The discovery of a cure for HIV may as well have happened in a dusty rural health clinic in Malawi.
The characteristics used to describe the now-famous case are typical in sub-Saharan African countries: an HIV-positive mother with virtually no access to proper health care failed to receive a common neonatal treatment that prevents mother-to-daughter transmission of HIV. She inconsistently checked in with doctors, and fell so completely off the grid at one point that doctors had to enlist the help of social services to find her again. By the time they re-established contact, she hadn’t given her baby anti-retroviral drugs for six or seven months.
Except that doctors happened upon the cure in the world’s only superpower: the United States. Specifically, Mississippi.
“The baby’s mom was having some life changes, that’s about all I can say,” Dr. Gay told NPR, adding that the care they provided for the mother and her unidentified baby is most appropriate for vulnerable children in resource-poor countries—places like Rwanda. Her case, they are quick to emphasize, is not normal in the United States.
One has to wonder at the irony that such a blockbuster medical breakthrough did not occur in the sterile labs of one of the mega HIV/AIDS research institutes that spend billions chasing the latest in medical innovations looking for a cure.
Mississippi is about as far away from all that as you can get, and this case is doubly ironic because it is an extreme oddity in the United States. Modern medicine prevents 98 percent of mother-to-daughter HIV transmissions, making the birth of the now-famous HIV-positive Mississippi baby an anomaly. Indeed, only 130 such cases happen per year in the United States.
Let’s slow down a second and talk about that a little bit. Mississippi sits at a dire intersection between poverty, power, and poor health.
HIV-positive patients in Mississippi are disproportionately African-American, poor, and without health care, according to a recent report by Human Rights Watch. For these patients, keeping a roof over their head and food on the table is a constant struggle. The cost of simply leaving work to visit the doctor for HIV treatment can be impossibly prohibitive.
According to the latest U.S. Census data, Mississippi is the poorest state in the nation. It has the highest poverty rate in the entire United States—22.6 percent of residents, significantly higher than the national average of 15.9 percent.
Mississippi is also the fattest state in the country, the clearest example of the intersection between privilege and health.
This is also the state in which an aggressively anti-choice legislature has whittled the number of legal abortion clinics in the state down to one.
Human Rights Watch found that half of people who test positive for HIV do not receive treatment, a rate comparable to Botswana, Ethiopia, and Rwanda.
HIV is so stigmatized in Mississippi that HRW documented some patients throwing away their antiretroviral medication just to keep their HIV-positive status secret from their family and friends.
The racial disparities in infection rates are likewise disturbing: African-Americans constitute 37 percent of the population but 76 percent of new cases of HIV.
In sum: Mississippi has historically ranked among the worst U.S. states in providing health care, and measures on par with some sub-Saharan African nations in inequality indexes.
The discovery is clearly a Malcolm Gladwell-esque outlier. It is also a call to critically analyze the racial and economic disparities in the United States health care system, because the inequalities that we as global citizens find appalling in the international health care system also exist in our own backyards.
image (cc) flickr user Novartis AG
