Apathy Over AIDS Could Prove Deadly

Nov. 26, 2007— -- Disease experts worry that a United Nations report that suggests the AIDS epidemic is waning could spark a false sense of security among those most at risk.

Recent numbers from the UNAIDS report hints that the AIDS epidemic may be in its final stage -- that is, it may be beginning to burn out.

However, infectious disease experts across the nation strongly disagreed and warned that that the AIDS epidemic is far from over. They emphasize that the AIDS epidemic is still active.

Their fear is that people who hear of the report will take it as a cue to relax treatment and prevention efforts, which is exactly the opposite of what needs to be done.

"The concern is donors will see these new estimates as reason to relax their response on AIDS," says Christopher Collins, a member of the International Treatment Preparedness Coalition. "That would be a terrible mistake. We are seeing concrete results from prevention and treatment programming -- this is no time to pull back.

"Instead, we need to scale up AIDS prevention and treatment and continue to make progress on what remains a devastating epidemic."

Not Out of the Woods

According to the UNAIDS report, the rate of new infections peaked globally in the late 1990s at more than 3 million per year. Today that rate has declined to about 2.5 million new infections annually. UNAIDS is the Joint United Nations Program on HIV/AIDS, and is the branch of the world body responsible for the organization's AIDS-related programs.

AIDS experts caution against interpreting these figures as a sign that AIDS is becoming relegated to the status of other chronic diseases. Rather, they say that AIDS is not like other diseases -- not only in its magnitude and persistence but also in its nature of infection.

"What makes HIV different from 'other pestilences' is that the persistence for the life of the human host assures that 30 million to 40 million carriers will be infected, in need of care, and potentially [become] transmitters ... for the next decade or so," says Dr. James Curran, professor of epidemiology and dean of the Rollins School of Public Health at Emory University.

Mitchell Warren, executive director of the AIDS Vaccine Advocacy Coalition agrees.

"While HIV may be behaving like other pestilences, it still has unique features -- not least is the magnitude, and that even with this new data, there are still 32 million people infected," he says.

In addition, AIDS is complicated by other issues, which makes it more difficult to talk about and treat.

"AIDS remains different because it is intertwined with sexuality and drug use, human behaviors that political leaders often have a hard time grappling with honestly and effectively," says Collins. "AIDS is also different because of the deadly stigma involved, in part because many of the groups at highest risk are marginalized in their societies."

And while HIV is similar to other diseases in that it can be transmitted from people who have the virus -- known among researchers as vectors -- to those who don't, its way of disrupting the immune system is different.

"HIV, conceptually, is like other pestilences ... a transmissible disease with known vectors and reservoirs," says Dr. Michael Saag, director of the Center for AIDS Research at the University of Alabama in Birmingham.

"What is different is the nature of infection engaging the immune system and thereby interfering with, or indeed using, the innate immune responses to prevent natural immunity and to propagate itself."

Still a Global Problem

Health experts emphasize that AIDS is still the leading cause of death in Africa and say that even if global rates of HIV infection are leveling off, there are still millions getting infected each year, and millions more who don't receive the medication they need.

"To me it just means I need to change all the power-point slides with the global numbers," says Dr. John Bartlett, chief of the division of infectious diseases at the Johns Hopkins University School of Medicine.

"The mission and the challenges in terms of prevention efforts and access to care are not changed because we have so far to go by either calculation. It's like hearing the national debt is 20 percent less. So what?"

Dr. Robert Schooley, head of the division of infectious diseases at the University of California at San Diego, agrees.

"The fact is that we are millions of patients away from reaching all of those who can benefit from a therapy that works quite well for a fatal disease that kills people in the primes of their lives," he says.

Additionally, Schooley explains that HIV can co-exist with other infections, increasing the prevalence of secondary diseases such as leishmaniasis, which results in chronic skin ulcers and swelling of the spleen and liver, and Chagas' disease, which can damage the nervous system, digestive system and the heart.

"HIV is increasingly becoming the global driver for tuberculosis. As HIV increasingly overlaps leishmaniasis and Chagas' disease, these illnesses that many thought were on the way out will resurge," says Schooley.

Even in the United States, where rates of HIV infection are lower than rates in Africa, experts say that the disease is not disappearing anytime soon.

"The CDC failed, for the first time in over a decade, to meet its stated goal of reducing HIV infections in the U.S. to 40,000 per year," says B.R. Simon Rosser, professor and director of the HIV/STI Intervention and Prevention Studies Program at the University of Minnesota School of Public Health.

He says that those with AIDS apathy, who no longer consider AIDS a real problem or who don't believe that an HIV is a threat to your health, should think again.

"HIV is a major killer in its own right, and it would be a mistake to declare the epidemic over when most who need therapy are not getting it and when there is no effective vaccine," Schooley says.