AIDS 2014 Newsmaker: Ron Valdiserri, M.D., MPH
Dr. Ron Valdessieri
Jim Sulton, educational correspondent for the Jackson Advocate, and Phill Wilson, President and CEO of The Black AIDS Institute, sat down with Ron Valdiserri, Deputy Assistant Secretary for Health and Infectious Diseases at the Department of Health and Human Services, at the 20th Biennial International AIDS Conference (AIDS 2014).
Jim Sulton: Please share your thoughts and perspectives on AIDS 2014.
Ron Valdesierri: The theme of the conference, "Stepping up the Pace," is very much in sync with the momentum of the department. I say that because we do have a National HIV/AIDS Strategy, 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. We see greater mortality rates among them 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 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 referred to as the treatment cascade, this concept is a model 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.
On the intangible side, 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: 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. 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.
Phill Wilson: What role will the Affordable Care Act play in reducing the treatment disparity in Hepatitis C?
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 inadequate 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. Why should we enroll more people?
RV: 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 seek health care before they become ill. The Affordable Care Act is in part a means to improve access to preventive health care.
PW: Ron, you are the architect or the drum major for the national hepatitis action 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. We want to make sure that Black Americans 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—be tested at least once. It is possible to cure Hepatitis C. If not treated it can cause 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 measures can prevent that transmission from occurring. Community-based organizations, nongovernmental organizations or foundation-based organizations all can 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 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.
James Sulton, III, Ed.D., is the higher education correspondent for the Jackson Advocate.