All’s Quiet On The Hiv-Aids Front? Don’t Be Misled
It was this time last year that people with HIV-AIDS and their advocates were celebrating a long-awaited turning point in a battle marked by 16 years of failed treatments and staggering death rates.
Just as hope had begun to wane, the new “wonder drugs” called protease inhibitors promised to transform what was once considered a terminal illness into a chronic manageable condition. As the search for a cure continued in a recharged environment, AIDS would become a disease you could live with, rather than die from.
For those with the right body chemistry and the economic, medical and social support necessary to succeed on the complicated treatment regimens, protease inhibitors have meant better health, increased stamina and provided a new lease on life.
AIDS units in local hospitals and nursing homes once filled beyond capacity now sit half empty. Resume-writing workshops run by AIDS organizations have become as popular as free legal clinics offering assistance with wills and health care proxies. And, for the first time since the early 1980s, overall AIDS deaths not only stopped their upward climb but fell by 19 percent in January-September of 1996, according to a Centers for Disease Control and Prevention report issued July 14.
While any drop in AIDS deaths comes as good news, it’s too early to claim victory - especially since the gains aren’t universal. Consider, for example, that AIDS deaths dropped 22 percent among men, but only 7 percent among women. Similarly, deaths fell 28 percent among whites, but only 16 percent among Latinos and 10 percent among blacks. Protease inhibitors aren’t working for everyone, and just as these statistics never made it into recent headlines, the stories of those who have found the drugs inaccessible, toxic or ineffective have been overshadowed by musings about the end of an epidemic we were slow to acknowledge in the first place.
That AIDS has become treatable for some - especially white men - also seems to have overshadowed that AIDS is 100-percent preventable. The same CDC report touting the drop in deaths also estimated that 40,000 people become infected with HIV each year - a number that continues to rise, particularly among those populations that haven’t experienced the benefits of protease inhibitors.
The growing popular notion that living with HIV simply means popping a few pills each day has given many license to abandon already-shaky safer sex practices. Indeed, it would be ironic if medical advances designed to solve a public health crisis actually made it worse, but in some ways that’s what seems to be happening.
A second wave of infections has already emerged among young gay men, and as attention remains steadily focused on treatment rather than prevention, the number of drug users, women and teens testing positive continues to rise unabated.
Perhaps that’s why some doctors are reportedly starting to use the powerful drugs to try to prevent infection in patients who show up in their offices the morning after a night of unsafe sex. Though there are no studies supporting the prophylactic use of protease inhibitors, some doctors are hoping that the same regimens used to prevent HIV infection in health care workers accidentally stuck with needles or splashed with contaminated blood can be carried over to those exposed to HIV in other ways.
Within a day after stories about the potentially preventive treatments appeared in major newspapers, the phones were ringing off the hook at AIDS hot lines with frantic callers asking where they could get “the morningafter pill.” Counselors spent hours explaining that the treatments have horrible side effects, cost several thousand dollars and at this point can’t be used to prevent HIV. Still, such details are frequently lost on those looking for any excuse to avoid condoms.
A year after protease inhibitors captured the spotlight at the Ninth International Conference on AIDS, their power remains undeniable. The new drugs have been a godsend to some, a disappointment to others and an absolute disaster for prevention efforts.
Without sustained attention, HIV will destroy whatever gains we’ve made in a way reminiscent of diseases such as syphilis, gonorrhea and tuberculosis, which re-emerged and thrived on complacency. The current calm on the AIDS front, like the eye of any storm, can be not only deceiving but downright dangerous if it prompts us to relax our vigilance and lose sight of the continued threat.
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