Emergency not over in HIV/AIDS battle

August 13, 2006|By DAVID HOLTGRAVE

In 2005, there were 39 million people worldwide living with HIV, 4 million new HIV infections and just fewer than 3 million deaths because of AIDS.

Four years earlier, the United Nations General Assembly Special Session on AIDS committed to substantial steps to reduce infections and provide treatment to people with HIV. Given the prevalence of HIV, as reflected in the statistics, has this commitment made a difference?

Yes, but it is not nearly enough. In the past five years, for example, the number of people receiving HIV treatment worldwide has jumped more than 540 percent. Yet despite this expansion of treatment, only about one out of five people needing anti-retroviral drugs now receives them.

HIV counseling and testing services have expanded by more than fourfold, but still less than 1 percent of the population in developing countries has access to this critical service.

Today, scientists, physicians, community providers and activists will gather in Toronto for the 16th International AIDS Conference to debate HIV prevention, treatment and policy issues. They have life-and-death matters to discuss. The global issues might dominate the discussions in Toronto, but the statistics that inform the state of AIDS in America are as disturbing.

The HIV epidemic in the United States is far worse than many people realize. There is now a death because of AIDS every 33 minutes in the U.S., and a new HIV infection every 13 minutes. One-half of the new infections occur among African-Americans though only 13 percent of the U.S. population is African-American. A 2006 nationwide poll found that 43 percent of respondents could not correctly answer basic questions about how HIV is transmitted.

Of the roughly 1.1 million people living with HIV in this country, about 25 percent do not know they are infected. This is most unfortunate because it means they could not get treated, and when people living with HIV learn that they are infected, most take effective steps to avoid transmission to others.

Despite living in a wealthy nation, only 55 percent of people in need of anti-retroviral therapy in the U.S. receive it. Those who do receive treatment often have to struggle to find ways to pay the HIV-related medical bills that can easily top $10,000 per year. Further, the federal government has cut spending for HIV prevention each year since 2003.

In this country, about one in five think that people living with HIV "got what they deserved."

How can we remedy this situation? First, we must remember that in the mid-1980s there was a new infection every three minutes and in 1995 an AIDS-related funeral every 10 minutes, so there have been tremendous strides made in prevention and treatment.

What is tragic is that as a nation we have good information about what types of treatment and prevention programs work, but we just don't deliver those services at the scale needed to make a larger difference in the epidemic. In 1988, Surgeon General C. Everett Koop sent a brochure about HIV to each and every household in the U.S. But when was the last time you received an AIDS message in the mail?

Also, studies have shown that HIV prevention counseling conducted in small groups can be highly effective at reducing HIV risk behaviors. And yet, in a recent national Centers for Disease Control and Prevention study of men who have sex with men in 15 major U.S. cities, only 8 percent had received such a service in the past year.

Intensifying our efforts in several areas is imperative. We must rebuild our crumbling foundation of basic HIV knowledge, and reduce the stigma against people living with HIV. We must expand counseling and testing services and provide science-based prevention services to persons engaged in risky sex or drug use.

We must ensure that all persons living with HIV have access to treatment that meets recommended standards. We must address the social inequities that lead to one-half of all new infections occurring in African-Americans.

In Baltimore, where the epidemic has hit hard, the challenges are great. In 2003, Baltimore had the fifth-highest rate of new AIDS cases among U.S cities. Of 650,000 people living in Baltimore, about 14,300 were living with HIV by the end of 2004. Four years ago, city officials declared a "state of emergency" to address HIV/AIDS; it's still an emergency.

Today, there are about 1,000 new HIV infections per year in Baltimore, concentrated in ZIP codes covering the most economically disadvantaged parts of the city. Without the critical community-based HIV prevention programs that are in place in Baltimore, the numbers would be even worse.

The city is trying new strategies, such as conducting special blood tests that can detect HIV infection very shortly after it occurs. This is critical for getting persons recently infected into treatment as soon as possible and avoiding transmission of the virus to others.

This week, 20,000 delegates to AIDS Conference in Toronto will give us a clear reminder of the pressing issues affecting AIDS and a call to action. But frankly, as we read the morning paper, we should only have to ask ourselves if even one more new HIV infection is acceptable.

David Holtgrave, Ph.D., is a professor and chairman of the department of health, behavior and society at the Johns Hopkins University's Bloomberg School of Public Health. His e-mail is dholtgrave@jhsph.edu.

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