This year marks the 30th anniversary of the first reports from Los Angeles of gay men dying of pneumonia, cancer, and other strange opportunistic infections. One year later, Tom Brokaw and Robert Bazell of NBC News reported on a “mysterious, newly-discovered disease” that afflicts mainly “homosexual men” – a disease which quickly came to be identified as Acquired Immune Deficiency Syndrome (AIDS), caused by the human immunodeficency virus (HIV). Now, HIV and AIDS are part of our common everyday nomenclature, but back in 1981, news reports containing those enigmatic initials evoked incredible fear in the public – with good reason. The death toll over the past thirty years has been staggering – more than 25 million people worldwide have died from the disease, 600,000 in the United States. In the early years, most died because no treatments were available. In 1987, approval of the anti-retroviral drug AZT offered the first ray of hope for people with AIDS (PWAs), representing a major breakthrough in the treatment of AIDS. Now, with the development of several classes of drugs that block the virus, “combination therapy” is now the medical treatment of choice – allowing HIV-positive people and PWAs to live fairly long, fulfilling lives. As the old advertisement says, we’ve come a long way, baby.
Yet according to statistics from the Center for Disease Control, HIV and AIDS are still significant public health issues. Worldwide, about 34 million people are HIV-positive, 1.2 million of whom are in the U.S. And in the U.S., one in five people with HIV have no idea that they’re infected with the virus – potentially creating a risk for further transmission. We may have made significant strides regarding treatment of HIV/AIDS, but our efforts at prevention – even with the surge of safer-sex workshops that were conducted during the 1990s – are pathetic at best.
In her November 8 address, borrowing from the phrase “combination treatment,” Secretary of State Hillary Rodham Clinton addressed her goal of an “AIDS Free Generation” by outlining a three-pronged “combination prevention” strategy. First, given that one in seven new HIV infections occurs when a mother passes the virus on to her child, preventing mother-to-child transmission would have a significant impact, particularly among poor people and in underdeveloped countries. The second prong of her strategy involves voluntary medical male circumcision, a low-cost procedure that, according to controlled clinical trials, reduces the risk of female to male transmission by more than 60 percent. Lastly, using anti-retroviral treatment for people living with HIV can reduce the risk of transmission up to 96 percent. Using these three strategies, according to Clinton, “we will be on the path to an AIDS-free generation.”
With all due respect to our Secretary of State, I’d like to suggest two more potentially powerful prevention strategies. According to the Centers for Disease Control, sexually transmitted diseases and infections are on the rise. By age 35, 50 percent of the U.S. population will have some type of STD/STI. Half of new STDs occur in adolescents and young adults. And increasingly, middle- and high-school students aren’t receiving comprehensive sex and relationship education – in one of my classes, a student told me that the extent of safer-sex education she received was this: “Use a condom.” More chilling is the fact that, because treatments for HIV and AIDS have improved so dramatically over the last decade, young people don’t typically consider it to be a serious health issue – and as a result, they are engaging in riskier sexual behaviors. If we can provide our young people with accurate sex education, they will be better equipped to make healthy choices for themselves.
The second prevention strategy I’d like to suggest involves elimiation of stigma, prejudice, and discrimination. The World Health Organization cites stigma as the main reason why people don’t get tested, why they don’t disclose their HIV status, and why they fail to take (or don’t have access to) anti-retroviral drugs. According to UN Secretary-General Ban Ki Moon, “Stigma remains the single most important barrier to public action. It is a main reason why too many people are afraid to see a doctor to determine whether they have the disease, or to seek treatment if so. It helps make AIDS the silent killer, because people fear the social disgrace of speaking about it, or taking easily available precautions. Stigma is a chief reason why the AIDS epidemic continues to devastate societies around the world.” If we don’t address stigma – homophobia as well as disease-related stigma – there is no way we’ll ever see an “AIDS Free Generation.” In the words of ACT-UP, Silence = Death.
World AIDS Day was this past Thursday, December 11, and the theme this year was “Getting to Zero.” Zero new HIV infections. Zero discrimination. Zero AIDS-related deaths.