Despite major medical advances and more than 30 years of effort, the United States is still in danger of losing the war on AIDS, according to the country’s top disease-control official.
In an essay in The New England Journal of Medicine published on Tuesday, World AIDS Day, Dr. Thomas R. Frieden, the director of the Centers for Disease Control and Prevention, and Dr. Jonathan Mermin, the agency’s chief of AIDS prevention, paint a bleak picture of the fight.
“Hundreds of thousands of people with diagnosed H.I.V. infection are not receiving care or antiretroviral treatment,” they wrote. “These people account for most new H.I.V. transmission.”
There are 45,000 new H.I.V. infections each year, the article noted.
In an interview, Dr. Frieden said he “still views the glass as half full.” While medicines are improving, legal barriers have been lifted and Americans are getting tested, more people with H.I.V. need to be put on treatment and kept on it.
While the article’s language was dry and academic, some AIDS experts said it amounted to a call for radical changes in how the disease is fought. But those changes can be made only by state and local health departments, over which the C.D.C. has little control.
“Tom is giving the view from 30,000 feet,” said Dr. William Schaffner, the chairman of preventive medicine at Vanderbilt University. “He’s trying to be the conductor of a disparate orchestra in which the drums and trombones have different bosses and are paid by different people.”
Other experts complained that Dr. Frieden should have gone further, calling for much more funding, a heavier reliance on preventive drugs and the decriminalization of H.I.V. transmission. “It’s a pretty weak piece,” said Mark Harrington, the executive director of the Treatment Action Group, an AIDS activist organization.
Dr. Frieden was effectively calling for H.I.V. to be fought the same way that syphilis and gonorrhea are, “and we’re doing terribly on those,” Mr. Harrington said.
He and other advocates urged wider adoption of a multipronged approach to treatment and prevention like that used in San Francisco, which offers services to the most difficult patients, including addiction and mental health treatment, help with housing and even escorts to the hospital.
(Click here to read the full article, written by Donald G. McNeil, NY Times)