Fighting AIDS: The Long War

Fighting AIDS: The Long War

"Twenty-five years ago, the US Centers for Disease Control and Prevention published the first official notice of a new, nameless and deadly syndrome that had affected a handful of gay men in New York and Los Angeles.

A generation later, HIV/AIDS has become one of the deadliest epidemics in human history. Around the world, more than 25 million people have died, and 40 million are currently infected with HIV.

As we look ahead, there are several key strategies that will help us reduce the suffering from this entirely preventable disease:

Greatly increase access to voluntary HIV testing. HIV diagnosis is the gateway to lifesaving treatment. In addition, CDC estimates that most new HIV infections in the United States are transmitted by the 25 percent of people with HIV who do not even realize they are infected. We need to expand access to HIV testing dramatically - by making it a routine part of medical care, and by ensuring easy access to new rapid HIV tests.

Focus prevention on both HIV-positive and HIV-negative people. More than 1 million Americans are living with HIV/AIDS. While it's critical to help people at risk avoid contracting the virus in the first place, equally important is helping those who are HIV-positive to avoid transmitting it.

Continue to address the role of substance abuse. From intravenous drugs, to alcohol to methamphetamine, substance abuse is a key reason why people who know how to protect themselves and others from HIV still take serious risks. Preventing substance abuse and increasing access to substance abuse treatment are critical to helping people make the right decisions.

Improve monitoring of new HIV infections. Reliable data are essential to fight any epidemic. For decades we have relied on imperfect tools - AIDS cases and HIV diagnoses - to estimate the number of Americans newly infected with HIV each year. Soon, a new national HIV incidence project will provide the most accurate picture yet of new HIV infections.

HIV prevention is complex, and requires a continued commitment from people at risk, people infected, and society as a whole. Prevention efforts also need to keep pace with a constantly changing epidemic.

For example, while white gay men were the first to bear the brunt of the epidemic early on, half of all new HIV diagnoses are now among black men and women. And rising rates of sexually transmitted diseases, such as syphilis, among gay men suggest a resurgence of risk behavior in that community.

Finally, new generations of Americans, who may not remember the deadly, early days of the epidemic, continually need to be reached with basic prevention messages.

HIV remains a serious, lifelong infection. Our commitment to prevention must be just as long and just as strong as the disease itself. At this 25th commemoration of AIDS, let's remember those lost to this terrible disease by stopping its spread."

The author is the director of CDC.

Akron Beacon Journal (06.06.06):: Dr. Julie Gerberding

We are providing the above information as a public service only. Providing synopses of key scientific articles and lay media reports on HIV/AIDS, other sexually transmitted diseases does not constitute endorsement. The above summaries were prepared without conducting any additional research or investigation into the facts and statements made in the articles being summarized, and therefore readers are expressly cautioned against relying on the validity or invalidity of any statements made in these summaries. This CDC HIV/STD/TB Prevention News Update also includes information from CDC and other government agencies, such as background on MMWR articles, fact sheets and announcements.

Persons at risk for HIV-2 infection include:

Sex partners of a person from a country where HIV-2 is endemic (this category includes persons originally from such countries).

Sex partners of a person known to be infected with HIV-2.

Persons who received a transfusion of blood or a nonsterile injection in a country where HIV-2 is endemic.

Persons who shared needles with a person from a country where HIV-2 is endemic or with a person known to be infected with HIV-2.

Children of women who have risk factors for HIV-2 infection or who are known to be infected with HIV-2.

Additionally, testing for HIV-2 is indicated when there is clinical evidence for or suspicion of HIV disease (such as an AIDS-associated opportunistic infection) in the absence of a positive test for antibodies to HIV-1 and in cases in which the HIV-1 Western blot exhibits the unusual indeterminate pattern of gag (p55, p24, or p17) plus pol (p66, p51, or p32) bands in the absence of env (gp160, gp120, Or gp41) bands.

Although most HIV infections in the United States are of HIV-1 group B subtype, current ELISAs can accurately identify infections with nearly all non-B subtypes and many infections with group O HIV subtypes. Infections with HIV-2 and HIV-1 group O are rare in the United States and routine screening for these subtypes is not generally recommended as part of diagnostic testing except in areas where several such infections have been identified. Routine screening for HIV-2 might be appropriate in certain populations where potential risk for HIV-2 infection is higher (e.g., in areas where West African immigrants have settled). Since June 1992, FDA has recommended routine screening for antibody to HIV-2 (in addition to HIV-1) for all blood and plasma donations. Clients with clinical, epidemiologic, or laboratory history that suggests HIV infection and negative or indeterminate HIV-1 screening tests should receive further diagnostic testing to rule out HIV infection, potentially including testing for HIV-1 non-B subtypes and HIV-2 .

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