ED GORDON, host:
From NPR News, this is NEWS & NOTES. I'm Ed Gordon.
For the first time since the 1980s, more than a million Americans live with HIV and almost half of them are African-American. That's according to a new report from the Centers for Disease Control. Health experts have long preached that testing and prevention are key to stopping the spread of the disease, but many feel that encouraging has fallen on deaf ears. Joining us to talk about the ongoing problem of HIV and AIDS are Ron Valdiserri, a doctor and a deputy director of the CDC's HIV, STD and TB prevention programs, and Phil Wilson, founder and executive director of the Black AIDS Institute, based in Los Angeles.
I thank you both for joining us.
Dr. Valdiserri, let me start with you. Could you give us a thumbnail sketch, if you will, of the study and its findings?
Dr. RON VALDISERRI (Centers for Disease Control): Certainly. This is the clearest picture to date that we have of the AIDS epidemic in America, and what we've found though using sophisticated epidemiologic techniques is that we estimate that between 1,039,000 and 1,185,000 persons are living with HIV in America. This is the first time that we have crossed the one-million mark in the epidemic. As you mentioned earlier, unfortunately, as many as 25 percent of those persons are unaware of the fact that they are infected.
When we look at those estimates by racial ethnic breakdown, we believe that about 47 percent of all people living with HIV in the United States are African-American, about 34 percent are white, and about 17 percent are Hispanic. About three-quarters of all persons living with HIV are male and about one-quarter female. And in terms of risk behaviors, about 45 percent of these individuals contracted infection through male-to-male sexual activity, about 27 percent through high-risk heterosexual contact and about 22 percent through injection drug use.
GORDON: We should note that this study took place over the month of December in 2003. Phil Wilson, you've been on the ground fighting this for a long time. These are stunning numbers. When you look at the black men engaged in this study, 67 percent of them did not know they were infected. Phil, tell me why you think this remains such an issue in the black community when, quite frankly, we have heard over the course of the last decade many, many pleas, many programs, many advertisements, many issues from television and radio to try to curb the behavior that has plagued many in this community.
Mr. PHIL WILSON (Black AIDS Institute): I think, sadly, we have not demonstrated that we're serious yet about fighting the epidemic, particularly among the most vulnerable among us. Now black gay men, for example, women, young people--one of the most startling pieces of information to come out of this conference is that nearly half of black men who have sex with men or black gay men in the United States may already be infected with HIV, and two-thirds of them don't know it.
I don't think that it's hyperbole to call this an unprecedented health disaster, and so far we're reacting as if someone said, `It's going to rain today.' Yeah, it's going to rain. It's going to rain dead bodies if we don't do something and do something quickly. While prevention has been shown to work when it is properly resourced and appropriately applied, we've not done either as of late. Our prevention efforts have been underresourced, and they're being undermined by public health policies that support abstinence-only programs at the expense of comprehensive HIV prevention, and oppose needle exchange programs that have been shown to reduce HIV infections and not increase drug use, and object to explicit prevention programs that target young adults and gay men.
GORDON: Dr. Valdiserri, let me ask you--there is still, as Phil Wilson suggests there, a stigma attached to this disease. It is part of the problem, in particular with the black community but in general, why we don't want to admit that this is such a problem in this country. With the idea of many people, including the Bush administration, pushing first and foremost abstinence only, can we look at these numbers and assume that that is the best way to approach this?
Dr. VALDISERRI: Well, first of all, let me be clear that CDC supports comprehensive approaches to the prevention of HIV. Certainly when it comes to young people, we believe that abstinence is the most effective means of preventing HIV transmission, but we also recognize that at some point in almost everyone's life they will become sexually active. And then I think, from that point of view, we need to address other kinds of risk reduction, including knowing who your partner is, having a single partner, encouraging people to be tested and be aware of their serous status before they become sexually intimate and, for people who have multiple partners, consistent and correct condom use. So we definitely support a comprehensive approach to HIV prevention.
I think part of what Phil brings up is the increasing complexity of the epidemic in the United States, and unfortunately, too many policy-makers think that a single approach is going to solve this problem. And in reality, the nation really has to invest in a variety of approaches, certainly early diagnosis. As Phil pointed out, there are too many people who are infected with HIV and don't know it, and those numbers are especially high when we look at African-American gay and bisexual men, though that phenomenon is not limited to gay and bisexual men.
So that's one of the reasons why we're pushing as an agency and as public health professionals--we're really pushing early diagnosis, but testing alone is not the answer. Once people are diagnosed with HIV, they have to get into care, and not only is medical care important, but ongoing prevention care. We want to work with people to help empower them to not spread this virus to their partners.
Mr. WILSON: And, Ed, Dr. Valdiserri is right. The CDC does support comprehensive prevention, but the CDC's hands are tied. If we have policies dictated by Washington, DC, that increase abstinence only in a flat-funding environment or in an environment where we're reducing dollars spent on prevention, that means that comprehensive HIV prevention programs are hampered.
A doctor in 2005 who used model therapy to fight HIV would be sued for malpractice. The problem with abstinence only is that it limits the amount of tools we can use to fight HIV. Just like in fighting a virus, we need to use multiple drugs; in fighting the epidemic, we need to use multiple strategies. We need to encourage people to know the facts about HIV. We do need to encourage people to get tested, but we need to make sure that when people are tested, they have access to adequate and appropriate treatment. As of late, access to treatment has been declining, and we need to hold people accountable on every level. We need to hold policy-makers accountable. We need to hold community-based organizations accountable. And we certainly need to hold individuals accountable. Those of us who are HIV positive need to make sure we don't transfer our virus to anyone else, and those of us who are HIV negative need to make sure and be held responsible for staying HIV negative.
GORDON: Gentlemen, isn't part of the problem--it's a strange catch-22 here--with the fact that, as we make progress with treatment of HIV, with the drugs and the like and research and development, and people seeing others to some degree living better than they were when we initially found this disease--it kind of puts the fear on a back burner, to a great degree.
Mr. WILSON: Well...
Dr. VALDISERRI: That's absolutely right. I think that complacency is an element of what's taking place here, and it's not just complacency among people who are at risk for contracting the virus. Unfortunately, it's also complacency among the American public, who hear reports of improvements in treatment and declining death rates, and that translates in the mind of the general public to HIV/AIDS is not longer a problem in the US, we've licked the epidemic, when in reality, the fact that we have more people living with HIV than ever before, which is wonderful news for infected communities--it's a godsend--but what it means is that, with people living longer, and the majority of those people are sexually active, it means more opportunities for transmission and it actually means the need to invest more in HIV prevention, not less.
Mr. WILSON: And, Ed, the truth of the matter is that fear has never been an effective long-term deterrent. I would submit that some of the advances we've made in treatment actually can support our prevention efforts. What it does--it addresses the issue of fatalism. Now there are reasons for people to get tested. Now there are reasons for people to get involved in the medical delivery care system because there is something you can do, but you cannot get treatment if you don't know your HIV status.
We also know that the more that people are in the health delivery system, the more people who know their status, the more people know people who are HIV positive, are greater chances for us to have conversations with folks to increase their awareness about the magnitude of HIV and AIDS in their communities and to give them the tools they need to protect themselves.
Dr. VALDISERRI: Yeah, you're so right, Phil. We definitely want to put a positive spin on this and not a negative spin. People have to understand that there are definite individual advantages to early diagnosis. Of course, there are also public health advantages as well because most people, when they learn that they are infected with HIV, are highly motivated to take steps to prevent spread to partners.
GORDON: Well, gentlemen, we hope that this study and these numbers will shock people into a reality to take a look at where we are and to understand that it is still a problem that we are grappling with and need to get ahold of. Dr. Ron Valdiserri is with the Centers for Disease Control and Prevention and Phil Wilson is with the Black AIDS Institute.
I thank you both for joining us today.
Dr. VALDISERRI: Thank you.
Mr. WILSON: Thank you, Ed.
GORDON: This is NPR News. Transcript provided by NPR, Copyright NPR.
