HIV alarmism has fiscal and behavorial consequences

Sometimes, I don’t understand alarmists. On September 16, David R. Holtgrave, PhD Professor and Chair, Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health testified before the Committee on Oversight and Government Reform (Waxman, chair) on prevention funding for HIV/AIDS.

He began by reporting that the HIV incidence is higher than previously thought (55,000 or 56,000 instead of 40,000 infections per year) and is rising particularly among gay men. Shocking right? Probably that statement made the evening news, but not what followed. He then went on to report that “the HIV transmission rate dropped from 92.3 in 1980, to 31.2 in 1985, to 6.6 in 1991. It stayed at roughly this level until 1997 when, after the advent of highly active antiretroviral therapy (HAART), the transmission rate went up temporarily to almost 7.5. Thereafter, it continued once again on a downward trend. In 2006, we estimate the transmission rate to be approximately just under 5.0 (4.98). This means that for every 100 persons living with HIV in the US, there are just under five new infections on average in a year. That also means that over 95% of persons living with HIV in the US are not transmitting the virus to someone else is a given year. Because the transmission rate is rather low in the US, it will be very challenging for the nation to push that transmission rate number down even further.”

I thought that sounded pretty good. Not only are infections down among gay men, but they have almost disappeared from the blood supply, from infants getting it from their mothers, and the IV drug users. So what’s the alarm? No one comes to a committee to say their funding needs are down. No, they need more funding to get that rate down to zero, as near as I can tell. Current funding for prevention is $18.6 billion, or $52,000 per infection NOT transmitted. And that saves on treatment money. Holtgrave was concerned that in real dollars, prevention funding was slipping since 2002 (Hmm, seems to coincide with Bush years even though transmission rates are down since the Clinton years.)

HAART (highly active antiretroviral therapy) works, abstinence works, keeping bi-sexual men away from women works, and reducing intravenous drug use works. However, after the advent of HAART transmission rates went back up--before that, the accomplishments were in behavior, not drug therapy. After HAART, it would seem gay and bi-sexual men thought they could go back to the fun, games and wild times of the 80s.

Here’s my idea for prevention. Let’s ask for a more responsibility and volunteerism from the gay community--the way it used to be when people were afraid of this disease. They are the best educated and wealthiest demographic in the country. They worked very hard 25 years ago to combat this disease, now it’s time for the younger generation of gays who never saw friends die or lifted a spoonful of soup to a wasted skeleton to step up and do the prevention thing, and not wait for the government to funnel even more money into their bad behavior and life style.