Beyond Education for AIDS


July 04, 1993|By SARA ENGRAM

Governor Schaefer has decided to form a new AIDS commission, this time with a narrower mission than the panel he dismissed last year. The new version will focus on prevention and education and will also deal with another infectious disease, tuberculosis.

But their efforts may not matter, unless the group takes a creative approach to those innocuous terms: prevention and education. Innocuous and, as some critics charge, irrelevant.

Why? Because education and prevention work only when the targets are motivated to protect themselves. Too many people at risk of contracting AIDS are already on the margins of society, with little left to lose.

Preventive tactics worked with gay men in the 1980s, as AIDS began to devastate their communities. Now gay men no longer comprise the majority of AIDS patients, although there are worrisome signs that younger gays are beginning to abandon precautions.

New risk groups are largely (but not exclusively) associated with intravenous drugs -- users or their families. In Baltimore, where the vast majority of the state's AIDS cases are currently found, health authorities now estimate that 25 percent of the city's 40,000 intravenous drug users are HIV-infected, with the virus spreading to four or five more users each day. Of all the city's AIDS cases, 42 percent stem directly from intravenous drug use, a higher percentage than other cities.

Sharing contaminated needles is a major risk factor for HIV infection. So is the presence of other sexually transmitted diseases, since lesions they cause seem to increase a person's vulnerability to HIV. Frequent sexual encounters with multiple partners, a pattern often associated with drug use, also increases the chances of contracting any sexually transmitted disease.

Lest you think these people deserve their fate, remember that users have spouses or other sexual partners who can be infected, and women with HIV can pass the virus to their babies. Many of the children seen today in pediatric AIDS clinics in Baltimore are the children of drug users.

When a disease like AIDS becomes prevalent in groups of people not well regarded by the larger society, it takes on a stigma that can blind the public to danger. One obvious risk is the temptation simply to write people off because they don't matter, an attitude that further damages the already tenuous ties that bind this society together.

Questioning the value of traditional prevention and education strategies does not fall into that category. Rather, these criticisms are attempts to make tough calls on the effective use of limited resources. It is simply naive to think that discreet public service announcements or even signs on buses are going bring about a permanent change in the behavior of truly risky people -- for instance, the female crack users who prostitute themselves several times a day to support their drug habit.

For most middle-class people AIDS does not appear to be a major threat now. But it is possible for the infection to spread into new groups, as it has in other countries. Americans have already seen it spread beyond gay males, the original at-risk population, and AIDS is now a heterosexual disease, particularly in poor, minority, urban neighborhoods.

Currently, there is no reliable way of testing or tracking the virus, especially in segments of the population that don't rely on public clinics. Even so, there are some worrisome signs. Some city hospitals are finding more positive HIV tests than they would expect among patients not considered to be at risk, and AIDS hotlines in the city are reporting increasing numbers of requests for information from suburban callers.

Some AIDS experts consider the country to be at a critical juncture, a point at which wise policies could contain AIDS and diminish its threat or, conversely, where the chances vastly increase that it could mushroom as it has in some African countries.

So what should the governor's new AIDS panel do?

One suggestion: Educate public officials on the connections between AIDS, drug use and sexually transmitted diseases (STDs). Right now, STD clinics in the city are so overburdened many people are discouraged from seeking treatment. AIDS exacerbates the crunch, since patients who shows up with HIV takes at least twice as long to evaluate as someone with syphilis, gonorrhea or some other easily treatable condition. Untreated, they are at greater risk of contracting and spreading HIV.

Other practical steps include more drug treatment and certainly a needle-exchange program like the proposal turned down by the General Assembly.

Sara Engram is editorial-page director of The Evening Sun.

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