In the war against HIV, the deadly virus that causes AIDS, we are fast approaching Appomattox.
Only this time, it isn't the rebels waving the white flag, it's the federal government; and this time the surrender won't be sealed with a signature in a country house, it will be sealed with a federally funded 20-minute HIV test administered in a sex club or bathhouse.
"Since the early 1990s, an estimated 40,000 new HIV infections have occurred annually in the United States," the federal Centers for Disease Control and Prevention (CDC) reported this April in its "Morbidity and Mortality Weekly Report" (MMWR).
The high incidence of infection has persisted despite massive increases in federal spending to fight the virus. The Kaiser Family Foundation reports that federal spending on HIV/AIDS increased from $3.1 billion (in non-inflation-adjusted dollars) in 1990 to $14.7 billion in 2002. ( President Bush has requested $16 billion for domestic HIV/AIDS spending next year, and $2 billion more to fight HIV/AIDS abroad. )
Between 1995 and 2002-while 40,000 Americans were infected annually-federal spending targeted specifically at preventing HIV infection jumped 45%, from $639 million to $925 million.
Increased spending did not decrease infections. Clearly, federal HIV-prevention efforts are failing and must be re-examined.
While U.S. policy has inspired better technologies in response to HIV, it has not inspired better behavior. Self-destructive activity has achieved a strategic balance with medical science. Despite new drugs, says the MMWR, "The annual number of incident AIDS cases and deaths have remained stable since 1998, at approximately 40,000 and 16,000 respectively."
This has become a war of attrition. Barring a fundamental change in tactics, the casualty count will mount.
But the government's latest response not only recapitulates the failed approach of the past, it reduces it to the absurd.
America has developed another miracle technology: a rapid HIV test called OraQuick. In 20 minutes it can determine if HIV antibodies are present in a pinprick of blood. In January, the Food and Drug Administration issued a special waiver allowing the test to be used in what it discretely called "outreach settings."
In June, the CDC announced it would purchase 250,000 test kits for $2 million and distribute them to local health organizations. News reports indicated the tests could be used in bathhouses and sex clubs. Indeed, CDC guidelines seemed to say the owners of such places would become "key partners" in the program.
"Agreements with law enforcement, owners of social venues such as bathhouses or sex clubs, neighborhood associations, and other key partners should be established before testing activities begin," advised the CDC in a document titled "Advancing HIV Prevention: Interim Technical Guidance for Selected Intervention."
I called the CDC to confirm that the federally funded rapid HIV tests could be used in, among other places, bathhouses and sex clubs. CDC Spokesperson Karlie Stanton confirmed that they could.
This is not compassionate conservatism. It is sex-club socialism. It transfers to all taxpayers some of the cost incurred by unrepentant practitioners of reckless behavior. It will work no better than previous federal efforts to fight HIV.
Certainly, the rapid HIV test has valuable applications. It can be used, for example, to determine the status of previously untested mothers giving birth, helping save their babies. It can be used to determine when health care workers have been exposed. And it can relieve anxiety, and speed treatment, for those who go to clinics determined to be tested and to change their behavior.
But when the government uses it in bathhouses, it will mean we have sued for peace with the behavior that spreads a lethal virus.
Tellingly, CDC guidelines for counseling HIV test-takers recommend that counselors take a "nonjudgmental" approach focusing on "HIV risk reduction" not risk elimination.
"For clients with several high-risk behaviors," say the guidelines, "the counselor should help clients focus on reducing the most critical risk they are willing to commit to changing. The step does not need to be a personal behavior change."
In the war against terrorism, America took a clear moral stand. You are either with or against us in resisting the senseless destruction of human life. Until we face with similar moral clarity the behaviors that spread HIV the virus will continue to defeat us.
