I think the latest evidence shows that HIV is mildly active continuously, replicating at a low level all the time. In other words, it doesn’t really become dormant. Though it’s true that people can be relatively symptom-free for years, so maybe that’s just getting picky.
Rob, Sorry if I’ve sounded exasperated or defensive. Of course there is scientific bias and we constantly evaluate our surveillance methods to try to find and address any bias we can find. No one would deny that is there. But I often deal with others’ political agendas around HIV issues, too. I may be unfairly lumping you into a group in which you do not belong. For example, I often hear people argue vociferously that there is a “hidden HIV epidemic” exploding in what are considered to be “low risk groups” such as teenage heterosexuals, elderly people or a certain ethnic group. None of our evidence: surveillance, seroprevalence studies, behavioral studies, etc. show this to be true (cases occur in those groups, but not at high rates), but certain people continue to misconstrue the data to make their point, or to spread mistrust about the data because the data do not support what they want to believe is happening. This is the kind of bias that drives me nuts. In some cases these are educators who are only interested in awfulizing sex for their students and want to use our data to scare them into delaying sexual activity (while denying that any of their students might be gay, too… most of these “sex education” curriculums I’ve seen are completely heterosexually based). Sometimes teacher sound downright disappointed that there are so few HIV/AIDS cases among teens in our area… I have to remind them that this is good news.
I suspect in some other cases the motives are to get more funding for organizations that cater to these low risk groups (taking funding away from groups who respond to the needs of populations that really are being heavily impacted by this epidemic). I’m not saying that such groups do not deserve attention and funding and that many of these people aren’t sincere, but I think their efforts are sometimes misguided and they are not looking at the big picture. It’s unfortunate that we end up in a funding situation in which different interest groups have to compete, but that’s what ends up happening, and it can be sickening to watch. We have been doing seroprevalence studies in STD clinics and youth detention centers for years and years. If there were a whole lotta heterosexual or teen cases, we’d have found them there, I think. We’ve found practically none (none at ALL in the youth detention facility). We’ve done other studies in other populations, too, as have most areas of the country.
Another thing we used to see - but not so often any more - is gay activists who want to focus on possible hidden epidemics in these other groups to draw attention away from what has been portrayed as a “gay disease” because they are tired of feeling blamed for the epidemic. This backfires, because HIV is still spreading like mad among men who have sex with men (about 75% of the cases in my state fall into this group - new cases, too), and they continue to need prevention programs and services.
As I said before, you seem pretty knowledgeable and I appreciate the discussion. I’m sorry if I’ve unfairly assumed motives that weren’t there.
Jill
