The good news is that the number of AIDS cases and AIDS deaths have been declining in the U.S. for a decade. AIDS was once a sure death sentence. Antiviral drugs are so efficient in extending the lifespan of AIDS patients that many now live long enough to die from other natural causes. AIDS remains a major public health concern but this is a triumph for medical research and public education.
In this context, it seems difficult to justify further increases in federal spending for AIDS research. The practical reality is that public research funds have a finite limit. Money spent on AIDS is money that will not go to other diseases. AIDS research already receives more funding than 13 other diseases that cause more American deaths.
Alzheimer's disease makes the point. About 5 million Americans are afflicted with Alzheimers and their numbers are fast-growing. Fewer than 400,000 Americans have AIDS. Unlike AIDS, researchers are still struggling to unravel the causes of Alzheimer's and there is no good treatment available. Its unreasonable to devote more to AIDS research at the expense of diseases like Alzheimer's, even if AIDS has a far more aggressive and effective lobbying effort.
AIDS prevalence is still increasing in Africa, but there are stronger arguments for devoting any funding increases to malaria. Malaria affects 300 million people a year while about 40 million around the world have AIDS. Malaria is Africa's leading cause of childhood death and consumes about half of all the medical care dispensed on the continent. It is a result of poverty but also an important cause. According to the World Health Organization, malaria costs African economies about $12 billion a year, even though it could be controlled for a frac
tion of that sum. Its unlikely additional AIDS dollars would have a comparable impact.
About 25,000 global AIDS activists met in August in Toronto not only to urge more funding but to insist on reduced stigmatization of the disease. Delegates cheered Bill and Melinda Gates when she declared that HIV is transmitted through activities that society finds difficult to discuss, activities that are infused with stigma, and that stigma has made AIDS much harder to fight.
Stigmatization is never pleasant, but it has its uses. When unwed childbirth was stigmatized (up until a couple of generations ago) there was much less of it, not more as would be predicted by Melinda Gates remarks. Likewise, there is no reason to believe that the stigma surrounding sex work, formerly known as prostitution, or homosexual behavior is a major barrier to reducing AIDS. These activities are increasingly less stigmatized, yet AIDS incidence around the world continues to rise. Stigmatization is not always a product of prejudice or ignorance. It can be the cultures way of discouraging destructive behavior.
NOT ABOUT STIGMA
The gay community, far from being stigmatized and powerless, has used its political clout to stave off a potentially powerful tool in preventing the spread of
AIDS: widespread testing and contact tracing. In the early years after HIV and AIDS were identified, there was a debate about whether to use these techniques to combat the spread of AIDS. Public health workers have long used discrete identification of vectors, or carriers of disease, and notification of their partners to interrupt the spread of communicable diseases caused by sexual contact. This information is especially critical with diseases, like AIDS, for which there is no antibiotic cure.
Nevertheless, gays and AIDS activists vigorously resisted the use of these measures in AIDS prevention. They not only won the debate, in the 1980s, against testing high-risk groups, but were able to push the discussion completely off the table, never to be seriously considered again.
The result is that today, the majority of new HIV/AIDS patients contract the disease from a person they do not realize is a carrier. The carriers themselves are often not aware of their status. Vital, easily obtained information is intentionally ignored.
The truth is that personal responsibility matters more to AIDS prevention than any concern about stigma. That doesn't mean AIDS victims should be deprived of medical care or research dollars. But other diseases deserve consideration, also.