AIDS: The Dangers of Letting Down Your Guard

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University of Kansas assistant professor Anil Kumar works on AIDS research

This Sunday, Secretary of State Colin Powell declared Africa's AIDS crisis "a national security problem" for the United States.

Powell's statement on ABC's Sunday morning news program "This Week" simultaneously signals an adherence to the Clinton administration's position and snubs a closely held conviction among some Republicans that an overseas epidemic does not constitute a domestic threat. But although they are groundbreaking in one sense, Powell's remarks represent a lost opportunity in another: In his zest to focus deserved attention on the shocking spread of AIDS overseas, Powell overlooked a chance to showcase the skyrocketing rates of infection right here at home.

While overall mortality rates in the U.S. have dropped significantly since 1995, sharp increases in infection rates have been reported recently — most notably among young gay black men (fully 30 percent of whom are reportedly infected with the virus) and heterosexual women of color.

Twenty years ago, when the first cases of AIDS were diagnosed in the U.S., the mysterious disease stuck close to the population that is still most associated with its ravages: gay men. But then, as the virus spread, it touched more "normal" lives, left its urban habitat and invaded small towns across the country. By the mid-'90s, everyone was talking about AIDS, not as the gay man's disease, but as a universal threat. Schools started talking about condoms; kids were shown videos touting abstinence or AIDS prevention or both; some cities started handing out clean needles to intravenous drug users.

AIDS research donations drop

And then, around 1996, almost as quickly as the AIDS panic had materialized, it eased, and then slipped away. Around the world, AIDS-related deaths dropped by nearly 50 percent annually. The reemergence of other, less deadly STDs, like chlamydia and herpes, took over the pages of medical journals and newspapers, while advances in HIV and AIDS prevention were relegated to the back page summaries. Wealthy corporations and private donors, once dependable sources of AIDS research funding, began to ease off — a 1999 Gallup survey showed a 22 percent drop that year in the number of groups making donations of $50,000 or more to AIDS-related causes.

Who can blame them? There was, after all, a new drug "cocktail" in town, and with assiduous self-medication, HIV-positive patients could now live virtually symptom-free for years. Everyone who could afford it was shoveling back the expensive combinations of drugs, and the side effects ranged from unpleasant to downright awful. But it sure as heck beat AIDS.

The problem, of course, is that no cocktail has ever beaten AIDS. And now, doctors and epidemiologists fear, the availability of potent drug cocktails have lulled many in the highest-risk populations, which now include both gay men and heterosexual men and women of color, into a false sense of security. Since 1997, for example, the rate of HIV infections in San Francisco's gay male population has more than doubled, a trend scientists fear is duplicating itself in other cities. New studies indicate that as many as one in 50 black men in the U.S. is infected with the virus.

Appearances can deceive

There is no cure for AIDS — so why are so many acting as if there is? Some of the blame lies in human nature and our easy embrace of good news. There is something ineffably seductive about denial — and for gay men, whose sex lives have been overshadowed by the specter of an incurable disease, the temptation to believe, to abandon oneself to the idea of a cure, must have been nearly irresistible. Even appearances can compound the denial: Thanks to the developments in drug regimens, many HIV-positive people look perfectly healthy for years, their rosy cheeks and robust schedules meaning that potential sex partners cannot detect an infected person by appearance alone.

But the latest numbers don't lie. And while millions are dying in Africa, here in the U.S. our task is unique: We've got to convince at-risk populations that helpful as they may be at extending life expectancy, the current treatments are not a cure.