It's fascinating what Americans choose to take seriously. Apparently, the very idea of losing your VCR to Y2K constitutes a national emergency. And don't forget all the other mind-boggling obsessions we've developed the past few years. Like whether or not President Clinton and Monica Lewinsky had sex. (I don't care; it's the First Lady's job to care.) Or who killed prepubescent beauty queen JonBenet Ramsey. The trials and tribulations of O.J. Simpson. Brad Pitt's love life. Madonna's baby. The cost to produce Titanic. The sexual orientation of a purple creature named Tinky Winky who, incidentally, bears no genitalia. And "Ally McBeal" star Calista Flockhart's weight. Titillating, tragic, interesting, amusing, but ultimately inconsequential stuff.
We Americans might want to look at the bigger picture for a change, especially as it relates to HIV and AIDS. Sure, the antiretrovirals are out there. Combination therapy is the new "standard of care" for those of us living with HIV. Never mind that if you take 15 pills a day 365 days a year it comes to a whopping total of 5,475 pills a year. (Brad Pitt will never date that many women in his entire lifetime.) And, yes, you are expected to take those drugs, otherwise you'll be labeled "non-compliant."
Other pieces of the big picture Americans seem to have missed: HIV drug therapy works about twice as well in clinical trials as in real life...combination therapy is rarely available outside industrialized nations...the cost of these drugs is prohibitive for people without health insurance (though you could produce Titanic sequels yearly from pharmaceutical company profits)...the list of side effects includes nausea, fatigue, insomnia, vomiting, farting, diarrhea, indigestion, neuropathy, life-threatening rashes, constipation, pancreatitis, birth defects and a delightful new one called lipodystrophy, which randomly redistributes body fat so that the veins in your legs pop out, your face takes on a sunken, ghoulish appearance, or you end up with an accumulation of fat between the shoulders not unlike The Hunchback of Notre Dame.
But the most common unreported side effect of combination therapy has been AIDS complacency. The media acknowledged the new HIV drugs, called them miracles, and promptly banished HIV and AIDS from the front page. Oh sure, you might find an AIDS story on page 42 buried somewhere under bogus astrological predictions and the adventures of those moldy "Peanuts" characters. What was the last big HIV story you remember? How about the one from 1997 flatly stating that AIDS deaths have fallen all across this country due to the arrival of new drug therapies. I can imagine the conversations editors, reporters and TV producers must have been having then: They've got their drugs. They've stopped dying. It's chronic and manageable now like diabetes. Maybe they'll finally shut up about it!
Unless you read AIDS-related publications, subscribe to the Centers for Disease Control's Internet news service or hang out in an AIDS service organization, you're not likely to hear anything relevant about HIV anymore. You probably missed those new statistics from the Brazilian Health Ministry showing that 536,000 of that nation's 165 million people are infected with HIV. I'll bet you never heard that the World Health Organization (WHO) estimates one million people in Western Pacific nations have HIV, with the infection rate rising quickly. Romania's AIDS commission announced this year that nearly 6,500 cases of HIV and AIDS have been recorded among Romanian children born before the fall of communism in 1989. The Worldwatch Institute reports the AIDS pandemic is killing so many people in Africa that it will slow world population growth because the number of infected adults is growing and they lack affordable AIDS drugs. Life expectancy in Zimbabwe has fallen by 16 years since 1990, and in South Africa, AIDS patients occupy 70 percent of hospital beds. Infection rates continue to rise, even among educated and well-traveled Africans. UNICEF Deputy Executive Director Stephen Lewis claims 48 percent of the world's AIDS cases are in the eastern and southern regions of Africa.
Sadly, Americans don't care much about foreigners with strange customs anyway. Unless they have oil or nuclear weapons.
Want further proof of complacency or denial of the epidemic in America? Statistics tell us that the virus has been spreading among women, youth, communities of color and especially the poor over the past several years. Between 40,000 and 80,000 Americans are expected to be newly diagnosed this year. Deaths may be down, but new infections are steady and expected to rise. Public and private contributions to AIDS service organizations have dropped 21% since 1997. There have been no substantial increases in the federal AIDS budget in four years. A recent report by Funders Concerned About AIDS (FCAA) and the Gallup Survey found the epidemic now disproportionately impacts minority communities and discovered that, domestically, there are more people living with AIDS than ever before. Here in Atlanta, Dr. Stephen Thomas, Director of the Institute for Minority Health Research at Emory University warned, "there's a real concern that as soon as the disease is perceived as a 'black and Hispanic thing,' all the money we've seen for research and treatment...will start to dry up."
There's more. Houston, Texas minister Melvin Lewis was ostracized by fellow ministers earlier this year for using his pulpit to speak about sex, abstinence and condoms. Minister Lewis was responding to statistics showing 173 of every 100,000 Houston black men in 1997 were diagnosed with HIV. His colleagues think the subject is taboo.
Los Angeles County's AIDS rate among African Americans is 347 per 100,000. The number of whites diagnosed with AIDS is falling in contrast to the number of blacks.
A recent CDC study revealed that there are 8,900 inmates with AIDS in the United States and as many as 47,000 with HIV, a rate of infection five times that of the general population.
And what's going on with gay guys these days? In Washington state's King County, there's been an increase in sexually transmitted diseases among gay men. Some gays still think relaxed attitudes towards unsafe sex is a fatal mistake, but many others are rejecting condoms because drug therapy has made AIDS seem like a controllable disease. The new drug therapies provide a false sense of security, so fewer preventative measures are being taken as a result.
The latest statistics suggest that while the number of AIDS deaths in the United States continues to fall, the trend appears to have slowed. Maybe combination antiretroviral drug regimens have been mostly responsible for lowering the number of AIDS deaths, but listen to the cautionary words of Dr. Helene Gayle, director of the Centers for Disease Control and Prevention's National Center for HIV, STD, and TB Prevention: "For the time being, it appears that much of the benefit of these new therapies has been realized." And still no vaccine in sight.
Okay, some progress has been made in decreasing the death rate, but the incidence of HIV remains high among gay and bisexual men and is growing rapidly in communities of color where individuals are routinely denied education and treatment options. What do we need here? How about a commitment to prevention similar to that invested in treatment? I can assure you that prevention and risk reduction education is a whole lot cheaper than HAART (highly active antiretroviral activity). Drug regimens fail, too, arguably a lot more often than condoms, which incidentally happen to be considerably less expensive and available without a prescription or health insurance.
By January 1, 2000, we'll know what the Y2K bug can do. Experts tell us it can be fixed or eliminated. Y2K may cause minor inconvenience, they say. The other big millennium bug, HIV, will continue to defy eradication for the time being, creeping into the next century, invading bodies all over the world, wreaking havoc on lives. No matter what you may have heard, AIDS isn't over.