Research at Indiana University

A doctor and his colleauges helping a sick child

A student in the Indiana University-Moi University Program recalls his first Kenyan patient, a young mother of five, this way: “I knew she had AIDS. I knew that she would die alone. I knew her children would share the same fate as so many orphans in Kenya . I think she knew all these things, too, and that this knowledge was more painful than her esophagitis or pneumonia. She came to the hospital because it was time to die. And I believe she came to teach me something I won't find in medical texts.”

Since 1990, hundreds of IU School of Medicine faculty and students have worked with Moi University in Eldoret , Kenya , to combat HIV and AIDS. The partnership has spawned a successful, federally funded program which is providing care to more than 30,000 adults and children at eight sites in western Kenya , including six new clinics in rural communities. The program, called the Academic Model for the Prevention and Treatment of HIV/AIDS, or AMPATH, also supports an enterprise program that assures sustainable economic security for affected Kenyan families, two farms that supply high-quality macro-nutrition to HIV-infected families, installation of an electronic medical record system to support patient care, teaching and research, and additional laboratory services needed to serve a wide region of western Kenya. For additional information, see http://medicine.iupui.edu/kenya/introduction.html.

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WORLD AIDS DAY IS DECEMBER 1

The following tips discuss AIDS in rural America , home HIV-antibody testing and abstinence-only AIDS prevention, and HIV and teens.

Denial and stigma are major issues in dealing with the AIDS problem in rural America . Many rural residents deny the possibility of HIV/AIDS being part of their community. Hence, many do not practice risk-reduction behaviors, falsely believing they have little chance of contracting HIV, said William L. Yarber , senior director of the Rural Center for AIDS/STD Prevention at Indiana University Bloomington. Stigma is a serious problem for people with HIV/AIDS in all communities, but particularly in rural areas, said Yarber, also a researcher at the Kinsey Institute for Research in Sex, Gender and Reproduction. "People with HIV/AIDS in rural communities carry an extra burden with their disease in that many are stigmatized as unworthy of community support and adequate health care," he said. People diagnosed with AIDS who live in rural areas now account for 8 percent of all cases nationwide, up from 5 percent in 1996. Despite these growing numbers, most AIDS control strategies have focused on urban communities. "AIDS in rural America is often isolated and forgotten. As a consequence, rural prevention efforts are under-funded," Yarber said. RCAP is the only prevention center in the country to exclusively address HIV/AIDS and STDs in rural communities. "Our center fills a void in AIDS/STD prevention and research," Yarber said. Yarber, a professor in the Department of Applied Health Science in IU Bloomington's School of Health , Physical Education and Recreation, can be reached at 812-855-7974 and yarber@indiana.edu . For information about RCAP, visit http://www.indiana.edu/~aids/.

Home HIV-antibody testing and abstinence-only AIDS prevention. Stephanie Kane is an associate professor in the Departments of Criminal Justice and Gender Studies at IUB and the author of AIDS Alibis: Sex, Drugs and Crime in the Americas (Temple University Press). She can discuss the following items:

Home HIV-antibody testing. There are both risks and benefits associated with the new home HIV testing kits. On the negative side, lack of face-to-face counseling can lead those testing positively to experience acute feelings of depression and isolation and thoughts of suicide. Home testing also does not provide direct and immediate access to specific information about drug treatment and other support services. On the positive side, testing in the privacy of one's home may encourage more people to test themselves for the first time and thenceforth periodically with greater frequency.

Abstinence-only AIDS prevention. A greater and greater proportion of money for AIDS prevention both in the United States and abroad is being funneled into programs based on abstinence-only models. These programs lead to increased transmission of HIV at the population level. Those who advocate such programs are comfortable sacrificing the lives of those who do not share their particular moral and/or religious code, or who share it in theory but not in practice. Abstinence as a strategy should only be included as one part of prevention programs that also include education about condom use, sexual communication, and political and economic empowerment. Kane can be reached at 812-855-0896 and stkane@indiana.edu .

Students know about HIV, but it doesn't scare them. HIV education in elementary and high schools has led to a greater awareness of the disease and its transmission, but many young people don't believe they could acquire HIV, said Catherine Sherwood-Puzzello , a clinical assistant professor in IUB's Department of Applied Health Science. Her research and teaching interests include human sexuality and public health education. "Some students have a hard time understanding the issues regarding the severity and fatal outcome of HIV infection. Some have the belief that 'It can't happen to me,' and even if they do become infected, there are currently medications that are allowing HIV-positive individuals to live longer and have a better quality of life." Sherwood-Puzzello said that comprehensive education should emphasize that there is no cure or vaccine for HIV in addition to providing information about condom usage. "Many people believe that young people should only be taught to remain sexually abstinent until marriage. However, the reality is that there will be those who choose not to wait. The 15- to 24-year-old age group accounts for half of all new HIV infections worldwide. Based on data from the federal Centers for Disease Control and Prevention, it is estimated that 20,000 new HIV infections occur each year among youth. Therefore all students need to be taught the information and skills to protect themselves from HIV," she said. In addition to education, getting students involved in the prevention effort will be a key to increasing awareness and understanding that they are not immune to the risk of HIV transmission, Sherwood-Puzzello said. Sherwood-Puzzello can be reached at 812-855-2673 and csherwoo@indiana.edu .

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