HIV Transmission and Progression to AIDS Continues
Medical Editor: Leslie J. Schoenfield, M.D., Ph.D.
I am frequently asked why, despite major educational campaigns and the development of new therapies, Americans continue to be contracting HIV and dying from AIDS. In fact, in association with the availability of more effective antiretroviral therapy, a sharp decline did occur in AIDS deaths between 1995 and 1997. The current estimate is that there are approximately 15-20,000 AIDS deaths per year, down from 40-50,000. However, the estimated rate of new HIV infections in the United States has not declined and has remained stable at approximately 40,000 per year.
Let us consider the HIV problem as a continuous sequence (continuum) from the initial HIV infection, to clinical progression with symptoms and AIDS, and finally to death. This approach enables us to address each potentially significant factor individually. First of all, the nature of the HIV epidemic has changed. For example, increasing numbers of people are being infected who do not perceive themselves to be at risk, such as heterosexual women. In addition, there is evidence that even gay men, particularly younger individuals, are putting themselves at increasing risk.
Why would these gay men put themselves at increased risk? Actually, many factors may be contributing to this major setback in our efforts to control HIV. For one thing, there is the inappropriate perception that therapy is so good that getting infected is no longer a "big deal." For another, many individuals are putting themselves at risk because they suffer from depression, drug and alcohol abuse, or sexual addiction. While education has been the mainstay of HIV prevention, these observations illustrate that there are indeed underlying, basic problems. Moreover, these fundamental problems need to be better identified and addressed if there is to be a decrease in the overall infection rate.
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