Since 2004, the President’s Emergency Plan for AIDS Relief (PEPFAR), which provides resources for prevention, treatment and training in the fight against HIV/AIDS, has been saving lives in more than a dozen underdeveloped countries, including many nations in Africa. With HIV infection rates in some U.S. cities reaching Third World levels, it is past time for a similar program targeting the communities with the highest rates of new infections in the United States. The return on investment would come not only in lives saved but in a reduction in overall health-care costs.
It is no secret that the HIV/AIDS problem in the Washington-Baltimore corridor is dire. An estimated 47,000 people live with HIV in the region, and there were close to 3,000 new cases in 2010. How can it be that our nation’s capital region has infection rates that are comparable to those of many of the countries supported by PEPFAR? The answer is simple: We are failing to make full use of what we know works.
When my lab showed that HIV was the cause of AIDS and developed the blood test for the virus in 1984, I never would have imagined that in 2012 the infection rates in U.S. inner cities would be so high. That’s why I am calling on President Obama and the U.S. Congress to create a domestic PEPFAR, to take full advantage of the power of diagnosis and treatment as part of a comprehensive prevention strategy to move us toward Obama’s vision of an AIDS-free generation. With such a program in place for targeted regions of the United States, we can decrease new infection rates, build stronger links between patients and the care they need, and help people live longer, healthier lives on anti-retroviral medication.
Treatment for HIV has become a powerful tool in HIV prevention. By suppressing the virus with medication, people infected with HIV are far less likely to spread the disease. Nationally, however, less than a quarter of those with HIV infections achieve viral suppression. Worse, many who are infected remain undiagnosed, while others who are diagnosed do not receive care. As a result, the disease can spread.
We have a long way to go before we fully achieve the hope of treatment as prevention, but we have to start somewhere. Given all we now know about treatment, there is no reason for anyone living in the industrialized world to die from AIDS. But to begin the path towards an AIDS-free generation, the rate of new infections must fall.
The good news is that taking on this challenge will not be a burden as the country grapples with its budget problems. The Centers for Disease Control and Prevention estimates that a $10 billion investment today will save $66 billion over the long term. Currently, the cost to treat one new HIV infection is $360,000 over the lifetime of the infected person. The 835 newly diagnosed cases of HIV in 2010 recently reported for the District added more than $300 million to the long-term health-care costs of the city. Isn’t it obvious? Not only do we have a moral obligation to combat the HIV epidemic here in the United States, but we have a fiscal responsibility as well.
Four years ago, in a 2008 Post op-ed, I noted that a domestic PEPFAR could also help enhance health-care infrastructure in our inner cities. Over the past decade, federal and state officials have allocated enormous sums to fight bioterrorism while Americans continue to die from AIDS. We need to recognize that investing in the infrastructure of our health systems to help neutralize the AIDS epidemic would, at the same time, strengthen America’s ability to handle a bioterrorism attack, particularly in regions of the country that are medically and educationally disadvantaged.
Last year, Maryland Gov. Martin O’Malley and D.C. Mayor Vincent C. Gray requested that the president implement a domestic PEPFAR pilot program targeting the Baltimore-Washington region. I join them and again strongly encourage the Obama administration to support such efforts — but not to limit them to Baltimore and the District.
The writer, a professor at the University of Maryland School of Medicine, directs the Institute of Human Virology in Baltimore.