Archive for Saturday, June 21, 2003

Policy will help fight AIDS

June 21, 2003


Two decades ago, when this country was first faced with the AIDS epidemic, the public health establishment made a fateful, deadly mistake.

The disease, many of us remember, was first considered a gay disease. Leaders of the gay community feared a backlash against gays. They worried that deadliness of the disease would lead to further stigmatization of gay men, discrimination, even violence. It's not too simplistic to state that traditional infectious disease control methods and new concerns about gay rights were in direct conflict and competition. Concerns about individual rights won traditional infectious disease control methods lost.

Unlike with SARS where screening, tracking of carriers and notification has been the public health approach AIDS was treated differently. Privacy of infected individuals became the primary concern.

Even though the Centers for Disease Control and Prevention recommended a decade ago that hospitals in areas of high HIV/AIDS prevalence routinely test patients for the disease, many, probably most, in the public health arena ignored the recommendation.

In most states, pregnant women, even those who are IV-drug users, still cannot be tested for HIV/AIDS unless they specifically request it in 2001, 175 infants acquired HIV infection from their mothers. And even today, tracking of HIV/AIDS patients is primarily for statistical purposes traditional public health models, such as partner notification for syphilis is not employed. CDC cannot tell us if the infection rates are stable or increasing, only that they are not decreasing. In the populations in this country that have been specifically targeted with the condom message, especially young gay men, HIV/AIDS rates appear to be on the rise. And up to a quarter of infected people are unaware of their infections.

For the good of everybody gay men, IV-drug users, pregnant women, newborns when it comes to AIDS, the times are changing. A positive HIV test is no longer a death sentence. Being HIV-positive is no longer reason to skulk in the shadows ask Magic Johnson.

The CDC has recently made a bold and important policy change that will help us begin to reduce the rate of HIV infection in the United States. It has taken a first step toward treating HIV/AIDS like a public health challenge, not a political issue. The CDC has recommended making HIV testing a routine part of all medical care, like cholesterol screening; that doctors and other health-care workers work with HIV patients to notify and work with their partners; and that HIV testing be included in the standard battery of prenatal tests, just like testing for diabetes.

It speaks volumes about how far our attitudes about HIV/AIDS have come in this country that these CDC policy changes were met with approval by the medical community and AIDS activists, and hardly noticed by the general public. We need to keep moving, quickly, in this direction treating HIV/AIDS as a disease, not a political issue. Then we will again be able to lower HIV/AIDS rates in this country.

Joe S. McIlhaney Jr. is president and founder of the Medical Institute for Sexual Health ( in Austin, Texas.

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