By Bob Roehr
The global AIDS pandemic continues to grow, with disconcerting evidence that some countries are seeing a resurgence in new HIV infection rates which were previously stable or declining, said UNAIDS in their annual report on the global epidemic. It was released on Nov. 21, in advance of World AIDS Day, Dec. 1.
"This is worrying," said executive director Peter Piot. "We know increased HIV prevention programs in these countries have shown progress in the past, Uganda being a prime example."
The Chinese ministry of health has reported a 30 percent jump in AIDS cases in just the first 10 months of this year, primarily among injection drug users. However, much of that reflects increased testing for and honesty about the extent of the disease rather than recent infections.
Australia, which has a highly respected program of HIV prevention and treatment, reported a 41 percent increase in the rate of new infection between 2000 and 2005.
In the United Kingdom, often thought of as one of the best programs in the world, newly diagnosed cases of HIV, gonorrhea, and syphilis are all up, particularly among men who have sex with men.
The Centers for Disease Control and Prevention (CDC) has not revised its estimate of the number of new infections that occur in the US, about 40,000, for more than a decade.
African-Americans have borne the brunt of the HIV burden in the US, accounting for about half of all infections, even though they constitute just 13 percent of the population. Men who identify as gay or bisexual, or as heterosexual but also have sex with men (MSM), are the hardest hit within that community.
The National Minority AIDS Council (NMAC) released a five-point program for addressing those concerns in a November 16 telephone news conference. Recommendations for Confronting the Epidemic in Black America was written by Robert Fullilove, with the Columbia University Mailman School of Public Health, in consultation with other experts.
The points include, strengthening the community by addressing issues of affordable housing; reducing the impact of incarceration though increased testing, the provision of condoms while incarcerated, and better transition programs when exiting prison; reducing stigma and discrimination against gays and MSM; increased testing tied to care; and expansion of drug treatment and needle exchange programs.
Dr. Fullilove said routine testing is important not only for the information it provides but because "it begins to normalize the notion that if you're sexually active or if you are engaged in drug use, that this is part of what you would do in order to receive routine healthcare."
The provision of condoms has become routine in jails in Washington, DC, Philadelphia, Vermont and other systems.
"In 2006, AIDS in America is a Black disease, and stigma aside, the only way that we're going to stop this epidemic in Black America is for Black folks to take ownership of the disease and confront it head on," said Phill Wilson, executive director of the Black AIDS Institute.
"Perhaps the most important factor in reducing HIV risk for Black gay men is the one that usually receives the least attention, and that is eliminating the homophobia and related stigma, discrimination, and violence experienced by so may Black gay men," he said.
Fullilove noted that there is only one CDC-funded HIV prevention program targeting Black gay and bisexual men "because there hasn't literally been enough money to help us roll out a variety of different prevention approaches. There hasn't been enough money to research and evaluate their effectiveness."
Wilson cited Rep. Nancy Pelosi's interpretation of the recent election results as a call for a new direction. He said, "It is important that we look at AIDS as part of that new direction."
"Congress has failed to do the hard work of reforming the 16-year-old [Ryan White] CARE Act (RWCA) to keep up with the ever-changing epidemic…It would be immoral if we test large numbers of people and do not have the capacity to find treatment for them."
Ryan White update
The future of the RWCA in the "lame duck" session of Congress, which continues on December 4, does not look promising. The House passed a reauthorization bill in October but a handful of Senators, led by Hillary Clinton, blocked passage in that chamber because their states would lose money with the changes in how funding is divvied out. The issues largely could be resolved by adding more money.
A group of conservative Republican legislators in both chambers is adamant that they not increase spending on the remaining appropriations bills for the fiscal year that began October 1. In addition to being philosophically opposed to increased spending, they want to leave that onus on the incoming Democratic majority.
AIDS Project Los Angeles (APLA) has backed off of earlier support for the current reauthorization bill, calling it "fatally flawed because of insufficient funding and ill-conceived political compromises. The result is an overly complicated revision of an already complicated Act," it said in a post-election briefing paper.
"APLA believes that changes in congressional and committee leadership, a result of midterm elections, may help salvage the problematic House bill."
While that may be the case in the House, it ignores the fact that Ted Kennedy, the incoming chair of the Senate health committee, has played a leading role in shaping the current measure, and he has not indicated any desire to make substantial changes.
Bill Arnold lobbies for funding for the AIDS Drug Assistance Program (ADAP). He cautions, "The disruptions and destabilization of a failure to pass [Ryan White] are a major potential problem."
However, he confesses, "It would likely take a joint congressional leadership public bipartisan effort, probably with active public support from President Bush," to pull off reauthorization with adequate new funding in this lame duck session. Still, hope springs eternal. and there is the glimmer of a possible "last minute" congressional deal that could get changed legislation through both houses and to the President before Christmas.
