MILLENSON: Preventing HIV/AIDS

Time for a change in message

By Elliott J. Millenson | Friday, December 5, 2008

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OP-ED:

Sexual infidelity has been in the news a lot this year. The partners of Silda Spitzer, Christie Brinkley and Elizabeth Edwards each demonstrated that when it comes to sex, hormones often trump integrity. Off the front pages, millions of other Americans, of both sexes, were also confronted with events that demonstrated appearance, accomplishment and devotion don't provide immunity against deceit and sexual betrayal.

Sadly, dishonesty is also a very real factor in the almost 60,000 Americans -- over 150 a day -- who become infected with HIV each year. An estimated 25-30 percent of the 1.1 million Americans infected with HIV don't know it. But, of those who do, one study revealed 17 percent of women, 19 percent of heterosexual men, and 42 percent of gay men admitted they don't tell their partners they are HIV positive. Most Americans become infected with HIV sexually -- and that means transmission can be dramatically reduced with realistic prevention approaches. A staggering 600,000 Americans have already died from AIDS -- as many Americans as died in the Civil War. These deaths are, in part, a testament to a predictable failure of people to conform to the government's AIDS prevention ideals of chastity, monogamy and protection. The "ABC" approach to AIDS prevention -- Abstinence, Be Faithful, Use Condoms -- helps, but isn't helping enough. If we want to get serious about HIV prevention in America, testing needs to be made a priority; to date it hasn't.

When AIDS first appeared in the U.S. in the early 1980s, many of those infected with HIV organized, demonstrated and lobbied aggressively at all levels of government. For activists, prevention was not the top priority; they were infected and were fighting for rapid approval of life-saving treatments. Their actions strongly influenced AIDS policy, and prevention took a back seat. After an HIV test was developed in 1985, making it as widely available as possible would have been the obvious and logical public health response, in normal circumstances, to a fatal, sexually transmitted disease. But hysteria surrounded AIDS. Activists lobbied against testing -- fearful of its impact on their lives. They were afraid, with some justification at the time, that employers, government, and sex partners would want to know their HIV status. So public health officials rejected the clarity of science for the fog of politics.

Promoting condoms as enabling "safe sex," despite their known high failure rate, became the cornerstone of a don't ask, don't tell approach to AIDS prevention. Condoms make sex safer -- not safe. Inexplicably, the FDA hasn't required condom manufacturers to detail infection risks in their labeling. Many Americans would be surprised to learn that the World Health Organization actual use data reveal a 10 percent annual seroconversion rate with condom use. Condoms help reduce HIV infection rates, but the only way to know you are having truly safe sex is to know - through testing - your and your partner's HIV status.

When politics have been sidelined, testing has worked. New infections from transfused blood are rare, and HIV transmission from mothers to newborns has been reduced in the last decade by almost 90 percent. Both successes can be traced to proactive testing programs. Since 1985 all donated blood has been tested for HIV. Similarly, reduction of HIV transmission from pregnant women to their newborn infants resulted from making prenatal and perinatal testing routine.

Most Americans who know they are HIV positive act responsibly, taking steps to prevent infecting others. At the same time, the reality is that others know they are infected, but don't take steps to inform their partners. And, many infected Americans don't know it -- and not only infect others unknowingly, but fail to get life prolonging treatments for themselves. Today, there are strong laws in place to prevent discrimination against those infected with HIV or AIDS. It's time to stop lying to ourselves that our AIDS prevention approach is working. Six hundred thousand American deaths confirm it's not. Promoting sound AIDS prevention approaches, which include encouraging Americans to know their and their partner's HIV status, as well as understanding the limitations of condoms -- and human nature -- will lead to a stronger and healthier America.

Recently, researchers at the World Health Organization developed a mathematical model which suggested that broadscale HIV testing could virtually halt the AIDS epidemic in Africa within a decade. A serious AIDS prevention approach utilizing testing could virtually eliminate AIDS in America, too. And, it could pay for itself – in addition to the tragic loss of life from AIDS, the CDC estimates that we are spending $40 billion a year on health care and lost productivity related to AIDS. It's time for a change.

Elliott J. Millenson was founder and CEO of the Johnson & Johnson subsidiary which developed the nation's first home AIDS test.

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