‘Stepping up the Pace’ theme in sync with U.S. AIDS agenda

Valdiserri-story03The Jackson Advocate conducted an interview in collaboration with The Black AIDS Institute on July 22, 2014, at the 20th Biennial International AIDS Conference. Jim Sulton of the Advocate joined with Phill Wilson, President and CEO of the Institute, to interview Ron Valdiserri, Deputy Assistant Secretary of the Department of Health and Human Services for Health and Infectious Diseases, to learn about his perspective and that of the department on the 2014 conference.

Jim Sulton: Please share your thoughts in general and your perspective on the substantive topics or subjects being addressed at the conference here in Melbourne.

Ron Valdiserri: First of all, the theme of the conference, “Stepping up the Pace” is very much in sync with the momentum of the department at this time. I say that because we do have a national HIV strategy, one which was developed in 2010.

Stepping up is an important idea because we continue to see wide disparities in healthcare for HIV/AIDS, particularly as the disease manifests itself among African-American men. When we look at health care disparities we see greater mortality rates there than there should be. We need to identify and act upon the challenge of why more young black men are becoming infected these days than other population segments.

JS: Please describe some of the tangible and intangible measures you are taking to accomplish this.

RV: Sure. On the tangible side, the principal issue is one of focusing on where the disparities are most severe. In this sense we are talking about the South. Clearly, there are identifiable populations, like young black men in the South that have been more adversely affected. We are pursuing tangible ways of stepping up the pace there.

That is why we are focused on what we call the “care cascade.” Sometimes also referred to as the treatment cascade, this concept is a model being used by the department to identify opportunities related to the improvement of service delivery to persons living with HIV/AIDS. Through this approach, we learn
how many people are at risk, how many people have been infected and what level of care they are receiving.

As for the part of your question about the intangible side, I am reminded that the issue of stigma is still very real. A lot of people think that this phenomenon resides exclusively outside of the United States. Unfortunately, that is not the case. Worse, the problem of stigmatization can be compounded by engaging in racism and/or homophobia.

This means that education is important. It is important to explain that there is life after contracting HIV/AIDS. Every nation has its cultural idiosyncrasies and too often those are negative phenomena when it comes to HIV/AIDS.

JS: Allow me to pursue that comment a little further if I may. What happens when those sort of cultural inclinations are compounded by religiosity or a heightened sense of what is right and wrong?

RV: As a physician, I always believe that we need to see people as fellow humans. As a government official, from the perspective of the United States government discriminating against someone is absolutely abhorrent. It is equally important in the context about which we are speaking.

PW: I have to ask about hepatitis C. What role will the Affordable Care Act play in reducing the treatment disparity?

RV: This is important in regard to young black men in particular. The Affordable Care Act is the single largest structural intervention. Therefore, it has tremendous potential for eliminating the existing in adequate treatment of young black men for Hepatitis C. When we talk about extending healthcare benefits this is what we need. Our audience is largely African-American.

PW: In a few months we will be entering the second enrolment period of the Affordable Care Act. What would you say as to why we should enroll more people?

RV: Let me say that healthcare should not be about just when someone is sick. Health literacy is extremely important. We do not want people to think that they need to get help only after they become sick. When they have a suppressed viral load they may not know it. So, we have to stress the importance of prevention more and get more people to act on seeking health care before they become ill. What the Affordable Care Act is in part is a means to improve access to preventive health care.

PW: Ron, you are the architect or the drum major for the national hepatitis plan. What can you tell African-Americans about this?

RV: I think many black Americans have gotten the message now that they carry a disproportionate AIDS burden. Unfortunately, not as many of them know that the same holds true for viral hepatitis. I would say to black Americans that we want to make sure they know that the Centers for Disease Control and other governmental health agencies are available for their vital care. I recommend that everyone between the ages of 45 and 65 (us baby boomers) should be tested at least once. It is possible to cure Hepatitis C. I
want to make sure that they understand that if not treated they could get cirrhosis of the liver or a wide range of other debilitating ailments.

PW: Recommendations for getting tested are in the plan. What else is there?

RV: There are steps recommended to eliminate the possibilities for Hepatitis B among pregnant women because there can be measures taken to prevent that transmission from occurring. Community-based organizations, nongovernmental organizations, or foundation based organizations all help in this regard. We need to further consider how they can get more involved. It is a huge health problem. So, we want to make the general public increasingly more aware.

PW: Is a cure for hepatitis C covered under the affordable care act?

RV: Well, many of these new drugs are quite expensive. There is a lot of discussion now about what is covered and what needs to be covered.