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A national battle plan against HIV/AIDS

Familiar. That’s what strikes me about the National HIV/AIDS Strategy for the United States released yesterday. This is not a criticism. The 60-page document is neither unimaginative nor reinventing the wheel. It rightly brings the federal government in line with the clear-eyed, innovative actions being taken across the country to stem the epidemic. What gives this approach authority is that it is backed by the power of the presidency.

I’ve written a lot about the HIV/AIDS epidemic here in Washington, where at least 3 percent of the city’s population is living with the disease. That’s a wide swath of heartache across every socio-economic strata. But we know that African Americans and men who have sex with men are bearing the brunt of the epidemic -- in the District and across the country. The District now makes HIV testing a part of routine care. And it is pushing to get people into treatment sooner than they currently are. That the city has those devastating statistics and a plan to (try to) slow the spread of the epidemic is a testament to Shannon Hader, the outgoing HIV/AIDS chief, and the man who appointed her, Mayor Adrian Fenty.

I see that same commitment and focus in the new federal plan. It’s the same commitment and focus that has made the President’s Emergency Plan for AIDS Relief (PEPFAR) a global success -- and now those lessons are being brought to bear at home. Obama has ordered six federal agencies to submit a report on how they will implement the national strategy within 150 days.

The domestic goals are reasonably ambitious, meaning they stand a chance of being met. The number of new infections should be reduced by 25 percent by 2015. By that same year, there should be a 20 percent increase (to 85 percent) in the proportion of patients linked to care within three months of their diagnosis. And within that same five-year period, the proportion of gay and bisexual men and African Americans, respectively, with undetectable viral loads should be increased by 20 percent. Obama has ordered the Office of National AIDS Policy to report to him every year on its progress in meeting these goals.

Another reason they stand a chance of being met is because the administration will focus its prevention efforts in the communities where HIV has hunkered down.

Not every person or group has an equal chance of becoming infected with HIV. Yet, for many years, too much of our Nation’s response has been conducted as though everyone is equally at risk for HIV infection. Stopping HIV transmission requires that we focus more intently on the groups and communities where the most cases of new infections are occurring.

This is bound to be a controversial statement. It could reinforce the mistaken impression that HIV/AIDS impacts “other people.” But this gets to the heart of why the HIV/AIDS epidemic has been so difficult to fight -- a lack of honest discussion, which feeds the stigma that chokes off the discussion before one can be had. We also must be honest that even if we’re not among those most at-risk, we have a responsibility to protect ourselves and others.

Every nine and a half minutes, an American becomes HIV-positive. Put more starkly, five people became infected during the 48-minute announcement ceremony at the White House yesterday. Every year, more than 56,000 Americans become HIV-positive. While this rate of infection has been rather steady over the last decade, the number of people living with HIV/AIDS -- now at 1.1 million -- continues to grow. Knowing one's HIV status is key to fighting the epidemic. Knowledge is power -- power to get into treatment if infected, power to protect yourself if you’re not. With one in five people living with HIV unaware of their status, knowledge can save your life.

By Jonathan Capehart  | July 14, 2010; 8:20 AM ET
Categories:  Capehart  | Tags:  Jonathan Capehart  
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The US has spent too much money on AIDS research and treatment. The dollars should be poured into the real killers such as heart disease, cancer, strokes, etc. These are life-threatening diseases imposed on human beings by nature. AIDS is strictly a self-inflicted disease through sex and drugs. Given our limited resources, it is senseless to worry about those who do not want to worry about themselves.

Posted by: SimmertimeinDC | July 14, 2010 11:05 AM | Report abuse

Using your logic, nothing should be done to treat heart disease, cancer, strokes, etc. because they are usually caused by lifestyle choices such as poor eating habits, smoking, drinking, choice of work environment so it is senseless to worry about those who do not want to worry about themselves.

Posted by: knjincvc | July 14, 2010 12:39 PM | Report abuse

You speak as if heart disease and strokes aren't self inflicted. Are they not the pathological result of people who "do not want to worry about themselves" either? I feel your thought patterns are not only riddled with prejudice but are also the perfect embodiment of what is wrong with how our country is thinking about treating HIV today.

Posted by: MSanchez2 | July 14, 2010 12:48 PM | Report abuse

@ SimmertimeinDC - beyond being stupid (much of disease is preventable), it's evident that you don't have a heart.

Posted by: wjfreeman1 | July 14, 2010 8:59 PM | Report abuse

Usually, medical studies tend to study how to preserve the human body, not vilify it and justify its destruction. For example, hernias used to require large incisions that left the patient with a scar. Now, with laproscopic technology, doctors can operate using just a few incisions in the body. The study of cancer is a tedious one, and usually researchers are trying to find ways to avoid the loss of organs, such as the testicles, the prostate, and/or the mammary glands. Circumcision "studies" are unique. They're the only ones of their kind that seek to preserve a procedure, and not the human body.

I'm sure that researchers have considered the scenario that not everyone will want to get circumcised. Have they considered or studied alternatives for HIV/STD prevention WITHOUT having to circumcise? Is the WHO or NIH doing anything to eventually move past circumcision? Is there research looking for ways in which men don't have to consider circumcision anymore?

According to the WHO Bulletin, African ritual circumcisions have a 35% complication rate, while clinical circumcisions have an 18% complication rate. A neonatal circumcision complication rate of 20.2% was found in Nigeria. Won't dealing with these complications divert resources away from other more needed programs, such as mother-to-child transmission reduction? The treatment of people who are already infected? Antiretroviral therapy?

These are hard economic times. I hear lots of talk of "efficacious spending" and "evidence-based decision making." Studies show one thing, but reality shows another.

In America, for example, 80% of men are already circumcised from birth. The rates of infant circumcision are dropping, but at large, the population remains circumcised. These rates are at their highest in the East Coast, where cities such as Philadelphia and Washington DC rival HIV hotspots in South Africa. In the 1980s, when the AIDS epidemic first hit, the rate of circumcised men in America was at 90%. One needs to question how something that never worked here in our own country is suddenly going to work wonders in Africa.

In other countries, the "protection" remains to be seen as well. AIDS is a rising problem in Israel, where the majority of the male population is already circumcised. On Wednesday, July 7th, two weeks ago, Malaysian AIDS Council vice-president Datuk Zaman Khan announced that than 70% of the 87,710 HIV/AIDS sufferers in the country are Muslims (in other words CIRCUMCISED). The Muslim, circumcised population accounts for 70% of the incidence of HIV, but only 60% of the population, which would mean that the circumcised population is getting HIV at a much higher rate than the non-circumcised population.

It is a waste to be spending money on a procedure with dubious benefits, when that money could be better spent on more effective modes of prevention. WHO, UNAIDS etc. need to start looking beyond circumcision for HIV prevention.

Posted by: kogejoe | July 20, 2010 4:44 AM | Report abuse

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