Michael Gerson

Second, they argue for the "routinization" of AIDS within the range of infectious diseases. Because of its politically charged history, HIV infection is treated differently. A positive syphilis test, for example, is reported directly from the medical lab to the local Department of Health. "If it is syphilis," says Teferi, "there is a knock on their door to get them into treatment. If it is HIV, no one talks to them."

Third, testing needs to be broader. At Unity, they refer to HIV status as the "fifth vital sign" (after temperature, heart rate, blood pressure and respiratory rate). People who know their positive status are more likely to change their behavior and get treatment for opportunistic infections. Early treatment can also reduce the virus to a nearly undetectable level in the body, drastically lowering transmission from mothers to children during childbirth and between discordant couples (partners where one is HIV-positive and one is HIV-negative).

This raises an interesting prospect supported by Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases. Developing an AIDS vaccine, he says, remains unlikely in the short term. But what if we were to begin treatment with AIDS drugs as soon as someone is diagnosed with HIV instead of waiting, as we now do, until later stages? Lower viral loads would inhibit transmission. "Treatment," he says, "would be prevention." According to the mathematical model Fauci has reviewed, the testing and treatment of 90 percent of those at risk could eventually eradicate -- not just control, but eradicate -- the disease in a geographic area.

The obstacles are immense. Would people take AIDS drugs when they are still feeling well? Would any community help promote testing on such a massive scale? Would it be cost-effective?

But even the attempt would have many good effects. It would encourage early care and effective prevention. And if everyone were tested, the stigma surrounding AIDS testing might decrease. It takes only 20 minutes.

Michael Gerson

Michael Gerson writes a twice-weekly column for The Post on issues that include politics, global health, development, religion and foreign policy. Michael Gerson is the author of the book "Heroic Conservatism" and a contributor to Newsweek magazine.
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