Moreover, many of the factors associated with new HIV infections

Moreover, many of the factors associated with new HIV infections, outlined above, are associated with a reluctance to get tested and diagnosed, and to enter into treatment. Furthermore, even if those individuals who are infected enter into treatment, factors such as depression, illicit drugs, and alcohol abuse often limit their ability to strictly follow their medication regimens. This poor adherence then promotes the development of resistance by the HIV to the medications (drug resistance), which, in turn, increases the risk of progression to symptoms and death.

Finally, the issues discussed above may in part explain why there has been a leveling off or even a slight increase in AIDS-related deaths. Thus, many individuals are dealing with issues that prevent them from getting into care, or when entered into care, being successful with their treatment. In addition, people who do not perceive themselves to be at risk are less likely to get tested for HIV. Consequently, these people often first find out they have HIV when they are having symptoms from AIDS. As a matter of fact, many people I care for who have HIV disease and symptoms or who have died from AIDS during the last few years are coming to the hospital without having ever been tested for HIV.

Only a better understanding of the reasons for these trends in HIV disease will enable us to approach the underlying basic problems. Hopefully, studies that address all of these issues will ultimately lead to changes in our national HIV prevention efforts. These changes should then reduce the number of new HIV infections, cases of AIDS, and AIDS-related deaths. In the interim, education and encouraging people to get tested remain a good start