HIV/AIDS & the Down Low (DL)


HIV/AIDS Data in Racial & Ethnic Groups l HIV/AIDS in African Americans: A Special Challenge l Down Low (DL) l Group Barriers to HIV Prevention & Control Challenges of Managing HIV/AIDS & Substance Abuse, Combined l AIDS Blanket Quilt/Names Project: Reminder of the Epidemic’s Destructive Impact

Our Overview of HIV/AIDS

HIV and AIDS have reached epidemic proportions in communities of color, especially among African-Americans and Hispanics. In our HIV/AIDS Trend Table section, Tables 1 and 2 show how serious the problem is. For example, while African-Americans made up 13% of the U.S. population in 2005, they were 50% of AIDS cases. For Hispanics, while they made up 14% of the U.S. population, they were 18% of AIDS cases. In other words, while African Americans and Hispanics combined made up 27% of the U.S. population in 2005, they represented 68% of all AIDS cases.

With adequate information, education, and access to high quality care, racial and ethnic minority populations can, with the help of others who care, reverse the AIDS Epidemic in communities of color. To do so so, however, more targeted financial resources are necessary, given the more limited resources in communities of color, and their competing needs. That’s why it is in the interest of “mainstream America” to ‘stay the course’ in supporting the fight against HIV/AIDS until it is no longer a leading national health problem.

The HIV/AIDS section of our web site provides a broad spectrum of information concerning HIV prevention, early detection and control. “What It Means”, our glossary, explains many other related terms such as

“Mainstream America” should care more about the AIDS epidemic in multicultural populations because:

  1. The costs of treating HIV and AIDS are very high, and all taxpayers pay those costs, directly or indirectly. An increased societal investment on prevention (Yes, AIDS is preventable) would, therefore, be a very sound investment;
  2. The intermittent illnesses of many people with AIDS, and the multiple demands of treatment often interfere with productivity in the workplace, whose composition is increasingly made up of multicultural populations;
  3. In a humane society, those organizations and individuals who have health and “wealth” (which is, of course relative), will hopefully soon recognize the great loss to society from silently (sort of) permitting the AIDS epidemic to continue destroying so many lives; and
  4. Treatment with medications called protease inhibitors, and the use of cocktails (multiple drug therapy) has changed AIDS from primarily being a fatal disease, to becoming more like a chronic disease (which people can live with for a long time).

For each of the above reasons, there is a need for national and local leaders, as well as others, to seriously rethink how to respond to the AIDS epidemic.

In rethinking HIV/AIDS, they should recognize and actively support the principle that “Prevention is Always Better Than a Cure“. However, once HIV or AIDS develop, ensuring access to high quality ongoing medical and ancillary care is in the best interest of those infected, their families, and society as a whole.
The Down Low (DL)

The term Down Low is most widely understood to mean keeping some information or activity private, or down low. It is also often used to describe the behavior of men who have sex with other men as well as with women, but do not consider themselves as gay or bisexual. Instead, they may refer to themselves as on the down low, on the DL, or on the low.

Although the practices of bisexual men are not unique to African-American men, the Down Low term is probably most often used regarding African-American men because it reportedly originated in the African-American community. However, there is an unknown, but significant, number of Hispanic and White men who are also on the Down Low/bisexual.

While it is known that some heterosexual women have become infected with HIV through sexual contact with bisexual men, the extent is not really known. For example, some heterosexual women develop HIV infection from bisexual men who also inject drugs.

Because the extent to which being on the Down Low may be related to the significant increase in HIV infection among African-American women in recent years is unknown, much more research is needed regarding this issue. CDC is currently collaborating in the conduct of several projects related to HIV-related risk practices in men, including men who refer to themselves as on the Down Low.

African-American and Hispanic Women are at Much Greater Risk

Today, women account for one-fourth of all new HIV/AIDS diagnoses:

  • Of the 126,964 women living with HIV/AIDS in 2005, 64% were African-American and 15% were Hispanic;
  • Further, the rate of AIDS diagnosis in African-American women was 23 times the rate in white women.Contributing to the very high incidence of HIV/AIDS in African-American, and then Hispanic women, is the fact that an unknown but significant number of their male partners and acquaintances also have sex with men, often without the women’s knowledge. Some of these men do not consider themselves gay or bisexual, and refer to themselves as on the Down Low. The Down Low is discussed further in What It Means, Health Power’s web site glossary.The various challenges for all involved associated with this practice requires that:
    • African-American and Hispanic women become better informed about how to protect themselves from HIV, and act on that knowledge;
    • The public health community, physicians and other health professionals, and researchers give a higher priority to health education, behavioral research, and the availability of support networks and related resources in disproportionately affected communities of color.

    Of the 207,810 men who reported having sex with men (MSM), 32% or one-third of the total was African-American men and 16% were Hispanic. Further, of the MSM who reported injecting drugs, another major risk factor for HIV, 39% were African-American and 14% were Hispanic.

    Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases of the National Institutes of Health and a widely recognized HIV/AIDS expert, noted in several interviews regarding this year’s World AIDS Day,Complacency on AIDS is dangerous.

    Further, when asked Who is the face of AIDS in the U.S. today? His response, in essence, was:

    • o A young African-American woman infected by a partner who she did not know. . . was infected, and had no reason to believe she needed to, or even had the means to, protect herself.
    • A young African-American man, who is bi-sexual, and because of the stigma associated with being gay, superimposed on the stigma with being infected, does not seek counsel nor appreciate what he needs to do to decrease or eliminate.

Now, almost 50% of men with HIV/AIDS are African-American, and in women, almost 60% are in African-American women. Again, additional racial/ethnic statistics on HIV/AIDS can be easily obtained from the Health Trends by Health Power Section of Health Power’s web site.

All women of color, especially African-American women, who bear the greatest burden from HIV/AIDS, need to be well informed about the Down Low, and to increase their knowledge, skills, and determination to protect themselves and their futures. Hopefully their sense of self worth will be enough to motivate them to do so. However, if not, they will hopefully do so for the good of those they love. . . or in the reverse, do so for the good of those who love them.

Participation in women’s support groups (even two people can be a group), can help women better protect themselves and their futures.

CDC’s 2006 HIV Surveillance Report Showed a
Large Spike in Reported HIV Cases
On March 24th, CDC released its 2006 HIV/AIDS Surveillance Report: Cases of HIV infection and AIDS in the United States and Dependent Areas. In the report, CDC compared the number of reported cases of HIV infection in 2005 and 2006, and found a 48% increase. However, some of the increase was related to the fact that more states reported in 2006 than in 2005. More detailed information on CDC’s 2006 HIV Surveillance Report is available on the CDC web site.

Based on a Statewide Research Project directed by Norma J. Goodwin, M.D for the New York State AIDS Institute, 1992- 1993, Published by New York State Department of Health

According to CDC, although African-Americans made up 13% of the total U.S. population in 2005 according to the U.S. Census Bureau, they were an estimated 50% of all AIDS cases in the United States. Hispanic Americans, who represented 14% of the U.S. population in 2005, were next most negatively affected, with an estimated 8% of all AIDS cases.

Another way of looking at the HIV/AIDS disparity in African-Americans is the cumulative, or overall, effect of HIV/AIDS since the beginning of “The Epidemic”. Specifically, in 2005, although African-Americans were 13% of the U.S. population in, they totaled 68% of the estimated cumulative total of AIDS cases.

Another striking finding in CDC 2006 U.S. data reports was that while the age-adjusted death rate from HIV was 2.3 deaths per 100,000 population for Caucasians, the mortality or death rate for African-Americans was 20.4 deaths per 100,000, and for Hispanics it was 5.3 per 100,000. The Health Trends by Health Power Section of Health Power’s web site provides additional data related to HIV/AIDS by race and ethnicity.

In 1992 and 1993, Dr. Norma Goodwin, President of Health Power, conducted an 18-month statewide strategy development action project on HIV prevention in African-Americans for the AIDS Institute of the New York State Department of Health. In addition to the AIDS Institute’s publication and wide distribution of the Final Report, it was also distributed for several years as a CDC resource of the AIDS Clearinghouse.

Key research activities were:

  • a comprehensive literature review,
  • conduct of 48 focus groups,
  • 92 in-depth interviews,
  • an all-day Grassroots workshop
  • an all-day Leaders and Experts workshop,
  • analysis of selected high profile print and broadcast commercials targeting African-Americans to identify common elements.

Focus groups were conducted with the following African-American groups:

  • adolescents
  • gay and bisexual men and adolescents
  • heterosexual men
  • lesbians
  • prison inmates (current and former)
  • substance users
  • partners of substance users
  • women of childbearing age, including a Caribbean group
  • faith based leaders
  • other leaders and experts

In addition, focus groups were conducted with representatives of community based organizations.

HIV prevention strategies were developed for:

  • the African-American groups listed above;
  • African-American faith leaders and communities;
  • Other African-American leaders;
  • HIV counseling and testing;
  • Community organizations; and
  • Public communication.

Key Project Findings:

Dr. Goodwin considers many of the findings and recommendations of her research still valid, and not adequately pursued, today. They were:

  • Although African-Americans then knew the two most common ways HIV is transmitted – through participation in unprotected sex, and sharing of needles and other materials used in intravenous (IV) drug use – their knowledge of other modes of transmission was limited.
  • While many African-Americans associated having AIDS with death and with being stigmatized, relatively few were aware of the wide range of physical, psychological, social and economic consequences often encountered by people with AIDS.
  • Even though African-Americans were aware that, theoretically, they could develop AIDS as a result of prior or current practices – and many had friends, relatives or acquaintances who had HIV infection or had died of AIDS – they tended to disassociate this knowledge from a feeling of personal vulnerability.
  • Although most African-Americans who were economically disadvantaged were aware that they might be engaging in practices which put them at risk of contracting HIV/AIDS, feelings of hopelessness and low self-esteem prevented them from acting in their own best interest. In other word, there was a strong link between poverty and attitudes which contributed to the disproportionate prevalence of AIDS in African-Americans.
  • Many African-Americans considered institutional racism to be a major contributing factor to the disproportionately high rate of HIV/AIDS in the African-American population; some also considered AIDS a form of genocide.
  • Although many African-Americans stated that they would want to know if they had HIV infection, most had not received HIV counseling and testing because, among other reasons, they distrusted government and feared they would lose family, social and community relationships if they were found to be infected and their HIV status became known.
  • Most African-Americans felt that Black religious organizations could, and must, play a much greater role in preventing AIDS in their communities.
  • Many African-Americans felt that African-American leaders and organizations should be much more active in trying to prevent AIDS in their communities.
The following more detailed findings are provided in this Section of the web site:
  • 12 Barriers to HIV/AIDS Prevention and Control in Racial/Ethnic Populations
  • Group-specific Barriers to HIV/AIDS Prevention & Control for:
– Gay and Lesbian Persons
– Heterosexual Men
– Heterosexual Women
– Prisoners and Parolees
– Substance Abusers (including of Alcohol and Non-injection Drugs)
– Teenagers
– Women of Childbearing Age

Following the group-specific information provided for the above groups, Health Power provides recommendations on what communities and community groups, and faith leaders should do.

The recommendations on the web site refer to communities of color rather than just African-Americans because there is a significant correlation between socio-economic status or poverty, and the incidence of HIV/AIDS, irrespective of race and ethnicity.

This does not mean, however, that the barriers identified by Dr. Goodwin and Health Power apply to all people/communities of color. The latter observation is made because of the importance of avoiding stereotypes regarding African-Americans, Hispanics and other groups and sub-groups that are disproportionately affected by HIV/AIDS, given the multiple harmful effects of stereotyping.

Many improvements have occurred regarding HIV/AIDS in the 15 years since Dr. Goodwin conducted AIDS and African-Americans: It’s Time for Action. Noteworthy among these improvements has been the availability today of rapid testing methods, effective combination treatment, and capacity building within many organizations that serve African-American, Hispanic and other multicultural populations and communities.

Unfortunately, however, the lower overall socioeconomic status of African-Americans as compared to the general population means that many African-Americans with HIV/AIDS have less access to high quality care and follow-up.

What Health Power Will Do to Help Reverse the HIV/AIDS Health Disparities in African Americans and Other People of Color

In the view of Dr. Goodwin, much too little action has been taken that is consistent with many recommendations resulting from her research. The increasing disparity regarding African-Americans and HIV/AIDS convinces her that there is a continued need for the adoption and implementation of research based strategies. Further, because of the continuum related to the various aspects of HIV/AIDS, an increased focus is needed on prevention, early detection and control.

Because Health Power considers such action still very much needed, we will periodically add more detailed findings from the AIDS and African-Americans: It’s Time for Action research to the HIV/AIDS Section of our web site. In that way, we hope to share useful information with others who want to help make a difference in eliminating the excessive burden of HIV/AIDS on African-Americans. Specifically, they will be able to select just one strategy from many, and then recruit others to join with them in actively addressing that strategy in order to help make a difference.

Soundness of This Research Project as a Basic Model for Replication

The soundness of the AIDS and African-Americans: It’s Time for Action Project is evident from a number of factors including:

  1. Credibility of its sponsor – the New York State AIDS Institute;
  2. Comprehensiveness of the Project design and effectiveness of its implementation;
  3. Project focus on gathering information and advice directly from those at risk and/or affected by the HIV/AIDS epidemic.
  4. Expertise and credibility of Project Director, staff and consultants*;
  5. Expertise and credibility of the more than 400 participating organizational representatives and other individuals; and
  6. Recognition of the project’s significance as reflected by wide distribution of the Final Report over a period of several years by the New York State AIDS Institute and CDC.

Dr. Goodwin has a limited number of copies of AIDS and African-Americans: It’s Time for Action that can be obtained for the cost of postage and handling, paid in advance.

* A list of the more than 400 organizations and individuals who participated in this project is provided in the Final Report.

A Special Need 15 Years Later from Health Power’s Perspective

Since health disparities regarding HIV/AIDS in African-Americans have continued to increase over the past 15 years, a comprehensive qualitative research study which has a similar design and approach to AIDS and African-Americans: It’s Time for Action is greatly needed today:

  • to identify those recommended organizational and community strategies that have been actively pursued, nationally, to what extent, and what the outcomes have been;
  • to determine changes in HIV/AIDS related the knowledge, attitudes and practices of the various population sub-groups that participated in this research project (and ideally, a number of additional population sub-groups); and
  • to identify key strategies needed today to reverse the damaging and increasing effect of HIV/AIDS on African-Americans because: It

Health Power considers it very important that a repeat research project, based on the AIDS and African-Americans: It’s Time for Action model, be conducted after updated modifications. The wide array of recommended strategies from the project, although apparently not adequately focused on in our opinion, make a strong case for comparing the findings from that baseline study with where we are today – both as health professionals and at-risk communities and populations.

Finally, as disturbing as the statistics and trends regarding HIV/AIDS and African-Americans are today, they are even more disturbing when one considers the fact that the statistics represent the sickness and loss of thousands of mothers, fathers, children, significant others, and families, both nuclear and extended. The net effect is also great loss to their communities, and to society as a whole.
12 Barriers to HIV Prevention and Control in
Racial and Ethnic Populations
Barrier Key Strategy/Strategies
1. Preventive health has a decreased priority because of competing needs and/or interests. a. Provide ongoing culturally relevant and “family”* centered direct, print and broadcast information, education and health services, with an emphasis on disease prevention, early detection and control.
* Traditional and non-traditional families.
2. There is widespread distrust of both the medical establishment, and the government. a. Openly discuss in various settings the historical validity of some concerns, such as the legacy of the Tuskegee Study.

b. Use culturally and linguistically appropriate health educators and service providers whenever possible.

c. Emphasize, especially with African-Americans and Hispanics who engage or have engaged in high-risk practices, the increased likelihood of poorer outcomes with delayed testing and treatment.

d. Downplay governmental involvement in direct education and service.

3. There is a prevalent stigma associated with having HIV/AIDS. a. Incorporate sensitive and informed discussion about HIV/AIDS in individual and group discussions involving persons with HIV/AIDS, members of the general population, and mixed audiences involving both groups.
4. Poverty and under-education occur frequently among persons with HIV and AIDS. a. Indicate in appropriate group settings, the high correlation between poverty and poor health status.

b. Encourage and support the informed participation of affected persons in both formal education and self-education, since increased educational achievement is associated with improved economic status and health status.

5. Many persons have inadequate skills in negotiating safer sex and other risk reduction and avoidance situations. a. Conduct skill development workshops that include: multiple sessions, improving self-esteem, and individual and small group situation-specific individual and small group practice exercises.
6. There are not enough ongoing peer and other mutual support opportunities regarding HIV/AIDS risk reduction. a. Develop and facilitate the conduct of a greater number of ongoing HIV/AIDS risk reducing peer and other mutual support opportunities.
7. There is wide opposition to condom use, in part because of concerns about population control. a. Incorporate discussion of concerns about population control in group discussions about condom use as well as the risk reducing benefits of planned condom use.

b. Discuss approaches to infection-free reproduction through pre-conception HIV testing (at two intervals), and condom use during pregnancy unless one is engaged in a monogamous relationship with an uninfected person.

8. Many persons with HIV and AIDS have experienced multiple layers of discrimination related to such factors as:

  • race and/or ethnicity
  • socioeconomic status
  • sexual orientation
  • injection drug use
  • history of incarceration

The result is less responsiveness to prevention and treatment requirements.

a. Discuss, in appropriate individual and group settings, the damaging impact on persons of having experienced multiple levels of discrimination

b. Develop and implement modified approaches in order to achieve adherence with diagnostic and treatment requirements.

9. There is an inadequacy of customized, culturally relevant, user-friendly health information, messages and services related to HIV and AIDS. a. Increase the availability and use of customized, culturally relevant, user-friendly information, messages and services related to HIV and AIDS.
10. There is a prevalence of low individual, family, group, and community esteem. a. Discuss the relationship of individual, family, group and community esteem on lifestyle and health behavior.

b. Develop and conduct, interventions which incorporate esteem building as a significant component.

11. As a result of religious conservatism, there is less faith community involvement than needed. a. Approach various faith leaders and alliances and, in coordination with them, facilitate the development and conduct of needed outreach, educational and advocacy activities, including joint activities with other faith-centered organizations.
12. There is a need for increased community leadership, organization, collaboration and advocacy related to HIV/AIDS. a. Develop and/or increase the level of active and ongoing involvement of community leaders in issues related to HIV/AIDS.

NOTE: See also the Health Power identified key group-specific barriers for the following 6 groups:

  • gay and lesbian persons
  • heterosexual men
  • heterosexual women
  • prisoners and parolees
  • substance abusers
  • teenagers

Note: While these barriers identified by Health Power apply to many people and communities of color, they do not apply to all.

Gay and Lesbian Persons

  • Prevalent community stigma regarding persons with these sexual orientations
  • Scarcity of HIV related information and services specific to their needs
  • Few HIV related peer and other mutual support group opportunities

Heterosexual Men

  • Frequent low level of consciousness that non-condom use increases HIV and other STD transmission
  • Tendency by some to dominate their female partners because of either:
    • cultural tradition, and/or
    • having limited power in “mainstream America”
  • Tendency of more men than women not to use the health care delivery system
  • Few HIV related peer or mutual support group opportunities

Heterosexual Women

  • Relative scarcity of eligible men of color influences sexual decision-making
  • Inadequate control in many male-female relationships
  • Fear of potential physical and/or psychological abuse if condom use is insisted on
  • Too few peer or mutual support group opportunities that incorporate HIV related issues

Prisoners and Parolees

  • Official denial that sex occurs in prison, thus eliminating access to condoms
  • Reported widespread availability and use of drugs in prisons
  • Negligible HIV related services to prisoners on release as well as their families or significant others

Substance Abusers (including Users of Alcohol and Non-injection Drugs)

  • Individuals are unlikely to practice safe(r) sex when “high” or “under the influence”
  • Inadequate number of drug treatment slots
  • Inadequate number of needle exchange programs that incorporate drug treatment


  • Teen idleness and hopelessness
  • Inadequate parent (and other adult) teen communication
  • Media messages glamorizing sex, violence and risk taking
  • Too few peer or mutual support group opportunities that incorporate HIV related issues

After being aware of the key barriers above, communities and community groups are urged to:

  1. Select (only) one or two barriers based on their local situation and priorities;
  2. Develop strategies for action including sources for financial and other resource support;
  3. Implement the agreed upon plan of action; and
  4. Evaluate and monitor the results. This same approach is advised for the 12 key general barriers also identified in this section by Health Power.

Key HIV/AIDS Data in Racial & Ethnic Populations

HIV/AIDS Table 1: Estimated Proportion of Persons Diagnosed with AIDS in the 50 States and District of Columbia, by Race/Ethnicity through 2005
HIV/AIDS Table 2: Percent U.S. Population and AIDS Cases (50 States and District of Columbia) by Race/Ethnicity in 2005
HIV/AIDS Table 3: HIV/AIDS Trends in Women, through 2003
HIV/AIDS Table 4: Top Ten Cumulative AIDS Cases by State/Territory through 2005
HIV/AIDS Table 5: Transmission Categories and Country of Birth of Hispanics/Latinos with AIDS diagnosed in the U. S. During 2005
HIV/AIDS Report 6: Age-Adjusted Death Rates per 100,000 Persons by Race & Hispanic Origin for Human Immunodeficiency Virus (HIV) Disease: U.S. U.S., 2004
HIV/AIDS Report 7: Asian and Pacific Islander HIV Prevention Needs


Challenges of Managing HIV/AIDS and
Substance Abuse Combined

Slide Presentation by Norma J. Goodwin, M.D.
President of Health Power

Why Substance and Alcohol Treatment are Key in HIV Care:

  • Illegal drugs and alcohol are risk factors for HIV;
  • Illegal drugs and alcohol interfere with adherence to HIV medications;
  • Illegal drugs and alcohol increase the risk of side effects from medications;
  • Illegal drugs and alcohol reduce the practice of safer sex.
Substance Abuse Screening
All clients, or patients, with HIV should be screened for substance use (alcohol and drugs) at least once a year.

Tips in Assessing Alcohol & Substance Abuse:

  • Heavy smokers often also have alcohol and/or substance dependence.
  • When substance abuse is admitted, ask specific questions about injection drug use
  • Be sure to use non-judgmental language in inquiring about, and discussing substance use.


Effect of Regular Use of Methadone – An Opiate
Causes physical and psychological dependencymeaning a regular user gets withdrawal when it is stopped.

Side Effects of Methadone:

  • Possible worse effect if one has a co-infection, such as HIV, hepatitis, TB and pneumonia;
  • Development of tolerance, meaning one is less responsive to the same dose, over time;
  • Physical dependence;
  • Psychological dependence;
  • Respiratory depressions;
  • Hypertension (low blood pressure);
  • Nausea, vomiting, constipation, sedation, dizziness, edema (swelling)

The most serious side effects of methadone, which can include death, usually occur with recreational use, and not in methadone maintenance programs.

Key Antiretroviral Therapy Goals

  • Restoring and/or preserving immune function (Keeping CD4 T cells high);
  • Reducing HIV-related illness and death;
  • Limiting the risk of viral resistance, thus preserving future treatment options;
  • Maximum and sustained suppression of viral replication (Keeping the HIV blood level low);
  • Improving the quality of life
  • Integrated care is the best care.
  • Thus, care team members need experience working with individuals with both HIV/AIDS & substance use.
  • Combined (HIV/AIDS and substance abuse) treatment clients have:
    • A greater probability of relapse
    • A greater probability of having cultural variations


Basic Classes of HIV Medications:

  • NRTIs – Nucleoside/nucleotide reverse transcriptase inhibitors or “nukes”
  • NNRTIs – Non-nucleoside reverse transcriptase inhibitors or “non-nukes”
  • PIs – Protease inhibitors
  • EIs – Entry inhibitors (including fusion inhibitors)


When a Person with HIV Can be Diagnosed as Having AIDS:

According to CDC, a person with HIV has AIDS when:

  • He or she has a CD4 cell count of less than 200. The CD4 count measures the strength of the body’s immune (or defense) system. A normal CD4 cell count is 500 or above.
  • He or she develops certain serious conditions related to HIV infection. They are called AIDS-defining illnesses, such as pneumocystis carinii pneumonia or PCP, which is an opportunistic infection, a skin cancer called Kaposi’s sarcoma, cervical dysplasia or cervical cancer, and tuberculosis.
  • Another key test used today in making decisions about treating people with HIV is the viral load. Ideally, it should be undetectable. However, the level at whichtreatment may be considered is usually more than 55,000 copies/ml.

Basic Principles of HIV Treatment:

Treatment for HIV takes into consideration both the CD4 and viral load levels.

  • Highly Active Anti-Retroviral Treatment (HAART):taking 3 or more drugs at the same time;
  • Preventive medicines to avoid opportunistic infections;
  • Treatment of HIV-related illnesses; and
  • Healthy living practices, including eating healthy, exercise, getting enough sleep, stress management, and avoiding cigarette smoking, alcohol, and street drugs.

Adherence: A Key to Controlling HIV/AIDS

It is very important that people being treated for HIV always take that medications as ordered. Remember, the medications are not as bad as the disease. Also, without adherence, there is an increased chance of developing resistance.

Possible Special Side Effects of Methadone Maintenance on HIV Treatment:

  1. Some HIV medications interact, or mix, with methadone, and require a change in the dosage of methadone or the HIV medicine. Therefore, the treatment of some people on combined therapy requires more frequent lab tests or check-ups.
  2. Because methadone is an opiate, adherence may be more difficult for some individuals who are also on methadone maintenance therapy. They therefore may require more frequent monitoring, as well as more support.
  3. Because of the physical and psychological dependence associated with methadone maintenance, if detoxification is done on a person receiving HIV therapy, it must be carefully done under medical supervision, and with the active support of the entire care team.

Special Tips for Controlling HIV/AIDS:

Always emphasize:

  • Keeping Pressure on the Virus


  • If there’s not enough of the right medicine in the blood:
    HIV can continue to multiply (make copies); and 
  • If there’s not enough of the right medicine in the blood:
    Resistance can develop, thus decreasing a person’s treatment options


Another key test used today in making decisions about treating people with HIV is the viral load. Ideally, it should be undetectable. However, the level at which treatment may be considered is more than 55,000 copies/ml. PCR. Treatment for HIV takes into consideration both the CD4 and viral load levels.

  • Highly Active Anti-Retroviral Treatment (HAART):taking 3 or more drugs at the same time;
  • Preventive medicines to avoid opportunistic infections;
  • Treatment of HIV-related illnesses; and
  • Healthy living practices, including eating healthy, exercise, getting enough sleep, stress management, and avoiding cigarette smoking, alcohol, and street drugs.


Adherence: A Key to Controlling HIV/AIDS:

It is very important that people being treated for HIV always take that medications as ordered. Remember, the medications are not as bad as the disease. Also, without adherence, there is an increased chance of developing resistance.

Possible Effect of Methadone Maintenance on HIV Treatment:

Some HIV medications interact, or mix, with methadone, and require a change in the dosage of methadone or the HIV medicine. Therefore, the treatment of some people on combined therapy requires more frequent lab tests or check-ups.

Special Tips for Controlling HIV/AIDS:

Always focus on :

  • Keeping Pressure on the Virus 
  • If there’s not enough of the right medicine in the blood:
    • HIV can continue to multiply (make many more copies of the virus);
    • Resistance can develop, thus decreasing ones’ treatment options.


The AIDS Blanket (Quilt) or the Names Project:

Reminder of the HIV/AIDS Epidemic’s Destructive Impact

Perhaps the best known and most touching single symbol of the more than 250,000 people who have died from HIV/AIDS in the United States is the AIDS Blanket or Quilt, also called the AIDS Memorial Blanket.Since the AIDS Blanket was started in 1987, more than 40,000 colorful panels have been created to remember and honor loved ones who have been lost as a result of HIV/AIDS.

Now more than 25 years since the start of the AIDS Epidemic, and although the number of persons dying from HIV/AIDS has decreased markedly as a result of effective combination therapy, there are still over 40,000 new HIV infections each year in the United States. In addition, this incidence has remained the same for the past 10 years. Further, there are more than 750,000 persons in the U.S. today with HIV/AIDS. Of great concern, more than 250,000 people in this country who are infected with HIV don’t know it.

In addition to the information on HIV/AIDS in this section of our web site, a broad mix of related information can be found in “What It Means”, our glossary, such as antibody, CD4 cells, HIV tests,

immune deficiency, Kaposi’s sarcoma, lipodystrophy, lymphatic system, opportunistic infection,

risk, risk factor, and viral load,
Leading additional sources of information on HIV/AIDS are CDC’s National Prevention Information Network (NPIN) and National Center for Health Statistics. Their web sites are only one click away from our Relevant Resources section.