Hotlanta

I'm off to Atlanta for a week for a CDC grantee meeting. I expect to have access to your internets, but they're planning to keep me prisoner during the daylight hours so blogging may be light.

I hope to get some material from the meeting but it's boring, technical stuff. They're trotting out their new data system for HIV counseling and testing. Like everything else the federal government does, it has an acronym, PEMS, Program Evaluation and Monitoring System. There is also a one hour session on how to fill out your expense reimbursement form.

Boring this may be, but obviously timely. The Retrorvirus Conference here in the galactic capital city has featured reports about the continuing substantial number of HIV-infected people who don't know their status. CDC is concentrating on "Positive Prevention" as the most effective way to control the epidemic here in the U.S. That means trying to identify every infected person, providing treatment to control their viral loads, and working with them to make sure they don't retransmit the virus. In the case of some people, this just requires a bit of counseling, but for others, it's a substantial undertaking. People may need substance abuse treatment, mental health treatment (the rate of HIV infection is disproportionately high among people with mental illnesses, and vice versa), and stable lives including housing, jobs, etc. All of this comes together with HIV disease control because people need to adhere to their drug regimens, stay sober, stay out of prison, stay out of the sex business or sex trading, not share needles and works, etc. if they are to avoid transmitting the virus. I emphasize that this must not stigmatize people with HIV. There is no way to generalize about them. People with substantial psychological problems or social disadvantages are at increased risk for HIV, as they are for many health problems -- and one consequence of the relationship to social disadvantage is the marked racial and ethnic disparity in infection rates in the U.S. -- but anybody can become HIV infected. The most common way is to have unprotected sex with an infected person -- which could even be your spouse.

CDC funded programs concentrate on outreach to people at high risk, case finding (i.e., giving HIV tests and identifying seropositive people), referring people to services including medical treatment, and partner notification. There are many practical and ethical problems involved in all this, which I will discuss in the days ahead. Such measures, along with more general education and risk reduction aimed at seronegative people, have succeeded in keeping the epidemic at a stable (though still substantial) level in the U.S. But as we know, the epidemic in much of the rest of the world is out of control and represents a growing crisis.

So I hope we can spend the next week concentrating on HIV and some of the many important scientific questions, social problems, and ethical and political debates associated with this extraordinarily socially complicated medical problem.