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A Matter of Health

Battles fought valiantly, but a war not yet won

by Ruth SoRelle, M.P.H.

Nearly a quarter of a century ago, a report of a new disease appeared in the U.S. Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report. That June 5, 1981, report discussed cases of Pneumocystis carinii disease – a deadly lung ailment – in five young men in Los Angeles.

It does not seem like 25 years and yet, in some ways, it seems longer. Many people have spent their careers in the AIDS fight – among them Wayne Shandera, M.D., who as an officer with the Epidemic Intelligence Service of the CDC investigated that first outbreak, although his name does not appear on the first report. Shandera is now an assistant professor of medicine at BCM and still involved in fighting AIDS and other infectious diseases.

In the United States and Western Europe, drugs specially crafted to fight AIDS (acquired immune deficiency syndrome) and HIV (human immunodeficiency virus) save and extend lives. Education has reduced the rate at which the disease has spread throughout the population.

If we could close our eyes, we could pretend that the crisis is over. Not only would that be foolish, it would be wrong. While the most recent report from UNAIDS/WHO (the World Health Organization) points to some countries where the rate of infection has decreased and behaviors have changed, the disease is still spreading worldwide and at an even greater rate. The infection rate in the African nation of Kenya has gone from 10 percent in the late 1990s to 7 percent in 2003. In Zimbabwe, infections in pregnant women decreased from 26 percent in 2003 to 21 percent in 2004. Similar decreases have been seen in another Africa nation, Burkina Faso.

Yet, there were an additional 5 million new infections in 2005, worldwide. The number of people living with HIV has reached its highest level – 40.3 million, up from 37.5 million estimated in 2003. So far this year, more than 3 million people have died of AIDS-related illnesses and more than 500,000 of them were children.

Sub-Saharan Africa continues to be the area most affected, with 64 percent of new infections occurring there. Yet, the steepest increases in the rate of infection occurred in Eastern Europe and Central Asia – a new cause for concern.

Access to HIV treatment has grown over the past two years with more than 1 million people in low- and middle-income countries on anti-retroviral treatment At Baylor College of Medicine, Mark Kline, M.D., has fought to bring potent anti-virus drugs to children in some of the countries that are hardest hit through his Baylor International Pediatric AIDS Initiative. On Dec. 1, 2005, the number of BIPAI clinic grew by two with one opening in Lesotho and the other in Swaziland – two Sub-Saharan nations where the disease is taking a ghastly toll. To learn more about his programs, go to http://bayloraids.org/.

If the lessons of BIPAI teach us anything, it is that ignoring a problem does not solve it. And just because a problem seems overwhelming does not mean that we can throw up our hands and refuse to help. BIPAI is saving thousands of lives, and each of those is precious. Every child and every adult with HIV whose life is extended by bringing new treatments to poor countries is human potential salvaged for the future. It is more than a good work. It represents the best that humans can do.

Much remains to be done. New drugs, and hopefully, a vaccine will come from labs around the world seeking to solve this inexorable problem. People like Kline will try to translate the developed world's successes into an area of the world where such treatments are only rarely available. Others will work to prevent new infections.

As the report from the WHO and UNAIDS states, the transmission of the virus from mother-to-child has been virtually eliminated in the United States and Western Europe. Yet this kind of prevention, using highly active anti-retroviral drugs, is not uniformly available in places like sub-Saharan Africa. Even more strikingly, the messages about the relationship between unsafe sex and transmission of HIV have not yet been conveyed universally. The report states that in 24 sub-Saharan countries, young women did not full understand how HIV is transmitted. In Latin America, the Caribbean, the Middle East and North Africa, attempts to keep track of HIV infections is making it much more difficult to spread the prevention message and means that those most at risk of becoming infected with HIV or passing the infection on are also the least likely to receive the prevention message.

Those who remember the AIDS epidemic in this country in the late 1980s and early 1990s also remember the song of denial among those who thought that refusing to discuss the modes of transmitting HIV would somehow prevent it from happening. And we counted our failures daily in obituaries and memorial services. HIV is transmitted through unprotected sex with an infected person, through sharing needles and other drug paraphernalia that comes into contact with blood or other bodily fluids, through transfusions of infected blood and from mother to child, when the mother does not receive the treatment that can prevent the virus' passage.

Dec. 1, 2005, is World AIDS Day, and it is clear the AIDS epidemic is not over. And it will not be over for a long time. We can mitigate its effects by doing what we can to provide treatment to those who might otherwise not get it – in the United States and around the world – and by telling the truth and taking straight forward steps to halt the transmission of HIV.

The UNAIDS/WHO report is available at http://www.unaids.org/epi2005/index.html.

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