And the Band Played On: AIDS in an Age of Miracle Treatments and Chronic Complacency

May 15th, 2015

The incredible success of HIV therapies has relegated a disease that was once a death sentence to a chronic condition for many people. With that has come a frustrating complacency about basic prevention and testing among some groups.

Consider that when men who have sex with men (MSM) became the first U.S. AIDS victims in the early 1980s the gay community rallied heroically and demanded action from a government and society that marginalized them and remained in denial about an epidemic that would eventually kill some 40 million people worldwide. Now MSM are a growing demographic of new HIV infections, increasing 12% from 26,700 in 2008 to 29,800 in 2010, according to the Centers for Disease Control and Prevention.

Though people who contract HIV, get tested and go into treatment have every chance to lead a long life, 13,712 people diagnosed with AIDS died in 2012 in the U.S. In 2010, there were around 47,500 new HIV infections in the United States. About 1.2 million people in the United States were living with HIV at the end of 2011, the most recent year this information was available. Of those people, about 14% - 168,000 people - do not know they are infected.

And the band played on.

It was in this frame of mind that we sought professional help, reaching out to Carol A. Kemper, MD, FACP, an HIV specialist and a clinical associate professor of infectious diseases at Stanford University in Palo Alto, CA.

HIC: Could recent reports of an HIV variant in Cuba that can progress rapidly to AIDS (less than three years) have a thin edge of a silver lining? Could such variant strains of HIV be a wake-up call for risk groups that seem to have grown complacent about AIDS prevention?

Kemper: “I don’t think the news from Cuba will have much of any effect. Complacency is a real problem - HIV just doesn’t sound that scary anymore. People used to die before, all the time, it was all over the news, your friends died. But now you just take some pills. Younger people don’t understand it means years of doctor appointments and blood draws, multiple medications every day, as well as potential short and long term side effects. To some degree, this may be partly our fault. We’re so thrilled with our success at treatment, the message that this is still a serious, life altering and potentially life threatening disease gets lost. Drug companies have also been faulted for portraying beaming healthy looking people, climbing mountains, etc. and taking HIV meds.”

HIC: There seems to be a recurrent theme in the news of people not disclosing their HIV-positive status to sexual partners.

Kemper: “Disclosure is a problem. Data suggests that at least 25% of HIV-positive persons fail to disclose their status for a sexual encounter. This occurs for a variety of reasons,but the obvious ones are either they don’t care - I believe this is usually not the case - or they fear rejection or get lost ‘in the moment.’ Drugs may play a part in this.I have also seen an increasing resistance to recommendations for safer sex by some -- almost a resistance - even a defiance of safer sex "rules", an insistence on enjoying the freedom of bare sex, whenever, with whomever. Unfortunately with freedom comes potential consequences, not just to themselves but others.”

For the rest of our interview with Dr. Kemper see the June 2015 issue of Hospital Infection Control & Prevention.