Applying Public Health Principles to the HIV Epidemic

The New England Journal of Medicine ^ | December 1, 2005 | Frieden TR, Moupali DD, Kellerman SE, Henning KJ

[neverdem]

The lead author, Thomas R. Frieden, M.D., M.P.H., is the Commissioner of Health and Mental Hygiene in New York City.

After more than two decades with quarantine being politically out of the question, and these folks not getting religion or otherwise doing the right thing, I agree with these proposals to lessen the spread of this incurable disease.

This article is freely available to anyone who registers at no charge with the New England Journal of Medicine. Its linked references are available once you register here. Then, just go back to home. Scroll down to find this article of opinion. Authors were listed in the format used by PubMed because of space.

[SpaceBar]

Michael Savage recounted a personal story on today's show about how he worked at a San Francisco clinic in the early eighties. At that time the AIDS epidemic was just getting started, and Savage was vocal about closing the gay bath houses to stem the spread of the disease, and posted fliers around the city to that effect. Needless to say he was called every name in the book. At the same time Dianne Feinstein was Mayor after the assasinations of Mosconi and Milk, and only after much pressure closed the bath houses.

[FreedomPoster]

My first reaction to the title, "Applying Public Health Principles to the HIV Epidemic", was "Well, that horse is long out of the barn, isn't it?"

[EBH]

Condoms, which can substantially reduce transmission, are not widely available nor is their use strongly promoted, and they are still used infrequently in high-risk sexual encounters

Funny, I can go to any drugstore or grocery store and purchase a pack of condoms. I find the remark made to be untrue. Years ago one would have to ask the pharmacist, but today anybody can go to the aisle and outright purchase them. Plus, if one goes to those new fangle grocery stores with the self checkout lanes you never even have to face a live person. Note: All our grocery stores now have at least 4 of these lanes.

Where does respect for your partner and personal responsibility come into account in this article.

[dhuffman@awod.com]

I have always applied public health principles to the AIDS epidemic. I'm nearly 60 y,o. and in great health even though born and raised in the SF Bay Area. My greatest fear of HIV is the evidence that HTLV-III can be transmitted by common insects. But that information was buried soon after its publication. Mosquitoes near Belle Glade, FL were found to carry Human T-cell LeukoVirus III.

[Sir Francis Dashwood]

After more than two decades with quarantine being politically out of the question,...

If it worked with Polio...

[Lucky Dog]

…perhaps society is ready to adopt traditional disease-control principles and proven interventions that can identify infected persons, interrupt transmission [emphasis mine], ensure treatment and case management, and monitor infection and control efforts throughout the population

The author’s postulation is not very likely given that to interrupt transmission requires those who engage in the high risk activity have already shown that they are unwilling to do so in the face of a virtual death sentence from contracting the disease. Additionally, it is even more unlikely given that those in society who merely point to statistics and cite logical prevention steps are shouted down as “homophobes” and “bigots.”

The economic costs, particularly to improve population-wide case management and notification of partners, would be substantial. But the human and economic costs of failing to adopt a comprehensive public health approach are much higher.

Logic has no place in this argument… Just examine previous attempts to inject it in to the national dialogue.

— but reducing sexual transmission is challenging…Condoms, which can substantially reduce transmission, are not widely available nor is their use strongly promoted, and they are still used infrequently in high-risk sexual encounters.

Notice that even this author who is championing attempting control “high risk behavior,” fails to mention the most obvious and most completely effective control: abstaining from homosexual activity. The god of “political correctness” must be appeased even when trying to state the obvious.

HIV/AIDS will continue to be a public health threat until everyone in society intellectually recognizes the ultimate sources and publicly pressures those who engage those activities to stop. This public pressure must incorporate effective disincentives if it is to be effective.

[Phlap]

Applying Public Health Principles to the HIV Epidemic?

HIV is epidemic only to the homosexual(can I still use that word?) community.

[Graybeard58]

HIV is epidemic only to the homosexual(can I still use that word?)

They are calling themselves "Queer" nowadays and I find that appropriate.

[neverdem]

HIV is epidemic only to the homosexual(can I still use that word?) community.

Only? Bisexuals and intravenous drug users do a pretty good job infecting those who have done nothing to harm anyone else. How do you explain females and children becoming infected? You can find the numbers here.

[Phlap]

You are buying into their lies. Monogamous heterosexuals have nothing to fear.

[neverdem]

You are buying into their lies. Monogamous heterosexuals have nothing to fear.

If you say so, it must be true. /sarcasm

Please check the link in comment 10. Monogamous heterosexuals are reduced to trusting that their spouses or significant others, believe me I don't care for the latter term, never engage in high risk behavior. How do you explain the transmission to females, and the perinatal infection of their offspring, from bisexuals and intravenous drug users whose habits were not disclosed to them? Heterosexual contact accounts for 56,403 males and 93,586 females infected for a total of 149,989 estimated # of AIDS cases through 2003.

[neverdem]

Where does respect for your partner and personal responsibility come into account in this article.

It doesn't, except for the push for voluntary testing, condom usage, clean needle exchanges and the barely mentioned hope for guilty consciences. This is a public health initiative for consumption by the MSM. Did you hear the news today?

[IronJack]

The apparatus of the "epidemic" -- needles, infected blood, and other body fluids -- becomes irrelevant if the practices in which they are disease vectors are eliminated. It doesn't matter if the needle is clean or dirty if you're not injecting drugs. It doesn't matter if your "partner" is a dripping pus bag if you don't have sex with him.

This is nothing more than an attempt to separate actions from their consequences.

[neverdem]

This is nothing more than an attempt to separate actions from their consequences.

I think it's a renewed attempt by folks in public health to get a handle on a growing epidemic. CDC numbers are available in the link in comment 10.

Since anyone who cares to know how to avoid getting infected with HIV knows what to do, knowing what is known about how folks still behave regardless, what do you propose for folks in public health to say and do?

[Casloy]

I would flatly dispute something is an epidemic if one can avoid getting it by simply avoiding certain kinds of sexual activity.

[IronJack]

knowing what is known about how folks still behave regardless, what do you propose for folks in public health to say and do?

If the domain of PUBLIC health is the safety of the PUBLIC, then the first concern should not be the burden placed on the infectors! Yes, attempts should be made to minimize the impact to them, but if officials are forced (by the irresponsible behavior of the infectors) to choose between the PUBLIC's wellbeing and the niceties accorded the infectors, then the latter are forfeit.

The precedent has been established that, in the interest of the public safety, certain constitutional safeguards can be overridden. If this truly is a public crisis, then habeus corpus can be suspended, search and seizure broadened, and detention made an option.

The only thing stopping such drastic action is the cowardice of the public health community. They want to appease the homosexual lobby and still pretend to be combating the problem. So they propose half measures and smokescreens like these, hoping people will believe that motion is progress. These don't work. They haven't worked. They won't work.

When a child makes a lot of bad choices, you remove the right of the child to make that choice. You don't concentrate on trying to make the consequences of that choice more bearable.

[neverdem]

When a child makes a lot of bad choices, you remove the right of the child to make that choice.

It seems that your recommending a quarantine, with which I don't have a problem. What pubbie politician has advocated a quarantine? Can you name one? I know of one pol, but he's the boss in Cuba. So what else can you do when it costs $200,000 per patient's lifetime cost with 40,000 new diagnoses every year?

[neverdem]

I would flatly dispute something is an epidemic if one can avoid getting it by simply avoiding certain kinds of sexual activity.

Call it whatever you want to call it. Epidemiologists call it an epidemic. Click on the link in comment 10, then click on the pdf format, HIV/AIDS Surveillance Report: Supplements or Basic Statistics. It's not simply avoiding certain kinds of sexual activity unless someone is in a monogamous relationship with someone who can be trusted with certainty that they don't engage in high risk behaviors.

[Brett66]

discriminatory responses ranged from descriptions of AIDS as "retribution" to violence and proposals for quarantine, universal mandatory testing, and even tattooing of infected persons. This response led to HIV exceptionalism

Homosexual activists led to the mindset of HIV exceptionalism.