USC Health Now

December 1st marked World AIDS Day, designated to remind us of the impact that HIV/AIDS has on the world’s health. Here, two USC experts talk about current infection rates and prevention efforts in the U.S.

by Katie Neith

In America, the number of individuals newly infected each year with HIV has remained relatively unchanged since the early 90s, despite prevention efforts aimed at cutting rates in half.

“People don’t see HIV/AIDS in the headlines anymore except what is occurring in Africa,” says Jerry D. Gates, Ph.D., associate professor of family medicine at the Keck School of Medicine of USC and director of the Pacific Aids Education And Training Center. “The news about the effectiveness of the new medications and the declining death rate makes it appear as if the HIV threat has passed.”

But the statistics tell a different story. Current estimates by the Centers for Disease Control and Prevention (CDC) show that approximately 40,000 people in the United States become HIV positive every year, joining the estimated 1 million people currently living with HIV in this country. Approximately 25 percent of those living with HIV are unaware of their infection status.

“Although prevention efforts have had a positive effect, progress in reducing HIV risk behaviors seems stalled, especially for populations at highest risk,” says Lynn Carol Miller, Ph.D., professor at the Annenberg School for Communication of USC who has worked on numerous HIV-prevention projects. “Many people still think of HIV as a white, gay disease, despite the fact that this disease is increasingly prevalent in the heterosexual population.”

HIV, or human immunodeficiency virus, is the virus that causes AIDS, or acquired immunodeficiency syndrome. HIV destroys certain white blood cells called T-cells needed for our immune systems to function properly and fight off disease. When a person has a low T-cell count and one or more infections that the body has difficulty fighting, that person is considered to have AIDS.

In recent years, researchers have developed medications to slow the progression of HIV to AIDS, resulting in fewer deaths from the virus. However, Miller points out that these drugs don’t work for everyone and are not an easy fix.

“Life on these drugs can often be extremely difficult, and these drugs can have nasty side effects,” she says. “Knowing that the drugs exist, however, may give some a false sense of security.”

So, who is at risk? According to Gates, anyone who has unprotected sex or injects drugs, since HIV is primarily transmitted through blood, semen and vaginal fluids.

“The fact that we are still diagnosing individuals with full-blown AIDS indicates that many people are walking around HIV positive—and possibly infecting others—and not knowing it,” he says.

Certain subpopulations are at an increased risk as well. For example, African Americans represent 13 percent of the population, but nearly half of all new HIV infections, according to the CDC. In 2004, HIV/AIDS was the leading cause of death among black women ages 25 – 34. Gates also says there is a reemergence of HIV among young gay men.

“A lot of subpopulations don’t think of themselves as ‘at risk’ unless they know about people with their attributes who have contracted the disease or messages are specifically targeted/tailored to them based on their risk profile,” says Miller. “We need to do a better job reaching today’s audience [with prevention messages], especially in high-risk populations.”

She points to new communication technologies that might make it easier to not only physically reach targeted audiences, but to actually change behavior. Miller has worked on intervention efforts with men who have sex with men, and has found that interactive technologies, such as interactive videos, are very effective for determining who is most at risk for engaging in risky behavior and also for changing risky decision making over time.

“In virtual environments, people get into what’s happening emotionally as they do in real life, so we can better diagnose what’s going on for them and personalize interventions to real-life contexts they are likely to confront,” says Miller. “Our research so far suggests this is an extremely promising approach to reducing risk-taking compared to other conventional prevention efforts.”

Gates recommends continued education efforts at all age levels and across all populations. In addition, he says that one of the keys to HIV prevention is educating healthcare providers to talk about the disease and offer routine testing.

“Every healthcare provider should be talking to and screening all patients regarding risk of HIV,” Gates says. “Testing should be carried out at all regular medical visits.”

For more information on HIV and AIDS, visit www.cdc.gov/hiv. To find an HIV testing site center near you, visit HIVtest.org or, on your cell phone, text your zip code to Know It – 566948.