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 will.

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 over again.

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 per year.

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 every day.

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 disease.

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 lesson.

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.