More than 30 years have passed since AIDS began to spread, and despite many advances in treating the disease, the United States may still lose the war against it unless public health policies change. This is according to Dr. Thomas R. Frieden, the director of the U.S. Centers for Disease Control and Prevention, Kathryn E. Foti of the CDC, and Dr. Jonathan Mermin, the agency's chief of AIDS prevention, writing in an essay in the New England Journal of Medicine that was posted online on World AIDS Day.
"We now know that treatment of HIV infection is most effective when started early and continued throughout life but face challenges that are familiar from other chronic, often asymptomatic diseases: patients who feel relatively well are reluctant to initiate or continue treatment that may have or be perceived to have adverse effects. The situation is further complicated by the stigma associated with HIV infection and HIV risk behaviors and the disproportionate social, drug-addiction, and economic challenges faced by people living with HIV infection," they wrote.
"In 2012, an estimated 1.2 million people in the United States were living with HIV infection- an increase of more than 20% over the previous decade, attributable to continued new infections and a 36.5% decrease in deaths related to the acquired immunodeficiency syndrome (AIDS)," the essay stated. Reported cases of infection with HIV, the virus that causes AIDS, have decreased overall, but these are now concentrating in gay men and younger men. Nearly half of all diagnoses are in black men. The number of diagnoses in people 13 to 24 years of age increased by 43%.
"Hundreds of thousands of people with diagnosed HIV infection are not receiving care or [antiretroviral treatment]," they wrote. "These people account for most new HIV transmission." About 45,000 new cases of HIV occur each year in the United Sates, with 30,000 of these being transmitted by people with the virus who are not receiving care and 10,000 who have not been diagnosed.
The essay notes that several behaviors that put people at higher risk for contracting HIV are growing increasingly common. These include anal intercourse and the use of intravenous drugs. It pointed out the HIV outbreak that occurred in Scott County, IN, where 181 cases of HIV infection occurred in a small town in less than 12 months due to shared drug needles.