Shortly after antiretroviral drugs created new hope for AIDS patients, a new and more virulent strain of HIV has emerged.
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In the 25 years since HIV emerged as a major public health threat, it has presented constantly changing faces and social realities. For both public health officials and infected individuals, the ebb and flow of gains and losses create alternating cycles of hope and despair.
Two new and worrisome trends in the United States are the threat of a new and more virulent strain of HIV and the emergence of women–especially African American women–among the newly infected.
The advent of antiretroviral drugs in the 1990s created a wave of hope in the face of a decade of devastating losses. Almost overnight HIV/AIDS went from being an almost certain death sentence to a disease that, when drug therapy is available, can be managed.
For many patients multiple drug therapy has been successful in keeping their viral load at very low levels. It’s not a cure, but it keeps HIV in check, preventing it from progressing to full-blown AIDS.
When drug therapy is begun soon after diagnosis, it’s possible for many with HIV to live two decades and perhaps even a normal lifespan.
Heath officials worry that the availability of drugs to treat HIV has lowered the level of concern for many young persons, especially those engaged in high-risk sexual encounters. This worry has been compounded by the recent emergence of a new and frightening face of HIV.
Drug-Resistant Strain?
A New York City man was diagnosed in early 2005 with a highly aggressive form of HIV that is resistant to current drug therapies. The man, who admitted to using crystal meth and to having engaged in sex with many partners in the past year, had a strain that progressed in only a matter of months to full-blown AIDS, a process that normally takes up to 10 years. Physicians speculate that the resistant strain may be the result of the patient being infected by a partner who was being treated with antiretroviral therapy.
The connection between crystal meth and HIV spread poses a major danger. As the methamphetamine epidemic has moved across the country, it has wreaked havoc in rural and urban communities.
One of the ways it has manifested itself in cities involves crystal meth parties for large groups of men who engage in unprotected sex with each other sometimes for a day or two on end. The use of crystal meth creates a sense of euphoria and heightened sexuality, clouding judgment and denying the safe sex message.
According to the Centers for Disease Control, men who are high on crystal meth are four times more likely to engage in unsafe sex than men who are not using methamphetamines. They are also more likely to engage in sexual binges with multiple partners.
Dramatic Increase for Women
The other recent disturbing development is the disproportionate effect the epidemic is having on the black community. Recent rates of infection among black women have soared. According to data from the Centers for Disease Control, African-American women are 19 times more likely to be infected by HIV than white women and 5 times more likely than Hispanic women.
African-American women are 19 times more likely to be infected by HIV than white women and 5 times more likely than Hispanic women.
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Why this dramatic rise in infection rates for African-American women? Earlier in the AIDS epidemic HIV infections in African-American women were less common and more likely to be associated with drug use. Current infections are more likely to be the result of heterosexual activity.
With no cure for AIDS on the horizon and a vaccine possibly decades away, prevention remains the most effective strategy.
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Some point to a more traditional moral code in the black community with strong prohibitions against homosexuality. As a result, African-American men who are gay are more likely to marry or maintain a relationship with a woman while also pursuing homosexual relationships. Women who are unaware of their partner’s other sexual activities can be unwittingly exposed to HIV infection.
The high rates of infection in African-American women are frequently compounded by poverty and lack of access to health care, As a result, many infected women don’t get the antiretroviral drugs they need to keep HIV in check.
With no cure for AIDS on the horizon and a vaccine possibly decades away, prevention remains the most effective strategy.
Testing is a major cornerstone of the strategy. In fact, because it increases awareness, voluntary HIV screening can increase life expectancy. Screening helps identify infection earlier, prompting those who test positive to seek treatment. People who are screened are also more likely to get counseling.
Screening also helps control the spread of infection. An individual who tests positive for HIV is more likely to take precautions to avoid infecting partners.
The Centers for Disease Control encourages those engaged in high-risk sexual activities to be tested at least annually. For those who think they may have been exposed to HIV, more frequent testing is recommended.
According to the Centers for Disease Control, 40 percent of AIDS patients developed the disease within one year of being diagnosed with HIV, a process that even without treatment, takes on average 10 years. These patients are obviously being diagnosed very late in the disease process.
Regular screening and prompt treatment with antiretroviral drugs can dramatically alter these figures.
In the United States we have the knowledge and the resources to stem the tide of AIDS. To do so requires education of at-risk segments of the community so that testing and prevention coupled with early treatment of those infected can prevent a new wave of the epidemic from obliterating our early gains.
REFERENCES:
“Aftrican-American Women Hit Hard by HIV/AIDS,” Contraceptive Technology Update, February 2005.
Geoffrey Cowley and Andrew Murr, “The New Face of AIDS: Why is HIV Preying on Minority Women, and What Can America Do About It? Newsweek, December 6, 2004.
“Earlier HIV Treatment Possible,” The BBI Newsletter, February 2005.
Brady Huggett, “HIV Drugs Making Progress, But Global Disease Out of Control,” Bioworld Financial Watch, July 26, 2004.
“Isolated Case Or Public Health Problem? Agressive HIV Strain,” Bioworld Today, February 28, 2005.
Robert Janssen, “The Challenge of HIV Testing,” OB GYN News, August 15, 2004.
Robert Janssen, “HIV Testing in Primary Care,” Family Practice News, January 15, 2005.
David Jefferson, “Party, Play and Pay: Multiple Partners, Unprotected Sex and Crystal Meth,” Newsweek, February 28, 2005.
“Repeated Testing Advised for At-Risk MSM Groups,” AIDS Alert, February 2005.
Randall Roark et al, “HIV Testing Among Men Who Have Sex With Men,” Journal of Public Health Management and Practice, Jan-Feb, 2005.
“Sex Education Distorts Education on Condoms: Key to Prevention, Condoms, Often Are Ignored,” AIDS Alert, March 2005.
Rebecca Voelker, “Women Shoulder Growing HIV/AIDS Burden,” JAMA, January 19, 2005.
