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By Marilyn Werber Serafini, National Journal
© National Journal Group Inc.
Friday, Jan. 19, 2007

It was 1994 when Annette Owens got the bad news. Her ex-husband, an intravenous drug user, had infected her with HIV. Devastated, Owens started planning her funeral. "Back then, it was like handing you a death sentence," she said in an interview.

A year or two earlier, funeral arrangements probably would have been in order. "She'd be dead by now," said her doctor, Ardis Hoven, medical director at the Bluegrass Care Clinic in Lexington, Ky. Until the early 1990s, HIV infections swiftly turned into full-blown AIDS, and patients quickly lost the battle to pneumonia or other infections because of severely compromised immune systems. They were dead within a year and a half of diagnosis, Hoven said.

At that point, panic was widespread. The Centers for Disease Control and Prevention had warned the public about HIV back in 1981. But even when Owens was diagnosed in 1994, Americans still didn't fully understand that the virus was transmitted through sex and IV drug use, and not through a kiss, a cough, or a touch. "You would tell people you were HIV-positive, and you could see them doing the Michael Jackson moon walk trying to get away from you," Owens recalled.

In 1987, drugmaker Burroughs Wellcome, now GlaxoSmithKline, introduced Retrovir (zidovudine or AZT), the first breakthrough treatment drug. In the mid-'90s, the Food and Drug Administration approved numerous other antiretroviral medications, just in time to save Owens with what doctors now know is a necessary multidrug approach.

Today, doctors call HIV a "manageable chronic condition" as opposed to a death sentence. A recent study in the journal Medical Care estimates that people can live 24 years after contracting HIV. In 1993, the year before Owens was diagnosed, life expectancy was seven years from the time of infection.

In 2005, 17,000 Americans died of AIDS, compared with 51,000 in 1995, according to the Kaiser Family Foundation. Doctors diagnose about 40,000 new HIV infections each year in the United States, compared with 150,000 every year in the 1980s.

Looking forward, drugmakers continue to develop antiretroviral medications and vaccines meant to boost the immune system or to decrease the virus's severity. Preventing HIV with a vaccine -- about 19 are in the works -- is thought to be about 10 years away; until then, the primary goal is to help infected people control the virus.

Federal funding has grown from less than $500 million in fiscal 1987 to nearly $22 billion in 2006. Medicaid, the federal-state health care program for the poor, and Medicare, the federal health care program for the elderly and disabled, both cover HIV care and medications. The 1990 Ryan White CARE Act, which Congress reauthorized last year, gives state and local governments grants for HIV/AIDS patients that pay for everything from medical care to drugs and housing.

Patient advocates aren't entirely satisfied, though. The CDC estimates that 1.2 million people are living with HIV in this country, yet only about half are getting care. One-quarter of those infected with the virus don't know they have it, according to Jennifer Kates, Kaiser's vice president and director of HIV policy. Those who know they're infected but don't receive care aren't getting it for a variety of reasons, but patient advocates say that increases in Ryan White funding -- which has remained relatively flat -- would help.

CDC's prevention funding has actually decreased in the last few years, according to a Kaiser analysis. Kates sees that as problematic, because initial education was targeted to white men having sex with men, but now, half of all people with HIV are African-American. In addition, nearly 47 million Americans lack health insurance, and without regular medical care, detection often comes too late. Kates cites CDC data showing that 40 percent of people diagnosed with full-blown AIDS were diagnosed with HIV less than 12 months earlier.

Still, for all of the suffering and deaths, more and more Americans are, like Owens, living with HIV. Hoven recounted that just last month a young man was "petrified" when she diagnosed him with the virus. Her message surprised him: If he took his pharmaceutical "cocktail" for the rest of his life, he would not die of AIDS. Even more unexpected was a lecture from Hoven, who told him that he should be more concerned about the two packs of cigarettes he puffs away on every day and the 40 extra pounds around his middle. [an error occurred while processing this directive]

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