HIV infection follows poverty south

HIV research and AIDS treatment in the United States are the focus of a recently published feature article in the journal Science. The article was timed to set the stage for the first U.S.-hosted International AIDS Conference in 22 years, which started yesterday in Washington, D.C. The meeting’s organizers had shunned the U.S. for decades due to a ban on the immigration of HIV-infected people imposed by Congress in 1987 – a ban that President Obama ended in 2010.

The AIDS epidemic has shifted over 31 years from a disease of white, economically secure gay men on the coasts to one of poor African Americans – gay and straight – in the South, home to 43 percent of the country’s HIV-infected people, according to the article.

Michael S. Saag, M.D., is director of the UAB Center for AIDS Research. Before flying to the AIDS conference, Saag sat down with us for the very first podcast from The Mix, the new UAB research blog. Saag helped to found the 1917 Clinic at UAB – a comprehensive HIV clinic serving Birmingham, Ala., and one of 10 efforts nationally highlighted in the Science feature.

Show notes from the interview

1:38 HIV infection risk has now been proven to depend less on the stereotypical notions of the past – multiple partners, lack of condom use, prison time, etc. 

1:51 Poverty is the single, overwhelming driver of HIV infection risk in African Americans, explaining why the epidemic is hitting so hard in the South.  

2:18 Many more people who are poor contract HIV due to lack of access to healthcare and the close ties between poverty and drug addiction. With more infected people living in poor communities, the risk of passing it to fellow community members is higher. Those living in poverty are also more likely to be focused on day-to-day survival, which drives risky behavior.

3:32 AIDS symptoms may be ignored or hidden more in the African American community due to cultural differences with respect to tolerance of homosexuality, says Saag. Being gay is taboo in both African American and white communities, but is especially so among African Americans, and even more so among African American churchgoers. This means that gay men often hide their orientation, living publically in heterosexual relationships while secretly having gay sex, which further spreads the disease.

5:09 HIV funding from the CDC shifted in 2012, with $40 million of its $338 million budget meant to have greater impact in harder-hit locales, according to the Science article. Medications are now available that have turned HIV into a chronic disease, enabling people to live for decades. The problem is that many poor people do not know they are infected, have little access to care or ability to maintain treatment regimens.  

5:58 Infected patients who don’t know they are infected represent 25 to 40 percent of those infected in the United States, says Saag. Public education campaigns in hard hit communities are needed to get more people tested, as are special programs that link newly diagnosed patients to treatment programs. 

7:15 UAB’s 1917 Clinic has conducted more than 300 clinical trials since its founding in 1988, and have made every major AIDS drug, and later the most powerful drug cocktails, available to poor communities. 

7:36 Testing, diagnosing and getting more patients into permanent care will be the focus of the HIV medical establishment over the next 10 years, rather than drug development, although that will continue. Excellent drugs are available. The challenge is to get people to know they need them and to keep taking them. 

8:41 The International AIDS Conference has returned to U.S. soil for first time in 22 years, which is important because the U.S. has been a major contributor to AIDS research and should participate fully in global discussions on how to improve care.

10:12 AIDS research themes that will gain the most attention at the conference should include how testing can drive people into care, how effective treatment can prevent transmission, pathways to a future cure and policy discussions about how countries afford and make accessible mass treatment, says Saag.

11:37 Treatment as prevention is a hot topic with the recent FDA approval of Truvada, shown to lower the risk of infection when given to people at high risk but not yet infected. The advent of preventive treatment creates many policy questions that will be discussed, including the potential for the use of vaccines.  

12:22 Resources for getting more information about AIDS and HIV include the CDC HIV/AIDS home page, and for researchers, the National AIDS Treatment Advocacy Project, which offers excellent coverage of meetings and abstracts, Saag says.

13:37 Support for the 1917 Clinic can take the form of volunteering and community outreach, or donations to the 1917 Clinic Development Fund, which helps program development (testing, linkage-to-care initiatives), and the 1917 Clinic Patient Assistance Fund, which helps people gain access to treatment during gaps in coverage. 

14:35 End

About the Podcaster

Greg Williams @gregscience @themixuab is research editor within Media Relations at the University of Alabama at Birmingham.