The recent HIV outbreak in southern Indiana’s Scott County illustrated one of the biggest problems facing the disease today: Many of the 81 people whose infections have been confirmed didn’t know they had it.
More than 1.2 million people in the United States are living with HIV infection, and almost 1 in 7 are unaware of their infection, according to the U.S. Centers for Disease Control and Prevention. Others who deal with treating the disease say the statistic is closer to 1 in 5.
Identifying those individuals continues to be a major focus of advocates who treat and work with HIV patients, Indiana University LifeCare Program Manager Kyle Bonham said.
As advancements in treatment have changed the perception of the disease from a death sentence to a chronic illness, Bonham said many people in their 20s and early 30s don’t understand the severity of the virus like those who grew up around its genesis in the 1980s.
“For a while, HIV has been considered out of sight, out of mind,” he said. “We still get people who ask if HIV is still a problem. Some of the young adults born in the late '80s and early '90s are not aware of the struggles that were going on before HIV medicine came out and there was some success in treating it.”
IU Health HIV/AIDS nurse practitioner Sylvia Wiley said there was a trend of treating a significant number of patients 18-22 years old a few years ago. Carrying an attitude of invincibility and a lack of concern for their personal health were common factors observed in many of those cases.
“Young people sometimes think they’re going to live forever and ‘that’s not going to happen to me,’” she said. “There is also a group of patients that have this fatalistic attitude that they’re going to get [HIV] at some point, so why should they use protection? I think, too, that some people that age are just not that concerned about risky behavior until something happens to them.”
Because early symptoms of the HIV virus are often comparable to the flu, Wiley said the younger populations may go 3 to 5 years before getting tested.
As a result, Bonham said a good deal of LifeCare’s efforts are spent identifying individuals who are unaware of their HIV status through encouraging testing at the state and local levels.
“That goes along with the whole idea of treatment as prevention,” Bonham said. “By treating those you know are HIV positive that becomes a form of prevention because they’re in care.”
Over the past decade, the CDC estimated the number of people living with HIV has increased, while the annual number of new HIV infections has remained relatively stable.
Certain demographics have seen the number of HIV cases increase in recent years, including gay and bisexual men of all races and ethnicities, which remains the population most profoundly affected by HIV.
In 2010, the estimated number of new HIV infections among gay and bisexual men was 29,800, a 12 percent increase from the 26,700 new infections in 2008.
Although gay and bisexual men represent about 4 percent of the male population in the U.S., in 2010, the demographic accounted for 78 percent of new HIV infections among males and 63 percent of all new infections. Men having sex with other men accounted for 54 percent of all people living with HIV infection in 2011.
"The disease tends to stay within populations,” Bonham said. “One of the things we’re seeing in southern Indiana is that the outbreak is almost exclusively due to needle sharing. It’s not a coincidence since they’re all connected in social circles. The same thing happens with the gay population, who are often in the same social circles.”
The black population continues to experience the most severe burden of HIV, compared with other races and ethnicities.
Blacks represent approximately 12 percent of the U.S. population, but accounted for an estimated 44 percent of new HIV infections in 2010. They also accounted for 41 percent of people living with HIV infection in 2011. Since the epidemic began, an estimated 270,726 blacks with AIDS have died.
Location is key in determining why the black population continues to be disproportionately affected by the HIV virus, Bonham said.
“You can take a given zip code where there’s a high prevalence of HIV and you’re automatically at a higher risk,” he said. “There’s a better chance of coming in contact with it. In some areas where there are a lot of sexually transmitted diseases, there are going to be a lot of people living with the HIV virus.
“There’s a much larger heterosexual population that is getting infected by the HIV virus,” he added. “The take home is that unprotected sex is putting people at a higher risk for HIV. In the '80s and '90s, it was a disease predominantly carried by gay men. The African American and Hispanic heterosexual populations are some of the most disproportionately affected populations.”
To combat the virus, testing has become more readily available, particularly through county health departments.
Howard County Public Health Nursing Manager Jennifer Sexton said the department offers free testing from 9 to 11 a.m. and 1 to 3 p.m. every Monday on a walk-in basis. Individuals can be tested on both a confidential and anonymous basis.
More testing is critical in both preventing future infections and getting those who are infected the treatment they need.
“People often say you can live a normal life with medication for chronic illnesses like diabetes,” Wiley said. “That’s why we recommend starting treatment as soon as you’re diagnosed, because patients who start treatment earlier end up doing much better in the long run.”