AIDS is a political disease and a medical scourge, says US Congressman

Shobha Shukla - CNS (Citizen News Service)
[Watch video interview] [Audio podcast]
So said US Congressman Dr Jim McDermott while receiving the Lifetime Achievement Award at the 9th National Conference of AIDS Society of India (ASICON 2016) in Mumbai.

In an exclusive interview given to CNS (Citizen News Service), he shared some of his deep insights on fighting this disease with view to ending it by 2030 as envisaged in the Sustainable Development Goals (SDGs).

Dr McDermott is a medical doctor who has been a US Congressman since 1989. Before being elected to the Congress, he was a practising psychiatrist. He worked as a Regional Medical officer in Zaire (now Democratic Republic of Congo) during 1987-88. There he saw the HIV epidemic, when it was in its infancy, from close range. This experience fuelled his desire to fight the disease as a lawmaker. Fighting AIDS has been one of his top priorities since he was elected to the US Congress.

Unmask the stigma of HIV-speak about it openly

Dr McDermott lamented that there is tremendous resistance in the global society to be open about this sexual disease. And so people find it difficult to talk about it. “Every year millions of youngsters become sexually active, and most have no idea about safe sexual activity. They are just driven by their emotions. The youngsters have to be educated that the main route of transmission of HIV is through sexual activity. Young people have to know that they have to practice safe sex, which means using the condom unless they want to have a baby. Continuous education about this issue and about safe sex is of prime importance”, he said.

No child should be born with HIV

He stressed upon enforcing 100% prevention of parent to child transmission. “When a woman gets pregnant she should get tested for HIV immediately, so that if diagnosed HIV positive she can get treated, and also the infant after being born. There is no reason for the disease to get transmitted at the time of birth from mother to child, as we now have the means to stop this transmission.”

Confront sex trade and injecting drug use
Dr Jim McDermott, US Congressman

“Sex trade is a reality in every country. We have to confront this directly (rather than hide it under the carpet) and test all sex workers—male or female-and make them aware to practice safe sex through condom use. Also, in almost every country there is an injecting drug culture and we cannot ignore that, as many IDUs are going out and having sex, and transmitting the disease even to non drug injectors. We have to seek this vulnerable population and teach them how to best protect them. In the US we have the needle exchange programme so that they use clean needles”.

Stigma around HIV

Dr McDermott said that when he started working in this field, contracting HIV was like a death sentence. When he worked in Africa, almost everyday while going to the office he would see a funeral procession of someone who had died of AIDS.

However, “The advent of anti retroviral therapy (ART) changed it from a death sentence to a chronic disease like diabetes. But there is one major difference - while there is no stigma attached to diabetes, there still is a lot of stigma around HIV/AIDS in India and elsewhere, because people generally get it through sexual activity. Somehow, in every religion and in every culture there is a feeling that you got it because you did something wrong. We have to get beyond this stigma and deal with the disease. We have to take action to prevent its transmission”.

Involve the politicians

Dr McDermott said that a lot of the onus to end AIDS by 2030, as envisaged in the sustainable development goals or SDGs, lies on the politicians. “Fighting HIV is an ongoing process. So unless we involve the government and politicians, the disease is bound to come back again. It is the politicians who decide how much money is to be spent and where. The cost to society and to governments of this epidemic is huge - not only in terms of human lives lost but also in economic terms. Politicians understand economic benefits more than human benefits. That is the essence of it all - it is not just about people and society but also about sound economic sense.

Proud moments to share

Looking back on his work of the past almost 3 decades, Dr McDermott’s almost 3 decades long involvement with HIV/AIDS is replete with many ups and downs. He particularly remembers two of his many rewarding moments. "When I started working in this field nobody wanted to talk about the disease. At that time nobody in USA really cared about HIV/AIDS as it was considered a gay man’s disease. But outside of USA, it was mostly the heterosexuals who were getting the disease. So I launched the Congressional HIV/AIDS task force in 1992. I also organised a big conference in Washington DC in 1992 and brought people from different parts of the world. I was proud to have brought the problem to Washington DC and raise the level of awareness of the American government. It took a lot of education for Americans to see the magnitude of the disease and what was happening in the rest of the world."

Another feather in his cap was initiating a free housing programme for people living with HIV (PLHIV). "In the earlier days (and even now) very often PLHIV lose their job, and lose their family. So their immediate need is a house to live in. In 1989, I started a big programme called housing opportunities for persons with AIDS (HOPWA), which is still going on 28 years later. Under this law free housing is given to PLHIV. These are just some small things which make me feel proud."

Learnings to share
Shobha Shukla CNS (L) and Dr McDermott (R)

Dr McDermott has some sound piece of advice for the politician and for the physician (as he is both of them). "As a politician one has the opportunity to do many things for the good of the people, even if it does not make one popular. Talking about HIV/AIDS does not make one popular, but it needs to be done. And if politicians are serious about taking care of the people, they need to talk about some uncomfortable truths too. HIV/AIDS is one of them. Money spent on this issue is money well spent. It is better to pay now and treat them upfront rather than wait till they get very sick and their medical problems multiply—this way we will be spending much more. We have to educate people and politicians need to be willing to do that."

"Educating the general physician is equally important. I have seen many physicians in South Africa and in India not wanting PLHIV patients in their clinics and sending them to an HIV/AIDS clinic. Any healthcare setting with the name of HIV/AIDS is stigmatising. Doctors should be treating all diseases— diabetes, high blood pressure, and HIV— all in the same clinic. And getting doctors to do that is not easy. The first line of defence for AIDS should be the general practitioner’s clinic. This is not easy but necessary. Integrated care is important. HIV/AIDS is not a sin or a crime but a disease. A doctor’s job is to take care of the patients who come to the clinic and not punish them," he said.

(Note: Dr McDermott recently relaunched the task force as the Congressional HIV/AIDS Caucus with the Democratic Congresswoman Barbara Lee and Republican Congressman Trent Franks, getting bipartisan support for the group)

[Watch video interview] [Audio podcast]

Shobha Shukla - CNS (Citizen News Service)
14 October 2016

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