Cost of epidemic, in money and lives, continues to rise along with rate of new infections, amid criticism of government policies, focus on abstinence-only education
A quarter of a century has passed since the first case of AIDS was recognized in the United States. At that time, the LGBT community united to support each other through decades of death, grief and recovery.
Now, even though the media spotlight has moved off of the HIV/AIDS crisis, the virus has continued to simmer on the back burner.
This year’s World AIDS Day message calls for accountability.
“This is the longest lasting epidemic in written human history,” said Raeline Nobles, executive director of AIDS Arms. “People have heard the message for 25 years, and I think folks tune it out after a while. HIV tends to wait for those opportunities. As soon as a community lets it guard down, the virus attacks.”
Locally, a significant number of new HIV cases are identified every year, according to Dr. Steven Wilson, medical director of the HIV/STD division of the Dallas County Department of Health. The county has been keeping track of the numbers since 1999, he said. Wilson believes that increased access to testing is partly responsible for the numbers, as well as a higher rate of infection among young people.
“Each individual needs to take responsibility for their own health and their partner’s health,” Wilson said in a phone interview. “They need to get tested and be accountable, so they don’t unknowingly pass it on.”
Nobles said that young people realize HIV is treatable today, and therefore take it less seriously than their older peers who watched their friends waste away with the disease. This, compounded with an innate sense of youthful invincibility, has resulted in a higher rate of infection among men who have sex with men (of any sexual orientation) and women who have heterosexual or anal sex without protection.
“When we do outreach, we try to tell a story about how HIV causes poverty and the side effects of the drugs,” said Nobles during a phone interview. “Life on meds is not easy. It’s like being on chemo for the rest of your life.”
The expense of the drugs, combined with difficulties to maintain unemployment, can create significant economic hardships for people living with HIV/AIDS, according to Don Maison, president and CEO of AIDS Services of Dallas. Many people end up homeless because their health expenses soak up all of their resources.
“I have no scientific proof of this, but housing is the most important resource,” Maison said. “People on the lower end of the economic scale tend to fall off that ladder first.”
AIDS Services of Dallas houses more than 1,500 families in three units. Because tenants live longer, fewer units have been available for new people with HIV/AIDS.
The non-profit has recently taken control of their target list from the county, which enables AIDS Services to serve the neediest population, Maison said. There are still deaths, he said, but more and more people have to deal with quality of life problems, like long-term permanent damage to the brain and nerves from medications.
“Pictures of mountain climbers from pharmaceutical companies we don’t have anybody like that here,” he said.
At the Resource Center of Dallas, Sheryldine Samuel-Fall, the HIV/AIDS nutrition/education program manager, has noticed more African-American women, young people and heterosexuals needing services, as well as men in their 30s who have sex with men, but are not openly gay.
She believes that some young women choose to have anal sex to preserve their virginity but don’t use protection because they can’t get pregnant through anal sex. There have also been higher rates of infection in the northern suburbs recently, she said.
“We try to encourage young people to get tested,” said Samuel-Fall. “The more you know, the more you can do.”
According to the National Minority AIDS Council, AIDS is ravaging the African-American community. African-Americans, 13 percent of the national population, constitute half of the new HIV diagnoses and 55 percent of the people dying from AIDS, according to a report released by the council in November.
The report noted that HIV/AIDS is among the three leading causes of death for African-American women, and that incarceration has been a major source of the disease for African-American men. And it listed a five-point plan to combat HIV/AIDS within the African-American community.
A White House spokeswoman in the Office of Media Affairs declined to comment on how President Bush will address the council’s concerns. She would neither provide her own contact information, nor information for reaching the Office of National AIDS Policy, which has been without a director since February 2006.
In Dallas County, new inmates are tested for syphilis and HIV. People work every day in the jails doing education and testing, according to Wilson.
AIDS Outreach of Greater Tarrant County works with the prison system to get new releases tested and into services upon release, said executive director Dara Austin.
According to the AIDS Epidemic Report released by UNAIDS, 39.5 million people are living with HIV, 48 percent of whom are women. Although rates of infection have subsided in East Africa, the disease continues to spread rapidly in sub-Saharan Africa, where women make up 60 percent of the cases.
Mary Robinson, founder of the Ethical Globalization Initiative and former president of Ireland, contends that gender-based violence is responsible for the prevalence of the disease in African women.
Young girls are sometimes forced by their teachers to have sex for grades, or they must exchange their bodies for food, she said. Also, many African men still believe the myth that having sex with a virgin cures the disease, accounting for a high prevalence of infection among young girls.
On a trip to Kenya, Robinson was told that many children do not have adequate food to tolerate the harsh regimens of medication.
“It’s a very holistic problem,” she said during a press teleconference. “There needs to be nutrition as well as medicine.”
The pandemic has taken foothold in Eastern Europe and Central Asia, according to the UNAIDS report. North America and Western Europe have continued to see infection rates rise. In 2006, 2.9 million people died of AIDS-related illnesses, the report said.
Federal funding for the global fight against AIDS has been a contentious issue for many AIDS activists. Dr. Paul Zeitz, executive director of the Global AIDS Alliance, said that one-third of all U.S. prevention money goes to abstinence-only education. He said that this policy is not working, but hopes that the new Congress will work on a bipartisan level to create more effective support.
Still, Francis Omaswa, executive director of the Global Health Workforce Alliance and a Ugandan physician, doesn’t think abstinence should be taken out of the picture altogether. He said that because of abstinence efforts in Uganda, the average age of sexual initiation has moved from 14 to 16.
“We need to eliminate competition for the different modalities of prevention,” he said during the teleconference, “and utilize them all.”
Marcel van Soest, the executive director of the World AIDS Campaign, which heads the World AIDS Day message of “Stop AIDS: Keep the Promise,” said that more work needs to be done to achieve universal access to care. Last June, the UN General Assembly recommitted to universal access to treatment by 2010, first proposed by the Group of Eight (G8) leaders in 2005. These countries are: Canada, France, Germany, Italy, Japan, Russia, the United Kingdom, and the U.S.
According to the World AIDS Campaign, expanded access to treatment saved 250,000 to 350,000 lives, but still only one in five people have access to antiretroviral drugs.
“Promises are not being kept,” said van Soest. “We need a radical change to make universal care a reality.”
Local AIDS activists stress the importance of remembrance and the ongoing need for compassionate care. Although the disease has become a chronic mark on the modern human condition, people need to continue to fight against it.
“You have to stay invested. It has ramifications on all of our infrastructure as a society,” said Nobles. “We all know somebody living with the disease. We can do something about it.”
This article appeared in the Dallas Voice print edition, December 1, 2006.