The Minnesota Department of Health just released theirHIV/AIDS Surveillance Report for 2008. The report documents 326 new cases ofHIV infection reported last year – one new case every 27 hours. I've beenfollowing these reports since 1986 – the year my first friend tested positivefor HIV.

The early years of the AIDS epidemic were horrific for myfriends who were diagnosed in the 1980s. Some lost their jobs and their homesand filed for bankruptcy. Most became estranged from family members. Forothers, their religious leaders abandoned – and sometimes condemned – them.Many did not live to see the introduction of life-sustaining anti-retroviralmedications.

But the 326 Minnesotans who were diagnosed with HIV/AIDSlast year have to confront something that my friends, who are now long dead,never had to deal with. These individuals became positive decades after welearned what behaviors cause the transmission of HIV and how to preventbecoming infected. With the general public today there seems to be littlesympathy – and perhaps no empathy – for those who have recently become infectedwith HIV. After all, new rates of HIV infection could be dramatically reducedif everyone followed the ABC model of AIDS prevention: Abstain, Befaithful, and use Condoms. Like all diseases that have a behavioralcomponent, however, it just isn't that black and white.

As my 88-year-old mother says, you only need look at all theunplanned children in the world to see that abstinence alone doesn't work – notas a form of birth control and not as an effective method of reducing thespread of sexually transmitted diseases. Monogamy is effective – but only ifboth partners practice it. Condoms work. They prevent the spread of HIV/AIDS.Still, some men resist using them and the cost and availability of femalecondoms have made this option less accessible for women.

There are factors, unrelated to education and outreachefforts, which contribute to the spread of HIV/AIDS. The use of alcohol anddrugs can cloud ones judgment and result in high risk behaviors. Young people oftenview themselves as immune from bad things ever happening to them andconsequently take chances. Others think that the medical advances in thetreatment of HIV/AIDS make this a manageable disease. They are under the falseimpression that if you contract the disease you just take a pill and go on withyour life as normal.

But there is another underlying issue that some people whohave been newly diagnosed with HIV/AIDS have talked with me about, and it hasto do with self-esteem. Time and again, women and men of varying age, race andsexual orientation, have told me that a negative self-image – feelings ofworthlessness, isolation, and deep loneliness – translated into them engagingin sexual behavior that resulted in them contracting HIV. Immediate humancontact, sometimes with the possibility (or fantasy) of a relationship, madeengaging in unprotected sex a risk worth taking for some.

Now, I'm not so naive as to believe that if every person wasself-actualized that we would see the elimination of HIV/AIDS. Iam suggesting, however, that as long as there are people – who intentionally orunintentionally – tell individuals or groups of people that they matter lessthan others, or that they don't matter at all; we shouldn't be surprised ifnext year's surveillance report shows yet another increase in new HIV/AIDScases in Minnesota.