Ominous HIV Setback
The therapeutic power of the new AIDS drug combinations has been rightly celebrated, but the misconception that they are miracle cures is having a dangerous, unintended effect: Both infected and uninfected men are engaging in more high-risk sexual behavior. While drug companies ought to consider the moral implications of ads depicting happy, handsome, athletic people living easily with AIDS and HIV, state and national public health officials should mount their own vigorous counteroffensive.
A report released last week showed that HIV infection rates have more than doubled among gay men in San Francisco since 1997. Other recent studies suggest that gay men, particularly young men, across the country are increasingly engaging in unprotected, promiscuous sex.
Health experts conclude that the breakdown in safe-sex practices is at least partly due to overconfidence in the healing power of new AIDS drugs. The first corrective step should be improved public education with a “truth squad” approach. Public service announcements should make it clear that the new AIDS drugs, contrary to pharmaceutical company images, can at best hold the illness at bay.
TV networks can also help by lifting their ban on condom advertising. The ban was instituted before TV networks began rating shows based on content and before TV sets had V-chips. Today, it seems senseless to prohibit condom ads on late-night shows in which characters discuss sex explicitly and extensively.
The federal Centers for Disease Control could also use some education. As UC San Francisco professor Joseph Catania explained in an article in the journal Science last fall, the federal agency’s HIV prevention campaigns are based not on the number of new HIV cases but on the number of new AIDS cases. Since AIDS often doesn’t appear until years after HIV infection, the campaigns are often aimed at the wrong people. As Catania says, “Frankly, we’ve lost track of the disease.”
Public health officials could keep better tabs if doctors were required to report new HIV cases, as they are with TB, syphilis and gonorrhea. In 1999, the CDC called on states and local public health departments to report all HIV cases either by name or code, but many states, including California, have resisted. In 1999, for instance, Gov. Gray Davis, citing insufficient federal funding, vetoed a bill by Assemblywoman Carole Migden (D-San Francisco) that would have required HIV reporting using secret codes.
With the alarming new reports in hand, Davis ought to welcome a new version of Migden’s bill, or at least the more modest measure proposed by Thomas J. Coates, director of the University of California’s Center for AIDS Prevention Studies, to require reporting only from prenatal clinics, substance abuse services and clinics for sexually transmitted diseases, the places where an increase turns up first. Better monitoring, public education and renewed personal responsibility will be key to preventing HIV from again spiraling out of control.
