Losing ground against AIDS

January 07, 1994|By John Gagnon

NEWS reports in recent months suggest that we are entering a new phase of the AIDS epidemic in which the effectiveness of our prevention efforts will determine how successful we are in fighting the disease. It is a phase for which we are nearly as ill-prepared as we were be fore 1983, when the cause of AIDS was still unknown.

In spite of the vast amount of money spent on biomedical AIDS research over the last decade, a vaccine for the human immunodeficiency virus appears to be as far away as ever.

Anti-viral drugs such as AZT have marginally increased life expectancy for those infected, but there is still no cure on the horizon. So for now our best hope of fighting AIDS remains prevention.

Yet this fundamental barrier against the virus has been steadily weakened over the last decade by resistance from hostile right-wing groups and by the inertia of government at all levels.

In their prevention campaigns, health officials have failed to focus on the two groups at highest risk of infection, the same ones that were afflicted at the beginning: gay men and intravenous drugs users, and their lovers, spouses and children.

Instead, they spend precious dollars on diffuse campaigns such as the one unveiled this week, in which animated condoms send a message of safer sex aimed largely at heterosexual young adults.

Thus the government's resources are aimed scattershot at the epidemic. This policy results from a misunderstanding of where the epidemic has been and where it is going.

In California, where 80 percent of people living with AIDS are gay men, only 10 percent of prevention dollars are spent on gay men.

The New York Times reported on Dec. 11 that there is evidence of a resurgence of high-risk sexual behavior and infection among young gay men in San Francisco. It is this community, at ground zero of the epidemic, that urgently needs an intensive prevention campaign.

The government has also failed to reach out adequately to the men and women who are in danger of infection through intravenous drug use -- the same people who are found in jails and prisons, among the homeless and those without either drug treatment services or clean needles.

We need to recognize that the AIDS epidemic is actually a number of micro-epidemics. Prevention and treatment both require an approach tailored to the particular needs of those afflicted.

What are the dangers of implementing a policy based on the recognition that not everyone is equally at risk? Some argue that if those in the mainstream believe that the epidemic is unlikely to affect them they will abandon those at the margins of society who remain at the highest risk.

A far greater danger, however, is the rising rate of infection in high-risk communities because inadequate prevention resources are too thinly spread.

It is not that all Americans shouldn't be informed about the risks of infection. There will inevitably be some transmissions of the HIV virus among groups at relatively low risk.

The advice that is given low-risk groups about how to avoid HIV infection should be as plain-spoken as the information given to those at high risk.

I live in New York City. I am in little danger of my house burning down in a wildfire or being swept away in a flood, but I happily support government efforts to prevent these disasters or help those who have been in harm's way.

I have not argued that these people knew the risks of fire or flood when they decided to live in Malibu or Omaha and that therefore they do not deserve a national response.

We now have a president who appears to acknowledge that AIDS is a national disaster.

Perhaps he will respond to the epidemic in a way that truly recognizes who is ill and who is at risk and treats them like all Americans who have been in harm's way.

John Gagnon is professor of sociology at the State University of New York at Stony Brook.

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