Fighting AIDS: The Long War

"Twenty-five years ago, the U.S. Centers for Disease Control and Prevention published the first official notice of a new, nameless and deadly syndrome that had affected a handful of gay men in New York and Los Angeles. ...

"A generation later, HIV/AIDS has become one of the deadliest epidemics in human history. Around the world, more than 25 million people have died, and 40 million are currently infected with HIV. ...

"As we look ahead, there are several key strategies that will help us reduce the suffering from this entirely preventable disease:

"Greatly increase access to voluntary HIV testing. HIV diagnosis is the gateway to lifesaving treatment. In addition, CDC estimates that most new HIV infections in the United States are transmitted by the 25 percent of people with HIV who do not even realize they are infected. We need to expand access to HIV testing dramatically -- by making it a routine part of medical care, and by ensuring easy access to new rapid HIV tests.

"Focus prevention on both HIV-positive and HIV-negative people. More than 1 million Americans are living with HIV/AIDS. While it's critical to help people at risk avoid contracting the virus in the first place, equally important is helping those who are HIV-positive to avoid transmitting it.

"Continue to address the role of substance abuse. From intravenous drugs, to alcohol to methamphetamine, substance abuse is a key reason why people who know how to protect themselves and others from HIV still take serious risks. Preventing substance abuse and increasing access to substance abuse treatment are critical to helping people make the right decisions.

"Improve monitoring of new HIV infections. Reliable data are essential to fight any epidemic. For decades we have relied on imperfect tools -- AIDS cases and HIV diagnoses -- to estimate the number of Americans newly infected with HIV each year. Soon, a new national HIV incidence project will provide the most accurate picture yet of new HIV infections.

"HIV prevention is complex, and requires a continued commitment from people at risk, people infected, and society as a whole. Prevention efforts also need to keep pace with a constantly changing epidemic.

"For example, while white gay men were the first to bear the brunt of the epidemic early on, half of all new HIV diagnoses are now among black men and women. And rising rates of sexually transmitted diseases, such as syphilis, among gay men suggest a resurgence of risk behavior in that community.

"Finally, new generations of Americans, who may not remember the deadly, early days of the epidemic, continually need to be reached with basic prevention messages.

"HIV remains a serious, lifelong infection. Our commitment to prevention must be just as long and just as strong as the disease itself. At this 25th commemoration of AIDS, let's remember those lost to this terrible disease by stopping its spread."

The author is the director of CDC.

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