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AIDS rising again EDITORIAL
  December 12, 2007
By James Driscoll - Overlooked in the presidential campaign rhetoric about health care access, AIDS continues to ravage disadvantaged Americans and is again increasing within the homosexual community.
For years, while rates of many sexually transmitted diseases have soared, the Centers for Disease Control and Prevention estimates of new HIV cases remained stable at 40,000 a year. AIDS fighters in cities like Washington told a different story. The CDC estimates, they warn, fail to reflect the rapid spread of HIV in minority communities. Vindicating their warnings, the CDC will soon announce updated HIV infection rates that are disturbingly higher than previous estimates.
Medical advances have changed HIV from a death sentence to a chronic manageable condition if detected and treated early. For those who delay, HIV can still be a death sentence as when Rock Hudson died.
Untested HIV positives often delay treatment until sickness forces testing upon them. Studies show that rising percentages of new cases are tested only after their disease becomes advanced. Early testing saves lives because treatment is most successful when initiated early. As with cancer, early diagnosis and treatment are crucial in the fight against AIDS.
In 2005, 17,000 Americans succumbed to HIV-related conditions, four times the death toll of the entire Iraq war. Many of these HIV deaths could have been avoided if testing and treatment had begun earlier. Indeed, effective prevention and more testing could also cut America's health care costs by stemming the epidemic of new infections.
Patients who know they have HIV take steps to avoid infecting their partners. Furthermore, HIV medicines lower patients' viral loads reducing their chance of infecting others. The CDC estimates that 25 percent of the 1.2 million Americans with HIV do not know they are infected. This reservoir of untested HIV-positive people is the source of 68 percent of all new infections. Untested positives are eight times more likely to spread HIV; if all were tested, new infection rates might be cut by nearly 60 percent.
Approval of rapid HIV testing outside the doctor's office, an important achievement of the Bush administration, made a technological breakthrough available to our war against domestic AIDS. However, outdated state restrictions, along with insufficient federal funding for testing and linkage to care, impede deployment of the new technology. Testing, as well as government programs for HIV medical care and drugs, remains chronically under-funded. Blame for this imprudent parsimony rests with both political parties.
But the blame does not end there. A recent study cites an alarming rise in risky behavior among men who have sex with men, and HIV in that group in Western Europe has increased 55 percent (1998-2005). While we lack complete U.S. figures, a 10-fold increase in syphilis cases among that group (2001-05) indicates an explosion of reckless behavior.
Why is this happening? Before HIV became a manageable condition, many were frightened into safe behavior. Whether the availability of treatment contributes to recklessness is unclear; but it is clear that efforts within the homosexual community to discourage risky behavior have diminished. Condoms and prevention information are no longer widely distributed in bars and at other meeting places. Substance abuse is on the rise. The homosexual leadership and its liberal political allies have been silent about these disturbing trends. They need to be reminded of the ACT-UP slogan, "Silence = Death.
Increased testing is the most effective and least controversial way to discourage risky behavior. Nonetheless few in the homosexual leadership and none of the presidential candidates have issued a strong call for increased testing. Sen. Hillary Clinton, the candidate best connected with the homosexual leadership, recently released a detailed HIV plan that was seriously marred by failure to emphasize testing. The credit Mrs. Clinton deserves for speaking out on HIV/AIDS where other candidates are silent was diminished by her virtual silence on testing. But it's not too late for candidates to call for more testing.
To turn the tide against AIDS in America, we must test more often, focus on the most vulnerable groups and make sure that all who test positive have ready access to quality HIV care and essential AIDS drugs. Despite the $23 billion a year we spend on domestic AIDS, we are losing ground. We need to scrutinize all programs and reallocate resources to where they are most cost-effective - heading the list of cost-effective programs is HIV testing.
The presidential candidates love broad, general talk about health care for all. One reliable measure of a candidate's commitment to health care is her or his actions to improve access to testing and care for all Americans with HIV. So far, the candidates of both parties are failing this HIV litmus test. Let's hope the CDC's disturbing new infection rates will be their wake-up call.
James Driscoll, who served as a Bush appointee to the Presidential Advisory Council on HIV-AIDS, is a Washington-based adviser to the AIDS Healthcare Foundation.
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