State of the Pandemic: The Good, the Bad, and the Personal

Maybe it's just my line of work or something, but it seems that HIV/AIDS has been cropping up everywhere... in the news, that is. The NYTimes ran an encouraging article by Marc Santora entitled, "US Close to Eliminating AIDS in Infants, Officials Say". I quote freely, since it was published on 1/30 and already archived. If you'd like the entire article, let me know.

In 1990, as many as 2,000 babies were born infected with H.I.V., the virus that causes AIDS; now, that number has been reduced to a bit more than 200 a year, according to health officials. In New York City, the center of the epidemic, there were 321 newborns infected with H.I.V. in 1990, the year the virus peaked among newborns in the city. In 2003, five babies were born with the virus. Across the country, mother-to-child transmission of H.I.V. has dropped so sharply that public health officials now talk about wiping it out.
...success in treating AIDS has raised the concern that the public may be growing complacent about AIDS prevention. A survey conducted by the city's health department in 2003 showed that 40 percent of people who had sex with multiple partners said they did not use condoms.
But as the struggle with pediatric AIDS shows, much can be accomplished when there are a clear focus and a concerted effort. Not only are children born with H.I.V. living longer, mothers now can take action to make sure they never pass on the virus, and there is anecdotal evidence that many now feel free to have more children.

The article is quick to point out that in the developing world the story is much different--more than two million people in sub-Saharan Africa died of AIDS last year alone. And it's not just abroad that people are getting left out. Yesterday's "Health and Science" segment of "All Things Considered" pointed out that black women are 23 times more likely than white women to be infected with HIV and five times more likely than Hispanic women. 53% of African Americans believe that a cure for AIDS is being withheld. Distrust and suspicion of the medical community is widespread. So now that we've made AIDS easier to prevent and easier to treat, will we push further to eradicate the disease worldwide, or will we let it fester among underprivileged nations and communities?

However, epidemiology only gets one so far. One of my acquaintances on LiveJournal is a woman named Christina, who was infected with HIV by her mother in infancy. She is just a few years younger than I am, and hasn't yet developed AIDS. Reading about her life has changed the way I answer questions from my students in class: yes, it is possible for someone to live for 15 years or more with HIV. Yes, it is possible to be born with HIV and grow to adulthood. Change a few circumstances, however, and you get a much different outcome. Without the right drug regimens, a well-informed doctor, or the medical care and concern that one gets for being young, white, and pretty, the prognosis dramatically worsens. A distrustful patient who can't afford or can't withstand the medical rigamarole will certainly not fare so well. And when parents die before their kids reach adulthood, someone--extended family, school systems, foster care--has to pick up the slack, emotionally and financially. The medical breakthroughs of the last two decades are stunning but meaningless if we cannot back them up with a conviction to provide care to every patient in every nation, improving their quality of life as well as our mortality rates.

There is still much work to do.