August 13, 2006

MORALITY, NOT MONEY:

Why the U.S. Has Not Stemmed HIV: Activists Blame Infection Rate, Unchanged Since 1990, on Policies and Funding (David Brown, 8/13/06, Washington Post)

[A] stable rate of 40,000 new cases a year is a "very, very significant finding," Ronald O. Valdiserri, deputy director of the CDC's HIV and AIDS activities, said last week. "We think it represents some level of success in HIV prevention. We will not deny that we have a ways to go."

What would it take to lower the infection rate?

Holtgrave, who worked at the CDC and at Emory University before moving to Johns Hopkins, tried to answer that in 2002 and recently updated his calculations.

He estimates that the number of new infections could be cut in half if the 5 million Americans at highest risk of HIV -- 4 million because of sexual activity and 1 million because of drug use -- received the full battery of proven interventions. Those include HIV counseling and testing, free condoms, one-on-one or small-group counseling sessions, and needle exchange.

The CDC now spends $720 million a year on HIV prevention. It would need to spend $415 million more to reduce new cases by 50 percent, according to Holtgrave's calculations.

He and his collaborators further estimated that the country would need to prevent 12,000 infections each year to save money in the long run. HIV infection is expensive to treat, and newly infected people will need to be treated for decades -- a huge cost to the health-care system.

There is a lot of evidence that there is much more prevention to be done.

The CDC last month published a survey of 10,000 men who have sex with men -- the term preferred by epidemiologists, as some such men do not consider themselves gay or bisexual. They were questioned at bars, dance clubs, gyms, raves, beaches and on the street in 17 cities between 2003 and 2005.

The survey found that 77 percent had been tested for HIV in the previous year. Testing is a crucial prevention tool. Studies have shown that each year, 11 percent of people who do not know they are infected transmit the virus to someone else, compared with 2 percent of those who do know. Overall, it is estimated, about one-quarter of infected Americans do not know their status.

Forty-seven percent of those interviewed said that in the past year they had engaged in unprotected anal sex -- the riskiest activity. Ninety-eight percent had gotten free condoms. But only 15 percent had had one-on-one risk counseling, and only 8 percent had had peer-group sessions -- two interventions found to change behavior.

The population most vulnerable is young black men who have sex with men. In a study of five cities -- Baltimore, Los Angeles, Miami, New York and San Francisco -- published last year, CDC researchers found that 46 percent of people in that category were infected. Two-thirds of them did not know it.


In other words, all that would be required is that they eschew anal sex and intravenous drugs. Meanwhile, liberal culture warriors have spent the AIDs years trying to rid these pathologies of the social opprobrium that traditionally attaches to them. Then they're surprised that their victims are still getting infected? Rich.

Posted by Orrin Judd at August 13, 2006 10:15 AM
Comments

I remember well when the gay lobby told us 10 years ago that this was not just a gay problem, but that this disease would spread widely throughout society. While there has been some small leakage due to blood transfusions and similar unintended consequences, this scare technique has proven largely false.

Get married, stay married, stay faithful - and one is pretty much immune from this epidemic.

Posted by: obc at August 13, 2006 11:12 AM

Don't share needles in shooting galleries.

Posted by: oj at August 13, 2006 11:16 AM

It's because "second-hand" homosexuality hasn't een treated with the same hysteria as "second-hand smoke", even though the former's adversive effects can be documented and the latter's can't.

Posted by: Raoul Ortega at August 13, 2006 11:18 AM

Could have stopped it long ago with the sort of quarantine that TB patients were routinely subjected to.

Posted by: M. Murcek at August 13, 2006 11:51 AM

M. Murcek is on the right track: grab up the sick queers, tatoo a skull-and-crossbones on their p*ckers, and just watch that HIV rate go down and down.

Posted by: Lou Gots at August 13, 2006 12:23 PM

Lou - you missed the words "could have." Too late now. Claiming that a quarantine at the right time equals some sort of scarlet letter campaign now is absurd.

Posted by: M. Murcek at August 13, 2006 12:38 PM

Lou:

The no deletions policy requires that you exercise some modicum of self-control.

Posted by: oj at August 13, 2006 12:48 PM

In other words: lets spend everyone's tax dollars babysitting adults who will not look after their own welfare. Why not intervene on behalf of base jumpers and extreme atheletes? When one of these types kills himself, do we say to ourselves "his death could have been prevented, if we only cared enough"? No, we shrug our shoulders. The guy's family usually says "he was doing what he loved".

Posted by: Robert Duquette at August 13, 2006 1:41 PM

But we do spend billions in public dollars on Raoul's smokers and rescuing your idiots who get stuck climbing mountains and the like.

Posted by: oj at August 13, 2006 1:50 PM

Is anyone listening? A quarantine would be useless now, and yeah, would cost lots of tax money. Back when it was a handful of cases, though? Oh, yeah, we'll get the argument "We didn't know what we were dealing with exactly." Yes. Exactly.

Posted by: M. Murcek at August 13, 2006 2:04 PM

no, it wouldn't. It would stop -- or seriously slow -- the spread.

Posted by: oj at August 13, 2006 2:10 PM

They DID quarantine them years ago - placing them in concentration camps with no contact with outsiders - until they died.

Of course, this was only in Cuba - the Leftist paradise. It seems aids is reasonably contained on that Carribean island, versus Haiti where it is rampant - with NO such quarantine policy. Hmmmm.

Posted by: obc at August 13, 2006 2:12 PM

Yes, the workable isn't always (generally) desirable.

Posted by: oj at August 13, 2006 2:29 PM

How many times has Israel released bad guys for some cockamamie peace engineered by the UN? I'm surprised to see moral equivalence on this question.

No country or nation can allow their citizens to be taken hostage and must do what is necessary to retrieve them. Isn't the failure to do just that how this all started? Carter proved a weakling and we've been feeling the repercussions for 25 plus years.

Posted by: erp at August 13, 2006 4:37 PM

My point is that we, as a society, are willing to go to extreme measures to ostracize smokers because it's perceived that they are a burden and menace to society. (Although both are in dispute.) Yet here we have another behavior for which it's been proved that they are a burden ("babysitting adults who will not look after their own welfare") and a menace (primary or only vector for spreading a number of fatal diseases), yet we are doing everything we can to ignore that behavior, pretend it never happens, promote it as "a lifestyle choice", and even make it a civil right.

The real problem is that we are unable or unwilling to forcibly prevent people from chronic self-destructive behaviors. See how we handle the drugged out or drunken so-called homeless, or even the mentally deranged. About the only case where a recent moral crusade has had success of that type is the treatment of drunk drivers, and there's still a long way to go there. (I don't include smoking, because wtih drunk driving, it was that specific action that was targeted, not the more general case of getting drunk and then calling for reinstituting Prohibition, which would be the smoker analogy.)

As for Lou's solution, there's already documentary evidence that a sizeable minority of that population would seek out such people because it enhances the thrill and perceived danger of the activity. (Something about a now respectable activity regaining that illicit aura it once had.) And I don't see why the state should be helping them by providing free certification and trendy tattoos.

Posted by: Raoul Ortega at August 13, 2006 5:32 PM

Your point is inane. It ought not be legal. Until it isn't we aren't treating them near seriously enough. That would not be extreme.

Posted by: oj at August 13, 2006 6:03 PM

I had forgotten about Castro's AIDS camps. What is unfathomable to anyone who thinks the left is rational, is how none of his admirers have batted an eye lash about this gross infringement on their rights. No treatment, no drug therapy, just an invitation to behave badly and die quickly.

Posted by: erp at August 13, 2006 7:17 PM

Forgive the lapse of decorum. I had been grasping at a literary effect which perhaps miscarried.

A strange thing is happening. The homosexual cultural movement is treating vulgar, unsanitary practices as believers regard the sacraments, as acts having beneficient power.

The sense of unclean abomination which had attended these practices had had the effect of retarding the transmission of disease below that level required for the pathogen to propagate itself.

No longer. The homosexual agenda has deeply insinuated itself into public education of even very young children. The curriculum is my school district was deeply tainted thusly. It was to express the lost, or soon to be lost, sense of disgust and shame which should accompany these practices that I experimented with vulgarity.

Posted by: Lou Gots at August 13, 2006 8:17 PM

A much more polite way of putting it--Thanks.

Posted by: oj at August 13, 2006 8:23 PM

erp:

According to this book, Fidel Castro actually utilized a state agency acronymed MUPA to round homosexuals up into camps during the mid-1960s, where they underwent "reeducation." It was commonplace to "judge" them at their places of employment, and they faced possible imprisonment if their behavior continued. The University of Havana actually conducted anti-homosexual purges.

International pressure brought the camps to an end, but I understand that some amount of harassment continues and homosexuals are occasionally sequestered in their own sections of Cuban prisons (the book I linked to above mentions Nueva Carceral in East Havana as an example).

As usual, watching people work their way around this double standard is really funny. I know a guy who has a high opinion of Castro and likes to condemn George W. Bush for utilizing homophobia for political gain. I'm biding my time for the right moment to ambush him with this information.

My prediction is he will immediately bring up the treatment of homosexuals in America and say that we're no better -- this is his usual m.o. (When I recently mentioned some of Castro's crimes, he replied that George W. Bush has screwed up a lot of people's lives, too.) This gets irritating sometimes but he's a good person and I figure someday he'll wake up.

Posted by: Matt Murphy at August 13, 2006 9:20 PM

Maybe there was a reason the cops raided Stonewall Inn. Vice and public health were public concerns in simpler times long, long ago.

Posted by: Tom C.,Stamford,Ct. at August 13, 2006 9:59 PM

Matt, good thing you're so young and have still have lots of synapses to give up for your country. Trying to debate facts with those who can hold opposite and opposing opinions at the same time, I've found to be debilitating and useless.

Liberals have been taught that their "feelings" trump your facts and that being judgmental is the last and only sin they recognize.

Posted by: erp at August 14, 2006 11:29 AM
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