In this era of increasing LGBT rights, it is remarkable how little has been done to dispel myths about HIV-positive men, women, and children and eliminate the stigma that separates us from society.
This has mushroomed into fear, which manifests itself in unwillingness to get tested and a fear of dating, much less having sex with, an HIV-positive individual, all this often from individuals who remain uniformed about HIV and remain HIV-negative either through safe sex or pure dumb luck.
Changing these thoughts and perceptions is one key to wiping out HIV. Meanwhile, the HIV-positive community, now numbering almost 2 million in the U.S., continues to grow every year by 50,000 people.
A recent article, "'Undetectable': Safe or Not?," published on the website TheBody.com, reports, "The current ban on health workers in the UK who have HIV, carrying out certain procedures involving possible exposure to blood and fluids, has been lifted." The author suggests that this has far-reaching consequences for anyone who is HIV-positive and medication-compliant: "The idea that people living with HIV can safely have sex with anyone in the community again, sticks in many a craw, including, astonishingly enough, many HIV organizations, who see it as subversive to all the work they've been doing to promote condom use and safe sex!"
"Subversive" is a strong word, but perhaps it's appropriate. Rather than embracing new data that give hope to those living with HIV, many U.S. health organizations seem stuck in ignorance. This is the heart of the problem.
This paradigm needs to change. There remains an incredible amount of fear based on a lack of solid information of what it means to be HIV-positive and how difficult it is to acquire HIV. The lack of information on HIV and the resulting fear and stigma are preventing us from moving forward to wiping out this epidemic.
In chapter 5 of Everything A Gay Man Needs to Know about HIV, Sex and Staying Healthy, "Healthy, Hot Sex," I discuss this and related topics in some detail.
We have all the tools at hand to detect individuals unknowingly carrying the virus, and we have the pharmaceuticals to control the infection. What is lacking is the will.
Over 100 years ago, the rural South was infected with an intestinal parasite, hookworm. The U.S. government had all the information but was ineffective.
Then the Rockefeller Foundation stepped in. This is what happened.
In 1910, an estimated 40 percent of the population of the southern United States was infected with hookworm. The Rockefeller Sanitary Commission for the Eradication of Hookworm Disease (RSC) was created with the intention of eliminating the disease across the region. By implementing a three-pronged approach, including mapping the disease, curing patients, and providing education, the RSC not only dramatically reduced the disease but created a culture of public health.
This became known as the most effective campaign against a widespread, disabling disease that medical science and philanthropy ever combined to conduct.
Once the state health agencies were armed with the necessary information and felt empowered to act, they continued the work, and hookworm was eradicated in the U.S., although it is still a scourge in certain parts of the world. The reason that we can go barefoot anywhere in the U.S. is because of the Rockefeller Foundation.
Today we have a similar opportunity. HIV is more complicated and carries more challenges than hookworm, but we have more than 100 years of medical knowledge, and we know what to do. We just need to begin to treat HIV as an epidemic, not as business as usual.
For a fraction of the money that the Bill and Melinda Gates Foundation, the U.S. government and other groups are spending in Africa, they could, based on information from the CDC, systematically test heavily in epicenters of infection, find the reserves who do not know they are HIV-positive (one in five) and fully fund the antiretrovirals to neutralize the virus -- and provide counseling and follow-up to assure compliance.
The CDC factsheet actually lays out an action plan:
These findings underscore the urgent need to prioritize and target HIV prevention efforts in disproportionately affected communities and ensure that both individual and social determinants of risk are considered in the design and implementation of prevention efforts.
But instead of action, we are treading water.
Note in the same paper:
As a result of treatment advances since the late 1990s, the number of people living with HIV (HIV prevalence) has increased dramatically. Yet, despite increasing HIV prevalence and more opportunities for HIV transmission, the number of new infections has been relatively stable since the mid-1990s.
The stability of new infections continues to be touted by many as evidence that we are making progress. I say we are standing still.
Ten years ago it would have been unthinkable that we could wipe out HIV in the U.S. and move forward. Today we have every tool we need to reduce this epidemic to perhaps 1 percent of the current level within five years, and from there wipe it out once the next level of drugs, or even the much-touted vaccine, are developed and approved.
I suggest that one way this can happen is for an outside group to mobilize and coordinate the programs, dollars and personnel and end the current state of paralysis.
The HIV/AIDS Epidemic in Africa is a problem of gargantuan size. It cannot be dealt with in the same way as in the U.S. The scaling issues of providing drugs for more than 20 million Africans are enormous, especially in countries with far less infrastructure than the U.S.
Africa awaits the next generation of treatments (microbicides, vaccines). Imagine the logistics of providing daily Atripla to over 20 million individuals every day for the rest of their lives and building the associated distribution centers and health clinics and staffing them with case managers. It is mind boggling. And I suggest that it's not workable.
But ending HIV in the U.S. is attainable. And the time to act is now! While Africa is basically awash in antiretrovirals, we are rationing these drugs at home and doing passive testing.
To me, this seems very wrong.