August 15, 2001
A 'Chilling Portrait' of Failure to Prevent AIDS
By CHARLES ORNSTEIN, Times Health Writer
from the LOS ANGELES TIMES
The nation's AIDS prevention efforts are hobbled by delayed testing, sporadic safe-sex education from physicians, and continued risky behavior among infected people, according to a series of studies released Tuesday.
A day after health officials acknowledged that sharp declines in AIDS cases have ended, the studies highlighted systematic failures to adapt to the changing epidemic and reach large numbers of people at risk.
"It is a chilling portrait. It's not a good picture," said Phill Wilson, executive director of the African American AIDS Policy and Training Institute in Los Angeles. "At least it provides a blueprint of what we need to do."
A huge concern is that 41% of people learn of their HIV-positive status a year or less before being diagnosed with full-blown AIDS.
These findings, released Tuesday by the Centers for Disease Control and Prevention, are based on comprehensive data from 25 states and take into account all patients diagnosed with HIV or AIDS between 1994 and 1999.
They are disturbing to researchers because HIV takes a median of 10 years to reach full-blown AIDS. Untested people are unwittingly passing the virus along to their sexual partners. At the same time, they are missing out on early drug intervention, which would probably extend their lives.
Dr. Ronald Valdiserri, the CDC's deputy director of HIV, sexually transmitted disease and tuberculosis programs, said he was dismayed that "In 2001, we still have a situation . . . where four out of 10 people are not testing until very late in the course of infection, often when they present with symptoms of AIDS."
Other findings from the second National HIV Prevention Conference in Atlanta:
* Forty percent of patients diagnosed with HIV in 1998 showed symptoms of the disease or had risk factors noted in their medical records at least one year before the diagnosis, according to a study by Group Health Cooperative in Washington state and seven Kaiser Permanente regions.
As a result, Kaiser has implemented new guidelines to help doctors identify patients who should be tested, and the HMO has streamlined procedures for patients to get tested and find out their results.
* Physicians rarely discuss strategies with HIV-positive patients to reduce transmission of the disease to others, say University of Washington researchers whose study was based in Seattle. Only 36% of the 273 men studied received counseling during a three-year period, and only 11% received counseling during the previous year.
"Physicians really have a difficult time talking to their clients about any sexual matter, and HIV is probably the most deadly," said Lee Klosinski, director of education for AIDS Project Los Angeles.
* More than half of gay and bisexual men who sought care for rectal gonorrhea already had HIV, according to the San Francisco Department of Public Health. Such men were more likely to find sexual partners in bathhouses or over the Internet.
The study did not indicate whether the men knew of their HIV status.
Prevention groups say people delay HIV testing for two reasons: They're afraid of the results or they don't think they are at risk.
"There are still large pockets in our society that don't know that AIDS is not a death sentence," Wilson said. "And even for some folks who know that, they don't have the medical access to know that there's something to do about it."
In particular, CDC researchers found that Latino and African Americans were more likely than whites to delay HIV testing at 12 sites studied, including Los Angeles County.
Valdiserri acknowledged that delays in diagnosis are prevalent in other diseases, notably cancer. But because HIV is a highly infectious, transmissible disease, delays can be deadly not only for patients but also their sexual partners.
For years, the CDC and public health agencies nationwide have focused their attention on uninfected people. But the data released at the conference and other studies argue for curbing risky behavior among the 800,000 to 900,000 people who already have HIV and AIDS.
Some communities are already trying.
Wisconsin, for example, offers meetings that link HIV-positive drug users and gay men with caseworkers to help them change their behaviors and create personalized prevention plans. San Francisco prevention groups have mobilized a program, whose motto is "HIV Stops With Me," aimed at infected people who may engage in risky behavior.
Many of those already infected are dangerously outside the reach of the health system. "These [people] are the marginalized of the marginalized," said Dr. Tom Coates, director of the Center for AIDS Prevention Studies at UC San Francisco. "These are people who use substances, have problems with alcohol, have difficult childhoods. They have trouble forming intimate relationships . . . and they are more likely to have one-night stands."
Part of the prevention effort for HIV and AIDS patients is ensuring that they have a stable living environment. In some cases, Klosinski said, infected people would offer sex for money in order to pay their bills.
Los Angeles County and San Francisco have received grants from the CDC to develop new outreach services, particularly for racial and ethnic minorities.
"If you can stabilize the life situation, you can help stabilize the infection rate," he said.