A government campaign intended to “break the back” of the AIDS epidemic will try to cut the number of new infections in half by 2005, largely by identifying Americans who carry HIV but do not know it.
The effort, announced Tuesday by the Centers for Disease Control and Prevention, is based on the idea that most AIDS infections are spread by outwardly healthy people who do not realize they have HIV.
The agency believes that if these people knew they were infected, they would be more careful to protect others, and they would also take AIDS drugs that would probably make them less likely to transmit the virus.
The CDC already spends about $600 million a year on AIDS prevention, mostly to try to keep uninfected people from catching the virus.
“We have been dealing with half of the equation,” said the CDC’s Dr. Robert Janssen. “Now it’s time to look at all of it.”
Officials said the campaign would cost an additional $300 million annually. The CDC already has $100 million of
this and hopes to get funding
for the rest.
The CDC estimates that 800,000 to 900,000 Americans are now infected with HIV, and 40,000 more catch the virus each year, a figure that has been stable since the early 1990s. The CDC’s goal is to cut the number of new infections to 20,000 annually.
To do this, the CDC will try to identify many more of the 200,000 to 275,000 people who are infected and do not know it. Currently, about 75,000 new HIV infections are diagnosed annually. The CDC hopes to increase that by 30,000 for the next two or three years. By 2005, it hopes that 95 percent of infected Americans will know their status.
“People who are infected and don’t know it need to get tested, need to be treated and need to be safe,” Janssen said. “It is critical that people learn they are infected.”
The agency believes that most people who have HIV do not want to infect others, and they will take precautions if they know they have the virus.
One CDC survey found that 90 percent of people adopt less risky sexual behavior during the year after they learn of their infections, typically using condoms more and having sex less often.
As the infection progresses, the amount of virus in people’s bodies increases, making them more likely to transmit HIV.
Drug combinations available over the past five years have made these virus levels plummet, and experts assume this will make infected people much less likely to pass on the virus.
Finding infected people as soon as possible is an important goal, said Dr. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases. “The critical reason for learning early is to treat them as soon as treatment is appropriate,” he said.
Details of the campaign, called SAFE – for Serostatus Approach to Fighting the Epidemic – were outlined at the Eighth Annual Retrovirus Conference in Chicago.
Among the CDC’s plans:
• Launch a new media campaign, called Know Now, involving radio and bus ads aimed at neighborhoods where HIV is most common. The ads will be tested in Detroit, New Orleans, Houston, Miami and Jackson, Miss.
• Work with the Food and Drug Administration to get rapid AIDS tests on the market later this year. These tests use saliva or a drop of blood and give results within 15 minutes. They can be used on street corners, in bars or almost anywhere else.
• Encourage much more widespread AIDS testing. Make AIDS tests a regular part of all emergency room visits in areas where the virus is common. Encourage routine voluntary testing in jails.
• Work with the 2,000 doctors who provide most AIDS care to encourage their patients to take precautions against spreading the virus.
Such an effort, said Janssen, “could possibly break the back of the epidemic in the United States.”
Dr. Helene Gayle, the CDC’s AIDS chief, said a rough estimate of the entire cost of the campaign is $1 billion.
“Academic researchers and health departments have looked at what it would realistically take, and that’s what it would realistically take,” she said. “It’s a matter of what our society is willing to pay for.”