World AIDS Day Provides a Reminder: A Lot of Work Remains

Americans found many ways to commemorate World AIDS Day on Tuesday. Prayer vigils in Las Vegas. Free rapid-result testing in Iowa. Even a carnival ring toss in New Mexico. But the atmosphere was hardly festive.

The disease may have evolved from a quick death sentence to an illness that can be managed. Yet AIDS experts warn that the global epidemic is still taking 2 million lives a year. They also point out the continued need for prevention and early diagnosis and the shortage of money for treatment.

UNAIDS, a United Nations program, recently reported that the number of new infections has dropped 30 percent from a peak of 3.5 million cases in 1996. But in the United States, the Centers for Disease Control and Prevention recently estimated that about 56,300 people a year still are newly infected -- about one person every nine and a half minutes. HIV-AIDS is an autoimmune disease, transmitted through methods such as sharing needles for intravenous drug use and some sexual practices.

"We have done a very good job of helping developing countries. Where we have not done a good job is inside the United States -- giving it attention," said Frank J. Oldham Jr., president of the National Association of People with AIDS, which represents the 1.1 million Americans with HIV and AIDS.

Moreover, AIDS has been bumped out of the medical limelight by the H1N1 flu virus. But the "swine flu" has killed fewer than 6,100 people, according to the CDC; 14,000 AIDS patients die annually.

Yanzhong Huang, director of the Center for Global Health Studies at Seton Hall University in New Jersey, said the public may ignore the AIDS issue because people feel they aren't at risk for getting the disease. AIDS can be managed with drug treatment, he said, but "still, it kills people."

Oldham said too many younger people aren't taking precautions to prevent getting the disease because they don't remember the horrors of the early years of the epidemic in the 1980s. Oldham was living in New York City when he was diagnosed 20 years ago and started a sad cycle of attending friends' funerals.

"My entire circle of friends was dying," he said. Many were dead within 30 to 90 days of diagnosis. As they wasted away, he said, some hospital personnel were too afraid of the new disease to even bring the patients their meals.

Now, he points out, HIV patients can live 20 to 25 years after diagnosis, many with treatment from anti-retroviral drugs. And new medicines are so recent that it's unclear how long they will prolong the lives of infected people but could give them close to a normal life span, said Judith Feinberg, professor of medicine at the University of Cincinnati and an AIDS researcher for 25 years. "This is not an automatic death sentence anymore," she said.

But that rosier picture has led to some complacency in following safe-sex practices, Oldham noted.

AIDS is the No. 1 cause of death among African-American women ages 25 to 35, he said. Their rate of infection is 15 times that of white women, according to the CDC.

"This is no longer just a disease of men who have sex with men," Feinberg said. "If you're a sexually active person, you're at risk of getting HIV no matter who you have sex with."

Half of the new infections and half the people living with AIDS are African-American. And half are among men who have sex with men.

One-fifth of people in the U.S. who are infected don't know it, according to the CDC.

"Somewhere out there are a quarter-million people who have HIV and don't know it," Feinberg said. "Since they don't know it, they can't alter their behavior."

And that means they can spread the disease and may miss the health benefits of starting treatment early, Feinberg said.

The activist group AIDS Action used World AIDS Day to call on Congress to pass health reform that would end the insurance industry practice of denying coverage to patients with pre-existing conditions. And, according to deputy executive director Ronald Johnson, Congress should drop the ban on federal funds for needle exchange programs aimed at reducing the transmission among illegal drug users of HIV-AIDS through dirty syringes. The needle exchanges can save the country money since it costs $700,000 over a lifetime to treat someone who is infected, Johnson said. "The human and health care costs are too great to continue to reject this prevention technique that has proved to be effective," he said.

Huang said former President George W. Bush's plan to spend billions fighting AIDS in Africa has stabilized the situation there. Still, of the 33.4 million people in the world living with HIV, 22.4 million of them live in sub-Saharan Africa, according to UNAIDS.

And Feinberg warned that Americans can't assume they are safe from the disease. "It's not melting away, and people shouldn't have the attitude it's somewhere else."