EMERGENCY NOT OVER IN HIV/AIDS BATTLE

In 2005, there were 39 million people worldwide living with HIV, 4
million new HIV infections and just fewer than 3 million deaths
because of AIDS.

Four years earlier, the United Nations General Assembly Special
Session on AIDS committed to substantial steps to reduce infections
and provide treatment to people with HIV. Given the prevalence of
HIV, as reflected in the statistics, has this commitment made a difference?

Yes, but it is not nearly enough. In the past five years, for
example, the number of people receiving HIV treatment worldwide has
jumped more than 540 percent. Yet despite this expansion of
treatment, only about one out of five people needing anti-retroviral
drugs now receives them.

HIV counseling and testing services have expanded by more than
fourfold, but still less than 1 percent of the population in
developing countries has access to this critical service.

Today, scientists, physicians, community providers and activists will
gather in Toronto for the 16th International AIDS Conference to
debate HIV prevention, treatment and policy issues. They have
life-and-death matters to discuss. The global issues might dominate
the discussions in Toronto, but the statistics that inform the state
of AIDS in America are as disturbing.

The HIV epidemic in the United States is far worse than many people
realize. There is now a death because of AIDS every 33 minutes in the
U.S., and a new HIV infection every 13 minutes. One-half of the new
infections occur among African-Americans though only 13 percent of
the U.S. population is African-American. A 2006 nationwide poll found
that 43 percent of respondents could not correctly answer basic
questions about how HIV is transmitted.

Of the roughly 1.1 million people living with HIV in this country,
about 25 percent do not know they are infected. This is most
unfortunate because it means they could not get treated, and when
people living with HIV learn that they are infected, most take
effective steps to avoid transmission to others.

Despite living in a wealthy nation, only 55 percent of people in need
of anti-retroviral therapy in the U.S. receive it. Those who do
receive treatment often have to struggle to find ways to pay the
HIV-related medical bills that can easily top $10,000 per year.
Further, the federal government has cut spending for HIV prevention
each year since 2003.

In this country, about one in five think that people living with HIV
"got what they deserved."

How can we remedy this situation? First, we must remember that in the
mid-1980s there was a new infection every three minutes and in 1995
an AIDS-related funeral every 10 minutes, so there have been
tremendous strides made in prevention and treatment.

What is tragic is that as a nation we have good information about
what types of treatment and prevention programs work, but we just
don't deliver those services at the scale needed to make a larger
difference in the epidemic. In 1988, Surgeon General C. Everett Koop
sent a brochure about HIV to each and every household in the U.S. But
when was the last time you received an AIDS message in the mail?

Also, studies have shown that HIV prevention counseling conducted in
small groups can be highly effective at reducing HIV risk behaviors.
And yet, in a recent national Centers for Disease Control and
Prevention study of men who have sex with men in 15 major U.S.
cities, only 8 percent had received such a service in the past year.

Intensifying our efforts in several areas is imperative. We must
rebuild our crumbling foundation of basic HIV knowledge, and reduce
the stigma against people living with HIV. We must expand counseling
and testing services and provide science-based prevention services to
persons engaged in risky sex or drug use.

We must ensure that all persons living with HIV have access to
treatment that meets recommended standards. We must address the
social inequities that lead to one-half of all new infections
occurring in African-Americans.

In Baltimore, where the epidemic has hit hard, the challenges are
great. In 2003, Baltimore had the fifth-highest rate of new AIDS
cases among U.S cities. Of 650,000 people living in Baltimore, about
14,300 were living with HIV by the end of 2004. Four years ago, city
officials declared a "state of emergency" to address HIV/AIDS; it's
still an emergency.

Today, there are about 1,000 new HIV infections per year in
Baltimore, concentrated in ZIP codes covering the most economically
disadvantaged parts of the city. Without the critical community-based
HIV prevention programs that are in place in Baltimore, the numbers
would be even worse.

The city is trying new strategies, such as conducting special blood
tests that can detect HIV infection very shortly after it occurs.
This is critical for getting persons recently infected into treatment
as soon as possible and avoiding transmission of the virus to others.

This week, 20,000 delegates to AIDS Conference in Toronto will give
us a clear reminder of the pressing issues affecting AIDS and a call
to action. But frankly, as we read the morning paper, we should only
have to ask ourselves if even one more new HIV infection is acceptable.