Global Health Research Fellow
The world’s top AIDS experts will meet next week at the International AIDS Conference (AIDS 2012) in Washington, D.C., home not only to the President and Congress, but also one of the highest concentrations of HIV in the country. Around the corner from the convention site, African American residents of the District of Columbia live with an HIV prevalence rate of 4.3 percent, four times higher than the 1 percent level at which experts declare there is a generalized epidemic. Nationally, the virus has killed more than 600,000 Americans and continues posting a new infection rate of roughly 50,000 a year.
The figure will come as a surprise to many Americans who see HIV as a disease of the past, but there are now 1.2 million people in the United States living with virus. The disease is particularly aggressive in certain communities. While they make up only 2 percent of the U.S. population, men who have sex with men accounted for 61 percent of new infections in 2009. African Americans are only 14 percent of the population, but suffered 44 percent of new infections that year
“Many Americans, because of the enormous scientific progress that we’ve made, have thought ‘Oh we’ve won that war, we have all these medications, it’s over and done’ and they also are not sufficiently invested in the lives of these young people, of these black people, of these gay people,” said Cornelius Baker, national policy advisor for the National Black Gay Men’s Advocacy Coalition.
That complacency will be challenged at the AIDS conference, the first held in the U.S. in 22 years. While the meetings historically have focused on global strategies and explorations of new science, participants also will push for resources and attention to domestic disease. Conference organizers have done their part to highlight the issue, with sessions devoted to the U.S. epidemic. The plenary session Monday, for example, features Phill Wilson of the Black AIDS Institute.
The conference is seen as a prime moment to better integrate U.S. and global programs and increase visibility and resources for both. “America’s need for a greater AIDS response underscores that AIDS 2012 is an important and long overdue opportunity for our domestic pandemic to become part of a global effort,” said Congresswoman Barbara Lee (D-Calif.).
Both responses have similar goals: broader access to testing; early, consistent treatment for all; better education focusing on paths of transmission; an end to stigma. Even with all the health care resources in the U.S., many statistics are disheartening and echo the challenges in affected countries in Africa: 20 percent of those infected don’t know they have the disease; only 28 percent of those who have been diagnosed have achieved optimal levels of viral suppression through proper treatment; education efforts are faltering as a generation comes of age without realizing the risks of HIV. “We have a population that is becoming increasingly ignorant about the epidemic,” Baker said.
AIDS wasn't always invisible for so many here. In the early 1980s, Americans were alarmed as a new disease began causing cancer and pneumonia in young gay men and then killing them. While early reaction was clouded by anti-gay sentiment, activists soon became more vocal and the virus spread to other populations, resulting in funding increases for research and treatment. The effort ultimately led to development of antiretroviral drugs that prolonged the lives of those infected. AIDS dropped from the #1 cause of death for those Americans aged 25-44 in 1994 and 1995, the peak years for AIDS-related deaths, to the 6th cause for that age group by 2007.
As the disease became more manageable, the terror subsided. Attention turned to Africa where AIDS was threatening entire societies with early, horrifying death. The Bush Administration reacted in 2003 with the President’s Emergency Plan for AIDS Relief (PEPFAR), literally saving millions of lives.
While the U.S. and global AIDS responses developed separately, some see better opportunity now for programs to adopt each other’s best practices. Two years ago, domestic advocates mobilized the federal government to develop a National HIV/AIDS Strategy similar to those required for PEPFAR countries, an achievement credited to President Obama. The document, says Chris Collins, vice president and director of public policy for the Foundation for AIDS Research “has helped drive forward important reforms in the effort,” including ensuring programs are reaching the most affected populations.
Shannon Hader of Futures Group, who ran the HIV/AIDS program in the District of Columbia after working on global AIDS with PEPFAR, said the combination of biomedical prevention strategies now available, including early treatment to reduce transmission risk, can be applied to epidemics both domestically and globally. “How we get to zero is now a shared challenge,” she said.
While efforts are being made to curb new infections and ensure appropriate care in the United States, much more can be done. With the eyes of the world on America’s capital city, policy makers and community leaders should commit themselves to an AIDS free generation not only for sub-Saharan Africa, but also for South East Washington.
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