EDITORIAL

Volume 5, Number 3
July-September 2000

Vol. 5, Num. 3: Contents | Editorial | Up Front | Abstracts

Editorial
Scott C. Ratzan

In the summer of 2000, few could miss the media coverage of one of the greatest challenges at the cusp of the 21st century—HIV/AIDS.  The 12,500 people convened at the XIIIth International AIDS conference helped reinvigorate the important agenda to combat a disease that has the potential to kill more than all prior wars and diseases known in human history. While a medical student, I remember HIV/AIDS as a challenge when it was first discovered and described in the 1980s.  My interest in it went beyond the traditional medical school lectures of etiology and epidemiology.  I later saw the need for a response beyond the medical model which was elucidated in a book I edited, AIDS: Effective Health Communication in the 90s.  While the 1993 publication may seem dated and focused principally for a US audience, the relevance of the first paragraph warranted republication verbatim: “The potential number of human lives—the creativity, compassion, and humanistic spirit that throughout history have prodded civilization forward—lost to acquired immune deficiency syndrome (AIDS) represents perhaps the greatest challenge as we enter the 21st century.  As communication technology webs humankind together as never before, we face an ever-growing pandemic reported in more than 152 countries worldwide, a pandemic with epicenters in the United States and Africa, with 204 and 150 cases per million respectively, which purportedly will cause more than 200,000 deaths in the United States alone.  In an era celebrated by the promise of disappearing differences and a world opting for democracy, our shared nightmare is no longer nuclear destruction, but fear of a death more heinous than any humankind has witnessed since the advent of modern medicine.  An age marked by international communication, negotiation, and cooperation must put such precepts to the test in a unified global effort to arrest the spread of the disease and to meet the ubiquitous challenges of the AIDS crisis.” (Ratzan, 1993) Clearly, the numbers have changed as the scourge of HIV/AIDS has grown in scope for the millions outside the US.  Today our approach still needs to be focused on the age old Hippocratic ideal discussed in Epidemics and later espoused by Sir William Osler: “It is much more important to know what sort of patient has the disease than what sort of disease the patient has.”  This central tenet is key to our approach to HIV/AIDS; overmedicalization will not conquer the AIDS pandemic. The recent UNAIDS supplement of this Journal released at Durban calls for a new communication strategy for the 21st Century.  Collins Airhihenbuwa and Rafael Obregon suggest incorporation of a perspective that values culture as a central construct that allows for national, regional and local differences in communication.  Ideally, these ideas can advance the dialogue so that a critical health literate public emerges that has a basic understanding of HIV/AIDS transmission, prevention, treatment and support AND knows how to effect the community in which they live. Quality communication is not just message repetition.  It must also enable an environment for community involvement to espouse common values of humankind: promulgation of the species with disease prevention along with appropriate services and support for those already infected with HIV/AIDS.  Ironically, even if the sole response is a single campaign with a “wear a condom” message, it will prevent not only HIV, other sexual transmitted illnesses (Hepatitis B, chlymadia, etc.), and unwanted pregnancies, but also the spread of tuberculosis. The critical elements that also affect health—the social, economic and environmental determinants—all require a commitment and understanding outside the laboratory.
Those of us in communication must advance health beyond the science sector and combat the HIV/AIDS pandemic through decision-making on policies, expenditures, system design and service availability. Finally, communication alone is not a simple solution to a complex problem.  Without it, we are doomed to fail.  Effective communication can lead the advance of medicine and health in this century.  The final statement of the AIDS book echoes today: “Effective health communication is our primary and most potent weapon in preventing the spread of AIDS.  Until a vaccine or cure for HIV infection is discovered, communication is all we have.”
  Ratzan, S. C. (1993). Health Communication and AIDS: Setting the Agenda in AIDS: Effective Health Communication for the 90s. Taylor & Francis, p.1.
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Scott C. Ratzan, MD, MPA is Editor of the Journal of Health Communication: International Perspectives.