One incredibly vexing problem in modern medicine, yet to have a solution, remains our difficulty in identifying patients who have acquired the Human Immunodeficiency Virus (HIV) shortly after they are exposed. Tests exist to diagnose HIV at any stage of infection or disease, however, early signs of the illness can be rather vague when they occur a few weeks after exposure– fever, sore throat, swollen lymph nodes, perhaps a rash – and are mistaken for common respiratory infections. Although testing rates for HIV have increased in recent years, a shocking 200,000 Americans are estimated to be HIV positive while not aware of the potentially deadly virus inside of them. This is a nightmare for public health officials, and the reason for our ongoing epidemic of HIV more than 25 years after the virus was discovered. How can we prevent its spread if we don’t know who is infected?
HIV, and its terminal stage, Acquired Immunodeficiency Syndrome (AIDS) is a devastating illness to say the least. I recall early in my career caring for a 34 year old African American woman admitted to the hospital with late stage AIDS. She was wasting away before our eyes, having lost 50% of her body weight in the previous year. She was being ravaged by 3 separate opportunistic infections, and her death occurred only days after coming into the hospital. She found out she had HIV roughly 2 years prior, but without health insurance, did not have access to life saving medicines. She was never able to pinpoint when she was infected – she was never taught about the symptoms of acute infection, nor did she know she could be tested for free at the City Health Department.
During the month of February, our blog will be examining carefully the CDC report on health disparities that exist in our country. What strikes me in reading this report is that there are, in a myriad of measures of health, citizens who are fortunate, and those who are not. The “haves” and “have-nots.”
Of course, having volunteered in Free Clinics for 15 years, I have known this fact for some time. Having trained in a tertiary care academic medical center, I have witnessed life saving medical care akin to science fiction, while those who seek care in free clinics are merely looking for medicines to manage their chronic diseases that may cost pennies a day.
The CDC report, as it addresses the disparity of rates of HIV in Americans, shows another example of our two separate Americas: “Racial/ethnic minorities, with the exception of Asians/Pacific Islanders, experience disproportionately higher rates of new human immunodeficiency virus diagnoses than whites, as do men who have sex with men (MSM). Disparities continue to widen as rates increase among black and American Indian/Alaska Native males, as well as MSM, even as rates hold steady or are decreasing in other groups.”
The CDC authors used a measure (p88) to compare differing ethnic populations in the US to Caucasians, and have found that rates of HIV infection are 9-10 times higher in the African American community and rising. It also shows an alarming difference in the rates of HIV among men who have sex with men (MSM) and those who do not. The CDC report on HIV disparities does not examine why this is, but rather provides an accounting and method of statistical comparison. But elsewhere in the report, as you will see from blog posts throughout this month, factors such as access to health care, income and educational inequality play a central role.
As I was preparing to write this, I could not but help but remember the announcement of Earvin “Magic” Johnson in 1991 that he was HIV positive. Magic has lived 20 years with HIV and thanks to highly active anti-retroviral treatment (HAART), has suppressed the virus to undetectable levels. He has made efforts to use his celebrity to combat the glaring disparity in rates of HIV between blacks and whites through his “I Stand with Magic” Campaign, but we need more than the rare courageous celebrity to address this.
Thankfully, The White House unveiled its national HIV/AIDS strategy in the summer of 2010. Due to the unique features of HIV infection, a comprehensive approach will be needed to erase existing disparities. The White House program is just such a comprehensive plan. Addressing prevention through education, testing through community health centers and increased access to primary care, as well as providing access to life saving medications are all sorely needed.
The CDC report (p2) says it best: “Differences in health based on race, ethnicity, or economics can be reduced, but will require public awareness and understanding of which groups are most vulnerable, which disparities are most correctable through available interventions, and whether disparities are being resolved over time. These problems must be addressed with intervention strategies related to both health and social programs, and more broadly, access to economic, educational, employment, and housing opportunities. The combined effects of programs universally available to everyone and programs targeted to communities with special needs are essential to reduce disparities. “