World AIDS Day--recognized every year on December 1 since 1988--is an occasion to reflect on the global impact of HIV and AIDS and health care inequities across world populations. On this day, HIV/AIDS organizations around the world affirm their commitment to eliminate stigma and expand testing and treatment to people living where rates of HIV and AIDS remain high.
The U.S. Global AIDS Coordinator--Ambassador Deborah Birx, M.D.--asserts, “We will only end the AIDS epidemic by 2030 if no one is left behind. It is unacceptable that key populations still face stigma, discrimination, and violence, which impede their ability to access quality HIV services.”
This year, the U.S. is working to control an epidemic in Scott County, Indiana that has a higher incidence of HIV than any country in sub-Saharan Africa. Austin--the county seat with a population of 4,200--has more cases of HIV than all of New York City. In this small, rural county, the forces of poverty, addiction, and politics drove an injection drug problem to cause the first-known HIV outbreak related to the current opioid crisis in America.
In 2013, the only Planned Parenthood clinic in Scott County closed in the wake of public health spending cuts. Since that clinic was the county’s sole free HIV testing center, there was no longer a place for residents to get tested. People living in the county and infected with HIV shared needles with family and friends not knowing they were spreading the virus. To date, 191 people have tested positive for HIV.
Public health efforts to test all people at risk for HIV infection have dramatically reduced the spread of the virus. A considerable body of evidence suggests that when people know their HIV status, they modify their high-risk behaviors. Research has shown needle exchange programs are successful, safe, and cost-effective, but Indiana law made it illegal to possess a syringe without a prescription.
Beliefs that needle exchange programs increase drug use, that HIV is an urban problem, and that drug addiction is a moral failure contributed to the current HIV epidemic in Scott County. Unfortunately, factual and scientific evidence are often ineffective at reducing prejudice and ignorance. In fact, several experiments show that when people’s beliefs are threatened by data, they often lock into a frame of mind where facts do not matter.
The Centers for Disease Control (CDC) warns that 220 counties across the U.S. are currently vulnerable to the spread of HIV because of poverty, opioid use, and inadequate public health services. It’s clear that proactive health interventions are needed to prevent or limit future HIV outbreaks.
On World AIDS Day 2016, my hope is that we can embrace all the science and wisdom gathered over the 35 years of this epidemic to guide us to meeting the goal of eliminating AIDS globally by 2030. The U.S. has made so many gains in its efforts to combat HIV. Health departments, community organizations, and health care providers have expanded HIV screening and testing, and as a result, a greater proportion of people living with HIV know their status. Over the past decade, the number of new infections has decreased, and people with HIV are living longer. Medications are more effective with fewer side effects. We need to be more vigilant to make certain our communities have the resources needed to keep all people safe from HIV. Let's not lose this momentum!
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