Wednesday, February 11, 2004

Everything Old Is New Again

My Significant Otter called my attention to this story in the Washington Post, which describes how public health officials in North Carolina managed to identify and address an outbreak of new HIV infections among black gay college students. When the first cases appeared, the health department interviewed the young men about their partners. Then they tracked those partners down, encouraged them to get tested, and got information about their partners. They were eventually able to identify 69 linked cases of HIV, some so early in the course of infection that a normal HIV test would not yet be positive. It's being lauded as a major public health advance.

What's ironic about this story is that, except for the PCR technique that diagnoses HIV prior to a positive antibody test, none of these techniques are new. Fifty years ago, that's exactly how public health officials addressed outbreaks of syphillis and gonorrhea: tracing partners of infected persons and ensuring that they got tested and treated. Those public health strategies have just never been applied to HIV on any kind of a widespread basis.

The reason boils down to what's been called "AIDS exceptionalism." When the AIDS epidemic was first identified, as those of you over thirty probably recall, outrageous discrimination against people with HIV was rampant. AIDS activists successfully argued that vigorous efforts to identify infected people - for example, by mandatory testing or contact tracing - would expose them to stigma, discrimination, even violence. So for the next twenty years, the public health approach to HIV was characterized by voluntary testing and efforts to persuade the public to reduce risk behavior.

It hasn't worked very well, so now more traditional public health methods are coming back into use and being trumpeted in the press as major innovations. We'll see if they work any better.