Day 21 (World AIDS Day): A higher U.S. incidence

In honor of World AIDS Day, the CDC reports that the HIV incidence in the U.S. may be higher than previously reported. I have heard that the incidence was stable at about 40,000 new infections per year, for several years. I read in the Wall Street Journal today that the incidence may be as high as 60,000 new cases a year. This leads to the inevitable question: regardless of the actual number of new infections, why is the incidence not decreasing in the U.S.?

 

As I often say, the greatest tragedy about HIV is that it is an entirely preventable infection. If you take the proper precautions, the risk of infection should be minimal. So, why are so many people still getting infected? Certainly, there is a level of personal accountability for everyone, but as a society, we need to do everything we can to make to easier to prevent infection. My blood still boils when I think back to the moratorium on needle exchange programs from the late 90s. I was living in D.C. when there was a ballot measure on needle exchanges, but the results would not be tabulated because Congress would not fund the District if it enacted such a program. Is it a coincidence that D.C. now has the highest prevalence of HIV in the country, at a whopping 5%? Regardless of the moral implications, we need to make needles and condoms available to those who are at risk. Nobody deserves this disease because they made a bad decision or didn’t have access to preventative measures.

 

While I am on the topic of prevention, why can’t we have some more discussion on microbicides? A preventative vaccine is always the goal, but given the recent track record, can we spend a little more time and money looking into microbicides? Sure, the record with microbicide trials is about as bad as preventative vaccines—and the clinical trials are just as expensive and difficult as the vaccine trials—but as a former virologist and immunologist, I think we are going to have a lot more success at creating a microbicide than we are at making an effective preventative vaccine. There are conserved features of the virus that you can target with a microbicide that you cannot target with a vaccine. So, President Bush, can you talk about microbicides when you propose $30 billion for AIDS?

 

M. Linde