02: A New Era In HIV Prevention

One of the greatest challenges in trying to develop a perspective on HIV, especially for those who have been fighting this disease since the early days of the epidemic, is being far enough away from it to allow objectivity. For all practical purposes, AIDS is still a young disease in terms of scientific research. However, given the great number of medical advances in the last 25 years for a multitude of conditions and increasing technology in an on-demand society, the challenge of remaining focused on the future is difficult. Add to that the outright fear and misunderstanding that surrounds AIDS and there is no doubt that AIDS has become a disease that brings out the best and worst in our policy efforts to control the transmission.

As a society, our attention spans have shortened and our expectations for instant solutions have increased.  A generation of young adults has grown up with HIV surrounding them but without much of the fear that captured everyone in the U.S. in the 1980’s and early ‘90’s when so much was unknown. They have often matured without even understanding or knowing the basics regarding HIV transmission. 

The early years of HIV focused on critical research to understand how the virus was transmitted and how to stop that transmission. Scientific advances were remarkably rapid. The first cases were identified and described, modes of transmission were documented, tests were developed for screening the blood supply and initial antibody tests were created. Basic strategies were undertaken to flood our citizenship with “safer sex” education and making condoms widely available.

This interest was further accelerated by a few high profile celebrity cases of HIV. Rock Hudson's announcement that he had AIDS and his subsequent death caught America off guard as it lost a visible leading man. Ryan White, a teenager with hemophilia who acquired HIV from infected blood products and was banned from his school out of fear and ignorance, drove a very public debate that required us to know more about AIDS – and to be more compassionate. Sports stars Magic Johnson and Arthur Ashe both announced their status in the early 1990’s and garnered significant attention to the issue. Ashe died shortly after his announcement but was able to capture his thoughts in his critically acclaimed biography “Days of Grace” and Johnson continues to speak about HIV today long after his career ended.

However, once our society reached the mid-90’s, the celebrity factor faded. Thankfully, people living with HIV saw major medical advances that improved outcomes for many and celebrity cases didn’t appear as often or with the impact they once had. During this time of economic expansion thanks to new technology and the dot.com explosion, we moved on to other issues. Celebrities that had been extremely committed to HIV awareness began exploring other causes that warranted support.

The challenge is that the HIV epidemic is not one, but many epidemics that continue to evolve.

Where does that put us today? Most youth today have no idea who Rock Hudson, Arthur Ashe and Ryan White are. They only see Magic Johnson as a successful businessman who has AIDS, but apparently has enough money to make sure it “isn’t a problem.” As medication options improved over the years, perceptions began to rise that HIV is treatable, manageable and to some who misunderstood the complexity and toxicity of the treatments, perhaps “curable.”

As a result, the urgency in the HIV prevention battle has waned for many. The challenge is that the HIV epidemic is not one, but many epidemics that continue to evolve. While the earliest cases were nearly all among homosexual and bisexual men and injecting-drug users, there has been a marked growth worldwide in the proportion of cases among women, infants, and minorities. Domestically, HIV continues to particularly decimate those in the African American and Latino communities and perhaps most disproportionately, communities of gay and bisexual men of all ages across the nation.

HIV education must be accepted as a continuous process that is driven by smart public health needs rather than celebrity interest.

Ongoing efforts need to continue to focus attention key points to maximize prevention effectiveness. HIV infection is preventable. But the only way it is preventable is if we have the will and the resources to provide the education and the tools necessary to stop transmission. Comprehensive sexual health programs that emphasize knowledge and training in communication and other skills are being shown to delay the onset of sexual activity and alter high-risk behaviors among adolescents, the next generation at risk for AIDS.

Until there is a cure or a vaccine, these HIV prevention efforts must be sustained and targeted to every new generation of young men and women who will make up the next group to face HIV. These efforts need to be consistent and include efforts to prevent discrimination against those who are infected and those from populations at high-risk.  The misperceptions about HIV appearing in this generation must be corrected if we are to be successful in stopping the spread of HIV.

HIV prevention cannot be viewed as a one-time event; it must be accepted as a continuous process that is driven by smart public health needs rather than celebrity interest. Only by remaining committed to this prevention and education in our on-demand world can we, in Minnesota, ensure that HIV does not take further hold of future generations.

Last Updated: Tuesday, January 15, 2008
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