Here There and Everywhere

AIDS advocacy efforts in the U.S. have waned in recent years, after medical innovations helped sufferers live longer, minimized obvious symptoms and alleviated the widespread social panic that characterized the early spread of the disease.

Globally, though, the spread of AIDS has yet to be curtailed: 33 million people are afflicted, including two-thirds of those living in sub-Saharan Africa.

But what might come as a real surprise is news that rates across some parts of the U.S. have yet to decrease. In fact, they’re right up there with the prevalence of HIV/AIDS in global hot spots, where the health scourge continues largely unabated.

Rates of HIV among adults in Washington, D.C., for example, now exceed 1 in 30 — higher than reported rates in Ethiopia, Nigeria or Rwanda. In New York, rates are higher among blacks (1 in 40) and injection-drug users (1 in 8).

In urban areas across the country, 30 percent of men engaging in “sex with other men” are contracting HIV — compared with overall population rates of 7.8 percent in Kenya and 16.9 percent in South Africa.

Groups at a high risk of HIV infection have remained largely unchanged since the 1980s. So what happened to ongoing efforts at prevention and education, which were largely concentrated on those same demographics?

According to the essay’s authors, it’s a question of insular sexual networks rather than individual behaviors.

“Understanding the context and settings in which risk is increased may lead to more robust and effective preventive interventions,” the authors note. The idea hits on some touchy subjects, like the vulnerable demographics of black and Hispanic women, who are more likely to have multiple partners within one community because of the rates of incarceration among men in their social circles.

Those at high risk are also less likely to have access to health care, which means fewer opportunities to learn about or benefit from preventive interventions like HIV tests, anti-retroviral therapy or even condoms.

And AIDS remains an epidemic in the U.S. Low prevalence in most areas is outweighed by the startlingly high occurrence in others.

Potential solutions are nuanced and require out-of-the-box thinking, the essay notes. For example, the authors urge public health officials to shed ideological biases, like an unwillingness to consider needle exchange programs or safe sex in bathhouses. There’s also a need for better understanding of how one’s social circumstances affect HIV education, prevention and rates of infection.

That means everything from addressing the massive incarceration rates among black and Hispanic men to helping women who feel forced into commercial sex because of poverty or drug addiction.

Then there’s the question of how to help groups who have yet to respond to previous efforts. “Research is also needed to identify interventions that will persuade men who have sex with men to undergo HIV testing, facilitate their disclosure of their HIV status to sexual partners and promote negotiations for safer sexual practices,” the essay notes.

Of paramount importance, though, is to acknowledge that AIDS has not gone away. “The time has come,” the authors write, “to confront this largely forgotten and hidden epidemic.”