Schenectady Gazette, June 4, 2006

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HOPE
at the end of the tunnel

After 25 years, doctors see cause for optimism in the fight against AIDS

BY BILL BUELL
Gazette Reporter

In May 1981, the Centers for Disease Control and Prevention in Atlanta realized something was terribly wrong. A rare kind of pneumonia was killing gay men at an alarming rate, and no one knew why.

Twenty-five years later, gay men are still dying from complications associated with Acquired Immune Deficiency Syndrome, as are other men and women, regardless of their sexual orientation. AIDS, it was discovered, doesn't discriminate. But after more than 25 million deaths world-wide, some people are now living longer with the disease, at least those with access to the latest modern medicine.

Dr. Douglas Fish, division head for HN medicine at Albany Medical Center, said there is plenty of hope for people with AIDS, and after working in the field for 12 years he's happy to be able to talk optimistically about treating the disease. Ac-cording to Fish, the light isn't at the end of the tunnel. It's much closer. "I would say that the light is here," said Fish. "We have excellent medications that work well to suppress the virus. The cure is still an indefinite thing, but we are controlling it. It's not that people don't die, they do, but AIDS is not the death sentence it used to be."

EFFECTIVE DRUGS

Protease inhibitors -drugs that make the disease more manageable -began being used in 1995, and medical and pharmaceutical improvements have continued to make living with AIDS easier. "That's what I tell people, especially the new patients I see," said Fish. "AIDS should not define them. It doesn't have the same terminality that it used to, and their life can go on. If they keep a good perspective, it doesn't have to dominate their life.

Of course, that's a lot harder to execute than it is for me to say it." Perry Junjulas, diagnosed with AIDS in 1995, knows exactly how difficult dealing with the disease can be, and sometimes the reality of the situation can curb one's optimism.
"It's been kind of a roller coaster ride for me," said Junjulas, director of Albany's Damien Center, a not-for-profit community center for AIDS patients and their families. "Right now I'm doing OK, but I don't feel the same hope that I used to that they will fmd a cure. The medication works, but it's not forever. Eventually, I'll reach a point where it stops working. Hopefully; they'll keep coming up with new medicine, but you don't know that."

Junjulas takes 15 different pills each day to fight his disease and the other oppor-tunistic infections it creates.

"The people who are dying now are the ones whose medication stopped working," said Junjulas. "I feel like I'm about three-quarters of the way there. I"m resistant to a bunch of drugs. The ones I'm on right now are holding, but the next time I develop a resistance I'm going to have to change drugs and there might not be any options. That's the scary part."

For some people, such as former basketball star Magic Johnson, the outlook is much brighter. Johnson was diagnosed as HIV-positive in 1991, but in his case the medication has kept the virus from developing into full-blown AIDS.

"Magic Johnson was very privileged, and he was diagnosed very early, before he had any symptoms and before the HIV turned into AIDS," said Linda Glassman, executive director of CARES (Corporation for AIDS Research, Education and Services). "He had the money to pay for the medication, and it was all cutting edge medicine that he had access to. In the case of poor people, they don't get diagnosed until they have a lot of the symptoms, and then by that time the medications aren't always as effective."

HOW IT SPREADS

AIDS is the most severe manifestation of infection with HIV (Human immunodefi- ciency virus). It is spread by direct contact of a mucous .membrane with a bodily fluid containing HIV, such as blood, semen, vaginal fluid or breast milk. That transmission can come in the form of unprotected sex, contaminated needles or blood transfusions.

The number of AIDS cases being treated at Albany Medical Center is at an all- time high, and while some of that can be attributed to people living longer with the disease, the number of new cases is also on the rise.

"It's no longer a 'gay' disease," said George Clifford, administrator of the AIDS program at Albany Medical Center, "Contaminated needles used by drug users continue to play a role, but most of the transmission is a result of unprotected sexual activity, and the change from the '80s is that it's being transmitted more heterosexually than it used to be."

The proportion of females making up the total pool of AIDS cases has increased, according to Clifford, and the disease is also being contracted by people of color at a much higher rate than in the past, Glassman, who worked with homeless youths in New York City before taking the job at CARES and moving to Albany; said the disease is especially hitting the poor, young people.

"Fifty percent of the new infections are people under 25. So I'm seeing the same people, many of them homeless youths, that I was seeing in New York," said Glassman. "Poor people and people of color. A friend of mine said the other day that it's not his group of gay middle class friends any longer. They're the exception."

Although all these people may be living longer, their quality of life often suffers.

"Back in the '80s and '90s, people would be dead within six months, but now they're living longer and as a result there is a big economic impact on these people," said Glassman. "The medication is expensive, and while there are state programs that help, you still have co-pays. If people get sick enough, they lose their job, they lose their health care, and then housing becomes a big issue. That's when the real struggle starts."

All those concerns, plus the problems of daily life, can make things pretty discour- aging for people diagnosed with HN or AIDS.

"I continued to take illegal drugs after I learned I was HIV because it was my way to avoid dealing with my feelings," said Marlon Brandow of Albany, who was di- agnosed with HN back in 1985. "I was medicating those feelings. I didn't want to have to deal with it, and I didn't for a long time. God knows why fm still here." While it took Brandow years to come to grips with his illness, Terri Gonhue faced up to the situation almost immediately.

"I was in jail for prostitution and possession of crack cocaine when they offered me an HIV test," said Gonhue. "I'd been arrested 32 times. So going to jail didn't scare me, but testing positive for HIV did."

CHANGING LIFE

Gonhue, who was pregnant with her now 2-year-old daughter at the time, changed her life. She has been drug-free since her diagnosis, and works at the Damien Center in Albany preparing meals for its visitors.

"They say you need a rude awakening to really get straight, and for me that diagnosis was a spiritual awakening," said Gonhue.

"Some people look at HIV as the end, but for me it was a beginning. I'm happy that God gave me a second chance, and I'm proud of how I've turned my life around. This disease got me off the street and put me in a better place."

While Brandow and Gonhue were both willing to talk openly about their experi- ence with HIv; the stigma attached to AIDS still does exist.

"I've been to funerals where I knew the person died of AIDS, but most of the family didn't realize it," said Glassman. "The stigma is still there. A few weeks ago, a woman with AIDS came in here with her uncle because she had a problem with her housing. It soon became obvious to us that she never told him that she had AIDS. As sick as she was, she couldn't bring herself to tell him."

Reach Gazette reporter Bill Buell at
395-3190 or bbuell@dailygazette.com

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