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AIDS in U.S. Marches On

Lack of AIDS Fear, Missed Opportunities Hinder Prevention Efforts
WebMD Feature

Zero percent. That is how much progress the U.S. has made in meeting its HIV prevention goal.

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The U.S. had some 40,000 new HIV infections in 2001. That's when the CDC set a goal of cutting this number in half by 2005. As of 2004, the estimated annual number of HIV infections is still 40,000.

"We have not made tremendous progress," David Holtgrave, PhD, tells WebMD. "HIV is still a major issue in the U.S., but it is not getting the attention it deserves.

A former CDC scientist, Holtgrave is now professor of behavioral science and health education at Rollins School of Public Health and director of behavioral and social science at Emory University's Center for AIDS Research in Atlanta.

The numbers are a bit deceptive, Holtgrave is quick to point out. They don't mean current AIDS prevention programs aren't working. There's strong evidence that they're keeping the U.S. HIV epidemic from getting worse than it is. But there's clearly a lot more work to be done.

AIDS Fear Down, HIV Fatigue Up

There's no cure for AIDS. There's no vaccine to prevent HIV infection. Unfortunately, many Americans don't know this, and many more may not care.

"There is some HIV fatigue. People have been hearing about the story since the early to middle 80s," Holtgrave says. "We are beginning the third decade of AIDS. And there is some misperception that there is already a cure for HIV. I think that some people may believe there is a vaccine already. They believe the consequences of HIV are not as substantial as they once were."

Truth be told, for most Americans the consequences of getting HIV infection really aren't what they used to be. And even if they were, there's just no way we could maintain the level of alarm we felt 20 years ago, says David Huebner, PhD, at the Center for AIDS Prevention Studies, University of California in San Francisco.

"You just can't live in that state of fear -- the state of mind that, for many gay men, came from going to several funerals a week," Huebner tells WebMD. "That psychological energy is not sustainable. Even without treatments, people would have developed fatigue around prevention efforts."

And fear-based prevention messages are counterproductive.

"There is a lot of research showing serious psychological consequences from living daily with the fear of getting a deadly disease," Huebner says. "I don't know that the safety engendered by that terror was healthy. Thankfully, HIV is now a different disease. As prevention people, we have to start thinking about it differently. We can't expect gay men to act the same way they did before."

Missed Opportunities

Why haven't HIV prevention programs worked better in the U.S.? One reason is that there have been missed opportunities.

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