It has now been 32 years since the Centers for Disease Control and Prevention (CDC) issued a report of five cases of a rare type of pneumonia, Pneumocystis carinii, seen in previously healthy young homosexual men living in Los Angeles (MMWR. 1981;30:1-3).
That seemingly minor case report, of course, was the start of what was eventually to be known as acquired immunodeficiency syndrome (AIDS), caused by the human immunodeficiency virus (HIV).
I was living in New York City and practicing in a Bronx hospital at the time, and I can still remember the agony of seeing so many patients, some colleagues, and even close friends succumb to the disease or suffer through the loss of loved ones. Those horrible memories flood back whenever I think about those years of ignorance, fear, sadness, pain, and helplessness as we struggled to find a treatment and cure, and as we attended funerals almost weekly.
Today, as younger generations come of age, they do not have those memories embedded in their psyches. Too many Americans have become complacent, no longer viewing HIV as a serious disease.
In 2011, a Kaiser Family Foundation report HIV/AIDS at 30: A Public Opinion Perspective detailing the foundation’s survey of more than 2,500 adults noted, “Thirty years into the epidemic, there is a declining sense of national urgency and visibility of HIV/AIDS.”
Furthermore, according to the Kaiser report, HIV testing rates have not changed since 1997 — even among some higher-risk groups.
Earlier this year, the United States Preventive Services Task Force (USPSTF) updated its 2005 recommendations for HIV screening. The 2005 guidelines recommended that clinicians offer HIV screening to all adults and adolescents at increased risk for infection, including all pregnant women, but for patients with no risk factors, the USPSTF recommended counseling regarding the benefits and harms of testing.
Now, the Task Force recommends screening all adolescents and adults aged 15 to 65 years, including all pregnant women, for HIV infection. Younger adolescents and older adults who are at increased risk should also be tested.
However, the USPSTF agrees with the CDC recommendation that HIV screening should be voluntary on the part of the patient, and done only with the patient’s knowledge and understanding. The Task Force concluded that the overall harms of screening for and treatment of HIV infection in adolescents, adults and pregnant women are small.
Today, the CDC estimates that 1.1 million people in the United States are living with HIV. Studies have shown that HIV prevention programs can significantly reduce risk, and we have more HIV-related resources than ever before.
Yet we still face substantial challenges. For example, nearly 1 in 5 HIV-positive individuals are unaware that they are infected. Complacency now haunts us. Each new generation needs to be reminded of the potentially fatal nature of HIV and the importance of prevention—our lives depend on it.