Prevention begins at home

Yesterday was World AIDS Day. As in the past, it was an occasion to reassesses the fight against the disease. It is going both well and badly. AIDS-related deaths dropped in the United States last year, thanks to the anti-HIV treatments that continue to be developed. In fiscal year 2003, the government spent $15 billion for everything from basic research to public education — the Centers for Disease Control and Prevention (CDC) spent about $800 million on prevention efforts. Yet, HIV cases still rose. A comprehensive analysis of 29 states released last week by the CDC showed that new diagnoses of HIV increased by more than 5 percent between 1999 and 2002. Hispanics saw a 26 percent increase, gay and bisexual men saw a 17 percent increase, and men overall saw a 7 percent increase. Women account for 30 percent of new HIV infections each year. Nationally, black and Hispanic women account for 78 percent of AIDS cases among women.

Some experts, noticing the jump in rates of AIDS infection among Hispanics, have suggested that endangered demographic groups need better targeting. Better management might help as well. Marsha Martin, director of AIDS Action, said that although the administration’s leadership globally has been “exceptional,” (especially considering the $15 billion AIDS initiative President Bush signed last May) there has been a great deal of confusion domestically.

However, the greater part of the problem appears to be complacency coupled to a lack of personal responsibility. About 40,000 new HIV infections occur in the United States each year, and according to CDC Director Julie Gerberding, all of them are preventable. After all, HIV has been studied extensively, and its means of action and methods of transmission are well-known. Condoms are almost ubiquitous — those who need them can certainly get them. Moreover, mother-to-child transmission is extremely rare, since treatments are usually given in time to prevent it.

Abstinence is the only sure way to prevent the disease. Short of that, monogamy between two responsible partners (coupled with other precautions) is the next best alternative. However, that depends on both partners being responsible enough to be tested for HIV and acting on those tests. CDC estimates that of the 850,000 to 950,000 individuals living with HIV, one-quarter do not know they have been infected with it. As a consequence, they are passing a slow sentence of death on to those with whom they have sexual contact.

Many of those in high-risk groups appear to have become complacent about AIDS. Dr. Robert Janssen, director of the CDC’s AIDS division said, “Because more effective treatments are available, there seems to be a perception particularly in the gay community that HIV is a manageable disease. The disease just doesn’t have the fear that it once carried.”

It should, since irresponsibility often has lethal consequences. While Americans were right to honor World AIDS Day, AIDS prevention begins at home, where Americans have the power — and the responsibility — to prevent additional infections.