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Sean Philpott: We Have Met The Enemy And He Is Us

This past Sunday marked the 26th annual World AIDS Day, which is held every year on December 1st to remember the nearly 30 million people who have died from the disease since it was first identified in 1981.

But World AIDS Day is more than just a day of remembrance. It is also an opportunity to show support for the 35 million people who are currently living with HIV, and a chance to raise awareness of the continuing impact of the most devastating pandemic in recorded history.

I've been involved in the fight against HIV/AIDS for nearly two decades, starting when I joined the New York State Department of Health in mid-1990s and continuing through my recent work with disease advocacy organizations in the US, Africa and Southeast Asia. Although I am no longer on the frontlines in the war against HIV/AIDS, I still think and write about the topic daily.

In looking back at my 18 years as a foot soldier in this battle, what strikes me first are the amazing victories that have been achieved. When I first enlisted in this war in 1995, we were losing the fight. The few antiviral drugs we had to treat those living with HIV/AIDS, for example, were partially effective at best. Acronymic medications like AZT, ddI and 3TC offered only short-term benefit, prolonging the lives of those infected for a few months.

The epidemic also seemed unstoppable. Here in the US, infection rates were continuing to increase, despite the best efforts of public and private organizations like the CDC, the Gay Men's Health Crisis, the National Minority AIDS Council, TeenAIDS, and the AIDS Council of Northeastern New York. Globally, the picture was even grimmer. In the hardest hit countries of Africa, for instance, rates of infection were approaching 30% of the total population.

Things quickly changed. The very next year, the fortunes of war began to favor the researchers, physicians and activists engaged in the fight against HIV/AIDS. In 1996, the number of new cases diagnosed in the US declined for the first time since the start of the epidemic. Similar gains were also seen worldwide, with countries like Uganda slashing infection rates in half. New and more effective antiretroviral drugs also became available. When used in combination, these new drugs prolonged the lives of those living with HIV for years and years. Being infected with the virus was no longer a death sentence.

We've made remarkable progress since. In the last decade, the annual number of new infections has fallen markedly. In 2001, there were 3.5 million new cases of HIV globally. This past year, there were fewer than 2.0 million new cases. Due to the significant increase in people receiving treatment, the number of AIDS-related deaths has also declined. But the war is not over, and a new and more dangerous enemy threatens our hard-won gains. That enemy is complacency.

During much of the 1980s and 1990s, HIV/AIDS was seen as the major health problem facing the US. That is no longer the case. A recent survey by the Kaiser Family Foundation found that AIDS now ranks seventh among national health concerns, after cancer, obesity, health insurance, heart disease, health care costs and diabetes. More disturbing is the fact that among those with the highest rates of infection (including gay and bisexual men and African Americans), many do not recognize their risk or believe that HIV is not a serious health threat.

Financial support for HIV prevention and treatment efforts is also slipping, in part because AIDS is no longer seen by public or private donors as a serious crisis. The federal government recently slashed funding to the Ryan White HIV/AIDS Program, which supports AIDS organizations across the country. Similarly, public and private funding for HIV/AIDS programs has remained stagnant since 2008.

That drop in support is likely to have serous consequences. We know, for example, that treating those living with HIV/AIDS not only prolongs their lives but also dramatically decreases the likelihood that they will spread the virus to others. By identifying and treating everyone who has the virus, we could effectively end the epidemic. Despite this, cash-strapped public health agencies and programs have cut back on their HIV testing and treatment efforts. As a result, nearly a quarter of the 1.2 million Americans living with HIV/AIDS still don't know that they are infected. Of those who do know, less than half are receiving treatment. We could win the war of HIV/AIDS now, but choose not to.

We have met the enemy and he is us ... or rather our apathy and complacency. The perception that HIV/AIDS is no longer a serious threat is a dangerous one. Despite the remarkable gains for the last two decades, we are all still at risk. AIDS is as much of a public health crisis as it was when the first cases were identified over 30 years ago. We need to be reminded of that fact, not just on World AIDS Day but everyday. We need to continue to raise awareness and fund prevention programs. HIV never sleeps, and neither should we.

A public health researcher and ethicist by training, Dr. Sean Philpott is Director of Research Ethics for the Bioethics program at Union Graduate College-Icahn School of Medicine at Mount Sinai in Schenectady, New York. He is also Acting Director of Union Graduate College's Center for Bioethics and Clinical Leadership, and Project Director of its Advanced Certificate Program for Research Ethics in Central and Eastern Europe.

The views expressed by commentators are solely those of the authors. They do not necessarily reflect the views of this station or its management.

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