AIDS Isn’t ‘Leveling Off’ : Health: Our preference for mythical good news blinds us to the reality of countless people living in the gray zone of approaching illness.
The AIDS epidemic “appears to be over.”
This is good news for the majority of Americans who accept it, and a further devastation for the hundreds of thousands who will lose their health, their dignity and their lives over the next five years.
Last month, there were news reports proclaiming the discovery that, nationally, AIDS was spreading at a slower rate; in Los Angeles County, the rate had not risen. Whether through indifference, or disdain for the affected groups, or the protective urge to deny the horror that lies ahead, countless people took those reports as news of a turning point marking the epidemic’s slowdown. This is tragic.
It is estimated that more than 120,000 persons in Los Angeles County have been infected so far with HIV, the human immunodeficiency virus, and studies have shown that about half of the people infected for 10 years develop full-blown AIDS. Since the peak years of infection are believed to have been 1983-85, and the median interval between infection and diagnosis is seven to 10 years, we are indeed right now on the edge of the cliff: Tens of thousands of county residents may be diagnosed with AIDS in the next three to five years, if no major therapeutic intervention or cure occurs by then.
Why, then, does a false sense of security prevail?
The county health department presents its AIDS statistics on a bar graph. The most recent shows a leveling off of new diagnoses of full-blown AIDS since the first half of 1987. What the graph doesn’t (but should) disclose right next to this “flattening of the curve” is that two major interventions occurred in that half-year period: The drug AZT was approved in March, 1987, and health-care providers began the widespread use of medication to prevent pneumocystis pneumonia, the major cause of a diagnosis of AIDS.
The “slowdown” of new AIDS cases means that early intervention can delay progression to AIDS--but the numbers of HIV-infected persons approaching illness continue to swell.
Ask the providers of primary care to the HIV-infected if there seems to be a slowdown. I work in an HIV setting that is seeing four to five times the number of patients it did in early 1987. Ask those who work at the county’s major AIDS treatment facility, and they will tell you that patients receiving major chemotherapy are so numerous, they must be treated on chairs in the hallway. Ask those who work at AIDS hospices, and they will tell you how many persons die while waiting to get in.
The sad reality that we on the front lines face is that the myth of the slowdown is an easy, and preferred, one to believe. People can point to the leveling off of new cases; to a lower estimate from the Centers for Disease Control of the number of HIV-infected persons to the lack of an AIDS explosion into the heterosexual community, and to longer survival times after a diagnosis of full-blown AIDS.
Even within the primarily affected communities, the myth’s appeal as a denial mechanism looms as an epidemic within the epidemic. In Seattle’s King County, several years of lower incidence of sexually transmitted diseases in gay men is undergoing reversal; apparently some felt that the epidemic had spared them and began to engage in higher-risk activities.
Within the black and Latin communities, where the focus of the epidemic will be through much of the 1990s, according to epidemiologists and early statistical trends, major complications loom in the problems, yet to be addressed, of cultural differences and lack of access to the health care system. These factors are behind the suspected under-reporting of AIDS cases in local minority communities, which in turn is probably a factor in the apparent leveling-off in numbers.
A somewhat ironic, if not cruel, joke in this entire epidemic is the public’s putting its faith in the myth just when we should be gearing up for the terrible reality ahead. We now have a temporary reprieve in the intensity of numbers of new cases. This is the time to prepare for the major battle when the thousands who have bought more time of reasonably good health themselves become ill. This is when we need to arm our health-care system, already cracking under pressures ranging from a severe nursing shortage to physicians who charge patients for tests not needed and perhaps never done.
The people who set public policy--the county supervisors, the governor and the President--must hear the concerns of those of us who work with HIV every day, so that we don’t have a devastating slowdown of funding to match the mythical slowdown of cases. Particularly in this city and county so involved with the catch phrase of “disaster preparedness,” we had better heed the warning signs of the catastrophe that is sure to come.
