Today the Minnesota Department of Health issued an unprecedented early press release regarding the highest level of newly-reported cases of HIV in 17 years during 2009. The increase is due to a surge of new cases amongst young (15 – 24) gay and bisexual men. So what does it all mean and what can we do? 
To begin with – keep in mind that over the past nearly 30 years of AIDS reporting, we would report each year new cases occurring (incidence), the number of individuals who have died of this disease (mortality) and the number still living (prevalence). While the number of new cases remained somewhat stable for about ten years, the number dying of HIV dropped significantly after the advent of new treatments circa 1997. That’s great news – but it also meant that the number of people living with HIV, the prevalence, was increasing rapidly – very rapidly. 
Before anyone starts finger-pointing at those living with HIV as being the modern version of typhoid Mary, keep in mind that study after study has shown, without question, that those who know their HIV status to be positive avoid transmitting the virus further. Of course there may that one or so person who doesn’t fit that description but overall we know that once a person understands that they are HIV positive, and what that means in terms of transmission, they take the steps necessary to protect others. That also means taking the steps to prevent re-infection for themselves. 
So why the sudden increase in 2009?  I believe it’s pretty simple. As a community, we have closed our eyes to the domestic AIDS crisis. As a nation, we collectively breathed a sigh of relief when the new drugs were introduced around 1997 and said, “Great, we took care of that problem.” But we didn’t take care of it – we just pushed it, and those living with HIV, to the side. While at best HIV is a life-altering disease requiring a lifetime of medication, labs and doctor visits; at worst it can be a life-ending disease. That message isn’t out there. These young people who are newly-infected came of a sexual age post-2000.  They don’t have any memory of the early days of the AIDS crisis let alone the death toll it took in this country. From a young person’s perspective today in Minnesota, HIV is a problem for people who live far away – it’s not something they need to know about. 
And during this same time period, real dollars for HIV prevention funding have declined. According to the Centers for Disease Control since 2002, HIV prevention budgets have been decreased by 20percent. And only four precentof the federal HIV budget goes for prevention – the rest is for medical care and research. 
As a society, we must do better. And we can. We can demand that HIV screening become a routine part of medical care – thus eliminating that conundrum for the physician who has to currently guess whether or not the patient falls into a high risk category and rather than offend the patient, often remains silent about HIV testing. And the patient – perhaps a closeted bisexual man – is most likely not going to request a test either from his family physician.  Second -- we must engage all of the Minnesota based GLBT groups to again raise HIV awareness amongst their constituency groups.And finally, we must educate our young people about this risk and the steps they can take to protect themselves and others. The benefit of practicing safer sex also prevents many other STD’s as well as unplanned pregnancies. 
And finally – let’s end this moralistic debate about teaching our young people about sex and how to be safe. Of course abstinence should be the first choice for a young person ill-equipped to deal with the consequences of sex. But many of our young people choose otherwiseand they need to information to stay safe. We teach our children to not play with matches – no question. We also teach them how to call the Fire Department if needed.