The AIDs Challenge to the Public Health Status Quo

HIV/AIDs has been, for the past three decades, one of the most recent epidemics and quite possibly the most feared contagious disease. AIDs is unique compared to other contagious diseases that were a great challenge to bring to an end, such as cholera, due to its infection patterns and delayed symptoms. HIV infection and transition into AIDs is unique, because the disease attacks the immune systems of the host, allowing other opportunistic infections to easily attack and kill the host. What has made HIV/AIDs so feared in society is its base in unaccepted social behaviors, and the stigma that is associated with these behaviors. These behaviors include homosexuality, injection drug usage, and the sex trade (prostitution). These groups were initially first groups to be affected by AIDs, which allowed the stigma of AIDs to grow. However as time went on, the disease also affected heterosexual people as well. It became public knowledge that this was a contagious disease, and one that did not discriminate amongst social groups. This fostered fear of the disease, and logically fear and stigma unknowingly work against any positive measures in testing, treatment, and rights of people living with AIDs.

 
From the article “Routine HIV Screening — What Counts in Evidence-Based Policy?” in the New England Journal of Medicine, by Ronald Bayer and Gerald Oppenheimer, we are given a glimpse of the Public Health community as well as the distinct division within it. The CDC continues to argue for routine testing, especially after the passage of the “Affordable Care Act” in 2010, as a necessary preventative measure. The U.S. Preventative Services Task Force, besides having a long and annoying bureaucratic name, has since 2005 determined that the evidence present did not justify routine testing as a preventative measure. We are exposed to the age old public health dilemma of doing what is scientifically exact, or doing what is necessary to fight the epidemic and save populations from harm. Since 2011, the USPSTF has been called to reconsider its 2005 determinations, to allow routine HIV screening to be considered a preventative measure, and therefore covered by the ACA.

Many in this class have experienced the AIDs epidemic’s later effects, which manage to be less surrounded by stigma and more involved in preventative measures and the search for a vaccine. In the year “1992, AIDs had become the leading cause of death of men between the ages 25 and 44” (Bayer, Oppenheimer). Most of us in the class were born in 1993, and it’s interesting to see how our perspectives of the disease differ from those who were alive when the disease first appeared in the 1980s. When I asked my father about his perceptions of the disease when it first came to light he responded “I wasn’t really worried, it was said to only affect gay men so I didn’t really think much of it.” Now we aren’t as much worried, however we understand that the disease is completely capable of being transmitted to anyone* and that we must act responsibly and using preventative measures to ensure we do not get or transmit the disease. As of the CDC report of leading causes of death in males, all ages, all races, “HIV disease” does not even rank in the top 10. This says a lot about the advances in treatment and how profoundly effective it has been. As Bayer states in “Public Health Policy and the AIDs Epidemic,” “the broad political context within which decisions will be made about the availability of resources for prevention, research, and the provision of care, will be affected by the changing perspective on AIDs.” This statement alone justifies that the decrease in stigma and fear, coupled with increase in education of the disease (changing perspectives), has resulted in the advancements in treatment, and continues the government funding for research for a cure. As preventative measures go, the ACA encompassed most, but as long as routine testing is fundamentally left out of the preventative measures group, routine testing will not be a significant preventative measure due to its patient cost and the amount of time it may take to show positive results.

 
From the Anastos article, “Women and AIDs,” we are presented with images and descriptions of the stigma that lies in AIDs. Anastos discusses the treatment of women infected with AIDs, and the how the AIDs stigma is reinforced by sexist and racist stigmas. Luckily as a society we have been moving constantly moving away from that stigma, to now promoting human and sexual rights of people with HIV/AIDs. People infected do have rights, we cannot just quarantine them or treat them like Typhoid Mary. We must treat them like humans, not criminals or agents of transmission. In part the increase and protection of rights for people living with HIV/AIDs may be due to the successes of the Gay Rights Movements, and legalization of gay marriage in several states including New York. Also, the fact that treatment decreases transmissions is key, because those who are undergoing treatment will also be following preventative measures against transmission. This brings us back to the routine testing argument. Imagine if everyone who was infected with HIV/AIDs knew that they were infected, and could use that information to prevent themselves from transmitting the disease. The disease would become almost nonexistent in any perfect scenario. Since we do not live in a perfect world, we can only attempt to use the same idea to decrease the amount of transmissions by about 20%. This is why routine testing of all adults in the U.S. is so important, and the difference between the cost of testing and the expected benefits in decreased transmissions is why it is still being argued.