- HIV/AIDS and Academic Research Institutions—Consider a New Era
HIV/AIDS has been a public health issue in the United States since 1981,1 and has been a global health concern even longer. From a very reductionist view of the epidemic in the United States, HIV/AIDS has evolved from a White, male, homosexual disease with a near certain prospect of mortality to a chronic disease prevalent among young men, specifically Black and Latino/Hispanic men, who have sex with other men. The global health goal seeks elimination of HIV/AIDS by 2030 with key targets by year 2020. The 90% targets include the following: 90% of those infected knowing their HIV status; 90% under treatment having suppressed viral loads; and 90% of young people living in high-prevalence settings having access to primary and secondary sexual and reproductive health services.2 Healthy People 2020 targets reflect, to some extent, the global agenda.3 Despite progress made in treatment and efforts at pharmaceutically-based prevention, the goals are not without challenge as infection rates have increased in some population sectors. The transition from a fatal illness to chronic disease may hold some insight into understanding why the disease is showing upticks or failing to show expected decreases in incidence and prevalence in particular segments of the population. The further complexity of changing times, social conditions and systems, and cultural norms may be in play as well.
The current data show behaviorally the most at-risk groups contributing to the incidence and prevalence of HIV are men who have sex with men (MSM); the most at-risk age group are those between the ages of 13–24; and based on race/ethnicity, African Americans and Hispanics contribute to incidence and prevalence beyond the proportion of their representation in the general population. How this translates into the numbers: in 2014, 82% of new cases of HIV infection were among those aged 20–24; for ages 13–24, most of the newly diagnosed cases were males identifying as gay or bisexual males, and in this age group the proportion of new cases was disproportionately high among African Americans.4
Considering the age group most at risk, the current members of the cohort, and those coming behind them, did not witness the first waves of the epidemic where funerals and quilts with the names of loved ones who did not survive were the order of the day; where the stigma was so great the disease was discussed in hushed tones and only among a trusted few. Now celebrities announce their status looking fit and healthy, and messages of education and management of the disease abound. Not only is treatment available but pre-exposure prophylaxis (PrEp)5 offers a pre-emptive option [End Page vi] against contracting the virus. It is within this environment that HIV/AIDS continues to have a stronghold that warrants focused public attention. In what is termed here the new era of HIV infection, a commensurate public health response is required; the challenge is made more difficult, especially with the developmental characteristics of a younger age group, the irony being that the perceived threat of the virus has been greatly reduced through public health advancements, including treatment and prevention options, and the experience of those living with HIV.
What to do? Consider a Community-Centered Ecological Approach
In an environment of rapid information dissemination, of social media for personal communications, of shifting sexual norms, of persistent racism, of structural economic inequities, and of persistent social injustices, the risk and consequences of infection for emerging adults have changed in profound ways, many not readily identified and measured. With the combination of decreased threat and shifting ecology of the disease, this is now a much more behaviorally complex issue. If viewed from a behavioral perspective, the options would be limited. Reviewing the current slate of programs and strategies to respond to the epidemic, a significant shift in dealing with HIV/AIDS seems to be in play demonstrating an ecological understanding and acknowledgment that the foundation that sustains the epidemic today is not simply/solely a matter of individualized risk factors (behavior, e.g.) and that the solution...