Prevention message still key in HIV

Even in an era of declining AIDS deaths and increasing drug regimens, prevention remains the best approach.

Editoriial. Sept. 25, 2000.

The lead story in our Health & Science section last week took an in-depth look at the complexities of highly active antiretroviral therapy for AIDS (AMNews, Sept. 18). Despite their current drawbacks, drug regimens are the key factor in a striking AIDS statistic announced this summer: The disease dropped off the top 15 causes of death in the United States for the first time since 1987.

But even this welcome news requires a reality check. The number of new AIDS cases reported annually by the CDC appears to be holding steady at 45,000 in recent years. The HIV infection number alone, harder to accurately track, is also estimated by the CDC to be similarly flat at about 40,000 a year.

Obviously, those numbers remain too high. It is critically important for physicians to continue to send out the HIV/AIDS prevention message.

The terrible irony of turning AIDS into a chronic illness is the growth of complacency about the disease. There have been disturbing reports of young gay men dangerously discounting their risk -- both in terms of receiving and passing along HIV infection -- due to their misinterpretation of HAART's success in lowering viral loads and prolonging life.

Also, the prevention message increasingly needs to be tailored to specific groups. Although men who have had sex with men remain far and away the single biggest exposure category, heterosexual transmission is on the increase. African-Americans and Hispanics have long been disproportionately represented in HIV/AIDS statistics, and those numbers remain high. Intravenous drug users are another disproportionately represented group -- they should have access to clean syringes.

All told, as many as 5 million Americans remain at high risk for HIV infection. Drug regimens provide a miraculous lifeline for those who will become infected, but prevention remains the better way.