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Fighting AIDS at Home

By Robert C. Gallo
Sunday, November 16, 2008

A lasting legacy of both President Bush and recent Congresses will be the largest global health initiative in the history of mankind. Bush's efforts to reduce HIV infection and mortality rates through the President's Emergency Plan for AIDS Relief (PEPFAR) have made the first real dent in Africa's HIV/AIDS plight. PEPFAR's success should illustrate for the next administration the benefits that would come from creating a similar program to battle the rise of HIV infections in America's inner cities.

When PEPFAR was launched in 2003, only about 50,000 people in Sub-Saharan Africa were receiving antiretroviral treatment for HIV/AIDS. Few Americans realize that through this program, our nation has supported lifesaving antiretroviral treatment for more than 1.7 million people around the world and prevention programs that have helped HIV-positive women give birth to nearly 200,000 HIV-free infants.

At the University of Maryland School of Medicine's Institute of Human Virology, we see the progress PEPFAR is making. Our institute treats more than 200,000 HIV-positive patients through its PEPFAR grants; we are helping to implement the program in six African and two Caribbean nations. We see firsthand the good that PEPFAR has accomplished -- good that could come of having a PEPFAR-style program for America's inner cities.

Sadly, in 2008, some places in the United States, chiefly poor urban areas, are home to the same rising HIV/AIDS statistics as those of some Third World countries. Our institute is in the epicenter of the growing HIV/AIDS pandemic in Baltimore; it provides medication and therapy to more than 5,000 HIV-positive city residents.

The most recent statistics from the U.S. Centers for Disease Control and Prevention show that Maryland leads the 50 states per capita in the rise of HIV/AIDS. Baltimore is one of many cities in need of a PEPFAR-style program to reduce infection rates and increase longevity. Though this pandemic is most prevalent in cities along the Interstate 95 corridor, including Miami, the Baltimore metropolitan area and the Washington metro area, infection rates show that it has spread throughout the nation.

A PEPFAR plan for America's inner cities would help to neutralize and diminish the number of people contracting HIV and the number dying of AIDS. It could provide access to prescribed care and medical therapies so patients with HIV can live a normal lifespan (many don't even realize this is possible). An effort to help these Americans, among our country's poorest, could also strengthen U.S. international relations, sending a message to the world that America recognizes that is not different from other countries and that we, too, have an HIV/AIDS pandemic.

Such a program could also help build clinical infrastructure for diagnosis and treatment in inner cities. Federal and state officials have already allocated enormous sums to fight bioterrorism. But in the past seven years, more Americans have been the victims of HIV/AIDS than have been affected or killed by any bioterrorist attack. In any case, a PEPFAR-style program focused on our inner cities would certainly help prepare people in the event of a bioterrorist attack.

Education is the key to managing and preventing HIV infection. This country needs a program that can teach people about prevention and early detection. As long as socioeconomic conditions prevail, those living in HIV/AIDS "hot spots" without education about the disease and facing other life challenges -- such as mental illness, drug abuse, homelessness and lack of health insurance -- will be at risk even if we do develop an AIDS vaccine.

At the same time that many in this country and around the world are working diligently to develop an AIDS vaccine, we must actively address the growing HIV/AIDS pandemic in the United States. When an AIDS vaccine does become available, a program to reduce HIV infection in our inner cities would ensure that our nation is educated and positioned to readily distribute the medicine, helping to put an end to this terrible disease. In the meantime, the program would help stabilize our growing HIV pandemic and stop the spread of HIV.

Unless we develop a program to fight HIV infection in America's inner cities, our urban centers will continue to face an even more daunting pandemic. To improve the health of millions of Americans and to reduce our HIV infection rates, the next administration should craft and implement a PEPFAR plan targeting our inner cities.

The writer, a professor at the University of Maryland School of Medicine, directs the Institute of Human Virology in Baltimore. He helped lead the co-discovery of the HIV retrovirus as the cause of AIDS and the development of the HIV blood test.

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