Manuel Laureano-Vega M.S., M.D. 
I remember when the service networks for AIDS Care were getting started in 1985. It was a different time and the epidemic presented differently than it does today. In those days people were already, sick with AIDS when they found out about their HIV infection. Many died during that first acute opportunistic infection episode, and some did not. People died within two years of that first acute illness that sent them to the hospital. The urgency then, was to create service networks for the people that were to acquire HIV infection as projected by the CDC. I remember the projections that millions of people would be infected by the year 2000, in the United States. There was so many parts of the AIDS Care network to create and so little time to put it all in place.
There was a lot of devastation then. People and communities were affected by the hundreds of thousands dead. Lives cut short and harmed due to death and survival of repeated acute illness episodes. The psychological effects of the epidemic have been great. Outbreaks of fear, despair, depression and anxiety have been the norm. Let me not leave out the many suicides that have occurred. AIDS dementia is the silent manifestation that is creeping up on us all. Is the system ready to take care of these mentally incapacitated patients? I do not think so.
When people are disabled and incapacitated, they need access to more diverse service networks, not less. Freedom of Choice is fundamental to maintain HIV positive people in treatment. I understand that due to the infiltration of organized crime into the Medicare and Medicaid health care networks in the United States the government has lost billions of dollars. That is not the patients fault, at least not the vast majority. Who gives these unscrupulous providers their provider numbers? The government system does. Do not get me wrong, patients that willingly participate in the Medicaid and Medicare Fraud should lose their medical benefits, but limiting access to services, service provision models and reducing medical care budgets is not the right way to curtail the loss of billions of dollars to Medicare and Medicaid Fraud. Catch the crooks, screen the providers more effectively, monitor closely and you will save some of our tax dollars that are stolen from the system.