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PARALLELS WITH OTHER DISEASES

Although HIV is a new disease organism, the problems it poses are common to several other diseases that have been dealt with by the public health system in the United States. The devastating sequelae of HIV infection make controlling the spread of the disease so important. Unlike an easily communicated disease such as measles, individuals can protect themselves from HIV. But because it is a sexually transmitted disease, it is certain to be a serious threat until a cheap, highly effective vaccine is developed. Even easily treated venereal diseases such as syphilis and gonorrhea are increasing rather than moving toward extinction.

When the AIDS syndrome was first described, it represented the end stage of the disease. AIDS was 100 percent fatal, with a short mean lifetime between diagnosis and death. As the syndrome became better defined, it was diagnosed earlier, and the mean survival time increased. With the ability to diagnose asymptomatic HIV infection came the realization that some persons infected with HIV could live ten or more years. It is expected that current drug therapies for HIV infection will again increase the survival of HIV-infected persons.

Nevertheless, it is assumed that HIV infection is still 100 percent fatal, with a mean survival time exceeding ten years.

It is unusual for a communicable disease to have a 100 percent mortality. Rabies is 100 percent fatal, and the disease usually progresses rapidly in humans. Several cancers are 100 percent fatal. In addition, there are many infectious diseases that have a very high mortality rate even with adequate therapy. Although such diseases are difficult for many health care providers to deal with, we do manage to care for the patients adequately.

HIV is not unique as an infectious agent. More than 60 infectious diseases are reportable in various states and are a common part of public health practice. HIV is less difficult to work with and control than many other diseases because it is less easily spread. Diseases that may be spread through respiratory casual contact, for example, can be much more difficult to prevent and control. Tuberculosis was controlled before it was treatable. Other diseases with carrier states must be managed without definitive therapy. Standard public health such as public education, screening, and contact tracing also are effective in the control of HIV.

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