( CNN ) -- This week , we hosted a renowned expert in HIV/AIDS care currently practicing at a hospital known for serving the poor and vulnerable in New York . It was her impression that there has been a dramatic decline in the number of hospitalized patients living with HIV . Presently , in fact , the hospital is considering closing the service that cares exclusively for these individuals because of the small number of admissions . Those of us involved in the care of individuals with HIV in Atlanta were amazed . At Grady Hospital and the Ponce de Leon Center , which is our outpatient HIV/AIDS clinic , we remain busy seeing newly diagnosed individuals with AIDS , particularly presenting with late-stage disease and afflicted by the classic infections and cancers so common 30 years ago , when HIV was first described . This month , Secretary of State Hillary Clinton gave a moving address at the National Institute of Health calling for an AIDS-free generation , and the theme of World AIDS Day on December 1 was `` Getting to Zero . '' Recently released data have shown a dramatic 96 % reduction in transmission of the HIV virus between individuals when the infected partner is on antiretroviral therapy , leading to the concept of `` treatment as prevention . '' Treatment regimens are simpler : Active medication regimens once exceeded 20 pills daily , yet now a single pill once a day can control the virus . Nearly three dozen medications have been developed and are effective at decreasing mortality and improving quality of life . Mathematical estimates suggest that an individual diagnosed with HIV infection today , while still healthy , can live as long as an uninfected individual . However , the fight is far from over . Although enthusiasm remains high , an effective vaccine is still out of reach . In the absence of a cure , lifelong treatment is required . But perhaps an even more disturbing question remains : Why do our patients in Atlanta resemble those who we saw on the medical wards in the early 1990s or see now in resource-limited settings , moreso than outpatients treated in New York today ? Despite tremendous progress , HIV/AIDS infections in the Southeast continue to rise . Nearly 50 % of all AIDS cases annually are reported from Southern states . Among adults aged 20-24 ( the fastest-growing age group to become infected ) , Georgia has 81.3 individuals with HIV infection per 100,000 population , compared with 58.6 per 100,000 in New York . Several important studies have documented the key risk factors associated with transmission of HIV , and all of them highlight social disparities . In the South , these disparities appear to be the most severe . According to the United Health Foundation 's health rankings , the region ranks lowest in the nation in `` overall health . '' Structural and socioeconomic factors play a significant role . Poverty , education and literacy , access to health care , unemployment , homelessness and food insecurity all contribute to poorer health outcomes . A recent study that examined outcomes in patients identified with early HIV infection found that a risk factor for development of AIDS was residence in the South . Furthermore , resources are scarcer for patients in the South . For example , federal support is based on the number of cumulative cases of patients with HIV or AIDS rather than the development of new cases , penalizing states with later epidemics ( like the South ) and those whose policies did not support early reporting of cases of HIV . Medicaid income eligibility is based on individual state policy . In the South , the income cutoff for eligibility is lower on average than elsewhere and is a fraction of the federal poverty level , leaving many without the ability to access this medical help . State health departments are often poorly funded or organized and do not have the same strong infrastructure and reporting capabilities that have been highly successful in Washington , New York and San Francisco . AIDS drug assistance programs in the South are underfunded , limiting access to life-saving medications for patients . In Georgia , which has the second-longest wait list in the country , patients may be less able to access medications for life-threatening AIDS complications than those in the developing world . Americans often turn a blind eye to the problem of AIDS in the United States . The message has been that the epidemic is nearly over . Even middle-class residents in Atlanta are unaware of the scope of the problem in their own city . There is denial that such striking health disparities can exist in one of the richest nations in the world . This disenfranchised population does not have the same political voice that the organized gay community had in the early days of the epidemic , when FDA drug approval policies were adjusted to help more patients get access to medications faster . Our patients feel stigmatized and are afraid to be seen entering the building where our clinic is located . Yet globally , the devastation from the disease receives attention not bestowed on the epidemic located a few blocks away . We are 30 years into this epidemic . How will we reflect upon the next 30 years ? Will we say that we halted this disease from eliminating an entire generation in Africa ? Will we remind ourselves of how the subcontinent of India was brought to the brink of disaster , only to be diverted by a worldwide effort to prevent and treat infections ? Or will the already-devastated inner-city neighborhoods and poor rural communities across the United States sink into greater despair ? Will we bear the guilt for so many lost lives that could have been saved ? In our opinion , both missions must be addressed , not one at the expense of the other . If an AIDS-free generation is to be realized , then we must not forget the disease within our own borders . Can we watch our neighbors suffer when the medical knowledge exists to change their future ? Facing this challenge is no small feat . There are signs of hope . For example , the Centers for Disease Control and Prevention has initiated the Enhanced Comprehensive HIV Prevention Planning Project for 12 municipalities , including Atlanta and Miami , for efforts to reduce HIV infections , link patients to care and reduce disparities . Yet this is only a beginning . Basic issues such as poverty , education , housing and safety need to be addressed . State and federal lawmakers must understand that basic health care is a requirement and will require money . One of our patients is a 33-year-old mother infected with HIV . She has taken her medications faithfully since her diagnosis and has been back at work for several years . She wants to raise her children to be happy , healthy and productive members of society . Her work insurance policy recently changed . Now her insurance will cover only one prescription per month ( maximum $ 200 ) . Her regimen requires three medications , which exceed $ 1,500 a month . State support and prescription assistance programs are restricted to those without insurance . She makes $ 1,800 a month , which she must use to pay rent and utilities , and feed and clothe her children . She can no longer afford the medications that keep her alive and give her children a mother . This is a tragedy that we should not be willing to tolerate in a society that values social justice and human rights . Take action now by encouraging your congressional representatives and political leaders to keep their promise on AIDS , increasing awareness in your own community , volunteering and/or giving to charities that support such efforts and sharing words of solidarity and compassion with those people most affected by this disease . The opinions expressed in this commentary are solely those of Wendy Armstrong and Vincent Marconi .
Nearly 50 % of all AIDS cases annually are reported from Southern states . Right now , a single pill once a day can control the virus . 96 % reduction in transmission when infected partner is on antiretroviral therapy .