AIDS: Today's and Tomorrow's Crisis

185 Presentation AIDS: TODAY'S AND TOMORROW'S CRISIS BENY J. PRIMM, M.D. Executive Director Addiction Research and Treatment Corporation New York, N.Y.; Director Office for Treatment Improvement Alcohol, Drug Abuse, and Mental Health Administration U.S. Department of Health and Human Services The AIDS crisis is reported in the papers on a daily basis. But examination of the underlying problems that predispose individuals to the human immunodeficiency virus (HIV) and full-blown acquired immunodeficiency syndrome (AIDS) is being neglected. We cannot afford to look at AIDS in isolation, solely as a medical problem. We must examine poverty and social dislocation, a theme that has been sounded throughout this conference. Poverty is a major reason for AIDS among minorities . Other viruses Before discussing the social underpinnings of the AIDS crisis, we need to remind ourselves that there are many more viruses now present in society and now causing disease; HIV-I and HIV-2 are only the beginning. Table 1 shows two of these with their associated disease syndromes, and there are as many as 17 more mutants of those viruses that can cause disease. For example, the Human Herpes Virus 6 (HHV-6) is one that is very important and is not being examined closely (Table 2). But there are others that are as important, for which we are not testing, and that are wreaking havoc in our community. In twenty years, society will have these other viruses to contend with unless something is done about them today. These viruses all come from a common tree. Some of them (HTLV-I, HTLV-2, STLV-I) cause cellular proliferation; some of them (HIV-I, HIV-2, SW) Journal of Health Care for the Poor and Underserved, Vol. 1, No. 1, Summer 1990 186 AIDS: Today's and Tomorrow's Crisis VIRUS HTLV-I TABLE 1 VIRUS-ASSOCIATED DISEASES YEAR DISCOVERED 1980 HTLV-2 1982 DISEASES CAUSED Adult T-cell leukemia Tropical spastic paraparesis Bell's Palsy* Guillain-Barre Syndrome* Atypical hairy cell leukemia Chronic T-cell lymphoma* Mycosis fungoides* * Link is unconfirmed. cause cellular death. Those that cause cellular proliferation must be given attention now. Testing for the presence of these viruses must begin now. Otherwise, twenty or thirty years from now, there will be a generation of young people dying from the resultant diseases, such as tropical spastic paraparesis, leukemia, and lymphomas. Poverty and AIDS Reuben Warren talked about poverty, and how poverty predisposes people to so many different problems in our society. The data bear him out. Figure 1 shows that in New York Qty, for example, there are disproportionate numbers of blacks and Hispanics living in poverty. Forty percent of Hispanics live in poverty, and children under 18 constitute a considerable proportion of VIRUS HIV-I HIV-2 HHV-6 TABLE 2 EMERGING VIRUSES YEAR DISCOVERED 1984 1985 1986 DISEASES CAUSED AIDS AIDS Roseola infantum AIDS progression* Mononucleosis* Hodgkin's disease* * Link is unconfirmed. Source: Medical World News ____________Primm________________________187 that group. People in that kind of distress turn to all kinds of different behaviors in an attempt to mitigate stressful situations. In my treatment program, the Addiction Research and Treatment Corporation , located in New York, we have analyzed a number of patients by HIV seroinfection status, source of income, poverty level, employment status, and education level. The data show that the greater the social dislocation, the more likely these individuals were to be seropositive. Moreover, for individuals in my program, the lower the socioeconomic status, the more likely the person is to be infected with the virus. Much the same is true in the District of Columbia. That is a city that I believe will be completely destroyed if something is not done quickly about social dislocation, drug use, drug abuse, and trafficking of drugs. It is right in the backyard of the White House and the Congress, yet we are not paying much attention to what is going on there. In Washington, a disproportionate number of blacks as compared to whites, and Hispanics as compared to whites, are clearly at higher relative risk of infection with the HIV. In my experience with the federal government from 1980 to 1988, there have been reductions in...