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June 11, 2019

Ending AIDS in the United States—If Not Now, When?

Author Affiliations
  • 1Department of Medicine, University of California, San Francisco
  • 2Zuckerberg San Francisco General Hospital, San Francisco, California
  • 3Bridge HIV, San Francisco Department of Public Health, San Francisco, California
  • 4Department of Epidemiology and Biostatistics, University of California, San Francisco
JAMA Intern Med. 2019;179(9):1165-1166. doi:10.1001/jamainternmed.2019.1577

The United States has the largest annual number of people with new HIV diagnoses of any high-income nation in the world. In 2017, there were 38 281 people with new HIV diagnoses and 1.1 million people living with HIV.1 Men who have sex with men, African Americans, and persons living in southern US states are the most heavily affected. It is deeply disturbing that the number of new HIV diagnoses remained stable from 2012 to 2016 when effective prevention tools were available but not widely implemented.

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1 Comment for this article
Combined Communitarian Therapy
Paul Nelson, M.D., M.S. | Family Health Care, P.C. retired
Putting aside the known and knowable strategies to eliminate HIV, the ultimate barriers are two fold. First, our nation is unique within the global community by its lack of any nationally sanctioned and locally implemented strategy to assure that enhanced Primary Healthcare is equitably available and ecologically accessible to each citizen within their own community. While we continue to fulfill the scientific mandate for healthcare, we have neglected its humanitarian mandate. This leads to the second barrier for eliminating HIV, best defined as out nation's loss of Social Cohesion.

With the second barrier, our nation has
endured a dramatic loss of Social Cohesion and its associated Social Capital within the last 30 years. The exact origins of this loss have been cataloged by Robert B. Putnam. But, their use as an means to understand population HEALTH, at best, remain poorly acknowledged. I will finish this train of thought with a quotation from Maya Angelou followed by my own view of a definition for Social Cohesion.

The quotation from Maya Angelou: "I've learned that people will forget what you said, people will forget what did, but people will never forget how you made them feel." Social Cohesion may be defined as a broadly shared belief among a nation's citizens that the citizens of each other's community are TRUSTWORTHY and that each of these communities maintains there own 'Suvival Commons' (an augmented safety net) with sufficient Social Capital for achieving their community's contribution to the norms of TRUST experienced by every national citizen within their own community.

In sum, HIV along with maternal mortality, child neglect, adolescent health, substance abuse/mortality, homelessness, mid-life depression/ disability, mass shootings, and declining longevity at birth will not be improved without a community by community strategy to promote enhanced Primary Healthcare along with the uniquely community driven improvement of Social Cohesion. The details are known. Think about the Cooperative Extension Service for the agriculture industry, since 1914. Among the world-wide community, our nation's agriculture is the most efficient and effective.