Widen the War on AIDS

The 12th annual AIDS conference that concludes in Geneva today was a showcase for the promising therapies made possible by science’s new understanding of how the HIV virus disguises itself so human cells don’t raise defenses to the deadly pathogen.

But the conference also raised a red flag, noting a key shift in the population contracting HIV that calls for a prompt and bold redirection of America’s AIDS prevention strategies. AIDS, long declining among the gay men it first afflicted, is now rising precipitously among the homeless, teenage girls and African Americans, who account for 45% of all new AIDS cases and 57% of new HIV infections even though they are less than 13% of the U.S. population.

The great majority of the new HIV infections are still contracted either through unsafe sex between men or through drug abusers’ use of contaminated needles, but the incidence among women who are infected by sexual partners is rising fast. While Washington has extensively funded both sex and drug education, it has misdirected many of those dollars.

For instance, Health and Human Services Secretary Donna Shalala has acknowledged the extensive evidence that properly administered needle exchange programs, which provide drug addicts with clean needles and offer substance abuse treatment, significantly reduce HIV transmission rates. Although it might seem to fly against common sense to use public money to pay for addict’s syringes, needle exchange reduces AIDS transmission by reducing needle sharing, and addicts who are in frequent contact with social outreach workers are more likely to be lured into treatment. Yet in March, when President Clinton had a chance to lift a congressional ban on federal funding for such programs, he declined to do so.

Crucial to lowering HIV transmission among young Americans are so-called “abstinence plus” sex education programs, which urge abstinence until marriage but also discuss contraception. But the $250 million that Congress allocated last year for sex education is restricted to “abstinence only” sex education programs whose message to young people is that they must abstain from sex until marriage; contraception may not be discussed. While laudable in principle, the message falls on deaf ears among many sexually active U.S. adolescents, who have doubled in number in the last two decades. Washington should extend funding to “abstinence plus” education programs, which, according to a new Centers for Disease Control study, “increase use of condoms among high school students without encouraging sexual activity.”

AIDS is as much a social problem as it is a medical one; weak leadership in Washington is just part of the problem. Different groups have different kinds of risks, and personal responsibility has to be a part of the conversation. Abstinence, condom use, honesty about sexual habits and drug history all continue to have an important role in reducing HIV transmission.

As the Geneva conference shows, science is taking quantum leaps in fighting AIDS, but as the infection rates show, the virus cannot be defeated in medical labs alone.

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Changing Face of AIDS

Of the total AIDS cases reported in 1997, 45% were among African Americans. The percentage of new cases among whites continued to drop.

‘87

White: 57%

Black: 27%

Latino: 15%

‘97

White: 335

Black: 45%

Latino: 21%

Source: Centers for Disease Control, study of data from 25 states