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Whatever Happened to AIDS?

Complacency Replaces Crisis As Epidemic Rages On
By
WebMD Health News

Nov. 27, 2002 -- Whatever happened to AIDS? It flashes across front pages and television screens every Dec. 1 on World AIDS Day -- but more and more, we in the U.S. tend to forget about it.

AIDS fundraising events report record low donations. U.S. AIDS prevention efforts are mired in debates over sexual ethics. Services that provide lifesaving medicines in the U.S. and abroad are running out of cash. Once considered a crisis, AIDS simply doesn't seem to be a priority any more.

In one way this is just human nature, says Howard Markel, MD, PhD, director of the center for the history of medicine at the University of Michigan, Ann Arbor. It's also a trap.

"AIDS was at first really scary. People were dying really quickly," Markel tells WebMD. "When I was treating people with HIV in the mid 80s I was losing a lot of patients. HIV infection meant acute illness with terrible wasting and disfiguring skin cancer and horrible pneumonia and all kinds of other scary stuff. First came AZT, then triple-drug cocktails. Now people are living with HIV in America. You can understand why healthy people say it's not a problem."

Elizabeth Fee, PhD, chief of the history of medicine division at the National Institutes of Health, agrees that HIV no longer seems a threat -- to nations that are able to afford treatment.

"For people at middle or higher income levels with access to the full AIDS drug cocktail, the crisis has lessened," Fee tells WebMD. "And so I think the degree of personal fear that a lot of people felt in the past has probably decreased. Unfortunately, we all pay most attention to the things that seem immediate threats to us. That means we who are concerned about AIDS get less attention when we talk about the size of the problem."

This complacency is a problem here at home. There have been nearly a half-million U.S. deaths from AIDS. Nearly a million U.S. citizens are living with HIV infection -- and 40,000 were infected in the last year. Surveys show unsafe sexual behavior is on the rise. Much of this behavior is among new members of the population that only a few years ago turned the U.S. epidemic around: young gay men. Prevention messages also are missing African-American and Hispanic men who have sex with men but do not think of themselves as gay. Last year most new HIV cases in Western Europe came from heterosexual sex -- yet American heterosexuals still feel little personal danger.

Treatment for HIV infection causes serious side effects and eventually fails many patients. Yet Western nations seem to have so much faith in HIV treatment they forget that prevention is the key to stopping AIDS, says Bernhard Schwartlander, MD, PhD, director of HIV/AIDS for the World Health Organization.

"Back in history, developed nations such as the U.S. had very successful programs among gay men and injection-drug users," Schwartlander tells WebMD. "But with the introduction of very effective treatment, there has been a complete shift toward treatment and giving pills. The prevention elements of the response have been almost forgotten. So what we see in all developed societies is an increase in risk behavior and sexually transmitted diseases and even in HIV. There is no room for complacency. Every infection that happens in places where we have all the resources is one infection too many."

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