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This award-winning blog supplements the articles in Hospital Infection Control & Prevention.

What if they gave an epidemic -- and nobody cared?

Three decades ago this year, Pneumocystis carinii pneumonia — an opportunistic infection then virtually unheard of in healthy individuals — was diagnosed in five gay men in Los Angeles. These were the first official cases of AIDS, an historic epidemic that inspired many a heroic response but now appears to be strangely beset by apathy among its highest-risk victims. Consider this warning in a recent report by the Centers for Disease Control and Prevention:

“Gay and bisexual men of all races and ethnicities remain the group most severely and disproportionately affected by the epidemic,” the CDC states. “Men who have sex with men (MSM) represent approximately 2% of the U.S. population, but accounted for 61% of all new HIV infections in 2009. By race, age and risk group, young, black gay and bisexual men (ages 13-29) are the only population in the United States in which new HIV infections increased between 2006 and 2009.”

Though the CDC spin is generally upbeat in this report – estimating that more than 350,000 infections have been prevented since the AIDS epidemic began – there is something passing strange about this finding that goes beyond the usual-suspects list of factors cited: “[A] range of social, economic, and demographic factors affect some Americans’ risk for HIV, such as stigma, discrimination, income, education, and geographic region,” the CDC reports.

Is it fair to ask if apathy should be added to that list?

Has the public health response to HIV/AIDS been undercut by its own success? No longer a death-sentence diagnosis in the U.S., this plague has become a chronic condition that is apparently no longer feared enough to prevent high-risk behavior. Maybe it never was, but it’s getting harder to believe in this information age that a given individual does not know his actions may put him at risk of HIV. Sure there are a lot of contributing factors — disease is all too predictable among the disenfranchised. But is the CDC asking us to believe that there remains a vast and abiding ignorance of the basic facts that avoiding unprotected sex and IV drugs could prevent many of these new cases? When does the lack of individual responsibility for one’s own bloodstream translate to a failed public health response at the highest levels?

I don’t know the answers, but the band is playing on. According to the CDC, some 50,000 Americans become infected with HIV annually, and 16,000 people with AIDS died in 2008. As a result, the number of people living with HIV in the United States, now at nearly 1.2 million, continues to grow by tens of thousands each year, creating more opportunities for transmission. After 30 years.