Director of California, Laura Thomas:
“We’re not going to end the HIV/AIDS epidemic until we end the war on drugs. We aren’t going to get to zero – meaning zero deaths, zero new infections, and zero stigma – until we end the war on drugs. Syringe access is essential, as is decriminalizing drug use and opening safer drug use spaces or supervised consumption facilities.” (World AIDS Day: We Can’t End the War on AIDS Until We End the War on Drugs)
COMMUNITIES MAKE THE DIFFERENCE: HOW YOU CAN HELP
There are so many incredible organizations working on the AIDS crisis from all different angles -- remembering the victims, organizing for current patients, working towards decriminalization, stigma-busting education and advocacy, and much more. Here are some organizations that are doing work right now, and could use your support:
Cascade AIDS Project - “Founded in 1983 and incorporated in 1985 as the Cascade AIDS Project, CAP is the oldest and largest community-based provider of HIV services, housing, education and advocacy in Oregon and Southwest Washington.”
The Center for HIV Law & Policy - “The Center for HIV Law and Policy challenges barriers to the rights and health of people affected by HIV through legal advocacy, high-impact policy initiatives, and creation of cross-issue partnerships, networks, and resources. We support movement building that amplifies the power of individuals and communities to mobilize for change that is rooted in racial, gender, and economic justice.”
San Francisco AIDS Foundation - “San Francisco AIDS Foundation envisions a future where health justice is achieved for all people living with or at risk for HIV. Ultimately, we strive for a day when: race is not a barrier to health and wellness; substance use is not stigmatized; HIV status does not determine quality of life; and HIV transmission is eliminated.”
National Minority AIDS Council (NMAC) - “NMAC’s mission calls on us to lead with race. What does that mean? What is NMAC trying to accomplish? NMAC’s urgency is in the numbers. Black women are 20 times more likely to get HIV than white women. Fifty percent of black gay men will have HIV by the time they are 35 (eight percent of white gay men are living with HIV). Even with quality HIV services, the results for many black women and gay men of color are awful. What are we doing or not doing that makes HIV so racially polarized?”
The Black AIDS Institute - Founded in May of 1999, the Black AIDS Institute (BAI) is the only national HIV/AIDS think tank focused exclusively on Black people. The Institute’s mission is to stop the AIDS epidemic in Black communities by engaging and mobilizing Black leaders, institutions, and individuals, in efforts to confront HIV.
Latino Commission on AIDS - “In response to the critical, unmet need for HIV prevention and care for Latinos, a coalition of Latino leaders founded the agency in 1990. The Commission realizes its mission by spearheading health advocacy for Latinos, promoting HIV education, developing model prevention programs for high-risk communities, and by building capacity in community organizations.”
Housing Works - “Housing Works is a healing community of people living with and affected by HIV/AIDS. Our mission is to end the dual crises of homelessness and AIDS through relentless advocacy, the provision of lifesaving services, and entrepreneurial businesses that sustain our efforts.” *Housing Works is based in and serves the greater New York City area.
The AIDS Memorial: What is Remembered Lives - “Stories of Love, Loss & Remembrance, the AIDS Memorial is a user-submitted, living memorial that keeps those we’ve lost alive through remembrance and storytelling.”
READ MORE:
World Health Organization: World AIDS Day 2019
CDC.gov: National HIV Behavioral Surveillance (NHBS)
New Republic: Why did AIDS ravage the US more than any other developed country?
New Republic: Five Startling Statistics About America's Dreadful Record on HIV/AIDS
Statista.com: The South Dominates the US in rates of new infection and death from HIV/AIDS
Fact Sheet from Tulsa Cares: AIDS rates and marginalized groups in the US
The Stranger: How a Bunch of San Francisco Queers Got Us Medical Marijuana
Clinton Werner: Medical Marijuana and the AIDS Crisis
The Drug Policy Alliance: We Can’t End AIDS Until We End the War on Drugs
Multnomah County Health Department: Needle Exchange Schedule
illustration by Stelleaux Peach
