Charting the HIV/AIDS epidemic

By Kevin Fenton

Today, thousands of public health leaders will gather in Atlanta at the National HIV Prevention Conference to discuss the path forward in combating America’s HIV crisis.

There is no simple solution to stop the epidemic, but we know now more than ever before about what works to prevent HIV infection. There are a growing number of proven, cost-effective prevention interventions. And the latest estimates indicate that U.S. prevention efforts have averted at least 350,000 HIV infections and more than $125 billion in AIDS treatment costs alone.

But substantially more must be done. More than 56,000 Americans are estimated to be infected every year. That’s one person every 9.5 minutes. Despite substantial knowledge of how to effectively prevent HIV, populations at greatest risk are not being sufficiently reached with proven prevention interventions, and Americans are becoming complacent about the threat of HIV — a virus that infects 1.1 million people in the country.

For example, just 20 percent of gay and bisexual men report being reached by a prevention program in the prior year. This is particularly concerning since men who have sex with men account for more than half of new HIV infections in the country — and this is the only group in whom new infections are increasing.

Further, about 1 in 5 people infected with HIV — more than 200,000 adults — don’t even know they have the virus and may be unknowingly spreading the virus to others.

At the same time, studies show that the level of concern about HIV in America has declined, and some of the populations at highest risk do not recognize their risk or simply believe HIV is no longer a serious health threat.

The severe and continued burden of HIV in this nation is neither acceptable nor inevitable. But, significant progress will require that we strengthen our national response.

First, all Americans should know their HIV status so they can protect themselves and their partners. These days, HIV testing should be as standard as a blood pressure check.

CDC recommends that everyone aged 13 to 64 years old get tested for HIV as a routine part of medical care, and that those at higher risk, such as gay and bisexual men, get tested annually. When people find out they are infected, they can take steps to protect their partners and can get the medical care they need.

Second, we must work collectively — across all levels of government and the private sector — to expand access to proven prevention programs for the populations at greatest risk, especially gay and bisexual men of all races, African-Americans, Latinos and injecting drug users.

Third, we must continue our search for new tools and approaches to prevent HIV infection — biomedical, behavioral, and structural.

For example, research is under way to determine if oral drugs used to treat HIV can be taken by HIV-negative individuals before potential exposure to help reduce their risk of infection. Studies continue to examine the impact of specially tailored behavioral interventions for people at high risk of infection.

And programs are being implemented that routinely offer HIV testing and counseling in clinics, emergency departments, and high-risk community sites. Because no tool is 100 percent effective, our success will be determined by how effectively we utilize all available tools in combination.

It is imperative that we confront complacency about HIV and the false sense of security that hides what remains a serious HIV epidemic in the United States. To help raise awareness of this continued threat, CDC recently launched “Act Against AIDS,’’ a five-year communication campaign designed to refocus national attention to the HIV crisis.

As a nation, it is time to determine the direction we will take in fighting this serious – yet entirely preventable – disease. One direction continues down the dangerous path of complacency. The other leads to a reinvigorated, accountable, science-driven effort to ensure all people know their HIV status, and have the tools to protect themselves and others from infection. The future of the epidemic in the United States will depend on the choices we make today.

Dr. Kevin Fenton is director of the National Center for HIV/AIDS, Viral Hepatitis, STD & TB Prevention at the Centers for Disease Control and Prevention. He is also co-chair of the 2009 National HIV Prevention Conference.