25 years later, AIDS still a concern

Dressed in full battle gear, William O’Brien was petrified as he prepared to wage war on a deadly microscopic enemy lodged in the bloodstream and cells of some of his patients.

The scene was a University of California at Los Angeles medical clinic in 1981. Young gay men and intravenous drug users were wasting away before O’Brien’s eyes. Panic was setting in among the gay community and even in the ranks of seasoned medical professionals.

On June 5 that year, the U.S. Centers for Disease Control and Prevention introduced this mysterious ailment to the world, in a report about the deaths of five gay men in Los Angeles from a “rare” pneumonia.

“We knew it was an infectious disease, but no one knew if it was spread like a cold or something else,” recalled O’Brien, who was seeing dozens of patients suffering from the ailment, dubbed gay-related immune deficiency.

“We wore masks and gowns and two pairs of gloves just to go in to examine a patient in an isolated, protected room and never really touched them directly. The unknown — seeing relatively healthy young men get sick and die — was terrifying to everybody.”

The Disease Gets A Name
When the disease finally had a name — Acquired Immune Deficiency Syndrome — in 1982 and it was determined that it was transmitted sexually, by sharing a drug needle or even a blood transfusion, the nation became consumed by the illness for the rest of the decade. By then, it was too late to prevent fear, apprehension, ignorance and homophobic outrage from spreading across the country.

HIV, the virus that caused AIDS, was public enemy No. 1.
“In those early years, people would come in for my care, and I would watch them get sick, lose weight and die. It was so discouraging,” said O’Brien, now a professor and chief of the AIDS pathogenesis research program at the University of Texas Medical Branch in Galveston. “For the first time, a sexually transmitted disease could kill you.”

Twenty-five years after the CDC reported those first cases, O’Brien, like many senior medical researchers and clinicians around the world, is still battling this viral killing machine. More than 500,000 Americans have died from AIDS, among 25 million deaths from the disease worldwide, according to United Nations estimates.

Taking time during an interview to reflect on this 25th anniversary of the emergence of the AIDS epidemic, O’Brien said the early discouragement and confusion have given way to a sense of purpose and tantalizing research and pharmaceutical breakthroughs that hint at the development of an HIV vaccine. So-called HIV “cocktails” combining multiple drugs designed to suppress the virus are allowing infected people to keep symptoms at bay and live far longer than was ever deemed possible in the 1980s. Today, only 300 U.S. children are born annually with HIV, down from a high of 2,000 a year in the mid-1990s.

Growing Frustration
And yet there is a growing frustration trickling down from the halls of the CDC, the nation’s Atlanta-based medical think-tank, to the ranks of local social workers and health care providers, the foot soldiers in this ongoing war.

That frustration is born from one salient statistic: Every day in this country, more than 100 people are still becoming infected with HIV, adding to the ranks of the more than 1 million HIV-positive U.S. residents.
In Texas, 50,933 people were known to be living with HIV/AIDS in 2003, a 55 percent increase from 1999. That is 164 out of every 100,000 people. And every week in Galveston County, new infections turn up in laboratory trays when patients are tested for the presence of HIV in their bloodstreams.

Nearly 160 new HIV infections were reported in the county between 1999-2005. As of Dec. 31, 375 county residents were living with full-blown AIDS, according to state records. Since statistics on HIV began to be accumulated in the county in 1983, 501 people have died from AIDS.

African Americans Affected

What’s more worrisome is the fact that the face of HIV/AIDS has changed. It is no longer just the white gay men’s disease. It is also quickly becoming a heterosexual scourge, particularly affecting African Americans.

Between 2001-04, according to the CDC, blacks accounted for 51 percent of all new HIV diagnoses in a survey of 33 states where blacks represent only 13 percent of the population.

In 2004, the HIV diagnosis rate among black males — 131 per 100,000 people — was the highest of any group measured. That rate of new infections was almost twice as high as the next group, which happens to be black females (67 per 100,000). Next were Hispanic males (60 per 100,000), while white males were near the bottom of the infection list (18.7 per 100,000).

White females had the lowest infection rate of all groups measured, 20 times lower than that of black females. In 2002, HIV was the No. 1 cause of death among black females aged 25-34.

Shifting Demographic

“The message,” according to O’Brien, who represents UTMB at high-level AIDS conferences around the world, “is that we have to pay more attention to prevention. The availability of the cocktail has made some young people feel they don’t have to be so careful (during sex) because if they get infected they can just take (the drugs). The thing is, this is a preventable disease. Prevention and treatment should go hand in hand. One should not be sacrificed for the other.”

Georgia Nelson has seen the disease’s shifting demographic firsthand. The director of operations at the Galveston-based AIDS Coalition of Coastal Texas — which has more than 260 clients living with HIV/AIDS in a three-county area — said those clients now include almost as many women as men, and just as many heterosexuals as homosexuals. And definitely, she is seeing more African-American clients.

“I don’t know if we’re winning the battle,” said Nelson. “Certainly gay men seem to have gotten the message, but that message (of prevention) needs to be targeted at the rest of the population. There is no cure for this, and it’s still out there. Just because it’s not in the news as much, people think it’s gone away.”

Disease Of The Week
Indeed, AIDS is no longer in the headlines every day, supplanted by newer, sexier and supposedly scarier scourges such as the bird flu. While some Third World countries seem overwhelmed by AIDS due to a lack of financial and medical resources, the disease has fallen away from public consciousness in this country.

“HIV used to be the disease of the week,” recalled Kurt Koopman, spokesman for the Galveston County Health District, who was HIV project director for the agency for 10 years. “It needs to be back on the front burner.”

Indeed, the fact that new infections are showing no sign of slowing down is particularly alarming to the CDC, which has called for more HIV testing to be done on individuals nationwide.

On May 5, during a media teleconference, Kevin Fenton, director of the agency’s National Center for HIV, Viral Hepatitis, STD and TB Prevention, urged the country “to fight complacency at every turn. The inescapable truth is that to defeat AIDS here and abroad, we need to reduce the number of people who become infected in the first place. Twenty-five years since the epidemic, prevention is the only cure we have for AIDS.”

CDC Targets Prevention
The CDC will spend about $650 million during fiscal year 2006 to target HIV prevention. That nationwide effort will focus on proven behavioral interventions aimed at emerging high-risk groups, notably African-American women and men who have sex with men. In addition, it will continue to pump money into research and clinical trials of innovative biomedical approaches to prevent HIV transmission.

“The younger generation has not seen or heard about the constant death and dying of 20 years ago. They don’t understand that this is still very serious,” said Kenny Gray, an AIDS Coalition caseworker who has been infected with HIV since 1989. He believes that more effort needs to be placed at the grassroots level to tell people that there are two ways to prevent the spread of HIV: abstinence or the use of condoms.

“Some people still seem to think it’s only a gay disease. I’m worried that so many people seem to be in denial about (getting HIV) or still don’t even understand how it is transmitted. One person told me they contracted it because an HIV-positive person made them dinner.”