May 5, 2015

HIV Outbreak in Indiana is about more than Indiana

There has been much in the news recently about an outbreak of HIV in rural southern Indiana (here's a recent NY Times article). While it is easy to focus on the conditions in that region as problematic (including the anti-gay fiasco, which continues to be a global issue i.e. Uganda), I think it is more a cautionary tale about how the approach to prevention has been and continues to be fatally flawed. I have said it repeatedly in this space that our prevention efforts target a group that is less than the HIV population, let alone all of those at high risk. It's an approach that relies on self-report and honesty in a hostile, judgmental society and that continues to chase the virus rather than get ahead of it. Like with chronic pain, staying ahead of it avoids a lot of unnecessary hurt. 

Blacks, gays and cities. This is another fundamental problem. The news out of Indiana shows "Targeting" these groups for prevention in HIV work has had little effect on the national education level about HIV. How else to explain sentiments expressed in the cited article like "I thought it was a homosexual disease"?  Likewise, how is it possible that public health officials, such as the Scott County public health nurse also cited in the Times article, be so misinformed about needle-exchange programs? Where did she get her education and training? Thankfully, this nurse looked further into the research and adjusted appropriately.  This really is more of a a national educational problem influenced by politics, and is not at all unique to Indiana. We just do not do a good job on educating people about the psychosocial aspects of disease prevention that open us up to getting the information necessary to truly prevent disease.

Perhaps the most cautionary aspect of this news is that we, as a society, still live as if the lives of others do not matter and are disposable. Certainly we do this demographically ("blacks, gays"), but there are countless others on the margins who don't easily fit into boxes or, if they do, many people resist because of the stigma. This, again, is a fundamental failure of HIV programs: by focusing on the virus through the lenses of the targeted groups, we ignore the entirety of human needs until HIV emerges. It's a part of why HIV continues to spread. It's been a systemic cycle that we have to break. Until then - until we can show greater compassion for all people - we will continue to have sentiments like those expressed at the end of the NYTimes article: "It took HIV to change our town. Those of us who are affected are devastated, but I'm glad HIV is here." 

About 15 years ago, a wise person told me that he thinks we can end the HIV/AIDS pandemic when we are a more compassionate and just world. While more people are accessing treatment, we are a long way from prevention, even more people are acquiring HIV, and we remain starkly divided in many ways. If we think that the news out of Indiana is just about Indiana, I think we are missing the real lessons, and we continue to not learn from the on-going mistakes. It's a denial of lessons and actions that will continue to plague efforts, wasting money and lives.