December 1, 2005
In an editorial in today's New England Journal of Medicine, New York City Department of Health and Mental Hygiene officials advocate that HIV be treated more like other infectious diseases. Nonetheless, "the political costs include offending both sides of the political establishment," from conservatives who oppose condom and syringe distribution to AIDS activists who object to the government's notifying a patient's sexual partners, wrote Commissioner Dr. Thomas R. Frieden and colleagues.
Nationwide, public-health agencies should aggressively monitor the progress and care of HIV-infected people, as well as talk with anyone those patients may have infected, the authors wrote -- much as is done for diseases such as syphilis and TB. In addition, the government should widely distribute condoms and hypodermic needles. Changes in medicine and politics make the times opportune for a new approach to HIV, they wrote.
"We're getting out a million condoms a month, we're testing a lot more people than we used to test," and the city funds needle exchange programs, Frieden said in an interview. However, some approaches require more money and changes to HIV-specific privacy laws, he said. For instance, New York law requires a patient to sign an HIV test consent form, separate from the blanket form permitting whatever tests a doctor deems necessary.
This year, New York began sharing with local health departments the detailed information doctors regularly report about HIV patients' progress. The local agencies, however, cannot legally do anything with the information.
Referring to TB patients, Frieden said, "I know who their contacts are, whether their contacts are infected, and if they're infected, whether they've started treatment. All of those things, I can't tell you a single one of them about HIV. But TB killed 25 people in New York City last year, and HIV killed 2,000."
The editorial, "Applying Public Health Principles to the HIV Epidemic," was published in the New England Journal of Medicine (2005;353(22):2397-2402).