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     The scientific Public Health approach to preventing and controlling sexually transmitted diseases has been well established for some 70 years.  Why is it then that the HIV epidemic has continued to claim 40,000 new victims every year for the past 30 years!?  What was the role of the government as “guardians of the public interest?” The Supreme Court ruled in 1905 that there is a governmental and societal interest in preventing the spread of disease. (https://supreme.justia.com/cases/federal/us/197/11/) The historical record demonstrates that the US Government has, for political and financial reason,  not only refused to take the necessary well known steps to end the HIV epidemic, they have also cut funding to the major institutions responsible for bringing the epidemic to an end.  Today the HIV epidemic rages across the nation disproportionately affecting Black and Latin people, almost half are unaware that they are infected.

     In 1981 the HIV epidemic began and by 1985 a blood test was developed.  A sustained Public Health prevention policy includes: universal screening, partner Identification, treatment and prevention.  These strategies could have been put into effect if priorities and funding had allowed an expanded Public Health workforce to take the necessary actions to end the epidemic.  Tragically this was not allowed to happen.  From 1992 through 2017, the HIV epidemic has continued to claim 40,000 new victims yearly.

    During the 1980’s while the HIV epidemic accelerated, the administration under President Reagan was focused on making cutbacks in federal health spending. (https://www.ncbi.nlm.nih.gov/books/NBK218212/) Huge cuts to the Public Health Services were made as extra billions of dollars were poured into a massive military buildup. (https://timeline.com/reagan-trump-healthcare-cuts-8cf64aa242eb). In New York State the people had to fight for an HIV partner notification law (1999), a key component for eliminating sexually transmitted diseases and crucial to protecting the Public Health. (https://scholarship.law.stjohns.edu/cgi/viewcontent.cgi?referer=https://www.google.com/&httpsredir=1&article=1506&context=lawreview_)  In 2008-9 cuts were made to public health funding as billions more were given to bail out banks and corporations. (https://www.prnewswire.com/news-releases/new-report-funding-for-public-health-has-declined-significantly-since-the-great-recession-300606063.html).   In 2018, $1.3 billion in cuts to Prevention and Public Health Funds as $1.5 trillion in tax cuts was given by the Trump Congress to bankers, corporations and the rich. (https://www.the-scientist.com/daily-news/cuts-to-prevention-and-public-health-fund-puts-cdc-programs-at-risk-30298)     The grim reality is that for 30 years HIV has been infecting 40,000 new victims every year, and now over one million live with HIV.  To this date, a complete public health prevention strategy for combating HIV has not been introduced as a comprehensive national program.  The Institute of Medicine declared in 1988 that the American Public Health System had fallen into disarray. (https://timeline.com/reagan-trump-healthcare-cuts-8cf64aa242eb)  Another way to conceptualize these failures is to understand that our economic system has been shown to place corporate profits and war above protecting the public from disease, especially the most vulnerable.  It is time to think about an economic system that puts the people’s health first.

 Dr. Nayvin Gordon is a California Family Physician.  He has written many articles on politics and disease.  He can be reached at gordonnayvin@yahoo.com

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  1. In central and west Africa as many as five million AIDS sufferers have no access to anti-retroviral drugs. Former South African President Thabo Mbeki promoted herbal remedies rather than ARVs, which saved the state’s funds at cost of up to 365,000 lives. Winnie Mandela to her credit “.. said to president Mbeki: ‘Why are ARVs not toxic for the members in Parliament who are taking them but toxic for the poor?’” Some have called for Mbeki to be tried for crimes against humanity.