I have a suggestion for the theme, partially suggested by my work with
colleagues here in Los Angeles and by a conversation I had last September
in Bangkok with Dean Chitr Sitthi-amorn of Chulalongkorn University. My
suggestion for the theme is:
EARLY DETECTION FOR GIVING YEARS TO LIFE AND LIFE TO YEARS.
By EARLY DETECTION, I mean discovering early in the natural history
of HIV that a person is infected. As you know, many years go by before
most people learn that they harbor the virus. Even in the United States,
about half of all AIDS patients did not learn they were infected until
8 to 9 years after becoming infected. Among heterosexuals who developed
AIDS patients, the percentage was about 60-65%. This problem of avoiding
knowledge is most graphically described by a poster brought back by Professor
Detels from one of his recent trips to Asia. It shows three persons bent
over with their heads firmly submerged in the ground. The caption read,
"another [country to remain blank] family considering AIDS."
By GIVING YEARS TO LIFE, I mean preventing infection of spouse,
lover or child and preventing early death from a compromised immune system.
Finally by LIFE TO YEARS, I mean encouraging the acceptance and
support of family and friends, reducing discrimination and promoting other
measures to help normalize HIV infection in the society so that it is viewed
as just another chronic disease.
If this theme (or a similar one) is adopted, then possibly the conference
will focus more extensively on ways to promote early detection. One approach
applicable to all countries is to encourage the use of HIV indicators -
simple devices that use saliva or fingerstick blood to determine likely
infection. People should be free to buy these self-help devices in their
pharmacies or grocery stores, giving them some control over their own lives.
If found to be positive, the test "indicates" that the person needs to
see a medical care provider for counseling and confirmatory testing. Such
prior screening would keep the "worried well" at home and allow hard-pressed
HIV/AIDS clinic staff to spend more time with those who are truly infected.
If this theme is selected, it would also encourage countries experiencing
higher levels of HIV infection to support universal premarital screening
and pregnancy screening, much as they now do for blood screening.
In addition, such societies would need to develop longer-term care programs,
so that HIV infected persons are not left alone to slowly be overcome by
the virus. Counseling would be couple-based, with continued contact over
time to help discordant couples understand how to avoid transmitting the
virus from infected to susceptible. Such support and care groups are now
in place in several Asian countries, but without testing these care givers
cannot reach those with silent infection. The early detection theme offers
new opportunities, but also new responsibilities. Presenting and discussing
these issues would give your conference an exciting edge and take us in
directions that have not previously been explored.
Please feel free to share my ideas with others and give this matter
your full consideration. I look forward to visiting with you at the coming
Vancouver meeting and hearing more about friends in the Philippines and
the challenges of your position these past few years.