HIV infection has steadily increased among gay and bisexual men in the United States since the early '90s, even as it has decreased among heterosexuals and injection drug users. Most new infections among black and Hispanic gay/bi men are among young men between the ages of 13 and 29. Young black MSM (men who have sex with men) are twice as likely as their white and Hispanic peers to get HIV. White gay/bi men are mostly being diagnosed in their 30s and 40s. Half of all infected gay/bi men don't know they are HIV-positive. More than two-thirds of infected black men, and nearly 80 percent of HIV-positive young men aged 18 to 24, are unaware they have the virus. And there is still the death toll of AIDS, in spite of medical advances that have allowed many to live well with HIV rather than die in short order from AIDS. By the end of 2007, AIDS had killed an estimated 282,542 gay and bisexual men in America, most in the prime of life.

Long-time Los Angeles gay activist David Mixner in August 2010 called it the best and worst moment in the plague's three decades. "The good news is indeed reason to celebrate," he said. "Real progress is being made in fighting this disease." As for the bad news, Mixner said the recessionary economy was "wrecking havoc with HIV/AIDS budgets, international funds to fight HIV, research and treatment and care." In particular, Mixner noted that the federal AIDS Drug Assistance Program (ADAP) has either cut back or frozen in place. "Unless this situation is totally corrected," said Mixner, "it could mean a death sentence for some people with HIV/AIDS."

At the time of Mixner's comments, more than 3,000 individuals in this country were on ADAP waiting lists in 13 states, hoping the program would enable them to receive the life-saving medications they can't afford on their own. In early summer 2011, the Kaiser Family Foundation reported that 8,100 Americans were now on the ADAP waiting lists across the country. Without guaranteed access to HAART for everyone who is HIV-positive and can't afford the expensive medications on their own, any hope of treating our way out of the epidemic is wishful thinking. And for those with HIV denied the medication they need to suppress the virus -- rendering them less infectious -- the chance of developing horrific illness and death from AIDS increases with each passing day, even in 2011.

In the summer of 2010, the Presidential Advisory Council on HIV/AIDS (PACHA) called on President Obama and secretary of Health and Human Services, Kathleen Sebelius, to work closely with Congress to provide adequate emergency federal ADAP funding in the current fiscal year ($126 million) to eliminate wait lists, reverse cost-containment measures, and meet the increased demand for treatment. PACHA further asked for adequate federal Ryan White CARE Act funding in fiscal 2011 and beyond to meet the growing need for the care, treatment, and essential support services the Ryan White program supports. Finally, the council asked for immediate expanded access to Medicaid for people with HIV through the enactment of the Early Treatment for HIV Act. PACHA noted that although the Patient Protection and Affordable Care Act of 2010 "will greatly improve access to affordable, high quality health care for many people living with HIV and AIDS," most of the provisions relevant for people with HIV do not take effect for years to come. This means insurance companies will be allowed to continue denying coverage to people with HIV and other pre-existing conditions until the practice is finally banned in 2014.

For now, health care reform means that if people who are currently uninsured want and can afford the high premiums of private insurance, they are by and large limited to a group policy or a state risk group plan. Some Medicare provisions affecting lower-income people won't go into effect until 2020. Though not speaking directly of the crazier-than-ever quilt of an American health care system, PACHA understatedly said, "People living with HIV and AIDS confront significant barriers to access to care and treatment right now."