We Should Say Yes to an Aggressive Policy on AIDS

Today is World AIDS Day. As a mother with a son who has been living with HIV for more than 20 years, I don’t need a World AIDS Day to remind me of the devastation that HIV disease is causing here and throughout the world.

From an unusual outbreak of pneumonia among gay men in large U.S. cities in the early 1980s, we have watched a pandemic that has gone on to kill millions of people. Current estimates of infections worldwide are staggering.

In the beginning, we talked about it being the “4H disease,” since those affected were homosexuals, Haitians, heroin users and hemophiliacs. Gay white males now represent fewer than 50% of those infected for the first time in the U.S. Today, HIV/AIDS is a disease of poverty, ignorance, official denial and, in this country, minority populations.

We read statistics about 28.5-million people being infected in sub-Saharan Africa, or 14 million children orphaned worldwide because of HIV/AIDS, but the numbers are so large they just don’t register. I am afraid that the numbers are numbing us into complacency.

George Will recently wrote in Newsweek, “The HIV epidemic in Eurasia is a phenomenon more destabilizing than any act of terrorism has ever been.” The Indianapolis Star concluded that “we must see AIDS for what it is: a weapon of mass destruction.” The epidemic’s next big wave now is occurring in Russia, China, India, Nigeria and Ethiopia, countries that are home to 40% of the world’s population. The infections are overwhelmingly occurring in heterosexuals.

At home, the U.S. must implement a comprehensive government-wide strategic plan to address the AIDS pandemic. And it must act now. With no cure or vaccine in sight and medications available only for a very few of the infected, this disease threatens to derail entire economies and even alter the global geopolitical balance.

On Nov. 7, the FDA approved a 20-minute HIV test that can eliminate the current two-week waiting period for test results. The Centers for Disease Control and Prevention estimate that between 850,000 and 950,000 Americans have HIV--and that a quarter of them don’t even know it. Some 600 positive HIV test results go undelivered in California annually because individuals fail to return to find out if they’re infected. Testing is very important to the disease’s management, along with getting sick people into care and educating them about how to prevent its spread.

In July, California passed a law that made HIV a reportable disease. Within months we will have accurate statistics and be able to track new infections. This information will tell us where to focus prevention efforts, which remain our most powerful weapon against the epidemic.

Orange County continues to establish public-private partnerships to provide services and care for the growing numbers of people living with HIV. The key to controlling the epidemic is prevention. The virus is entering new demographic groups at an alarming rate. We must be culturally sensitive in building our strategies and coalitions. And we must target both HIV-negative and HIV-positive individuals.

After 20 years, the AIDS crisis has caused many advocates and caregivers to burn out -- wearied by the constant battle. The media often portray the disease as a chronic, manageable illness. Pharmaceutical companies pay big bucks for advertising that shows healthy young men capable of climbing mountains.

The advertisements do not show the devastating side effects of the drug cocktails. Those under 30 don’t have memories of friends dying terrible deaths, of hospital wards and funerals every month. Attitudes toward safer sex are casual, and warnings are often ignored. Sexually transmitted diseases are on the upswing. They could very well signal that new HIV infections might be about to explode again. Are we ready for that?

Our current federal administration’s emphasis on the “abstinence only” message is totally worrying for those of us in the trenches. Abstinence will prevent some of the spread of HIV, but hormones often prevail over morals and even the best intended education. We parents know that. We have to give our children and young adults the tools, the skills and the knowledge to protect themselves and others.

In a recent poll conducted by CollegeClub.com, more than half of the U.S. college students responding reported that they have had unsafe sex during the last year. Nearly 80% acknowledged “no problem having sex without being in a relationship.” Let’s face it: Our “war on unsafe sex” through abstinence will not work any better than our war on drugs and “just say no” did.

The “abstinence only” message, which is receiving funding from the Bush administration, is painfully shortsighted. The scientific community and our best behavioral scientists are very clear on this. Let’s listen to them and not moralists, however well-meaning they may be. It is time to blend some common sense with behavioral science and adopt prevention programs that reflect reality.

As a mother, I ask you to support enlightened public policy, aggressive HIV education and prevention (including education about condom use) as well as abstinence. Our young people deserve nothing less.