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 courthouse, 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 percent, 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 discreetly 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.