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AIDS researchers seek long-term answers

By David Rothstein

and Niraj S. Desai

Long-term prospects for the biomedical and sociopolitical control of the Acquired Immune Deficiency Syndrome epidemic were the topics of Tuesday's symposium on "AIDS: Long Term Prospects."

The symposium was held in Killian Hall in honor of the late Robert Swain Morison, who became Class of 1949 Visiting Professor at MIT upon his retirement from Cornell University in 1975.

Provost Emeritus Walter A. Rosenblith, who introduced the symposium, told the audience that AIDS would have been a subject "singularly congenial to [Morison's] concerns." The first of the event's two sessions was devoted to biomedical aspects of the disease.

William Haseltine, chief of the Laboratory of Biochemical Pharmacology at Dana Farber Cancer Institute, began the symposium with a discussion of the prospects for prevention and cure of AIDS.

Despite the great advances made in understanding the virus that causes AIDS since it was discovered in 1984, the disease remains an incurable one, Haseltine said. It is estimated that 85,000 people in the United States show signs of the AIDS virus, and an additional two to four million people carry the disease but do not yet show signs of the virus, which can remain dormant in the human body for five or more years.

"At this point, we cannot predict with confidence when, or if, a vaccine will be developed," Haseltine said. Scientists are more likely to devise a way to control the virus than to eliminate it, according to Haseltine.

"AIDS [was] designed by nature to cohabit with us for a long time," he said.

Haseltine described three stages of the AIDS infection: an early, rampant stage, characterized by fever, when the virus is present in high level; a two- to 10-year quiet stage, when the virus level drops; and a final 11/2- to 2-year terminal stage, during which the virus level again rises, almost always resulting in death.

Haseltine said that researchers' aims are to prevent the virus replication from reaching the terminal, prolific stage. He described a rare instance -- one in 5,000 cases -- in which the AIDS virus is dormant. There is some hope, he said, doctors will be able to drive AIDS victims into this so-called silent stage, but that is a hope for the distant future.

When speaking of the long-term fight against AIDS, Haseltine spoke in terms of decades. Society must begin to think of AIDS patients as, for example, diabetics, who require life-long treatment.

"We will be extraordinarily fortunate if we can put [AIDS patients] into remission," he said.

Gerald Friedland, professor of medicine at Montefiore Medical Center, followed Haseltine by discussing the prospects for treatment of AIDS. Friedland described his reactions to treating his hospital's first three known AIDS patients -- three male drug users who had contracted what, until then, was thought to be a gay disease.

"I felt a clear sense of foreboding," he said. "... This was a disease particularly cruel."

Friedland, like Haseltine, noted the great advances made by research scientists into the understanding of the AIDS virus, but said that knowing "how and how not the infection occurs" is not enough to solve what is becoming a "disastrous public health emergency."

"We really are at the beginning of the AIDS epidemic," Friedland explained.

Because no cure is in sight, Friedland felt that society's goal ought to be to focus on clinical care that extends beyond the hospital and takes into account a patient's "environmental needs."

A continuity of care must be developed, he said, for this disease which is "not amenable to one-shot technical care."

Friedland further stressed that drug abuse must be treated along with the AIDS disease. Drug abuse might make preclude any treatment of the disease among these groups for two reasons: abused substances may chemically reduce the efficiency of drugs used in the treatment of AIDS; and drug abusers may lack the discipline to undergo regular treatment.

Friedland ended his lecture on a philosophical note, calling health care workers the "unsung heroes of the AIDS epidemic," and quoting from Camus' The Plague: "We learn in time of pestilence that there is more to admire in man than to despise."

Sociopolitical prospects

"AIDS is the same virus in Africa [as it is in the United States], but it is a vastly different disease," declared Harvard Professor Lincoln Chen. The reaction to, transmission of, and prospects for AIDS vary in different cultures and in different parts of the world, Chen said.

This belief was the motivation behind the symposium's late afternoon session on the sociopolitical prospects of AIDS. Chen spoke on the role of AIDS in Africa, while Yale Law Professor Harlan Dalton discussed the virus' impact on American blacks. Brown University Professor Stephen Graubard, editor of Daedalus, moderated the session.

There are important differences between the nature and impact of AIDS in the West and in Africa, Chen noted. In the United States and Western Europe, AIDS sufferers are principally homosexual/bisexual men and drug users. Heterosexual relations are the major source of AIDS in sub-Saharan Africa, Chen said. The male/female ratio of AIDS victims in Africa is nearly unity, while men form the majority of American victims. Transmission from mother to infant is a major problem in Africa, while it involves relatively few American cases, Chen noted. Also, African reaction to the disease has been subdued in comparison to Western reaction since AIDS is not the major health problem in Africa -- malaria and other diseases kill more people.

Having discussed the differences between AIDS in the West and Africa, Chen concluded by pointing out the fundamental unity of the epidemic. Only a global effort can contain the spread of the disease , he said.

Dalton sought an answer to the question of why the black community has not adopted the AIDS epidemic as a principal issue in the same way that America's gay community has. About a quarter of diagnosed victims in the United States are black, Dalton pointed out. A large majority of women and children afflicted by the disease are minorities. Even though the rates of infection in other communities are declining, they are still growing in the black community.

Yet established black leaders and organizations have been hesitant to identify themselves with the fight against AIDS, Dalton said.

One major reason that Dalton cited for this paradox was fear of what being associated with the virus would do to the black community's image. Some have suggested that AIDS originated with rhesus monkeys in Africa and then spread to humans, Dalton noted. This strikes many black Americans as implying that black in Africa are both responsible for the disease's spread and have had sexual relations with monkeys. Also, "we [blacks] fear society is going to assume we are all junkies because some of us are junkies," Dalton said, noting that intravenous drug use is one of the major methods of transmission.

While some white Americans feel that black people's fears are baseless, according to Dalton, they fail to understand the depth of the mistrust that still exists between the races in this country.