Looking ahead to World AIDS Day 2014, and beyond

With Sunday's World AIDS Day, behind us, today is as good a day as any to think about the future and to embrace the World Bank's "Development Goal 6": "to halt by 2015 and begin to reverse the spread of HIV and AIDS, through prevention, care, treatment and mitigation services for those affected by HIV and AIDS."

Here in the United States, the Centers for Disease Control and Prevention (CDC) website Act Against AIDS has fact sheets and testing information available, as well as a reminder that over one million people in the United States are living with HIV.  While there is no cure for HIV/AIDS there are drugs available to control the virus, and President Obama on Monday announced the $100 million funding of a new National Institutes of Health initiative to discover next-generation therapies. That's the good news. The bad news is from the Morbidity and Mortality Weekly Report, the weekly epidemiological digest published by the CDC. It finds that rates of unprotected sex by men having sex with men have increased between 2005 and 2011.

There's a public health solution for that: harm reduction, a strategy that seeks to reduce the harm from a hard-to-stop behavior, most typically drug use, rather than stopping the behavior itself. reduction.  The CDC report makes clear the steps that are needed: "Health-care providers and public health officials should work to ensure that 1) sexually active, HIV-negative MSM (men having sex with men) are tested for HIV at least annually (providers may recommend more frequent testing, for example every 3–6 months); 2) HIV-negative MSM who engage in unprotected sex receive risk-reduction interventions; and 3) HIV-positive MSM receive HIV care, treatment, and prevention services."

In short, get tested, use condoms, and, if infected, get treatment.

Condoms. The word used to be something left out of polite discussion.  Today it is something we have to talk about.  Condoms can and do prevent infection.  For more information see the CDC fact sheet on condoms. And better condoms may be coming soon. The Bill and Melinda Gates Foundation is supporting a Global Health Challenge to develop next generation of condoms and they even have a condom blog.with links to promising new products, such as Origami Condoms'  female (video embedded below)  and male condoms. Until that next generation arrives, you can access free, current generation male and female condoms from the Philadelphia Department of Public Health's Take Control Philly program.

Another aspect of HIV prevention is needle exchange. Prevention Point Philadelphia runs a syringe exchange, as does the Camden Area Health Education Center. They also provide confidential HIV screening and counseling and provide other medical services.  Despite scientific findings that needle exchange is a lifesaving, cost-effective means of preventing blood-borne diseases, a federal funding ban remains in place.  The American Foundation for AIDS Research (AMFAR) along with many others, is working to end that ban and extend services.  You can still celebrate World AIDS day in a meaningful way by signing their petition and contacting your  representatives in Congress.

Janet Golden, a Rutgers University history professor, specializes in the histories of medicine, childhood and women.

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