Much has changed in the 35 years since Hawaii’s first published case of a health condition that would later become known as AIDS (Acquired Immune Deficiency Syndrome). Today, it’s no longer a death sentence if a patient tests positive for HIV (Human Immunodeficiency Virus), which can develop into AIDS.
Advancements in drug therapies have largely changed the outlook for HIV/AIDS patients — although until a cure is reached, those treatments are lifelong.
In the years following the first reported AIDS case on June 5, 1981, intense public education eventually led to HIV cases decreasing significantly over three-plus decades. Today, researchers estimate there are 2,900 HIV cases in Hawaii.
While the stigma associated with being HIV positive has diminished with time, so too, though, has the vigilance when it comes to prevention, advocates say. Hawaii’s share of federal funding for HIV prevention activities has suffered major cutbacks, making it more challenging for the state and its nonprofit partners to educate young people about HIV/AIDS.
“We really need to remind people … there’s absolutely no reason to become HIV positive,”said Paul Groesbeck, executive director of the Life Foundation, which offers support services for HIV/AIDS patients. But new cases develop across all sectors of the community: “Just recently we tested a 14-year-old boy, and a 75-year-old man positive. It’s all over the place.”
The number of cases, Groesbeck said, is not as dramatic as in years past, but education efforts must continue.
Meanwhile, groundbreaking research to develop strategies to eradicate HIV in infected individuals also is taking place at the Hawaii Center for AIDS at the University of of Hawaii’s John A. Burns School of Medicine. Whereas scientists for decades have been trying to devise a vaccine, the Hawaii to Zero (H20) HIV Cure Initiative is focusing on development of a “shock and kill” therapy.
“We need to understand where (the virus) is hiding and how we can get rid of it,” said Lishomwa Ndhlovu, an associate professor at the UH medical school involved in the H20 effort. “We need to conduct cure research here in Hawaii.”
Ndhlovu said much of the H20 initiative is funded through government research support, but finding a cure for HIV is a costly venture, and the initiative needs community support to further its work. Hawaii, he said, is in a unique position to find an HIV cure through its own work and collaborations with research teams throughout the world (see http://hawaii2zero.jabsom.hawaii.edu).
H20’s research aims to force the virus out its hiding place and “find ways to kill it in the hope that we can get people off treatment,” Ndhlovu said.
Groesbeck acknowledged that today’s drug therapy allows HIV patients to live longer lives, but it’s lifelong treatment. “These days, if you are prescribed medications, which you always are, and you take them when you’re supposed to, you’re not going to die,” Groesbeck said.
But research has shown that if people with HIV stop taking anti-retroviral drugs, they experience a rapid, aggressive rebound of the virus in the blood. Further, being HIV-infected still increases risk of heart attacks, dementia, liver problems and other complications of aging, according to the H20 website.
In the early days of treatment, patients were taking about two-dozen pills a day, Groesbeck recalled. In 1994, there were 64,000 AIDS-related deaths across the U.S., and two years later, that toll dropped to 16,000 due to successful drug therapy known as the “AIDS cocktail,” Groesbeck said.
Over time, the number of medications needed also has decreased, with some patients taking just one pill. “The fact that you can take one pill and it goes away doesn’t mean it won’t give you side effects,” Groesbeck said, noting prevention is key.
However, federal funding is hard to come by for organizations that support HIV/AIDS patients and outreach, such as the Life Foundation. The foundation used to have 15 outreach workers; it now has three.
Yet the foundation gets about 150 new clients a year, with a daily census of about 700 patients, Groesbeck said.
“When the Life Foundation started, … it became the first organization in the country to take AIDS education in the schools so that people could learn about this stuff early,” Groesbeck said, noting the curriculum was introduced to Punahou School, then later brought into public schools through the state Health Department.
“There was a period when it was required education,” Groesbeck said. “They don’t do that anymore.”
The Life Foundation for 11 years received $400,000 annually from a competitive grant through the federal Centers for Disease Control and Prevention (CDC). But when that request for proposal came out in September 2014, it was limited to 50 metropolitan areas that did not include Hawaii, Groesbeck said.
He and the organization have learned to adapt, Groesbeck said.
“The main issue is, AIDS is still here, HIV is still here, the Life Foundation is still here.”
