"Your HIV test is positive, " I tell a 22-year-old man, confirming that he has the human immunodeficiency virus that causes AIDS.
I reassure him that HIV is a treatable disease. If he takes antiviral medications daily, he can have a normal life expectancy. And unlike the conversations I had with patients 20 years ago, today there is reason for optimism and hope, because HIV is treatable with medications that have few side effects and can be as simple as one pill daily.
Unfortunately, I am not having this conversation as much as I should, as one in five people who have HIV have yet to be tested, and don't know that they are infected.
Twenty years ago in Connecticut, one-third of deaths in young men were caused by AIDS. Until 1996, antiviral therapy for HIV was of marginal benefit. Hospitals had entire floors where patients with AIDS were treated for infections caused by a severely depressed immune system, and dying from AIDS was all but certain. But today, these infections are uncommon for HIV patients taking antiviral therapy. HIV has become a chronic disease that no longer instills the dread it did a generation ago, which is a mark of tremendous progress — but also cause for alarm.
The HIV epidemic continues, and there is an increasing rate of new infections in some populations. Connecticut has a large racial and ethnic disparity in who has HIV, with 63 percent of HIV cases in African Americans or Hispanics, even though they account for only 20 percent of the state's population. While early in the epidemic HIV infections were highest in people who injected drugs, today 75 percent of new infections are sexually transmitted, mostly in young men who have sex with men, and in women through heterosexual contact.
One of our biggest challenges in controlling the HIV epidemic in Connecticut, as nationwide, is that an estimated 20 percent of those with HIV do not know they are infected. They have not been tested and continue to infect others. Testing and treatment are crucial, because antiviral therapy is not just life-saving for the person treated, but it also dramatically prevents transmission of HIV to others.
In March 2012, the U.S. Department of Health and Human Services revised treatment guidelines to recommend that all people with HIV receive antiviral medication rather than delay treatment, citing the proven benefit to the patient, as well as prevention of new infections to others. One article in the respected British medical journal Lancet postulated that if we tested everyone, and treated all who tested positive, the number of new infections would decline so dramatically that the AIDS epidemic could actually end. But getting everyone tested is not an easy task.
For example, in 2006, the Centers for Disease Control and Prevention recommended everyone age 13 to 65 be HIV tested, regardless of perceived risk. Yet in Connecticut, as nationally, few primary care providers follow this recommendation. As a result, many HIV-positive individuals, unaware of their status, unknowingly infect others. Last Monday, the U.S. Preventive Services Task Force, which provides standards of care for health care providers, also recommended that everyone age 15 to 65 should be tested for HIV, stating that our focus on testing only people perceived to be at risk of HIV has missed a substantial proportion of infected people.
But testing and treating is not enough. We need to educate our youths because young adults have the fastest growing rate of new infections. HIV prevention efforts directed toward youths is paramount. Parents, teachers and others working with youths need to educate them about HIV and the risk of sexually transmitted infections.
If we hope to reduce or perhaps eliminate HIV in Connecticut, everyone should get an HIV test. Those who test positive need to be in treatment. For those without health insurance, Connecticut has one of the nation's best AIDS Drug Assistance Programs to provide antiviral medications and a strong network of community health centers that can care for them.
No one should die from AIDS in 2012 and everyone with HIV should be in treatment. We have the resources to make this happen.
Gary F. Spinner is an HIV specialist at Southwest Community Health Center in Bridgeport. He can be reached at firstname.lastname@example.org.