| Perspectives on Texas

Calvin and Eunice Marshall, an African-American Houston couple married for 32 years, were both diagnosed with HIV in 2007. Since then, both have become advocates for HIV reduction and a reminder that it impacts all communities: straight and gay; black, white and brown; rich and poor. The disease doesn't discriminate.

Scientific breakthroughs have changed the virus from a death sentence in the 1980s and '90s to a chronic, manageable one today. But HIV remains at epidemic proportions in Texas, and Houston has the highest number of new cases in the state. A report by the Houston Health Department showed one out of every 200 Houstonians is living with it, and, alarmingly, young people ages 15-34 are getting hit the hardest. Heading into 2017, health care providers and policymakers must find a renewed sense of urgency to stop the spread of the virus.

Houston is now stepping up to the plate. Thanks to a generous grant from the Ford Foundation and AIDS United, Legacy Community Health, working closely with more than 50 community leaders and elected officials, has developed a new report, "Roadmap to Ending the HIV Epidemic in Houston," that provides a comprehensive strategy to cut new infections in half over five years. Houston is the only Texas city to join the ranks of a distinguished group — Atlanta, San Francisco, New York — that have already begun tackling, with impressive results, their own HIV challenges.

The report relays the conventional steps for HIV reduction from a medical perspective, from increasing testing — people living with HIV must first know if they have it to do something about it — to expanding the market for the daily pill, pre-exposure prophylaxis (PrEP), that is more than 90 percent effective in preventing the virus.

Medical professionals must also redouble their attempts to understand, in a judgment-free way, the high-risk HIV population: those who are gay, African-American, Latino and transgender. Most physicians don't wear ignorance, apathy or discrimination well. People who don't feel comfortable with the care they get won't walk through the doors. One solution to this obstacle is to hire medical assistants and physicians from the community they serve.

Even then, though, these inside-the-exam-room solutions are only possible if significant attention is paid to what is going on outside. Day-to-day realities —poverty, racism, machismo, language barriers, poor education, stigma and homophobia — prevent folks from seeking HIV treatment and prevention. In the absence of a cure, the golden ticket out of the HIV epidemic is honing in on these "social determinants of health" that disempower people from having basic health literacy in HIV, or any disease for that matter.

In addition, lawmakers have a public health responsibility to develop policies conducive to HIV eradication. Locally, much greater emphasis from the City of Houston and Harris County, as well as private philanthropy, must become realities if we are to meet the report's five-year goal.

The big enchilada is, still, access to accordable health care. Cost is a major barrier to care for the HIV-vulnerable population, and the Lone Star State has the horrible distinction of having the highest rate of uninsured people in the nation. Whatever happens with the Affordable Care Act under a Trump Administration, the goal for Texas legislators remains the same: Include more low-income, uninsured people in the health care system.

As we commemorate World AIDS Day on Dec. 1, our hope is health care providers, the public and policymakers in Texas realize the virus is still invading neighborhoods at astonishing rates, often so silently that increasing numbers of youth don't realize they are living with HIV. Ignoring it won't make it go away — it's been tried before. Save a cure, all the medical advances in the world won't end the epidemic. It's time to adopt a new strategy that accounts for socio-political factors so we can put an end to HIV once and for all.

Disclosure: Legacy Community Health has been a financial supporter of The Texas Tribune. A complete list of Tribune donors and sponsors can be viewed here.