Tomorrow is National HIV Testing Day—do you know your status? One can be forgiven for thinking that HIV awareness days seem like a very '90s throwback. The intensity—some might say hysteria—at the apex of the AIDS crisis has long since subsided, but instead of coming away with a more reasoned, nuanced, and smarter attitude toward safe sex and HIV prevention, most of the country just seems eager to forget everything about that very scary time, including the lessons we learned.
It's a condition Dr. Susan Blumenthal, former U.S. assistant surgeon general and chair of the Global Health Program at the Meridian International Center, calls "AIDS amnesia" in a new article on the state of AIDS treatment, prevention, research, and policy. She writes:In the almost 30 years since the CDC recognized AIDS, treatments have improved, stigmas have lessened, and awareness has increased. But there's still much to be done. I've included Blumenthal's entire article after the jump. It's a great, comprehensive look at what we should accomplish on several fronts to keep Americans and the world free from HIV and AIDS. Policy can be wonky and dense, but it's essential. So for those who are so inclined, click "MORE" to read her entire paper. For everyone else: make an appointment to get tested.
By Susan Blumenthal, M.D., and Yi-An Ko
On the eve of National HIV Testing Day, we are reminded that 1.1 million Americans are living with HIV in the United States, yet one in five of them do not know their status. For those who have been tested, more than one third learn they are infected less than a year before developing AIDS—missing the opportunity for early intervention. Ensuring that HIV is detected early and that people get immediate treatment to suppress their HIV viral loads can make a lifesaving difference.
Since it was first reported in 1981, HIV/AIDS has infected 60 million people worldwide, killed 50 percent of them, and caused a global pandemic affecting nearly every community. Each year, more than 2 million people die from this disease. While significant attention has been focused on the newly emergent H1N1 “swine” flu that has resulted in the deaths of 238 people globally, every 15 seconds a person is infected with HIV worldwide and every 9 ½ minutes in the United States. A 2008 report from the Centers for Disease Control and Prevention (CDC) revealed that 56,000 Americans are infected with HIV annually, a number that is 40 percent higher than previous estimates. Our nation’s youth, ages 13 to 34, composed 41 percent of new HIV infections in 2006. In our nation’s capital, 1 in 20 people are HIV positive. Yet, a recent poll reveals that there is AIDS amnesia in America with only 6 percent of people in the United States naming this disease as a national health problem, down from 44 percent in 1997.
While significant progress has been made in understanding, treating, and preventing HIV/AIDS, much more remains to be done. A comprehensive response to the epidemic is needed that must include the development and implementation of a coordinated national AIDS strategy that places greater emphasis on prevention because for every person treated, as many as three more people will be infected with HIV. This devastating cycle must be broken by implementing proven prevention strategies that can save lives now as well as research on new approaches such as pre-exposure prophylaxis (PrEP, using antiretroviral drugs as a prevention pill taken by HIV-negative individuals at high risk for contracting the disease) vaccines, and microbicides. After all, research is the foundation for effective public health and medical interventions and is a cornerstone in the eradication of AIDS. Increasing investments in science holds the promise of improved prevention and treatment strategies and someday perhaps a cure.
Addressing the needs of vulnerable population groups is also critical in the fight against HIV/AIDS. In the United States, HIV/AIDS disproportionately impacts African-Americans, who represent 12 percent of the population but compose 45 percent of all new HIV infections; Hispanics account for 18 percent of new infections and men who have sex with men (MSM) represent the majority (53 percent) of new HIV cases. Women around the world are acquiring HIV at an alarming rate, composing 26 percent of new diagnoses in the U.S. in 2007 and 50 percent of those affected worldwide.
Eliminating health disparities related to HIV/AIDS requires evidence-based strategies that address biological, social, structural and economic factors that are drivers of the epidemic.
Furthermore, a seamless system of care is urgently needed that expands access to the continuum of HIV/AIDS services, from universal voluntary testing to effective treatments. Scientists at the World Health Organization (WHO) have developed a new mathematical model for HIV prevention based on a “test and treat” strategy of universal, voluntary, annual HIV testing and immediate treatment for those who test positive. While its assumptions are still under evaluation and require further exploration, this model predicts a reduction in new cases of HIV by as much as 95 percent over a decade and possibly the eradication of the disease in 50 years following widespread implementation of this program.
The National Institutes on Health (NIH) and the CDC recommend HIV testing for everyone ages 13 to 64 in the United States as part of their routine health care. High-risk populations such as injection drug users, gay and bisexual men, female partners of bisexual men, and people with multiple sexual partners should get tested at least once a year. Community-based outreach strategies and new social-media tools like mobile phones, the Internet, Twitter, and Facebook are being harnessed to rapidly disseminate information about the importance of HIV testing, treatment, and prevention. A CDC campaign using social-networking strategies encourages people to get tested for HIV and directs the public to text their ZIP code to “KNOWIT” (566948) or to visit www.hivtest.org for more information about local HIV testing sites and other educational resources.
Another important way to reach the American public is with evidence-based reports like those prepared by the surgeon general of the United States. The first surgeon general’s report—an AIDS brochure—was issued by Dr. C. Everett Koop in 1985 and was the first time that public-health information was sent to all American households. There has not been another surgeon general’s report on this disease since 1992 and a new one is needed to raise awareness.
Looking forward, we must harness science, political will, and public awareness to address one of the most significant and devastating public-health problems of our time.
Do your part today by getting tested for HIV. Such actions by Americans combined with increased investments in research, stirred with leadership, innovation, and collaboration across our country and among nations provides hope for a world without AIDS.
Rear Admiral Susan Blumenthal, M.D. (Ret.), former U.S. Assistant Surgeon General, is clinical professor at Georgetown School of Medicine and chair of the Global Health Program at the Meridian International Center. Yi-An Ko is a recent graduate of Harvard University.