The Chicago Tribune; Sunday, December 7, 1997
Ronald Kotulak, Tribune Science Writer

Then, last month, the United Nations revised upward its estimate of those people infected with HIV to a staggering 30 million worldwide--fully a third more than earlier projected.

Such stories demonstrate that despite a few hopeful developments, the deadliest plague of the 20th Century continues to burn its way through society virtually unchecked.

Sandra Thurman, the outspoken activist director of the White House Office of National AIDS Policy, fears that complacency and misperception have led Americans to let down their guard. Thurman, 44, has been deeply involved in the fight against AIDS since 1983, a time when victims were ignored, shunned and abandoned.

Q: The latest figures indicate that the AIDS epidemic is going from bad to worse. What is the situation?

A: In this country, between 650,000 and 900,000 people are infected, and half a million Americans have already died from AIDS. Globally, 3 million people are being infected each year, a million of whom are children. The numbers speak for themselves.

Q: Despite such alarming figures, has interest declined because of the misconception that the epidemic has pretty much run its course?

A: People do tend to think it's over, and some of the interest--and the fear--have waned. That's partly due to better education about disease prevention, but also because we've had all this good news recently about protease inhibitors, the new drugs. We're making some progress, but we don't see any decline yet in the incidence of new HIV infections in the U.S. That's holding steady at about 40,000 a year.

Q: Is the AIDS virus attacking new groups?

A: There's a huge shift toward people of color, toward people in Latino and African-American communities in particular. And it's shifting toward women, young people and heterosexuals.

Thirty to 50 percent of all new cases in this country--as much as half--can be attributed to intravenous drug use, either directly or indirectly. The same holds true in Chicago: The Chicago Health Department for the first time is seeing a huge shift away from the traditional gay population to IV drug users and other groups.

Q: As the nature of the epidemic changes, what is your biggest worry?

A: That it will continue to grow. It's going to increase in the populations where it's now moving--the traditionally disenfranchised populations who have no voice. One of the things that allowed us to have a quick response to the epidemic in the early days was the gay community. They were mobilized when the epidemic hit, as unfortunate as that was. But they had a voice in ways that the populations where the epidemic is moving now never had. That worries me because it's so easy to push these people aside in ways that we've always pushed them aside.

Q: Do Americans still have a problem understanding that AIDS basically is a sexually transmitted disease?

A: Absolutely. We tend to think that we're much more sophisticated than we really are. Early on people saw this as a gay disease. It was them and not us. We have stuck to that misperception and haven't followed the epidemic into the next generation.

Q: Are most people unaware of their own risk of being infected with the AIDS virus?

A: There's a real stigma associated with this disease and stereotypes about who's at risk and who's not. We have to focus on educating people that everyone is at risk--our kids, the next-door neighbors' kids and everybody else. Look at the New York case where one man infected all those girls who, in turn, are suspected of infecting other boys they had sex with.

Q: How quickly is AIDS spreading in the heterosexual community in the United States?

A: We've seen big increases among women over the last few years that are indicative of a frightening trend. It tells us we've got to do a better job of educating people about their risk. There are people out there thinking they are not at risk, when in fact they are.

Q: Is the risk to women primarily from IV drug-using sex partners, or is it spreading beyond that?

A: Most cases in women come from partners who are infected because of IV drug use. Others may have received it from prostitutes or from former IV drug users or from people who may have slept with them in the past.

Q: Is the AIDS epidemic reaching into the adolescent population?

A: We see the same thing with adolescents as we do with women. Increasingly adolescents are becoming infected, and a lot of that is related to IV drug use. Young people are not getting the prevention messages we've been sending.

Q: There has been a big surge in sexually transmitted diseases in this country. Does that raise concerns that HIV infections will increase as well?

A: Yes. People who have a sexually transmitted disease are much more likely to become infected by HIV and spread it. That tells us that we have to stay focused on STD prevention, not only in this country but around the world.

Q: What is the cornerstone of U.S. AIDS education and prevention efforts?

A: We don't really have a cornerstone. We need to do some real soul searching about our AIDS-prevention programs in this country. What we are doing is clearly not working as well as it should. We need to see if we can't be more creative. Community-based programs always work best, and we need more of them.

Q: Are the new anti-AIDS drugs enabling some patients to return to normal lives?

A: Yes. We really have great news. We see people coming back literally from the brink of death and leading fairly normal lives. But the bad news is that protease inhibitors don't work for everybody. We're also beginning to see failure rates that are substantial. It's very alarming.

We've got to continue our focus on developing treatments for those who can't tolerate these drugs. We've also got to simplify treatments. These drugs are very complicated. Some people take up to 30 pills a day.

Then we need to look at developing new and less expensive therapies. These drugs cost between $12,000 to $15,000 a year.

Q: Are some AIDS patients not getting the drugs because they can't afford them or don't have insurance?

A: Sure. Some people are falling through the cracks. We're looking at ways to develop programs so that everybody has access to these therapies. But as always, nothing that the federal government can put together is going to ensure that everybody has access.

Q: Is there an AIDS vaccine in our future?

A: We have several vaccine candidates that are down the line. We'll never end this epidemic without a vaccine.

Q: Africa has borne the brunt of the AIDS epidemic so far. Will it spread with the same ferocity to other developing countries?

A: Unfortunately, yes. That's true, particularly of Asia. I think Asia will quickly surpass Africa in this epidemic. It's happening, and it's going to be huge. That includes India, Vietnam and China.

The epidemic is going to have an impact in those countries in ways that we really don't understand in this country. We had an infrastructure to deliver services and an ability to educate people. We had everything right, and we still weren't able to cope particularly well with this epidemic. The other countries don't have any of that. Putting this epidemic on top of all of the other struggles they have is going to be disastrous.

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An edited transcript

CAPTION: PHOTO (color): Sandra Thurman. PHOTO: Sandra Thurman sees complacency as a major foe in the AIDS fight. Tribune photo by Chris Walker.

Copyright 1997/The Chicago Tribune. Reproduced with permission. Reproduction of this article (other than one copy for personal reference) must be cleared through the Permissions Desk, The Chicago Tribune, 435 North Michigan Avenue, Chicago, IL 60611.
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