COMMENTARY ON AIDS : Community Effort Is Imperative in Halting Spread of Disease : In the ongoing campaign to curb transmission, we must not be sidetracked by the specter of new, AIDS-like viruses.
The recent international AIDS conference in Amsterdam highlighted the devastating and complex aspects of this disease. Considerable attention at the conference and in the press was given to several cases of an AIDS-like illness where laboratory evidence of infection with HIV is lacking.
At about the same time in Orange County, the Health Care Agency’s statistical section released a report summarizing the leading causes of death among Orange County residents for the three-year period of 1988 to 1990. The report showed that AIDS increased from the 11th-leading cause of death in 1988 to the eighth in 1990. For those aged 25 to 44, there were more deaths from AIDS than any other cause.
Surprising as this may seem, the trend was predictable and illustrated how Orange County, with 1% of the U.S. population, reflects state and national trends.
Despite the predictability of these trends, efforts to control the disease continue to challenge health professionals.
We know how AIDS is transmitted and what behaviors pose a risk for acquiring the infection. In fact, the means of AIDS transmission were known epidemiologically before any causative viruses were identified by laboratories.
Furthermore, this understanding of the transmission route has not changed since the epidemic began. The problem in protecting public health is to ensure that people adopt those safe behaviors that reduce the risk of infection.
In Orange County, we have employed targeted public health control measures to promote a clear public understanding of the epidemiology of AIDS and develop educational and environmental strategies to effect individual behavior change. We have provided preventive educational intervention as well as counseling and medical evaluations to individuals exposed.
We were first in California to implement HIV antibody testing and to culture HIV, and in early 1987, we led the way for collaborative, participatory planning with the establishment of an HIV Advisory Committee, representing a broad spectrum of care providers, community agencies and those affected by the disease. Close collaboration with the AIDS Response Program, the Red Cross and other agencies has contributed to a less rapid progression of the epidemic here than has occurred in other California communities of similar size and demography.
Our aggressive outreach program in the jail and an “on the street” program for drug abusers helped stabilize infection rates. This should be no cause for comfort but rather for more aggressive efforts and continued innovation.
Although unique educational approaches for ethnic minorities have been developed locally and adopted statewide, additional efforts are needed to prevent the disproportionate impact on communities of color.
Continuing efforts will serve to remind residents that the prevention message is sound and has not changed. Be reminded that every year we face a new generation of individuals who are becoming sexually active, just as certainly as we face a new beginning class in school every year.
CBS recently portrayed this disease in its program “48 Hours” as “the killer next door” and illustrated why “the epidemic cannot be dismissed as someone else’s problem.”
The fact is that AIDS may touch any one of us through involvement with a family member, a close friend or a neighbor. Awareness of the disease usually becomes evident after the fact, and usually only individuals directly affected are mobilized to action.
Business and community leaders have the capability to turn that around by anticipating action needed and by developing policies and plans for employees in the workplace and persons in the community. A recent survey by the American Management Assn. revealed that less than half of 1,633 companies surveyed were prepared to handle future cases of HIV infection or AIDS, only a third had AIDS awareness programs and only 14% had training for supervisors.
Development of such programs will not only serve to prevent transmission through behavior change but prepare individuals for a compassionate response to the disease in the event that AIDS comes to the work site, the community or the family.
Mobilizing the business and professional community--the community movers and shakers, so to speak--to persuade the entire community to action is an imperative that must be heeded.
In the next few months, we may be hearing a lot about “new viruses” and the causative factors contributing to AIDS-like illnesses.
The Centers for Disease Control and the National Institutes of Health recently convened a conference on this issue, and preliminary reports suggest that multiple explanations are probably involved in this phenomenon, reducing the likelihood that we are facing a new virus.
We must also remember that there are estimated to be fewer than 35 such cases, compared to 2 million cases of AIDS worldwide. With more than 2,000 AIDS cases and 1,200 AIDS-related deaths in Orange County, our efforts need to focus on preventing further transmission, remembering that the epidemiology has not changed.
The same control measures we have been emphasizing need to be adopted by all individuals, not just specific groups.
Seeing yourself as a part of one group or another often allows individuals to opt for no change in behavior, thinking they are not at risk. If individuals continue to practice unsafe behavior, they are at risk of acquiring the infection.
This disease is indeed “the killer next door,” and we need to realize that sooner or later it will affect each and every one of us in some way--through a loved one, friend, neighbor or colleague.
It is imperative that business and community leaders, political leaders, health professionals, educators, religious leaders--all people who have an ability to influence policy in the workplace and other community settings--step forth to engage their community, indeed the entire community, in action.
Clearly, that is the order of the day.
