July is National HIV Awareness Month: Stigma Remains a Barrier to Treatment Despite Medical Advances

In 1982 the first cases of acquired immune deficiency syndrome (AIDS) were diagnosed in Colorado; there were seven reported cases that year. By the end of 2011, almost 12,000 people in Colorado had been diagnosed with human immunodeficiency virus (HIV), the virus that causes AIDS, and approximately 5,000 had died from complications of the disease. These are not just numbers; they represent people -- our children, mothers and fathers, brothers and sisters, partners, friends, neighbors and colleagues.

Today, we know more about HIV than we did 30 years ago. Many of these advances can be linked to Colorado's role in HIV treatment, prevention and education, earning our state a respected and prestigious reputation within the global HIV community.

The historic 1983 Denver Principles asserted for the first time the fundamental rights of those living with HIV to participate in the decision-making for their care. The Colorado AIDS Project and other organizations were founded to facilitate and supplement care and education. The Governor's AIDS Coordinating Council and Mayor's Planning Council came into being, and brought many to the table to collaborate as advisory bodies on advocacy and public policy, and eventually, in decision-making on equitable distribution of much-needed federal funds for care and treatment.

In the 1980s, researchers at Denver Public Health (DPH) and National Jewish Hospital (NJH) studied the epidemiology and immunology of this, then mysterious, disease, and both DPH and the University of Colorado participated in early prevention programs in at-risk populations. In the 1990s faculty members from CU's Division of Infectious Diseases led the National Institutes of Health's AIDS Clinical Trials Group and Community Programs for Clinical Research on AIDS, providing novel and experimental treatments to many patients, paving the way to the development of successful combination treatment regimens against HIV. Through collaborations with the Centers for Disease Control and Prevention (CDC) and community clinicians at Rose Medical Center and NJH, in 1998 came the first reports of reduction in the death rate from AIDS. Most recently, critically important work led by doctors at DPH has brought needed attention to important gaps in accessing HIV medical care. All of these discoveries came about because of the Coloradoans who volunteered for clinical studies. The world is indebted to these many individuals.

Today, with access to medical treatments and care, HIV need not lead to AIDS and death. Indeed, people living with HIV can expect a high quality of life and normal life span. But decreased death and better medicines have led to false perceptions that HIV isn't a serious health threat or that people are no longer at risk. We are concerned that these beliefs and other societal barriers have kept our state's diagnosis rate, averaging 430 Coloradans per year, from declining over the past decade. Although these represent a rate of new infections that are three times less than those 20-25 years ago (1), we still need to address the "plateau." Stigma, discrimination and prejudice prevent many people from getting tested. Perhaps even more alarming is that among those who do test positive, many never enter medical care or fail to stay successfully engaged with potentially life-saving treatments.

As advocates, activists, and concerned citizens who have joined the fight to end HIV/AIDS, we must do more. Today, one new person becomes infected with HIV every 9.5 minutes in the United States, and an estimated one in five individuals don't know that they are HIV-positive.

The first step anyone can take to help in this fight is to get an HIV test (the CDC recommends regular testing for anyone 13-64). Getting tested is not time-consuming, complicated or painful. Most tests involve a simple finger prick, and results are available in less than 12 minutes. Last week the Food and Drug Administration approved the first over-the-counter HIV test, allowing people to test themselves at home and get preliminary results in less than 30 minutes.

We can all be HIV/AIDS advocates. So we call on everyone to educate yourself about HIV and start this discussion with your family and friends. By creating a robust public discourse, we can help make discussions about HIV/AIDS less taboo.

After all, HIV awareness shouldn't just take place one month a year, but each and every day.


(1) HIV/AIDS Surveillance, City and County of Denver", 7/3/12, internal document from Denver Public Health, provided by Christie Mettenbrink, Epidemiologist at DPH

Dr. Benjamin Young, Medical Director of Rocky Mountain Cares and Chief Medical Officer of the International Association of Physicians in AIDS Care and Dr. David Cohn, former Associate Director of Denver Public Health and founder of the Denver Health Infectious Diseases/AIDS Clinic are co-authors of this piece.