The reason AIDS presents such a difficult disease to manage from a public health aspect is due to its ability to cross a wide range of behaviors and identities within communities still somewhat uncomfortable talking about sexuality. The challenge is effectively informing such diverse populations with targeted messages that are able to change their beliefs and, ultimately, their sexual behavior. As Dr. Del Rio stated in his addressing of AIDS, when the disease first came out in the 1980s it was primarily one that affected affluent, white, males (1). The resultant public chatter about the disease made it one that only could present from homosexual activity, which, as we know now, is very far from the truth. Now a completely different population is at the highest risk to get HIV and develop AIDS.
So while we need to combat AIDS on a public health stand point, it must be done with message that cross many different identities. As Judith Levine describes, “In AIDS prevention, the challenge where they affiliate and speak to their sense of belonging for the purpose of instilling and reinforcing safe-sex values and habits”(2). It must convey that this is disease that can affect anyone who is performing unsafe sexual or drug activities. It must be presented in a concise, easily understood way which effects change in the people it serves to target.
Another interesting factor to consider will be the effect that the new drug Truvada will change the way people act. Truvada is a drug that is given to healthy people and, along with other safe sex procedures, has been shown to prevent the contraction of HIV. While this is an important step in the controlling and hopeful eradication of HIV/AIDS, it also may have some negative consequences. Firstly, it must be taken every day to actually impart immunity. Incorrect use of it could lead to the development of strains of HIV resistant to Truvada. Secondly, although it was not shown in the preliminary clinical trials, the use of the drug may cause people to take part in more risky sexual behaviors because they feel they are protected. Truvada is not 100 percent effective in stopping the spread of HIV and this well intentioned drug could actually cause the disease to spread because of the invincibility factor it provides (3).
It is plausible that a cure for AIDS may be invented within our lifetime. However, its high mutation rates and the resulting high evolutionary selective pressure make it unlikely candidate for a universal cure. This emphasizes the importance of effective public health management of the disease. I think the effort needs to occur on 3 fronts. Grade school health education must express how important it is to use safe sex procedures as well as the risks of intra venous drug use. This early exposure will hopefully create young adults more aware of the disease. Secondly, public health marketing campaigns must continually stress the universal nature of the disease. This is not a disease that only affects certain races or sexualities; anyone can get AIDS if they are not being safe. And finally, primary care physicians need to be a resource willing to talk about sexual practices and the appropriate ways to stay protected. AIDS is unlike any other disease of humankind in that so many different societal aspects contribute to its spread. This requires social efforts to fight back against it.
1- Del Rio, C. Viral Cultures lecture 02/20/2012
2- Levine, J. Community: Risk, Identity, and Love in the Age of AIDS. Speaking of Sexuality: Interdisciplinary Readings. New York: Oxford University Press, 2010. 619-630. Online at https://classes.emory.edu/bbcswebdav/pid-1642090-dt-content-rid-262294_2/courses/FA12_AMST_385_DTROKA_Combined/risk%20identity%20and%20love%20in%20the%20age%20of%20AIDS.pdf
3- Park, A. Truvade: 5 Things to Know About the First Drug to Prevent HIV. Time (July 17, 2012). Online at http://healthland.time.com/2012/07/17/truvada-5-things-to-know-about-the-first-drug-to-prevent-hiv/
Kienbean: An important addition to the profile that Dr. Del Rio laid out for HIV+ folks in Atlanta in the 80’s was *gay* middle class/upper class white males. Great job bringing together some of our class readings (correctly cited) and outside research on the AIDS drug Truvada. I really like your three point plan for the public health management of HIV/AIDS. What would you suggest for those who are taking Truvada and think it makes them immune to the disease and therefore return to less safe sexual and injection drug practices? How would you inspire/encourage them to maintain safe practices even when taking the drug?