Margaret Rogers can remember back to the day she met her first AIDS patient, more than two decades ago. It was a clear day in 1986 and the young man was admitted to Brevard Hospice in the final throes of the fatal disease.

“He was emaciated – so skinny and sad,” said Rogers, 80, a founding member of Brevard Hospice (now Wuesthoff Brevard Hospice and Palliative Care) as a nurse helping provide dignity and care for hospice patients.

Back then, America was in a panic over AIDS, with little or no information filtering in on how the disease spread and why so many young men were dying from it.

“No one and I mean no one, knew anything about how it was transmitted,” she said.

At the time, Rogers was 62 years old, past childbearing years and full of the will and heart to help others.

“I didn’t become a nurse to pick my disease,” she said.

She suited up in blue surgical scrubs with face mask, boot covers and gloves – she calls it her space suit – and went to visit the 30-something year old man.

“He was so angry, so mad. He had pushed away all his family and was trying to do that to me, too,” she said.

Rogers didn’t argue. She understood why he was mad. Instead, she walked over and hugged him.

“I did,” she said with a smile, “and then the tears came, lots of tears from us both.”

In the 25 years since Rogers saw her first patient, many things have changed.

But, if you think AIDS is no longer a problem in America, you’re only thinking about it half way. Although the prevalence of people dying from full-blown AIDS has dramatically decreased since the Centers for Disease Control acknowledged the disease in 1985, the sad reality is that infection rates for HIV, which causes AIDS, continue to rise.

And though people are living longer lives with antiretroviral drugs that stave off AIDS, getting HIV is still a death sentence, said Lisa Kalaf, executive director at Wuesthoff’s Brevard Hospice and Palliative Care in Viera.

Kalaf also serves as the President of the Board of Directors for Project Response, an HIV/AIDS service organization providing care services and case management to more than 1,400 people in Brevard, Indian River, St. Lucie, Martin and Okeechobee counties.

“People have blinders on and still think this is a disease of gay men,” Kalaf said.

Far from it. AIDS is now transmitted mostly between heterosexuals (56 percent of all AIDS transmissions in 2006 were passed among “straight” partners) and particularly among African American women. In 2006, black females accounted for 69% of all AIDS cases.

Why the rates continue to climb – when we’re more educated about causes, transmission, prevention and care – can be linked to, among other causes, risky sexual behavior and lack of evidence-based education. This is especially true in our nation’s schools, where teens are being fed a continuous diet of misinformation and mixed signals.

Teens and Sex
In a report issued in 2006, the Council on Contemporary Families stated that the increase among teens in sexually transmitted diseases, including gonorrhea, syphilis and AIDS, is due in part to abstinence-only teaching, rather than comprehensive programs that combine the discussion of abstinence with information about safe sex.

This causes teens who do participate in sexual activities to avoid practicing safe sex because they generally are not instructed about how to do so.

It’s a vicious cycle and one that prompts heated debate among educators, medical professionals, government officials and parents.

But Rogers, who’s been on the HIV/AIDS frontline for decades says she knows the answer: “Abstinence is not it,” she says, “people have sex. Period. Education is the key.”

Abstinence-Only Education
In 2004, research published by the National Association to Prevent Teen Pregnancy found that abstinence-only programs did not reduce instances of teen pregnancy or sexually-transmitted infections among high school students.

The study also found that students who received abstinence-only education were more likely to engage in more unprotected sex than students who received a comprehensive sex education.

“People aren’t paying attention because it’s no longer the devastating looking disease it once was – and the word is not getting around about how difficult it is to live with HIV. Really, it’s no cake walk,” said Kalaf.

Defining HIV/AIDS
Human Immunodeficiency Virus (HIV) is a retrovirus that attacks and destroys the immune system, leaving the body defenseless against what commonly are referred to as “opportunistic infections,” and causing the onset of Acquired Immune Deficiency Syndrome (AIDS).

A retrovirus uses RNA (instead of DNA) to alter the normal genetic coding process, causing the host cell to replicate the virus instead of itself.

Among others, these infections include a host of bacterial, fungal and viral infections which rarely are problematic to those with healthy immune systems.

Understanding Asymptomatic and Symptomatic HIV
Asymptomatic HIV Infection
In this stage, there are no visible signs of illness but the infection is at work, slowly destroying the immune system. Often, during this phase, there is a decline in CD4 counts – the white blood cells that fight infection – an indicator that the immune system is beginning to break down. (More information on CD4 counts on page 21.)

Depending on environmental and personal health factors, this phase might last for as long as 10 years (and, in some cases, longer). But, during this time, the infection can be passed to others.

To avoid passing HIV at this stage, it’s critical first to know whether or not you are infected. A simple oral swab test (approved by the Food and Drug Administration in October 2004) provides immediate results (within 20 minutes) using saliva, blood or plasma approximately six weeks after infection.

(For information on where to get tested locally, see the resources box on page 22.)

Symptomatic HIV Infection
This is the period where a host of symptoms may indicate HIV infection and is further divided among three stages: early, middle and late.

A note: having any one or all of these symptoms does not necessarily mean HIV infection is present. The only way to be sure is to be tested.

Early Stage Infection
This stage occurs when CD4 counts are at 500 cells per milliliter, or higher. Symptoms may include fever, night sweats, headache, fatigue, diarrhea and unplanned weight loss greater than 10 lbs. over two months. Dermatological changes also are common and can include: Herpes zoster virus (shingles), Herpes simplex virus (oral and skin lesions) and bacterial infections.

Middle Stage Infection
This stage occurs when CD4 counts are from 200 to 500 cells per milliliter. Symptoms: skin and oral lesions described in early stage infection may persist or worsen, Candidiasis, or vaginal or oral yeast infection (thrush), Oral Hairy Leukoplakia (a white thickening or coating of the mouth), fatigue and other symptoms described in early stage infection. Bacterial sinusitis, bronchitis, strep and pneumonia also may present in middle stage infected individuals.

Late Stage Infection
This stage occurs when CD4 counts dip to or below 200 cells per milliliter. Patients at late stage infection are susceptible to an increased risk of opportunistic infections.

Among the Late Stage Infections
Pneumocystis Carinii Pneumonia (PCP), a fungus-based infection that affects the lungs and causes a form of pneumonia.

Cryptosporidiosis, or diarrhea caused by parasitic infection.

Toxoplasma Encephalitis, a brain infection identified as the second-most common neurological condition in HIV-positive patients. Can cause inflammation of the brain, one-sided weakness or numbness, mood and personality changes, vision disturbances, muscle spasms and severe headaches. If untreated, cerebral toxoplasmosis can lead to coma and death.

Esophageal Candidiasis, a fungal disease found in the mucous membranes of the mouth and tongue, the most common mouth lesions found in HIV-infected individuals.

HIV Wasting Syndrome, or progressive weight loss often accompanied by weakness, fever, nutritional deficiencies and diarrhea, is common at late stage infection.

AIDS Dementia Complex, a group of brain-altering infections that can cause symptoms such as brain inflammation, behavioral changes and a gradual decline in cognitive function, central nervous system disorders, cancerous tumors and psychological disorders, among others.

Transmission Information
To avoid passing HIV to a partner or friend, the following methods have been compiled from various sources. (For more information, see online resources on page 22.)

• Avoid sexual contact with an infected person (including vaginal, anal and oral sex). Numerous studies have demonstrated that oral sex can result in the transmission of HIV and other sexually-transmitted diseases (STDs), according to information from the Centers for Disease Control.

  Research has documented the presence of HIV in saliva in very low concentrations, creating some concern that kissing could be a means of HIV transmission. According to experts, the chance of this happening is extremely low, so kissing is not considered a viable method of infection transmission.

• Use a latex-condom. The Centers for Disease Control report that the correct and consistent use of latex condoms is highly effective in preventing the transmission of sexually transmitted diseases and HIV. Further, “the ability of latex condoms to prevent transmission of HIV has been scientifically established in ‘real-life’ studies of sexually active couples as well as in laboratory studies.”

• Avoid sharing needles and/or syringes (primarily for drug injection) with someone who is infected.

• Blood transfusions. Once a serious concern in America, this risk now is extremely low due to heightened safety protocols and the widespread adoption of the single-use needle for drawing blood.

• Birth and breastfeeding. Babies born to HIV-infected mothers could become infected before or during birth or through breast-feeding after birth.

Drug Treatment
Available treatments include 26 drug therapies approved by the FDA. Called antiretroviral drugs, these medicines can be started as soon as an HIV diagnosis has been established. Antiretroviral drugs fight the activity or replication of HIV, can slow disease progression and allow patients to live healthier and longer lives. (For a full list of the approved drugs, visit www.fda.gov.)

AIDS Has No Cure
Currently, there is no cure or immunization available against HIV/AIDS, though researchers are working towards a vaccine.

Medications can slow the progress of HIV/AIDS, allowing patients to stay healthier and live longer, but they do not cure the disease and must be taken indefinitely once started. The goals of these treatments are to suppress the viral load, or amount of HIV in a sample of blood, to restore or preserve immune function, to improve quality of life, to reduce morbidity (hospital visits) and mortality (death).

For as long as we’ve been studying it, we’re still very far away from a cure for this global epidemic which in 2006 infected 4.3 million and claimed 2.9 million lives.

Rogers does her part spreading the word by continuing her work at Brevard Hospice, helping out three days each week and advocating for victims rights. She frequently attends and speaks at HIV/AIDS awareness rallies and lectures on hospice and compassionate care to anyone who will listen.

Her hope is that all the death and all the loss she’s seen might translate to better understanding about the disease and more compassion for the victims.

“I hope people come to understand the significance of this disease – about how many lives have been lost and how it’s possible to avoid getting

Brevard Resources
Brevard County Health Department
The county health department offers anonymous and confidential HIV testing and counseling. Visit the Brevard County Health Department online at www.doh.state.fl.us/chdBrevard.

Anonymous Testing - no names are used so patients are provided anonymity. The patient is instructed to return to the clinic two weeks after testing for results and counseling. To make an appointment, call (321) 690-6486.

Confidential Testing - counseling and testing is provided in Family Planning, STD (sexually transmitted disease) and Maternity clinics. A signed consent form is required. To schedule an appointment, call (321) 637-7300.

State law requires that HIV and AIDS cases be reported to the Brevard County Health Department. Upon receiving this information, the county investigates and reports findings to the state health office in Tallahassee.

Project Response
Project Response provides free, rapid HIV counseling and testing at community sites where the agency can assist high-risk individuals. Clients receive results in 20 minutes. Those who test HIV-negative are counseled on how to stay negative. Clients who test positive learn how they can obtain HIV/AIDS health care, often at no cost. If your organization serves a high-risk population and would like to have HIV testing offered to your clients, contact the Project Response Melbourne office at (321) 724-1177 or visit online at www.projectresponse.org.

Online Resources
AIDS Education & Training Centers:
www.aidsetc.org
AMFAR, American Foundation for AIDS Research:
www.amfar.org
Centers for Disease Control and Prevention:
www.cdc.gov
thebody.com, an internet compilation of HIV/AIDS resources:
www.thebody.com
Immunodeficiency Clinic at Toronto General Hospital:
www.tthhiv.com
The National Institutes of Health:
www.nih.gov