Last week, the governor of Indiana declared a public health emergency in that state as a result of a Human Immunodeficiency Virus (HIV) outbreak. HIV is the virus that causes Auto-Immune Deficiency Syndrome (AIDS), a disease that has no cure and is deadly as a result of the way it suppresses the human immune system. Indiana Governor Mike Pence called the state of emergency because 71 new cases of HIV have been confirmed since December, with nine more possible cases still being investigated.
However, the panic and invocation of an emergency state seems premature. The rate of infection actually seems to be lower than it has been, even in recent years. Over the course of 2012, an average of 39 new patients each month were infected with HIV. Further, HIV has not spontaneously begun to spread rapidly and uncontrollably. We know exactly how it’s transmitted and have the ability to stop this spread with strategies more aggressive than simply “riding it out.”
Calling a state of emergency too early, seemingly as a precaution, could have some negative effects on both the impact of the use of the term “state of emergency” itself and the efforts put forth over time to de-stigmatize HIV/AIDS in our society.
Overusing the claim “state of emergency” will cause it to depreciate in value. The term will cease to have the same amount of weight that it ought to imply, and as a result, people will not take its use seriously enough. People also may not react with the same amount of urgency that they should when the word “emergency” is used.
Invoking such a state with regard to HIV/AIDS will also undo much of the work that has been done up until this point relating to de-stigmatizing the disease. When AIDS was first identified, there was a high stigma against people with the disease, primarily due to lack of education and fear. People who were known to have contracted HIV were ostracized and often shunned from their communities, as people did not want to be in contact with them. Further, since HIV was initially known as a disease primarily, if not only, contracted by gay men, discrimination against people based on their sexual orientation increased dramatically. Calling a state of emergency could send people into a panic if they incorrectly assume that the disease has begun to spread uncontrollably. This could reinforce some of the stereotypes about HIV and people who have it that activists and patients worked so hard to break down in the ’80s.
If not a precaution, an emergency state ought to only be called under very specific conditions. The necessary conditions would be fulfilled when two factors are concurrently occurring: First, the health issue in question should be posing a serious, deadly and imminent threat to local populations; second, health officials should be at a loss as to how to go about solving the problem and have no way of predicting when the outbreak might be contained. For example, it was probably appropriate to introduce a state of health emergency in West Africa due to the Ebola outbreak, especially when infection rates soared over this past summer. The threat to local populations was real and very deadly, and there was no plan for containment other than to try to keep as many patients in isolation as possible. West Africans effectively had to ride out the disease’s progression.
The situation in Indiana is entirely unlike this. While HIV is deadly when it becomes full-blown AIDS, it can be treated with anti-retroviral drugs. Under proper treatment regimens, a patient with HIV can live a relatively normal life for a long time. Not only that, but HIV is not highly infectious. It isn’t transmitted through the air, water or closed-skin contact. It can only be transmitted through exchange of bodily fluids. This most often happens through unprotected sexual contact and reusing hypodermic needles. In this case, the outbreak seems to be a result of the latter common cause of spread. Thus, the route to solving this “epidemic” is simple: Get people to stop sharing needles.
We ought to applaud the state’s effort to distribute clean needles to addicts, as well as the reminder that treatment and help are available for those who seek them out. However, this is not enough, if simply because the solution is not sustainable. While doing this distribution, we need to figure out what factors caused such an upsurge in the infection rate, and then make changes to correct those factors. This would entail figuring out where the motivation for not using fresh needles comes from and attempting to determine why people start doing drugs. If we identify that cause, we can address it and perhaps stop the usage in the first place.
The point is, we have strategies. There are not out of control. Calling a state of emergency can only make things worse, so we should call this situation as it is: a public health problem. One that needs to be solved, but can be done so in a calm and methodical manner.
Contact Mina Shah at minashah ‘at’ stanford.edu.