Commemorating World AIDS Day

National Aids Trust - 7Feb14

by Laura Fredrickson

As we commemorate the 28th annual World AIDS Day on December 1, I would like to take a moment to look back and remember the past, celebrate the present and look forward to the future.

It was 1981 when the first young, otherwise healthy American men first became sick and died with a rare illness called Pneumocystis pneumonia, or PCP, and an ever more rare skin cancer called Karposis Sarcoma. By the end of 1981 there were 270 reported cases of severe immune deficiency among gay men, and 121 of those individuals died. In 1982, it was labeled Acquired Immune Deficiency Syndrome, or AIDS, but they still didn’t know the reason for it. At the time, it was believed that it was a “gay disease.”

In 1983 The Centers for Disease Control (CDC) reported the first cases of AIDS in females and identified all major routes of transmission—and ruled out transmission by casual contact, food, water, air or environmental surfaces. But people still thought this deadly infection could be contracted by touching, hugging or sharing dishes. People living with AIDS were discriminated against and feared. People living with AIDS were afraid themselves. There was no treatment, there was no cure and a person with AIDS was likely to die.

That was 35 years ago and thankfully much has changed.

By 1983 the virus that caused AIDS was identified and finally in 1986 was labeled as Human Immunodeficiency Virus, or HIV. Now that the cause was known, work went into finding treatment and a cure.

The first HIV drug was approved by the Food and Drug Administration (FDA) in 1987 and marketed as AZT. AZT alone did very little against HIV. HIV targets a key immune system cell called the CD4 cell. After HIV successfully invades the CD4 cell, it replicates by changing the DNA of the CD4 cell, turning it into an HIV producing cell. So a major part of the immune system is now producing more HIV virus rather than fighting it off, and the cycle continues. There are a series of steps that need to take place for this whole process to be complete. AZT alone was only able to affect one of these steps and could not stop the virus from destroying the CD4 cell. When the measure of the CD4 cell in the blood reaches a number below 200 a person is considered to have an AIDS diagnosis.

By 1991 there were a few more meds and some new classifications, but again they were not very effective. In 1992 AIDS became the No. 1 cause of death for U.S. men ages 25 to 44. In 1994 AIDS became the leading cause of death for all Americans ages 25 to 44.

It wasn’t until 1995 that everything changed with a classification of medication called the protease inhibitor. The impact of the protease inhibitor was dramatic. In 1996 the number of new AIDS cases diagnosed in the United States declined for the first time since the beginning of the epidemic and AIDS was no longer the leading cause of death for all Americans ages 25 to 44

In the beginning, the United Sates was slow to respond to the epidemic, but thanks to past HIV advocates like Ryan White, Cleve Jones and Larry Kramer, programs eventually were developed to help people living with HIV/AIDS access needed care and treatment. The Marquette County Health Department was able to start the Continuum of Care Program in 1988 and the program continues today. The program is an HIV Case Management Program and helps people throughout the U.P who are living with HIV. The focus of the program is to help people access medical care and medication and to ensure people are able to remain in care and treatment.

Unlike the early days of the epidemic, today there are 40 medications to treat HIV and PrEP to prevent new infection. PrEP means Pre-Exposure Prophylaxis, and it’s the use of anti-HIV medication that keeps HIV negative people from becoming infected. Fortunately, these medications are very effective. However, it is critical to take the medication as prescribed without missing doses. If too many doses are missed, resistance can happen, rendering the medication ineffective. The goal of medication is to keep the CD4 cell count high and the viral load low. The higher the CD4 cell count, the stronger the immune system and the less likely a person will become sick with HIV related illnesses. The lower the viral load the less chance of HIV transmission to another person.

As important as HIV medication is for many reason, it is not easy for anyone to remain adherent to medications for long periods of time. Programs like case management are in place to help people access care and treatment and to deal with the daily struggles and barriers faced with living with HIV, especially in small rural communities.

The CDC Estimates that there are currently 1.2 million people living with HIV in the United States and 1 in 6 do not know they have the disease. However, the global impact is much larger. The World Health Organizations (WHO) reports that there are 31.8 million to 35.9 million people living with HIV worldwide.

WHO also reports that 1.1 million died in 2015 alone. In response to this worldwide pandemic, World AIDS Day was established in 1988 and is recognized every year on December 1.

World AIDS Day is a time for people and communities around the world to dedicate the day to activities and events to cherish the memories of those who battled with the disease, and to celebrate progress achieved in the global response to HIV. This year’s theme is “Leadership. Commitment. Impact.” The Marquette County Health Department will continue its tradition of recognizing World AIDS Day with a Christmas tree that is decorated at the Peter White Public Library as part of the annual Winter Wonderland Walk. The tree is decorated with red ribbons or ornaments bearing the names of loved ones in our communities who have lost their battle to HIV/AIDS.

The tree decorating also includes a small ceremony with the reading of the names on the tree and a prayer. Community members are invited to add a ribbon or ornament to the tree. The tree will be decorated from 6:30 to 8:30 p.m. on December 1, and will be on display through the month of December.

I have been working in the HIV programs at the Health Department since 1998 and much has changed even in the past 18 years. But it is not over yet. HIV is a manageable disease instead of a terminal illness, but it is still a very serious illness. There is still fear and stigma. People still die. All the advances in treatment seem to have made people less concerned about contracting the illness and has made prevention work that much more difficult. It is also complicated by the fact that symptoms may not be present for up to 10 years. Of the 1.2 million people that the CDC estimates are infected, about 1 in 6 don’t know and could be unknowingly infecting others.

So as we prepare for another World AIDS Day, I urge people to get tested. The Health Department now offers rapid testing which provides results in 20 minutes. The test is free and can be a confidential or anonymous test. The best way to prevent the spread of HIV is to know your status and take care of yourself. Only by working together, reaching out to those living with HIV and helping them in their struggles, taking care of ourselves,  knowing our own HIV status , and taking measures to prevent new HIV infections can we finally put this behind us — Leadership. Commitment. Impact.

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