December 3, 2008

Vanquishing AIDS: Notes on Ending the Epidemic in America

Paul Curtis Bellman, MD, is a physician whose private practice in Greenwich Village, New York, has specialized in caring for HIV-positive patients since 1986. Dr. Bellman is a board certified internist and currently an associate attending in the Department of Medicine at St. Vincent’s Manhattan and a senior lecturer in the Department of Immunology at Weill Cornell Medical College in New York. He is a 1982 graduate of the New York University School of Medicine and has been involved in the clinical care of HIV-positive people since the epidemic began. Bellman actively participates in clinical research as well as the clinical practice of HIV medicine.

Note: The contents of this essay should not be construed as specific medical advice regarding the treatment or prevention of HIV. If questions arise regarding treatment or prevention based on this essay, please consult your physician. This essay is also not intended to suggest that carefully considered current safe-sex guidelines regarding HIV prevention such as those available from the Centers for Disease Control and Prevention (CDC) website should be ignored or changed as a result of some of the research on HIV transmission reported on here. Please follow current safe-sex guidelines carefully until, and if, revisions to those guidelines are made.

In his victory speech on election night, President-elect Barack Obama said, “If there is anyone who doubts that America is a place where all things are possible, who still wonders if the dream of our founders is alive in our time, who still questions the power of democracy, tonight is your answer. It’s the answer…told by the many…who believed this time must be different because their voices could be that difference. It’s the answer spoken by young and old, rich and poor, black, white, Hispanic, Asian, Native American, gay, straight, disabled and not disabled.”

As a doctor who has treated people living with HIV/AIDS since the early ’80s, it is my hope that when Barack Obama is inaugurated, he will add to the above list: “and HIV-positive and HIV-negative people.” Because the time has come for HIV/AIDS to be a nationally recognized epidemic, and it is my great hope that the new administration, led by Barack Obama, will bring a new day of reckoning to our fight against HIV/AIDS in America.

In his speech, Obama claimed that the very act of electing the first African-American president was itself an indicator of change. He said, “It’s the answer that led those who’ve been told for so long by so many to be cynical and fearful and doubtful about what we can achieve to put our hands on the arc of history and bend it once more toward the hope of a better day.… It’s been a long time coming but because of tonight, because of what we did on this day, change has come to America.”

Certainly on the occasion of this 20th World AIDS Day, we need a world of change. As the number of people living with HIV globally tops 30 million and as we discovered this year that the HIV infection rate in the United States is 40 percent higher than previously estimated, it is clear that our approaches to preventing HIV are not working optimally. It is my belief that the key to stopping AIDS lies in the destigmatization of people living with HIV—and a key to that lies in illuminating the fact that people on treatment are less infectious than is generally understood.

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