HIV Complacency

The advent of protease inhibitors and other anti-retroviral (ARVs)  medications has certainly been great news for those people infected and living with HIV. People are now living longer and AIDS diagnoses and deaths are down. But with every bit of good news there seems to be some bad news as well.

Due to prevention efforts, the number of new HIV infections is down from a peak of about 100,000 / year to a current figure of about 40,000 / year. While this is a significant decline, why are there still so many infections occurring each year? In fact, while new infections have gone down, HIV and AIDS among Africans is at a record pace.

These facts have health officials concerned about a growing complacency about HIV, especially among groups most at risk.

Research among gay and bisexual men suggest there is a growing lack of concern about becoming infected, and in turn more risks are being taken. This may be true in other high risk groups as well who believe that safer sex is not as important since the advent of HIV medicines. Myths abound among some high risk groups regarding the need for continued prevention efforts. Lets take a look at some.

"We have defeated HIV with ARVs."
While it is true, AIDS cases are declining, the number of people living with HIV is on the rise. In addition, new HIV infections have remained stable and in some parts of the world are on the increase. In Africa rates are approaching record rates. All these things point to the continued need for prevention efforts.

"Prevention efforts have not worked."
Past prevention efforts have been effective in changing behaviors that in turn have slowed the epidemic overall. However, some high-risk behaviors such as unprotected sex continue at far too high a rate among those not infected as well as those infected.

"If I become infected, I can just take the pills and I will be fine"
While HAART therapy has been proven to decrease progression to AIDS and results in living longer, the long-term effects of the drugs are just now beginning to become evident. While vast improvements have been made, the pills still can be difficult to take and even more difficult to tolerate. Side effects such as diarrhea, nausea and fatigue among others make therapy less than a walk in the park. Even the slightest diversion from prescribed regimens can result in resistant virus, which makes treatment even more difficult. And resistance is not limited to those who have problems staying on schedule. Even patients who take their medicines exactly as prescribed can develop resistant virus. Like any other illness, the fact is that treatments are not perfect and may not be effective in some people. The best solution is not to get infected at all.

"We can track the epidemic and monitor how bad it really is."
In the past, AIDS rates have been a reliable indicator of HIV infection trends. That is no longer true. With the decline in progression to AIDS diagnosis, we are now finding it difficult to monitor where and how new infections are occurring, making prevention and treatment issues even more difficult. Some believe we have never been so close to losing our ability to monitor the epidemic.

So while funding for treatment is on the rise, prevention dollars are slowing fading away. One can't forget the importance of prevention in beating this disease. Without continued prevention efforts, the fight is only going to get tougher.