The Hope of a False Profit

Questioning the things one reads in print is not only wise'especially when someone offers up an opinion'but also important. Readers should always be cautious when opinions are freely given'and should take issue with them when they fail to be worthy of the paper they are printed on. Case in point is a commentary I read in late June that praises the Centers for Disease Control and Prevention's planned shift of funds, beginning in 2004, away from traditional HIV prevention programs and toward widespread antibody testing. The commentator, Joe S. McIlhaney Jr., MD, calls this 'a bold and important policy change that will help us begin to reduce the rate of HIV infection in the United States. [The CDC] has taken a first step toward treating HIV/AIDS like a public-health challenge, not a political issue.' McIlhaney, who is president and founder of the Medical Institute for Sexual Health, likens the CDC's recommendation that HIV testing become a routine part of medical care to cholesterol screening. He also says that the CDC should have reacted toward HIV when it appeared 20-plus years ago as it did with the appearance of severe acute respiratory syndrome'that is, to screen individuals, track the carriers, and notify individuals who had been in contact with SARS patients. Instead of following this standard public-health approach to infectious-disease control methods, McIlhaney says, the CDC got caught up in the debate over gay rights and privacy issues. Thus his comment about HIV having been treated as a political issue and not a disease. I do not deny that McIlhaney has a point when he says that the overall HIV infection rate in this country is not dropping and that, in fact, among some at-risk populations the rate is increasing. I agree that this is a problem and that something about our prevention efforts is not working. It probably would not be a bad idea if antibody testing became a routine part of medical care. All people need to realize that they are more affected by and at risk of HIV infection than they want to believe. But I cannot buy into most of what this man says. With cholesterol screening, for example, when your physician tells you that your level is too high, you work together to remedy the situation. Once you have HIV, you have it for life. As for his SARS analogy, well, HIV is not contagious; it is communicable but not contagious. There is a big difference. With further research I found that McIlhaney's Medical Institute for Sexual Health advocates that 'we must actively promote risk elimination, rather than just risk reduction.' Being at the self-proclaimed forefront of work on the 'worldwide epidemics of nonmarital pregnancy and sexually transmitted disease,' the institute points out that the 'only 100% effective way to avoid nonmarital pregnancy and STD infection is to avoid sexual activity outside a mutually faithful lifelong relationship'marriage.' In a perfect world, life truly would be this simplistic. But we cannot expect that it ever will be. Advocates at AIDS service organizations are up in arms over the CDC plan; you can read about their concerns in our overview of the Midwest in this issue. Even though HIV testing is important for maintaining health as well as risk reduction, once a counselor tells someone that he or she has HIV, it is way too late to prevent that person from getting it. Strong prevention programs are important tools, and any plan will have to incorporate them in a broad-reaching and realistic way. Crippling these programs will doom us further. Until next time, be aware'beware wolves in sheep's clothing'and be well.