HIV--"the epidemic of the century"--will continue to plague us well into the next millennium. Are we doing enough to help the people it affects and protect the rest of us from its spread? Globally, the answer is a chilling "no."
The World Health Organization recently reported it had been underestimating the spread of the human immunodeficiency virus, especially in countries where poverty and politics make prevention and education next to impossible.
Here at home, we're doing a far better job. California has forged one of nation's strongest public-private partnerships to prevent the spread of HIV and help the people it affects. One result is that all Californians with HIV have access to the new combination drug "cocktails," and the impact on their health has been profound.
For example, at AIDS Services Foundation, which has served two out of every three people with AIDS in Orange County, the number of client deaths declined by 53% in 1997. In addition, we have seen a general decrease in the fear, ignorance, denial and discrimination which spread HIV as surely as unprotected sex and contaminated needles.
These positive developments have led some to say that we're doing enough--or even too much--about HIV. But after 15 years of dealing with this wily virus, I think there has never been a more complex and challenging time in the fight against HIV and AIDS.
If we become complacent as we emerge from years of crisis, we will be giving a new advantage to a virus that has, in the words of one researcher, a "genius for survival." There already are worrisome signs that gay men are becoming less vigilant about safe sex, even as infections spread among heterosexuals who remain unaware or unconcerned about HIV. And yet, after having done so much, what more can we do?
For starters, parents can listen with open hearts to their kids' questions, doubts and insecurities about sex. They can speak candidly about the moral challenges and health risks of living in a society which is divided and confused about how we should handle our sexual drives. Parents can stress the moral value and health advantages of abstinence. Or they can make it clear to their kids that the minimum age of consent is when they are mature enough to protect themselves and their partners from unwanted pregnancies and sexually transmitted diseases.
Young people can wait until they are older to have intercourse, and can have fewer partners, fewer unplanned pregnancies and fewer sexually transmitted diseases, including HIV. Studies show that this is precisely what happens when schoolchildren are given explicit, age-appropriate information about human sexual behavior. These same studies debunk the myth that providing sex education--or even making condoms available--promotes sexual activity among the young.
Gay men can renew their commitment to safe sex as a badge of self-esteem and brotherhood. We can encourage them by our growing acceptance of homosexuals as fully human. As this happens, perhaps we will become less shocked by the prospect of same-sex marriage and more interested in how it promotes monogamy and protects the public health.
Injection drug users can stop spreading HIV among themselves, their sex partners and their unborn children. That would happen more often if they had legal access to clean needles on an exchange basis. Multiple studies have shown that needle-exchange programs prevent the spread of HIV and do not promote drug use. We might also consider the merits of building rehab centers for addicts convicted of nonviolent crimes, instead of sending them to prisons where drug use and unprotected sex are rampant.
People can get tested for HIV and get treatment if they test positive. This would go without saying if we had a law protecting all Americans from misuse of their medical histories by government, employers, landlords or insurers.
The HIV/AIDS community can build bridges to other groups who are concerned about the quality of health care for people with chronic diseases. It will take a massive coalition to require our profit-driven managed health care system to give all Americans access to quality medical care.
Right now, we are somewhere between the end of the beginning and the beginning of the end of AIDS. Exactly where depends on our willingness to make the most of our opportunities. The things that we still need to do about HIV also illustrate a fundamental truth: fighting HIV isn't only about HIV. It's about our vision of a better society where we are clearer about our responsibilities to our ourselves and one another, and act accordingly.