Do the Needs of the Many Outweigh the Needs of the Few?

Does Leonard Nimoy's famous quote (the titile of this blog) from Star Trek II: The Wrath of Khan, apply to people living with HIV in the prisons of two southern states? Not according to the American Civil Liberties Union, who has brought a class action suit against the Alabama Corrections Department where HIV+ inmates are isolated from the general prison population. South Carolina is the other state with the same policy. In Alabama, inmates are tested for HIV when they enter prison. HIV+ men and women are housed in special dormitories; eat alone (not in the cafeteria); cannot hold jobs around food; and have to wear white armbands that identify them as being HIV+. The policy is designed to to limit the spread of HIV through consenual sex, rape, or when inmates tatoo each other, even though most medical experts say that isolation is unnecessary. It is also counterituiative to treat HIV differently than other, more rampant, viruses such as Hepatitus C and B. According to the Bureau of Justice Statistics there were a little over 20,000 inmates in state and federal prisons in the U.S. at the end of 2010. The rate of HIV/AIDS among state and federal prison inmates declined from 194 cases per 10,000 inmates in 2001 to 146 per 10,000 at year end 2010. A study, published by the Centers for Disease Control and Prevention in 2006 found that although male prisoners have a relatively high rate of HIV infection, very few of them acquire the virus while behind bars. For example, about 90 percent of HIV-positive men in Georgia's prison system -- the nation's fifth largest -- were infected before they arrived, the study found. Over a 17-year period, 88 men became infected in prison by the virus that causes AIDS, chiefly through same-sex intercourse. Therefore, if there is a declining number of HIV+ inmates in prison, and if few acquire it there anyway, why the draconian policies in Alabama and South Carolina? Sadly, the answer has as much to do with our own attitudes about HIV/AIDS as it does with those two prison systems. There is not a lot of sympathy about the incarcerated in general and certainly even less for those infected with HIV. The point missed here is that treating HIV+ prisoners as lepers only exacerbates their shame and disgrace at being incarcerated. It also continues to foster the stigma that drives HIV underground and prevents people from getting tested. As a society, we should criticize any excessive policy that limits the rights of human beings to live in basic dignity. If not, we too might find ourselves on that 'slippery slope.'

Preventing HIV Transmission with Youth Infected at Birth

As we reach a certain age, many of us long for the vitality of youth, without of course, the consequences for our youthful discretions. It is a time of learning and discovery. For many, it is also a time for sexual exploration. Adolescents, in 2012 have lived their entire lives with the HIV epidemic. They may have learned about it in health class, read about it on the internet, or perhaps learned that someone close to them have been infected. Now imagine that at age 15 or 16 you are told that you are HIV+; not because you became infected through risky behavior, but because you have had it all of your life. More troubling: what if you have been sexually active before you found out? There are three primary ways for newborns to become infected with HIV: while growing in the uterus; during delivery; or while breastfeeding. Antiretroviral treatment of pregnant mothers has been shown to reduce mother to child infection rates to about 4%, significantly reducing the number of children being born with HIV worldwide. Yet, according to the Centers for Disease Control (CDC), there are approximately 10,000 people in the United States who are living with HIV acquired at or before birth. A new study of adolescents infected with HIV from birth, found that 20% were unaware that they were HIV+ until after their first sexual encounters. The study of 330 HIV-positive 10- to 18-year-olds was conducted at clinical sites nationwide as part of the Pediatric HIV/AIDS Cohort Study, which is funded by the NICHD and several other NIH institutes and offices. On average, participants who had initiated sexual activity reported having their first sexual experience at age 14. Most of the sexually active youth in the study reported some incidents of sexual activity without condom use (62%). Only one-third of these said they had disclosed their HIV status to their first partner. Another troubling statistic was that young people who did not take anti-HIV medication regularly were more likely to initiate sexual activity than were those who were more consistent. There are many lessons to be learned through this research, but one obvious point: 'kids are kids.' In other words, the adolescents in this study simply behaved like most adolescents who are experimenting with their sexuality do. Therefore, it is imperative that they be made aware of their HIV status before they become sexually active and of the importance of adhering to their antiretroviral medication. While I can understand caregivers wanting to delay disclosing HIV status to a young person until they are mature enough to handle it, delaying that disclosure risks them exposing other young people to possible infection. They should also receive robust risk reduction education, especially geared to disclosing their status to there sexual partners and the proper use of condoms.