Washington Blade - August 8, 2008
Having lost patients and even my partner to AIDS, I wonder why the U.S. won't fight
epidemic at home
NEW GOVERNMENT statistics show startling increases in HIV
estimates. Shame and blame won't fix this, action and funding
I started treating AIDS patients in the early days of the
epidemic, helping so many young, frightened individuals both live
with hope and die with dignity. I have seen a community respond
to a crisis with unstoppable determination, effective activism
and remarkable compassion. I have seen the advent of effective
therapy turn what was once an almost certain death sentence into
a more manageable and chronic disease.
I have had the privilege of working with and learning from my
patients for more than 22 years. Yet the past several years have
shown me that lessons learned are easily forgotten. Too many
young men and women in their 20s are coming to my clinic with
advanced HIV disease. In many ways, it seems as if it is 1988 all
My experiences are not unique. Other doctors around the country
have noticed a similar increase in the number of advanced HIV
cases. And now the Centers for Disease Control and Prevention has
released a long awaited report showing a spike in HIV rates --
something those of us in HIV care have known for some time.
THESE NEW NUMBERS make it clear that our nation's efforts to
control the spread of HIV in the U.S. have failed. The revised
CDC estimates, which were officially released on Aug. 2 in the
Journal of the American Medical Association (JAMA), show
approximately 56,000 new cases of HIV each year. That is a 40
percent increase over the previous estimate of 40,000 new cases
Based on new surveillance data, the CDC also says that for the
past 15 years the annual number of new cases is actually 25-50
percent higher than previously thought. Simply put, the U.S.
epidemic is and has been worse than previously estimated. The CDC
attributes the increase to an upsurge in testing and enhanced
surveillance, yet better data alone cannot explain what I see
There will be plenty of blame and anger from activists and
communities impacted by this news and to a degree, rightfully so.
The impact of HIV disease is overwhelming on men who have sex
with men of all racial and ethnic backgrounds and especially
African-American men and women.
It's inexcusable for the United States to lack a national plan to
address this ongoing crisis. The absence of leadership, at all
levels of society, is intolerable. Stigma continues to drive this
Also, too many people think HIV is no longer a problem in the
U.S. We must overcome this incorrect perception not just during
this brief flurry of media attention, but for the long haul.
TO WIN THE war against HIV we must develop a national AIDS
strategy to fight HIV/AIDS. Our strategy for combating the
disease must use available tools such as rapid HIV testing and
fully implement and appropriately fund policies such as the CDC's
recommendation to make HIV testing a part of routine health care.
We must target evidence-based prevention efforts to those most
impacted by this disease.
However, the CDC's HIV prevention budget has remained stagnant
for far too long. A recent analysis conducted at Johns Hopkins
University revealed that the CDC's HIV prevention budget buying
power fell 17 percent between fiscal years 2002 through 2007.
Ryan White programs, which provide life-saving medical care and
services to the most vulnerable people living with HIV/AIDS, have
not received enough funds to keep up with the ever-growing
epidemic. These programs have reached a breaking point. We have
the tools to keep HIV in check, yet our nation seems to lack the
will to combat this epidemic at home.
Growing up in a family that lost many members during the
Holocaust, I remember being taught to never forget and make sure
such horrific events never happen again. Losing my partner and so
many of my friends and patients to AIDS, I often wonder why we,
as a community impacted by HIV, have not followed the same
We, owe it to those who died before researchers developed the
life-saving medications that have rescued millions of people. We,
owe it to those who struggle while living with HIV today. We have
the power to make a difference now, before we lose another
generation to what is today a preventable disease.