At the Crossroads

A midyear report indicates that as of 2002 the nature of the battle against HIV in this country may have changed forever. The number of annual AIDS diagnoses in the United States increased'rather than continuing its yearly decline'for the first time in almost a decade. Those annual declines made up a trend that was short-lived. Much too short-lived'just under half of the two-decade span of the pandemic. So what happens now? Or, more important, what will we let happen now? We are at a critical set of crossroads in the path of history'the face-off of AIDS care with HIV apathy. Many advocates and activists have been predicting that we were approaching this collision course. Well, welcome to it. Traveling along one avenue, medical science truly has made tremendous strides in getting us to the age where small dosages of antiretrovirals have become easier to take than the handfuls of pills that were the only options just a few years ago. Just as senior editor Bob Adams reveals in this issue in his article 'Antiretrovirals: The Next Generation,' not only do many of these medications carry fewer toxicities than their predecessors, but researchers are striving to get to market only new drugs that will be the easiest and least painful for patients to take. Traveling along an opposing avenue, we have had rampantly growing apathy about HIV'made clear by a few groups. First, we have people who do not think they are susceptible to HIV'that it is a disease that affects only 'those people.' Second, we have people who will tell you that they have decided to have sex in any manner they please to. (Without regard for others' health, much less their own!) And, last, we have people who just do not have a clue. They are easily summed up in a comment made in August by Ronald Valdiserri, the deputy director of the National Center for HIV, STD, and TB Prevention, to the Los Angeles Times: 'The improvements in treatment are wonderful, but unfortunately, it minimizes the threat of HIV and AIDS. People say, 'Isn't that cured? Like syphilis?' ' It should be painfully clear that none of these mind-sets is acceptable. People's inability to empathize about what HIV disease is truly like has been compounded by our country's ideological and financial shift away from strong education messages. Yes, we are, as Valdiserri points out, moving into a world where wonderful anti-HIV medications are being created. And these indeed may be able to make HIV disease manageable rather than a death sentence. The overlooked problem, though, is that a disease that is manageable is quite a leap from a disease that is inconsequential. Furthermore, these medications are expensive and demand lifelong devotion. But how are we to help the generations ahead understand these facts without proper resources'both ideological and financial? I see two possible futures'one where we insist that education and other avenues of support remain open to allow us to thrive or one where we let ourselves be overcome with complacency and trampled by so-called compassionate conservatism. One road leads to a bright future; the other does not. And with the news about AIDS diagnoses starting to increase, we can see that too many people are headed toward a frightening future for every citizen.