The New World of AIDS: Stopping the Virus

HIV Prevention Fractures Into Local Struggles

By Susan Okie
Washington Post Staff Writer
Tuesday, September 2, 1997

Tameka Sauls was only about 14 when an adult cousin began losing weight and eventually died. She didn't learn the reason until long afterward.

"I didn't know she died from AIDS 'til, like, down the line," said Sauls. "Me and my mother were talking about stuff and it just came up. I was shocked."

As a student at South Florence High School, Sauls had taken the health education course that South Carolina public schools are legally required to provide. But, she said, the class never taught her about AIDS and other sexually transmitted infections. "It wasn't really sex education," recalled Sauls, now 18 and raising a 22-month-old son. "It was more like body development and differences between men and women."

This year, after two more relatives had died of complications from AIDS, Sauls enrolled in a federally funded training course as an HIV educator at a local adult education center. Smart and articulate, she's the kind of person other teenagers might listen to -- and her teacher is urging her to go on a local radio program to answer questions about AIDS. But Sauls is scared. She's afraid everybody will think she's infected with the virus. "They would say it just to talk," she said.

In some ways, what Sauls knew about AIDS -- and what she didn't -- illustrates the state of the nation's attempts to prevent the spread of the human immunodeficiency virus. Aggressive HIV prevention efforts proposed in the early years of the epidemic -- such as widespread condom distribution, clean-needle giveaways to drug addicts and frank sex education in schools -- triggered intense controversy and enormous political opposition in many more conservative parts of the country. Moreover, some public health experts argued that money spent on national media campaigns could be more effective if focused on those at greatest risk of contracting the virus. So three years ago, the federal government revamped the country's prevention strategy, abandoning a single national effort in favor of locally tailored efforts that it hoped would be both more acceptable and more effective.

Gone are the mass mailings and national media campaigns of the 1980s. The last crop of government-sponsored television commercials, produced in 1995 to promote condom use, are rarely shown anymore. The national AIDS hot line is running, but it gets only about 3,000 calls a day, compared with the peak of 189,251 on a single day in 1992, the day after a network television special on AIDS sufferer Alison Gertz.

Now that better treatments for AIDS are available, officials at the Centers for Disease Control and Prevention (CDC) in Atlanta are considering a new public service announcement campaign to encourage more people to be tested for HIV, but that project is still in the planning stages.

Instead, America's war against AIDS has fractured into thousands of local skirmishes, which are being fought in high schools and housing projects, bars and barber shops. These small grass-roots programs are designed to target groups considered at higher risk of infection, such as drug or alcohol users, young male homosexuals, minority women living in housing projects and sexually active teenagers.

Priorities for fighting the epidemic are set by community planning groups -- committees of public health experts, behavioral scientists, activists and ordinary citizens who try to figure out what will work best in their state or city. The result is a patchwork of locally designed and run prevention efforts as varied as the vast AIDS Quilt.

Supporters of the change say it was painful but salutary. Critics, however, contend that the quality, content and intensity of the efforts vary widely, and no one really knows if they are effective.

And the virus continues to spread. Despite recent improvements in AIDS therapies, and a slowing of the pace of the epidemic in the United States, an estimated 40,000 Americans continue to become infected with HIV each year. Public health officials are particularly concerned that the virus is spreading fastest among African Americans, Hispanics, young people, women and, in general, people who acquire the infection through heterosexual sex.

"The news is good news, but it's not as good for everybody," said Helene Gayle, director of the National Center for HIV, STD and TB Prevention at the CDC. "Our challenge is to make sure we can have the same benefits for all parts of our population and where there are inequities, address those inequities."

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