Sunday Aug 3. A political firestorm and some actual mainstream media coverage about the 40% increase in the numbers of people with HIV in the United States as declared by the Centers for Disease Control and Prevention. Government officials sat on the data that demonstrated that prevention efforts were failing because of a lack of federal money to fund programs known to work, including using existing HIV treatments to reduce viral loads. Here is an excerpt from the Journal of the American Medical Association (JAMA). It was released early, and scientists and policy makers are angry as hornets, not to mention that about 40,000 new cases of HIV in the United States could possibly have been prevented had we been given this information and the support to implement it last year. But these are just mostly American men and women, especially Latinos and Blacks and young men. The rate of HIV caused by used syringes has remained constant, surprisingly, so hapless patients in haphazardly run clinics and hospitals and injection drug users don't seem to merit an urgent response either. I'm not sure who exactly is left, but I'm sure they are struggling with their own set of burdens and don't have all that much time or energy to focus on what is happening to other people. Mexico seems to have gotten the idea. Like I said, I just don't get what the US is thinking.
Since 2002, the CDC has launched new prevention initiatives that included expanding HIV prevention to individuals living with HIV, increasing HIV testing, and expanding the use of proven behavioral interventions in prevention programs for high-risk populations. Condoms
are highly effective in preventing the sexual transmission of HIV infection but frequently are not used. HIV counseling and testing has been found to reduce high-risk behavior by approximately 68% among individuals who find they are infected with HIV. Most behavioral interventions reduce risk behavior by 20% to more than 40%. Many of these interventions have been implemented in prevention programs across the country, but their reach must be considerably expanded to accelerate progress. An estimated one quarter of individuals living with HIV do not know it, and over a recent 1-year period only approximately 15% of MSM participated in individual-level and 8% in group-level interventions, among the most effective behavioral interventions available. A substantial reduction in HIV incidence will require wider implementation of the effectiveinterventions currently available and the development of additional interventions, such as antiretroviral chemoprophylaxis or a vaccine.
Estimation of HIV Incidence in the United States
JAMA. Aug 6 2008;300(5):520-529. H. Irene Hall, PhD; Ruiguang Song, PhD; Philip Rhodes, PhD; Joseph Prejean, PhD; Qian An, MS; Lisa M. Lee, PhD; John Karon, PhD; Ron Brookmeyer, PhD; Edward H. Kaplan, PhD; Matthew T. McKenna, MD; Robert S. Janssen, MD; for the HIV Incidence Surveillance Group
Author Affiliations: Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia (Drs Hall, Song, Rhodes, Prejean, Lee, McKenna, and Janssen); The Ginn Group Inc, Peachtree City, Georgia (Ms An); Emergint Corporation, Louisville, Kentucky (Dr Karon); Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Dr Brookmeyer); and Yale School of Management, Department of Epidemiology and Public Health, Yale School of Medicine, and Yale School of Engineering and Applied Science, New Haven, Connecticut (Dr Kaplan). Dr Janssen is now with Gilead Sciences Inc, Foster City, California.
Should we make an HIV test required for everyone applying for or renewing a driver's license or an identification card? We will someday make AIDS preventable, but not at the rate we are going. The CDC has just reported that there are a lot more people with HIV in the US than has previously been reported. Not people who have known for ten years that they had HIV, but new cases. In fact, the rate seems to be proportional to the reduction in base and supplemental funding to states to provide treatment to people with HIV.
I'm tired of debating why HIV is not 100% preventable now, but we should be at least ten years further on down that road than we are now. There shouldn't be new cases of HIV in this country. There should be science based, targeted prevention education programs that don't avoid talking about how our people (including people over 50) get HIV, and there should be accessible health care resources and support services to ensure all of us are able to prevent getting HIV. The recent report that 5% of the entire population of Blacks in DC have HIV should have sent shock waves throughout the country. That's not to say there are not Whites or Latinos or Asians in DC with HIV, but 5% is a rate higher than some developing countries. We know that teaching kids just to abstain from sex has been a failure (you don't have to be Black or live in DC for that to be true), and that people who have less equal access to routine medical care are many times more likely to die of diseases that get treated successfully in people with higher incomes and private insurance. As private insurance becomes even less affordable to more people, and Medicare Part D co-pays become more impossible, we just might even that number out. That would not be a good thing.
The number of new cases of HIV in the US has not gone down in the last ten years, and today we learned we weren't using the best formula to count the actual number of people who are HIV-infected. It's a lot higher than we thought.
Hopefully, with a new administration, federal grants to educate people how to prevent HIV (and other blood and/or sexually transmitted diseases) won't prohibit discussion of condoms or buying them with federal funds. They may some day even allow the purchase of clean syringes for a few bucks to prevent lifelong diseases like HIV and Hepatitis C costing billions of dollars to treat every year. Long term and chronic illness care is what costs the most money, why aren't we spending money to treat HIV disease earlier and prevent new cases?
Although pharmaceutical companies really charge way too much money for their products, their Patient Assistance Programs save millions of lives in the US every year. Drugs are actually not a large reason why health care costs just keep increasing. Not funding prevention programs and treatment programs for HIV, and chronic hepatitis, and other disease is. We should be able to depend on our government to provide the funds to allow for programs through which the cold hard truth about how to prevent HIV can actually be discussed.
Let's go easy on the AIDS is 100% preventable hyperbole. In the US, it still seems like contaminated needles and unprotected sex are fueling the explosive growth of HIV, and the risk of contracting HIV through vaginal/penile sex is a lot higher than anyone thought. Breaking News? Unlike to come from any US media outlet. Also, regardless of sexual orientation or whether you are the receptive partner in any type of sexual interaction, a pre-existing disease which you probably have no idea you have or just don't think is serious increases the risk of HIV transmission many times over.
Getting tested once for HIV doesn't protect you from any other STDs, or prevent you from contracting HIV in the future. That seems to be tripping even well informed people up. In 2007, 25 million people worldwide were living with HIV, over two million died from it. What you thought was true about transmission and prevention and treatment of viruses like HIV 5 years ago may already be dangerously out of date.
Making affordable treatments available to all HIV-infected individuals in the US is one of the best prevention techniques we have. It is far less likely that HIV will be transmitted if someone has a very low amount of measurable HIV in their blood. It doesn't mean they are cured or that they are incapable of transmitting HIV, but along with making condoms and clean syringes available to those who ask for them, and providing federal funding to states to be able to test people for HIV, it's an HIV prevention strategy that just might finally get our viral national viral load to undetectable.
Of course it requires that each of us take personal responsibility for our actions. But if a fraction of the money that gets spent every year on heart disease and diabetes and hypertension prevention or treatment were applied to HIV - and Hepatitis - with the same level of political will and support, we could actually prevent a lot of illness and death, and greatly reduce the cost of treating these diseases in their advanced stages. Every state has the option to prevent expensive future costs to their stressed budgets as well. Medicaid needs to be open to people at a much earlier stage of HIV disease. Otherwise, the disease becomes a very expensive disease to treat.
A Congress that has the federal government pay for effective prevention education and prevention and treatment related care would be very popular. It would also benefit the economy by keeping young workers healthy instead of becoming an expense during the years when they could be making their most significant contributions to the welfare of people of all ages in this country. In a country that takes pride in taking care of those who have contributed to make this country great, it doesn't follow that we wouldn't also want to do everything to keep our young men and women healthy. It's what I've believed made me a Democrat for my entire lifetime. I used to be able to point to Republican leaders who acted in ways that said they believed that as well. It's getting harder to point them out these days.