AIDS at 30
It’s World AIDS Day again and this year’s theme is “Getting to Zero,” suggesting that the complete elimination of new HIV infections and AIDS-related deaths is within our grasp. After thirty years and 30 million AIDS deaths worldwide, that’s of course, great news. Echoing the theme, Secretary of State Hillary Rodham Clinton mused about an “AIDS-free generation” in a November 8th speech and Ambassador Dr. Eric Goosby, who serves as the U.S. Global AIDS Coordinator, recently opined on the Huffington Post that we are at a “tipping point” in the fight against the deadly disease.
President Obama, in the forward to his administration’s long-awaited National HIV/AIDS Strategy released in July of last year, noted that nearly 600,000 Americans have died of AIDS since the onset of the epidemic, 56,000 still become infected each year and an estimated 1.1 million are living with HIV, the virus that causes AIDS. Still, the document predicts that “the United States will become a place where new HIV infections are rare,” and lays out a goal to reduce HIV infections by 25% by 2015. Wait. Twenty-five percent? Is that really the best we can do?
That means that in 2015, 42,225 people will become infected with HIV, instead of the current 56,300 and that between now and then, best case scenario is another 150,000 Americans infected with an incurable, invariably-fatal virus that is 100% preventable. That’s what success looks like in Washington these days. At that rate – a 25% reduction in new infections every five years – we’ll still have 24,000 new cases in 2025, 10,000 annual infections in 2040 and in 2060 – 50 years from now – we’ll still have 3,171 people each year that contract HIV. We won’t fall below 1,000 new cases until about 2081, which is exactly 100 years after the epidemic first appeared among a handful of gay men. Now anything can happen, but it sure looks like we’re going to take our time “getting to zero” and it’s safe to say that the “AIDS-free generation” probably won’t occur in our lifetimes. What’s worse is that given the current state of affairs, we probably won’t even hit those targets.
Obama’s director at the Office of National AIDS Policy – who helped write the report – resigned last month, the federal budget is a mess and HIV is the last thing on anyone’s mind. The failure of the Congressional “supercommittee” to come up with a workable fiscal plan means that essential programs for people living with, and at risk for HIV are threatened with deep cuts. Medicaid, Medicare, the Ryan White Program, public assistance, unemployment benefits and HIV prevention programs are all on the chopping block. State and county funding cuts have impacted local community-based programs and schools, which means fewer HIV-tests, less prevention education and ultimately, more infections.
While AIDS has historically been protected from funding reductions, both because of the severity of the epidemic and the grassroots activists that sprung into action at every whispered threat, those days are over. Everything is on the table, AIDS has morphed from a short-term acute crisis into a chronic, intractable problem and fighting the disease doesn’t appear to be on anyone’s list of priorities.
But there’s another variable that promises to set-back anti-HIV efforts in a big way and it didn’t even get a mention in the Administration’s report: our rapidly expanding heroin crisis among young people. We’ve seen it here on Long Island and communities – especially suburban centers – across the nation are experiencing the same thing.
A quarter of all new HIV infections nationwide occur in young people ages 15-29. Most don’t know that they are infected and as such, unwittingly pass the virus on to their peers either through unprotected sex or contaminated needles. Kids who are high on heroin – or anything else for that matter – have sex more frequently than their peers, and they do things they wouldn’t otherwise do when they are impaired or in search of the next fix.
Heroin has hit Long Island hard and the number of addicted young people continues to skyrocket. Most start with prescription pills and eventually move from $50 OxyContins to $10 bags of heroin. The longer you use, the more you need to use in order to achieve the same effect, so you become the go-to person who heads into Bushwick and brings back enough for your friends in order to finance your increasingly expensive habit. Boom. Heroin has gone viral, just as AIDS did back in the day when our complacency gave the virus a head start that will take us a full century to overcome.
Young people who two years ago were snorting heroin, are now injecting it. They’re sharing needles and they’re having unprotected sex, in part because they haven’t gotten the messages about HIV, Hepatitis C and sexually transmitted infections. Prevention materials – created in the 1990’s – tend to focus on the older drug user and many treatment programs still don’t do a great job teaching risk reduction, despite the well-established connection between addiction and communicable diseases, including HIV. This cohort of young people isn’t likely to call an AIDS hotline, attend an educational program or visit a health-related website because they don’t see themselves as being at risk.
Sure, they know about AIDS, but only as a distant threat and as a chronic manageable condition akin to diabetes. They were in diapers when President Clinton took on AIDS in a way his two predecessors wouldn’t and when MTV ran a steady stream of PSAs between music videos. They’ve never heard of Ryan White and probably don’t even know that Magic Johnson is HIV-positive. They didn’t see their friends tethered to IV poles and literally wasting away in what was then called the Nassau County Medical Center or Stony Brook Hospital for weeks at a time. They didn’t witness the discrimination – the worst of which often came from family, or attend the steady stream of funerals, and have never climbed the walls waiting for results of an HIV-test.
While we’ve made some strides in the last 30 years and AIDS is a different disease than it was back then, it’s still no party and if we don’t change course, we’ll have a brand new wave of HIV infections on our hands. Young people who find a path to recovery from addiction and begin rebuilding their lives will get slammed with a life-changing diagnosis and an AIDS-free generation will remain even further out of reach.