The HIV Epidemic: 50,000 New Cases a Year

According to Medscape's Clinical Review for August 2010, over 50,000 new cases of HIV infection were diagnosed in 2005 - the same rate of infection documented in 1995, ten years previously. With all of the opportunities for testing, the decades of HIV/AIDS prevention education, the reduction of risk in the adoption of a no-exposure policy to bodily fluids, free needle programs, the changes in the provision of our blood, the medication therapies allowing for a near-normal lifespan, and all the intense media coverage, how can we have not decreased the rate of HIV infection? How?

This huge medical and cultural dilemma seems to stem from both individual, personal delusions and a larger cultural policy. Let me explain:

For instance, studies undertaken at the end of 2006 indicated that 21% of the over 1,000,000 million adults with HIV were undiagnosed. Thus, almost a quarter of a million people were failing to seek treatment for their condition and failing to modify their behavior to reduce the chances of infecting others. For the most part, these individuals weren't being purposely ignorant. Further studies have indicated that ­most people diagnosed in 2010 with HIVdid not consider themselves at risk.

This little personal delusion or inability to see one's behaviors as particularly risky when it comes to acquiring HIV only becomes truly dangerous when combined with that larger cultural policy mentioned earlier. While testing for HIV has been readily available for years, most people don't believe themselves at risk and therefore don't "opt" to have the test done. This has been the overall policy for HIV testing all these years, i.e., in the absence of a healthcare worker's inadvertent exposure to your bodily fluids, you must literally "opt-in" and provide your permission to have the test.

The Centers for Disease Control & Prevention now recommends global testing of everyone between the ages of 13 to 64. This policy would be implemented as an "opt-out" policy. In other words, it would be standard procedure for everyone to be tested for HIV in both routine and emergency cases unless they specifically refuse permission. We could, conceivably, stop that spread of 50,000 cases annually or at least those directly attributable to the quarter of a million people unaware of their positive status.

The HIV/AIDS epidemic and epidemiology is big and ugly and very complicated. There remain huge issues in race and income disparities as to treatment and outcomes. But this is one simple change we could do that would have enormous consequences.

Let's change the policy. In the meantime, get tested.

Sources:

http://cme.medscape.com/viewarticle/726835?src=cmemp&uac=103560EK

"Who's at Risk for HIV? Today's HIV Epidemic," Clinical Review, August 2010