The Simple Truth about HIV Prevention

Nearly half of all people living with HIV in America are black. (Graph credit: the Black AIDS Institute.)
Nearly half of all people living with HIV in America are black. (Graph credit: the Black AIDS Institute.)

There is much about the HIV/AIDS epidemic that’s terribly complicated. The wily bug itself has defied science’s best efforts to kill it for three decades. That said, there are also simple truths we’re all too ready to ignore, particularly when it comes to prevention. I’m referring to neither the abstinence-until-marriage fantasy nor the just-wear-a-condom mantra; both are dreadful simplifications of the decisions we make when reveling in love and lust. No, the simple truth about HIV is this: Our elected officials have plainly refused to give public health enough resources to meaningfully combat it.


The U.S. Centers for Disease Control and Prevention held its annual HIV prevention conference this week, at which hundreds of super-smart people gather to parse the latest research on the virus’ spread. They weighed novel medical “interventions,” such as using AIDS drugs as prophylactics and developing vaginal microbicides to give women greater control over prevention. They shared lessons from public education campaigns and testing drives and, yes, efforts to promote abstinence and/or condom use. This is important stuff; you can’t beat an enemy you don’t understand. CDC highlighted, for example, a few studies that further prove black gay and bisexual men aren’t doing anything more risky in their sex lives than their white peers—and yet are somehow getting infected at fantastically higher rates than any population in America.

Yet, all of this knowledge doesn’t mean a thing if federal and state lawmakers don’t care enough to do something with it. And a study released last month demonstrates clearly that they do not. Kaiser Family Foundation and the National Alliance of State and Territorial AIDS Directors reviewed all HIV prevention funding, both federal and state, dating back to 2004. The usually reserved Kaiser called the results “striking.” Writes Kaiser president Drew Altman,

The overall level of spending for HIV prevention in the U.S. has been essentially flat since fiscal year (FY) 2004, the last year for which we have state-by-state data. … [snip] … More striking, the absolute amount of money we spend on HIV prevention is quite small nationally and on a state-by-state basis. Nationally we spend less than $600 million in combined state and federal dollars for states to deliver HIV prevention services.

That’s sad. Can you imagine us content to spend a collective $600 million on any other fatal, incurable contagion that’s infecting an estimated 56,000 Americans a year (HALF of them black)? And that’s a 2007 number, before several states made dramatic budget cuts. Beleaguered California has cut its HIV prevention spending by more than 60 percent.

Yes, people must take responsibility for their own health. Nobody is arguing the contrary. But that truism doesn’t make public health’s role in stopping HIV any less crucial than it is in stopping swine flu. It’s simple: We must do better. Altman put this in context well:

Virtually every issue we work on in health makes a claim for more money and usually a valid one. In the real world of budget priorities there are many legitimate needs that have to compete for scarce dollars and not all needs can be met, especially in today’s economy and the budget environment at the federal and state levels. But even in a world of competing needs, the small size of the investment we are making in HIV prevention revealed in this report stands out.