, Salem, MA

December 1, 2012

Column: Where do we stand with AIDS?

Sandra Yudilevich Espinoza
The Salem News

---- — Around the globe, Dec. 1 is annually recognized as World AIDS Day, a day whose purpose is to raise awareness of the continuing HIV/AIDS pandemic. Sandra Yudilevich Espinoza, an assistant professor in Salem State University’s School of Social Work—and an authority on AIDS/HIV in the Latina population—writes on the current state of the pandemic below.

Since the Centers for Disease Control and Prevention (CDC) reported the first cases of a rare pneumonia (later determined to be an AIDS-related illness) in 1981, millions have become infected with the Human Immunodeficiency Virus (HIV) and have developed Acquired Immunodeficiency Syndrome (AIDS). According to the World Health Organization, more than 25 million people have died from HIV/AIDS, including children and adolescents. Thankfully, there have been many positive developments as well.

This we know with certainty: HIV is the virus that leads to AIDS and its transmission happens through contact with infected body fluids such as semen or blood. In addition, HIV can be passed from mother to child in utero, during the birth process, or through breast milk. Discovering the HIV transmission mechanisms has made it possible to prevent HIV infection, stave off its progression to AIDS, and maintain health for increasingly longer periods of time once an AIDS diagnosis is made.

The advent of Highly Active Antiretroviral Therapy (HARRT) in 1995 has now made it possible to live a “normal life span” once diagnosed with HIV, rather than progressing to AIDS and dying within a relatively short time. Treating an HIV-positive woman with AZT, one of the first antiretroviral medications available, as early as possible during a pregnancy, along with handling the pregnancy as a high risk one, has reduced an infant’s chances of being HIV-infected at birth to less than 2 percent.

The effect of these treatment discoveries, as well as other advancements, has been fewer HIV infection diagnoses and fewer HIV/AIDS-related deaths in Massachusetts and across the country. Moreover, the time from HIV infection to an AIDS diagnosis has lengthened considerably . In fact, some consider HIV/AIDS to be a “chronic condition” — and therein lies the rub because as statistics demonstrate that is clearly not true for everyone, and for various reasons.

Highly Active Antiretroviral Therapy is an expensive, somewhat complicated proposition. A one-year supply of medication for one patient is estimated to be between $10,000 and $15,000; not everyone can afford that price tag in its entirety or the co-pays involved. In addition, medications are not effective for everyone. To achieve and maintain effectiveness, though, they must be taken strictly as prescribed and without missing doses. The cost of not doing so can mean running out of medication options, as there are not an infinite number that can be given and their viability ends once someone no longer responds to it. Thus, to be put on a drug regimen as early as advisable, patients must be able to follow through on the instructions for taking the medications. Furthermore, not everyone can tolerate the medications’ potential, powerful side effects.

Clearly, the alternative to treating HIV infection is its prevention—a task not as straightforward as it might seem. Teaching how to prevent HIV infection involves discussing sex and safer sex practices, including condom use— difficult and sometimes taboo topics for many populations. The difficulty in preventing and treating HIV/AIDS is felt most by women and men of color. Statistics say it all: There are 26,000 to 28,000 individuals living with HIV/AIDS in the Commonwealth of Massachusetts. An estimated 21 percent do not know their HIV status. Thirty percent of those infected are black and 25 percent are Hispanic/Latino—disproportionate percentages as they represent only 8 percent and 6 percent of the state’s population, respectively. Massachusetts females fare the worst: 44 percent of all females living with HIV/AIDS are black and 28 percent are Hispanic/Latino, figures that equate to 26 and 15 times that of white (non-Hispanic) females.

We need this continuing epidemic to be brought into the light again and we need to disabuse the public of the idea that it is a chronic condition. We must redouble the effort spent in promoting HIV prevention, particularly among the most affected populations. We must find a way to provide information that is straightforward and encourage conversations that are “real” and meaningful. Yes, prevention involves using condoms, talking about sex and discussing projects such as needle exchange—and yes, there are many who object to this level of directness for various reasons. However, not doing so is nothing less than allowing HIV/AIDS to continue to ravage our citizens. We cannot allow that to happen. I have seen and experienced professionally, and personally, the scourge that is HIV/AIDS: It is truly devastating.

Sandra Yudilevich Espinoza, PhD, is a professor of social work at Salem State University.