Expert says AIDS toll rivals bubonic plague

Q&A

August 24, 1993|By Holly Selby | Holly Selby,Staff Writer

Dr. Michael L. Levin listens to the concerns and fears of people with AIDS routinely in his private practice. A founder of the division of infectious diseases at Sinai Hospital of Baltimore, he has been active in HIV and AIDS research and treatment since the 1980s.

Last week, the associate professor of medicine at both Johns Hopkins and the University of Maryland medical institutions was named chairman of the Mayor's AIDS Coordinating Council, a 6-year-old body of 50 health professionals, activists and people with AIDS, appointed by the mayor.

In the metropolitan area, where 3,704 people have been diagnosed with AIDS and about 70 percent of these people are intravenous drug users, Dr. Levin and his council are charged with assessing the needs of the AIDS community and with coordinating private and public efforts to fulfill those needs.

QUESTION: In Baltimore, is the spread of the AIDS virus slowing or increasing?

ANSWER: In the next two years, worldwide, we will pass in numbers the toll that the bubonic plague -- the deadliest plague so far -- has taken.

In Baltimore, the numbers [of people infected with HIV] are increasing, and they are increasing in populations of people who are disenfranchised -- those who are drug addicts, who are black, heterosexual and female.

People who think it's "them," not "us," are wrong. AIDS is affecting more than the gay, male population. It is affecting the heterosexual population.

Q: As the chairman of a committee that does not receive funding itself, what can you realistically hope to accomplish?

A: Since funding is limited, we should concentrate on two things: education and access to care.

We need to focus. First, we need to speak to the City Council -- if you want to call it an AIDS 101 course, that's OK.

What we want to demonstrate is the impact on their constituents, to demonstrate the amount of money that will be expended in care on this burgeoning problem.

If they can be convinced that their espousal of this problem as a cause will help and can be convinced to continually verbalize their support of AIDS prevention as a cause, this will show people it is a problem for all of us.

My understanding is that no city funds are given toward AIDS -- there are "Ryan White funds," [Ryan White Care Act, which provides federal assistance for AIDS and HIV victims] but they come from the federal and state government and then are disbursed by the city. But there is not City Council funding for AIDS -- when they can see how [funding AIDS programs] can save money in the long run, perhaps this will change.

Q: What kinds of education are you talking about?

A: We need to have education in an informal way across the media: Whether it's a sound-bite on TV, signs written in restrooms, owners of gay bars handing out condoms, whether we get drug users to speak to other drug users, whether it's in churches.

Anyplace we can reinforce the message -- and it doesn't have to be contrary to religious views -- that if one wants to abstain from sex, that's fine, but if and when one chooses to have sex, one needs to be educated.

Q: In what ways could the council promote HIV/AIDS education?

A: We need to convince corporations to be more visible in their support. I don't think people realize that AIDS will affect employers. One can't have a corporation of thousands of employees and not have at least one HIV-positive employee.

We are beyond not knowing anyone with AIDS. Everyone knows someone or knows someone who knows at least one person with AIDS and the question is: How do we challenge corporations to educate their employees?

It has now become recognized that things like alcoholism and addictions costs corporations in sickness and in no-shows -- AIDS prevention and help will also pay off.

Q: What did you mean when you said better access to care is a committee goal?

A: We are talking about a group of people who are not getting care. For example, there are people who don't get primary care, who don't go to the doctor -- and who are HIV-positive but don't know it.

If they are intravenous-drug users, if they have sex with men or women, they are continuing to infect others through high-risk behavior.

A Hopkins study showed that black males in Baltimore with AIDS die faster than elsewhere. That's either because many black males who are infected with HIV have no access -- or choose to have no access to health care. So, when they become sick and finally have to seek care, it's late.

Q: Last week, at the first council meeting you presided over, council members voted nearly unanimously to support Mayor Kurt L. Schmoke's idea for a needle-exchange program. Why can a needle-exchange program be effective in prevention of the spread of HIV?

A: People were concerned that we would increase drug use if there were needle-exchange programs -- that we were supplying drug users with equipment to abuse drugs. But studies have shown this isn't the case.

First, there's a General Accounting Office report that needle exchange programs elsewhere showed a 33 percent drop in the spread of HIV in intravenous drug users.

There are cities that have tried these programs and have shown that this is a way to expose these people to contact with health-care workers.

This is a population that is very hard to reach, and the health-care workers aren't just handing out needles; they're passing out information, making contacts with these people.

It's 1993, and it's recognized that this idea is not a liberal or conservative approach. We're all fighting for the same goal.

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