Sunday, December 8, 2002

Facing the AIDS challenge

Rock star Bono is calling on `the greatness of America' to save Africa from an AIDS pandemic. The impact of the disease is also being felt in Cincinnati.

By Tony Lang
The Cincinnati Enquirer

Rock superstar Bono has been mobilizing a worldwide media blitz against AIDS in Africa, but there are also plenty of homegrown reasons to take a global perspective on the epidemic.

AIDS/HIV infection is still a scourge in Cincinnati. "It has plateaued, not slowed," said Dr. Carl Fichtenbaum, director of University Hospital's Infectious Diseases Center. One of Bono's arguments for action in Africa is that AIDS drug regimens are simpler now and could save millions of lives there. That's true, but in Cincinnati, despite the more powerful drugs and a treatment center second to none, new HIV cases aren't slacking off. Infection rates have stayed steady the last five years. "We see about 200 new people every year," he said, "and 60 to 80 of those are newly diagnosed."

The AIDS stigma, whether in Cincinnati or Zambia, can still keep people from becoming informed about the risks or seeking medical treatment. People are uncomfortable talking about AIDS for a host of political or religious reasons, including the fact that some victims are gays or drug users or contract it from sex out of marriage. It's as if some hope it will go away if we don't talk about it.

A free and open discussion of AIDS is as necessary in Cincinnati as it is in South Africa to destigmatize this disease and roll back the epidemic. It is particularly important for women and people of color - the hardest hit populations here. Prime ages for infection are 16 to 30. A new cadre of young people has come along, and they seem to have missed the warnings that were prevalent five or more years ago. The medical community in the 1980s let its guard down on tuberculosis and it surged back. To some extent, a similar easing up occurred with AIDS.

Also, drug affordability and availability are not just African issues. "There's a waiting list on the Kentucky side, about 75 people waiting to get these powerful medicines," Dr. Fichtenbaum said. "Seventy-five percent of the (HIV positive) people we see at University Hospital and the Health Alliance don't have health insurance."

If the humanitarian appeal of saving AIDS-ravaged families in Africa isn't persuasive enough, there are other self-interested reasons to see this as a global, not just local, scourge. As Dr. Fichtenbaum says, when business people from other parts of the world visit, some do more than just business here. "The world is a smaller place," he said. Global companies such as Procter & Gamble suffer reverses when they encounter instability, poverty and disease overseas, and that can affect jobs here at home.

Bono is big on prevention and has seen in Africa how just delaying the age of sexual activity "really, really helps." The experts here lament that some of our schools, especially at the junior high level when young people become sexually active, avoid talking about AIDS altogether or only discuss abstinence. Dr. Fichtenbaum says Denmark and Norway where condom use is more acceptable show much lower AIDS rates.

The AIDS stigma even spills over, to some extent, to the UC research center. It's not considered wise hospital marketing to play up the AIDS center, even with UC's internationally renowned researchers such as Dr. Judith Weinberg and clinicians such as Dr. Peter Frame and 250 patients involved in research. UC's research group is one of the leading centers and has made landmark findings.

"The best hope for the world would be an effective AIDS vaccine," Dr. Fichtenbaum said. A Cincinnati researcher, Dr. Albert Sabin, did it with a life-saving polio vaccine. Experimental work here could be a godsend for Africa and the world. More people are being killed by AIDS than by terrorism. But while the world waits for a cure, there is still much we can do to push for better prevention and treatment.

Tony Lang is an editorial writer for the Cincinnati Enquirer.

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