December 3, 2008

Vanquishing AIDS: Notes on Ending the Epidemic in America

Paul Curtis Bellman, MD, is a physician whose private practice in Greenwich Village, New York, has specialized in caring for HIV-positive patients since 1986. Dr. Bellman is a board certified internist and currently an associate attending in the Department of Medicine at St. Vincent’s Manhattan and a senior lecturer in the Department of Immunology at Weill Cornell Medical College in New York. He is a 1982 graduate of the New York University School of Medicine and has been involved in the clinical care of HIV-positive people since the epidemic began. Bellman actively participates in clinical research as well as the clinical practice of HIV medicine.

Note: The contents of this essay should not be construed as specific medical advice regarding the treatment or prevention of HIV. If questions arise regarding treatment or prevention based on this essay, please consult your physician. This essay is also not intended to suggest that carefully considered current safe-sex guidelines regarding HIV prevention such as those available from the Centers for Disease Control and Prevention (CDC) website should be ignored or changed as a result of some of the research on HIV transmission reported on here. Please follow current safe-sex guidelines carefully until, and if, revisions to those guidelines are made.

In his victory speech on election night, President-elect Barack Obama said, “If there is anyone who doubts that America is a place where all things are possible, who still wonders if the dream of our founders is alive in our time, who still questions the power of democracy, tonight is your answer. It’s the answer…told by the many…who believed this time must be different because their voices could be that difference. It’s the answer spoken by young and old, rich and poor, black, white, Hispanic, Asian, Native American, gay, straight, disabled and not disabled.”

As a doctor who has treated people living with HIV/AIDS since the early ’80s, it is my hope that when Barack Obama is inaugurated, he will add to the above list: “and HIV-positive and HIV-negative people.” Because the time has come for HIV/AIDS to be a nationally recognized epidemic, and it is my great hope that the new administration, led by Barack Obama, will bring a new day of reckoning to our fight against HIV/AIDS in America.

In his speech, Obama claimed that the very act of electing the first African-American president was itself an indicator of change. He said, “It’s the answer that led those who’ve been told for so long by so many to be cynical and fearful and doubtful about what we can achieve to put our hands on the arc of history and bend it once more toward the hope of a better day.… It’s been a long time coming but because of tonight, because of what we did on this day, change has come to America.”

Certainly on the occasion of this 20th World AIDS Day, we need a world of change. As the number of people living with HIV globally tops 30 million and as we discovered this year that the HIV infection rate in the United States is 40 percent higher than previously estimated, it is clear that our approaches to preventing HIV are not working optimally. It is my belief that the key to stopping AIDS lies in the destigmatization of people living with HIV—and a key to that lies in illuminating the fact that people on treatment are less infectious than is generally understood.

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Previous Comments:

santiago, NY, 2009-01-21 15:09:25
dr bellman's courage and dedication to command change in health care for hiv for so many years is admirable. his dream of compassion to a social acceptance of hiv+ persons sheds light on such a dark dilemma. thank you for educating us more on the subject..

Lora T, Brooklyn, NY, 2009-01-06 20:00:41
Is America able to shead it's neo-colonial, puritanical view of love, sex and hiv* so we can erraticate this plague? We made Obama president....maybe ther is a glimmer of hope for the courageous ones! Thank you Dr. B! (*I refuse to capitalize the disease and made it stand out....)

Rob C, Brooklyn, NY, 2009-01-06 00:14:29
I think the article is brilliant with challenges to radically change course as we face this disease in 2009. I find the last paragraph most interesting, because THAT is the call to action. Do we have anyone interested in heeding Dr. Bellman's call? It will turn sex education on its head and reopen blistering arguments about gays, the disease, and plague. I sat out the Act Up Years. I'd be interested in helping Dr. Bellman's proposed campaign. Now what?

peregrine, new orleans, 2008-12-15 09:14:17
A Dr. chastizing newly infected patients? Prepostorous! Destigmatization of HIV is an uphill battle that needs to be fought. People are sexual beings and as such, it is not practical to expect abstinence to be a viable solution to control HIV spread. But, I believe the use of condoms is essential, not only to prevent HIV spread, but also to prevent the risk of other STD infections. As an HIV poz, I certainly do no want to become infected with any other diseases!

Thomas F. Olson, New York, 2008-12-10 12:14:23
What a wonderful article written in a nonjudgemental manner. Being in the medical field myself, I only wish more MD's practiced in this manner.

JO, , 2008-12-10 11:45:16
Great article!

Robert Evans, New York, 2008-12-10 11:13:44
I and many other folks who have HIV will be happy that it may be reduced for others and that there may be light at the end of the tunnel after all. The election of Obama was a great source of hope for folks all around the world.

Wiser, NY, 2008-12-04 18:05:20
This is an extraordinarily clear, concise, practical and well thought through article which also conveys great feelings of passion and hope. Dr. Bellman is healing in his writing as well as his clinical practice. Treatment is more than chemistry. Thank you.