HIV testing fails

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While new HIV-infection rates stabilized or fell in Wisconsin among other demographic groups between 2001 and 2008, they tripled among young black men who have sex with men in Milwaukee. This increase came despite an aggressive HIV-testing program targeting the city’s African-Americans.

Epidemiologists from the U.S. Centers for Disease Control and Prevention came to Milwaukee to investigate the problem. Their first order of business was to determine whether the high numbers truly reflected a rising infection rate or were instead the result of increased testing efforts finding cases that had previously gone undiagnosed.

The CDC found that the infection rate is indeed rising at an alarming rate, offering evidence that a new wave of the epidemic could be forming. Investigators also found that young African-American men were tested a median of three times before becoming HIV-positive.

Both of these findings show that HIV testing failed to prevent a resurgent epidemic in a target community. That’s a matter of great concern, because Wisconsin, following guidelines set by the CDC, puts the lion’s share of its scanty HIV-prevention dollars into testing and treatment.

It appears that treatment is also failing as a prevention strategy, since access to HIV care in the African-American community expanded at the same time that infection rates were climbing. Conventional wisdom is that reducing a patient’s viral load decreases his or her likelihood of spreading the infection to sexual partners. But this has never been proven conclusively, and the CDC findings in Milwaukee argue to the contrary.

In the wake of the findings, federal, state and local health officials must rethink prevention. They can begin by exercising leadership that brings together HIV/AIDS service providers to share information, expertise and resources. Stakeholders who attended the CDC’s presentation of its findings in Milwaukee on March 2 commented that it’s rare to see so many of them together in one room. They should be working together on a regular basis.

Increasing HIV-prevention will also require more money, and stakeholders must seize this opportunity to lobby for it. Wisconsin’s HIV-prevention budget is about $4 million, and it costs approximately $2 million to care for a single person infected with HIV.  Advocates should use these numbers to argue that prevention dollars save not only lives but also taxpayer money.

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