Since the mid-1990s when combination antiretroviral therapy became available in the United States, HIV has quickly become a chronic condition. “Like diabetes” we often say. AIDS is a problem of “Africa” and other “overseas” nations, the general consensus goes.
Yet, in the United States, tens of thousands of people are newly infected with HIV on an annual basis. Despite the availability of medications people still die of AIDS in the US. I once took care of a middle-aged woman who was diagnosed with HIV about a decade before I made her acquaintance. She was plugged in to the healthcare system all along but was non-compliant with taking her medications. Thus she had been on several different anti-retroviral regimens and was failing each of them. She was in and out of the hospital with various problems. She was cachetic and dying. We tried everything to make it easier for her to take her medications as that was the major barrier. Our attempts proved unsuccessful. She died a month after entering hospice care.
Imagine the end of life discussion with the patient and her family. It’s never easy to tell a patient they are dying. It wasn’t easy to tell this patient that she was dying of AIDS. That although we have wonderful medications they are of no use to her. It was surreal. I couldn’t understand why she just couldn’t or wouldn’t take her medications. I kept think of the unfortunate ones around the world who don’t even have access to antiretroviral medications.
The day she died, I met a a young woman barely out of her teens. A woman in college with many plans for her future. A third-party had disclosed to her that her boyfriend had HIV. She ended up testing positive as well. I felt so bad for her and yes I was angry with her now ex-boyfriend. How is it possible for such uncaring people to exist? How sad is it that young women cannot, do not, or will not protect themselves and insist on condom use? I fear that the sexual liberation of women has resulted in weakening girls when it comes to negotiating sex. Why is it difficult for couples to discuss sexual health before engaging in action? One thing I agree with the current Bush administration is abstinence education as part of HIV prevention efforts. But please, not abstinence-only education. No! That is clearly ineffective here in the US as well as around the world.
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