In the early 1980s, “AIDS was just a whisper in the corner of a gay bar.”
Within a few years it grew into a global epidemic, and today, despite many victories in the fight against HIV/AIDS, some 1.2 million people in the United States alone live with the virus. Every 9.5 minutes another person becomes infected, totaling more than 50,000 new infections annually. Meanwhile, the brunt of the epidemic disproportionately affects black women and intravenous drug users.
“The sad part is that we are talking about HIV infection 35 years later,” said Paul Cleary, dean of the Yale School of Public Health and director of Center for Interdisciplinary Research on AIDS (CIRA) at Yale.
Cleary on Friday joined three other experts—School of Public Health Professor Robert Heimer, Stephen Latham, director of the Yale Interdisciplinary Center for Bioethics and Jim Pettinelli, assistant director of CIRA’s Community Research and Implementation CORE—for a panel discussion to mark World AIDS Day. Adedotun Ogunbajo, a second year MPH student, moderated the event.
Needle exchange programs were one of the strongest public health interventions to emerge in the 1990s, said Heimer, a professor in the Department of Epidemiology of Microbial Diseases. Reliable access to clean syringes was shown to drop HIV transmission rates over 40 percent among intravenous drug users (and are also effective in preventing hepatitis infections).
Heimer recently testified in Cape Cod as an expert witness in a lawsuit to keep a needle exchange program open. The judge ruled in favor of the AIDS Support Group of Cape Cod, which was seeking to protect access to clean needles.
“Drug use and HIV are still criminalized; that is not an effective public health strategy,” he said.
Latham recalled the intense and irrational fear that swept the country in the 1980s and 1990s as the epidemic grew. People were afraid of gay waiters and wanted to force HIV-positive children from public schools and play areas. Many dentists and other health professionals refused to treat HIV patients.
Drug use and HIV are still criminalized; that is not an effective public health strategy.
Robert Heimer, PhD
“HIV/AIDS has been an agenda-setting disease for much of my career in health law,” said Latham. Laws with no scientific merit, such as making it illegal to hurl feces (a problem in prisons) and spitting, exist in many states. People who transmitted HIV have also been charged with assault with a deadly weapon and there have been harsher sentences nationwide for crimes committed by HIV-positive people.
Pettinelli said that advocates, including the gay and lesbian communities, scientists and health care and government organizations, eventually coalesced and brought about meaningful changes. AIDS is no longer the automatic death sentence that it once was.
“It’s hard to over-describe the role of activism,” said Cleary. Social scientists have totally changed the way research is done and trials are better. “Nowadays we wouldn’t do studies without community involvement and input.”
The panelists called for network studies that allow policymakers to assess the best places to dedicate resources and also of the need to address racial and ethnic disparities in mortality. The pockets of resistance among some ethnic groups to pre-exposure prophylaxis, a preventive option for people at high risk, also needs more attention.
Looking forward, the panel agreed that the success of the Ryan White HIV/AIDS Program, which has worked with community-based organizations to provide overarching social services and health care, should serve as a model for the Affordable Care Act.
“We should replicate it for every other chronic condition in the U.S.,” said Pettinelli.
This event was co-sponsored by the Center for Interdisciplinary Research on AIDS at Yale and the Yale chapter of the American Public Health Association.