Don’t Let Up in War on AIDS

Mortality rates among people with AIDS have been declining ever since a strikingly effective class of drugs, protease inhibitors, became available in 1993. Now, newly released figures paint a bright picture indeed: From 1996 to 1997, AIDS deaths declined by 44% in the United States and by 55% in Los Angeles.

Continued declines can hardly be assured, however, for while AIDS seems under control in some populations--notably the middle-aged gay white males who suffered inordinately in the ‘80s--epidemiologists say it is not declining nearly as rapidly in other groups. Most at risk are intravenous drug users and those who cannot afford to pay for the new drugs, which cost about $15,000 a year.

Several recent studies show that the most effective way of slowing the spread among IV drug users would be to offer federally funded needle exchange and drug prevention programs. Congress temporarily barred Health and Human Services Secretary Donna Shalala from funding such programs, but that restriction ends in March and Shalala should act quickly to provide funding.

The federal Medicaid program will pay for protease inhibitors for people with very low incomes, but that is just a fraction of those who need help. Last April, Vice President Al Gore proposed extending treatment to people with AIDS who lack insurance but are not poor enough to qualify for Medicaid. Federal budget analysts estimated that the plan could cost $3 billion, and it went nowhere. It is worth revisiting: Guaranteeing protease inhibitor treatment is good health policy, for it has been shown to markedly reduce transmission of the human immunodeficiency virus, which causes AIDS.

The final keys to preventing transmission are continued changes in sexual behavior and better HIV reporting. Health experts now agree that HIV tracking is essential. But California is not among the 30 states that require health officials to report every HIV infection to the federal Centers for Disease Control.

The AIDS declines are dramatic good news. Better treatment programs, nationwide HIV reporting and new prevention campaigns could preserve this trend, perhaps eventually into oblivion. The only wrong response would be complacency.

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AIDS in L.A. County

Number of cases

‘84: 498

‘92: 4,193

‘97: 1.385

* Data provisonal for 1996 and 1997

Source: L.A. County Health Dept.