HOUSTON — In his State of the Union address, President Trump surprised Congress by asking for a “commitment to eliminate the H.I.V. epidemic in the United States within 10 years.” I’m a physician who specializes in H.I.V. and AIDS prevention in a city with one of the highest infection rates in the country, so that’s music to my ears. But the president needs to know that we’re going to fail if we don’t start working much harder.
After nearly 40 years, we finally have the biomedical tools and the public health strategies to end the H.I.V. epidemic in America. The winning strategy goes like this: Increase the number of people who get tested for H.I.V., and start those who test positive on antiretroviral therapy as soon as possible, which helps prevent transmission of the virus. Those who test negative but are vulnerable to infection because of sexual activity should take pre-exposure prophylaxis, or PrEP, the daily drug regimen that reduces the risk of getting H.I.V.
The tragedy is that those tools are sitting on the shelf in many parts of the country, especially the South, where H.I.V. rates are still rising among some groups and where AIDS disproportionately afflicts African-Americans. Just this week the Centers for Disease Control and Prevention reported that the “progress in H.I.V. prevention has stalled.”
Big cities on both coasts — where AIDS was concentrated when it was officially recognized as a health condition in the early 1980s — have deftly managed the disease. San Francisco was once ground zero, yet in 2017 new H.I.V. diagnoses there fell to 221, a record low. The city’s Department of Public Health credits PrEP and a rapid-start program that gets those who test positive for H.I.V. into care within five days.
Other urban areas have made similar strides. In New York City, new H.I.V. infections dropped 26 percent from 2012 to 2016. In the city’s clinics, people are offered treatment as soon as the virus is diagnosed. Demetre Daskalakis, the deputy health commissioner for disease control, said this program is working with “staggering success.”
The H.I.V. epicenter in the United States has instead shifted to the South, which now accounts for more than half of new infections and nearly half of deaths directly related to H.I.V. Eight of the 10 states and all of the 10 metropolitan areas with the highest rates of new H.I.V. diagnoses are in the South. The region had 20,000 new cases in 2017, compared with 6,000 cases in the Northeast.
Even after learning they have the disease, Southerners face serious hurdles to getting care. A lack of public transportation, in both big cities and rural areas, makes going to the doctor more difficult. The cost of medications can be prohibitive, especially in a state like Texas, which has the highest uninsured rate in the nation. Not enough H.I.V. -positive patients are beginning treatment within a month of diagnosis, even though research shows that doing so improves health and reduces the risk of transmission. Far too few people who could benefit are taking PrEP.
And of course, there is lingering stigma that keeps people who need help on the margins.
Over the past few years there has also been a demographic shift. African-Americans now represent 44 percent of all people infected with H.I.V., nearly four times their proportion of the population; Hispanics, 18 percent of the population, account for 26 percent of infections. Houston’s population is 44 percent Hispanic and 23 percent black, and H.I.V. rates among young people of color here are rising. H.I.V. rates among black women are 17 percent higher than among white women.
We are making slow, steady progress. The Joint United Nations Program on H.I.V./AIDS last year honored the Ponce De Leon Center in Atlanta, which serves more than 6,000 people a year, most of them living in poverty and uninsured or underinsured. The center provides not only H.I.V. diagnosis and treatment but also financial counseling and nutrition.
And nationwide, while we don’t yet have a cure, the medical breakthroughs around H.I.V. are impressive. Thousands of Americans are living happy, successful, long lives with the infection.
But this makes some of the cases I see all the more distressing. I had a patient who died last year of an AIDS-related cancer at age 31. Another woman, who has been infected with H.I.V. for 15 years, is 41 years old and unable to get out of bed. Little can be done for these women, the infection having been diagnosed late in their illness.
So, yes, we can meet the president’s goal of ending AIDS in a decade, but only if we race to get our new tools more efficiently and equitably to those who need them.
Charlene Flash is an infectious-disease doctor and associate chief medical officer at Legacy Community Health, and a clinical assistant professor at Baylor College of Medicine.
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今期新版跑狗玄机图【暗】【恋】【一】【个】【人】，【真】【的】【很】【辛】【苦】。 【长】【歌】【又】【借】【着】【机】【会】【来】【了】【沈】【度】【的】【办】【公】【室】。 【组】【长】【来】【找】【沈】【度】【做】【任】【务】【汇】【报】，【长】【歌】【作】【为】【新】【入】【职】【的】【组】【员】，【是】【没】【有】【资】【格】【参】【加】【的】。 【但】【为】【了】【能】【多】【看】【沈】【度】【几】【眼】，【长】【歌】【厚】【着】【脸】【皮】，【以】【学】**【由】，【跟】【在】【组】【长】【的】【后】【面】，【眼】【睛】【一】【直】【偷】【瞄】【着】【沈】【度】。 【组】【长】【是】【个】【四】【十】【几】【岁】【的】【女】【人】，【经】【历】【过】【各】【种】【各】【样】【的】【爱】【情】，【她】【完】【全】【看】【得】【出】【来】【长】
【带】【着】【疑】【问】，【魏】【轩】【当】【即】【道】：“【走】，【我】【们】【出】【去】【转】【转】！” 【贞】【子】【刚】【准】【备】【提】【醒】【他】【的】【时】【候】，【门】【外】【又】【是】【一】【声】【炸】【吼】：“【魏】【轩】！【起】【床】【了】，【都】【几】【点】【了】？” “【咚】【咚】【咚】！” 【门】【外】【传】【来】【了】【自】【己】【母】【亲】【暴】【躁】【的】【声】【音】，【震】【的】【房】【子】【都】【要】【抖】【三】【抖】。 【魏】【轩】【耳】【朵】【都】【快】【听】【出】【茧】【子】【了】，【自】【打】【到】【了】【次】【世】【界】【见】【到】【母】【亲】，【三】【天】【两】【头】【就】【要】【来】【一】【声】，【要】【说】【不】【烦】，【那】【是】
【我】【是】【李】【诚】【泽】，【母】【亲】【早】【逝】，【父】【亲】【再】【娶】，【从】【小】【生】【活】【便】【不】【开】【心】，【我】【以】【为】【我】【这】【辈】【子】【也】【就】【这】【样】【了】。 【没】【想】【到】，【那】【一】【年】【里】，【那】【个】【地】【方】【会】【发】【生】【一】【个】【人】【生】【里】【的】【大】【转】【折】。 【在】【高】【二】【那】【年】【转】【到】【她】【所】【在】【的】【学】【校】。 【那】【一】【次】，【我】【跟】【我】【爸】【大】【吵】【了】【一】【架】，【负】【气】【出】【走】，【而】【我】【父】【亲】【也】【是】【气】【极】，【并】【没】【有】【阻】【止】【我】。 【那】【一】【次】，【我】【回】【到】【了】【老】【家】【的】【那】【个】【地】【方】。今期新版跑狗玄机图【也】【没】【办】【法】【改】【变】：【萧】【墨】【宸】【喜】【欢】【苏】【皖】，【而】【苏】【皖】【却】【并】【不】【打】【算】【嫁】【给】【萧】【墨】【宸】【这】【个】【事】【实】【了】。 【苏】【皖】【见】【萧】【墨】【宸】【的】【脸】【绷】【得】【紧】【紧】【的】，【周】【身】【散】【发】【出】【生】【人】【勿】【近】【的】【威】【压】，【心】【里】【有】【点】【紧】【张】。 【她】【并】【不】【知】【道】，【这】【个】【冷】【酷】【睿】【智】、【桀】【骜】【不】【驯】【的】【宸】【王】【爷】，【现】【在】【心】【中】【纠】【结】【的】【竟】【然】【是】，【他】【喜】【欢】【苏】【皖】，【而】【苏】【皖】【却】【不】【喜】【欢】【他】，【而】【且】【这】【个】【事】【情】【还】【让】【苏】【皖】【知】【道】【了】，【这】【么】【一】
“【你】，【你】，【你】【赶】【紧】【去】【给】【我】【找】【个】【替】【罪】【羊】【来】，【记】【住】，【一】【定】【要】【让】【他】【心】【甘】【情】【愿】【的】【去】【死】，【或】【者】【让】【他】【开】【不】【了】【口】，【无】【法】【将】【真】【相】【说】【出】【来】，【知】【道】【了】【吗】？”【黎】【满】【声】【嘶】【力】【竭】【的】【对】【着】【盛】【京】【太】【守】【吼】【道】。 【他】【是】【真】【的】【怕】【了】，【他】【怕】【死】，【他】【害】【怕】【没】【有】【人】【帮】【他】【扛】【下】【这】【个】【罪】【名】，【秋】【后】【问】【斩】，【他】【可】【不】【想】【死】。 【盛】【京】【太】【守】【擦】【了】【擦】【脑】【门】【上】【的】【冷】【汗】，【对】【跪】【在】【地】【上】【的】【管】【家】
……… 【他】【的】【话】，【她】【完】【全】【不】【相】【信】！！ 【这】【样】【的】【对】【比】，【让】【苏】【止】【寒】【心】【里】【很】【不】【是】【滋】【味】。 【苏】【止】【寒】【扭】【头】【慢】【悠】【悠】【的】【看】【了】【一】【眼】【苏】【糖】【糖】，【很】【不】【爽】【的】【哼】【着】，【苏】【糖】【糖】：“……” 【她】【感】【觉】，【自】【己】【就】【是】【一】【个】【空】【气】，【哦】【不】，【可】【以】【说】【是】……【一】【个】【炮】【灰】，【她】【就】【是】【一】【个】【大】【炮】【灰】！ 【苏】【糖】【糖】【嘴】【角】【抑】【制】【不】【住】【的】【抽】【搐】【了】【两】【下】，【伸】【手】【撩】【了】【撩】【头】【发】，【季】【少】【白】【紧】【跟】【其】【后】
【结】【束】【了】【精】【灵】【女】【王】【的】【一】【生】，【白】【术】【并】【没】【有】【想】【以】【前】【一】【样】，【回】【到】【球】【球】【的】【私】【人】【小】【空】【间】【里】。 【她】【直】【接】【穿】【越】【到】【了】【下】【一】【个】【世】【界】。 【一】【个】【科】【技】【发】【的】【星】【际】【世】【界】。 【但】【也】【是】【一】【个】【在】【白】【术】【看】【来】，【国】【民】【生】【活】【算】【不】【上】【太】【幸】【福】【的】【星】【际】【世】【界】。 【至】【少】，【穿】【越】【了】【那】【么】【多】【世】【界】，【白】【术】【就】【没】【听】【说】【过】【单】【身】【还】【要】【纳】【税】【的】。 【偏】【偏】，【这】【个】【世】【界】【的】【单】【身】【税】【超】【级】【高】，
【直】【到】【天】【明】，【王】【平】【才】【缓】【缓】【收】【工】，【看】【着】【有】【些】【苍】【白】【的】【皮】【肤】，【王】【平】【有】【些】【哭】【笑】【不】【得】，【简】【单】【是】【收】【拾】【了】【一】【下】，【起】【身】【洗】【漱】【去】【了】。 【此】【后】，【王】【平】【白】【天】【比】【武】，【晚】【上】【炼】【针】【灸】【术】，【过】【得】【倒】【也】【充】【实】。 【时】【间】【一】【点】【点】【过】【去】，【期】【间】，【王】【平】【多】【次】【来】【往】【白】【府】，【和】【白】【展】【商】【讨】【针】【灸】【术】，【而】【观】【察】【着】【王】【平】【踪】【迹】【的】【四】【位】【家】【主】【也】【被】【王】【平】【这】【一】【出】【一】【进】【给】【弄】【得】【一】【愣】【一】【愣】【的】，【有】