HIV Surveillance: The conscience of the epidemic.

Abstract

[1]. The report of five homosexual men with a rare pneumonia was presented as a case series, but, in retrospect, established a working surveillance case definition for a new disease. Dr. James Curran, the scientist who led the CDC team for that MMWR report, later oversaw the US HIV surveillance system for many years and has famously called HIV surveillance “the conscience of the epidemic”. Dr. Curran’s statement (like all good truisms), works on many levels. In its simple context, HIV surveillance data on counts of cases have been objective measures of our challenges and our successes in responding to the epidemics in many countries throughout the world. Surveillance data, objectively presented and interpreted, should be used as guideposts for determining how prevention resources can be best allocated, and for planning what resources will be required for those living with HIV. On another level, our current understanding of surveillance data describing the extent of late diagnoses and health disparities by gender, poverty, and race in HIV epidemics speak to the obligations of our communities to address issues of prompt access to HIV testing, treatment and care, and attention to the socio-economic factors that are critical drivers of many HIV epidemics. Through the decades, HIV surveillance systems have informed our increasingly detailed understanding of the disease in populations, and advances in understanding of the transmission dynamics of the infection and its management have driven refinements in the surveillance systems [2]. As public health activity evolves--to embrace new technologies, to address new challenges (e.g., resistant HIV), to investigate new approaches to old challenges (e.g., health disparities), to expand into new ways of discharging essential functions (i.e., assuring linkage and retention and the quality of HIV care) – the surveillance foundation supporting it has to evo-lve as well. Surveillance approaches have arisen that are suited to the epidemiologic conditions, public health infra-structures, and resources available in diverse regions of the world. In some countries, especially those with generalized