The faces of HIV/AIDS.

There have been 242,146 reported cases of AIDS in the United States through September 1992. Two-thirds of those (160,372) have died from Aids-related complications (CDC) 1992. At least one million people are estimated to be infected with HIV, the virus that causes AIDS. Most Americans, however, still think that AIDS "cannot happen to them." But it did happen to Rock Hudson, Ryan White, Michael Bennett, Kimberly Bergalis, Alison Gertz, Arthur Ashe and Magic Johnson. These are the well-known faces of the U.S. epidemic, but there are thousands of others living with HIV disease in our communities, our counties and our states. Some of them have become AIDS educators and activists, and we know them. But for most, the disease is known only to families or friends; and for some it is known to no one at all.

During the 1980s, the public's perception of AIDS was that it was a disease of gay men, and secondarily of male intravenous drug users. With the onset of the 1990s, HIV disease is in fact increasingly a disease of women, of adolescents, of people of color and of the poor. More than 50 percent of American women who were diagnosed during the first decade of the AIDS epidemic were African American; more than 20 percent were Hispanic. In 1982 women accounted for six percent of all AIDS cases, and in 1992 they accounted for 11 percent. In the last year, the percentage of increase of AIDS cases among women was 37 percent. Regarding teenagers, the number of AIDS cases diagnosed in the 13-to-19 year old group is not extremely high (i.e., 912 cases); however, the number rises dramatically in those 20-to-24 years of age (i.e., 9,270 cases) and in those 25-to-29 years of age (i.e., 37,206 cases). In fact, 20 percent of those between the ages of 20-29 are thought to have acquired the disease as teenagers, given the extended latency period before the onset of symptoms.

Although the human impact of the AIDS epidemic is immediately apparent, the economic costs are not. The annual cost of treating a person with AIDS is not $38,300, and the average cost of treating an HIV-infected person is about $10,000. In 1991, these estimated costs were $32,000 and $5,100, respectively. The lifetime cost of treating a person with AIDS in the United States rose to $102,000 in 1992, up from $85,000 in 1991. By the year 2000, it is estimated that AIDS will siphon off between $81 billion and $107 billion-about one percent of the gross domestic product.

By the year 2000, it is also estimated that at least 40 million worldwide will be carrying HIV, and 15 to 20 million of these infections will be among women. "At the present time," says William Haseltine, chief of the human retrovirology division at the Dana-Farber Cancer Institute in Boston, "there is nothing standing in the way of this happening." It is my contention that we in the profession of recreation and parks can stand in the way of the spreading virus. In fact, we must stand in the way.

AIDS is not curable, but it is preventable. Working together, as commission/board members, educators, managers, supervisors and leaders, we can establish HIV/AIDS prevention education programs to reach millions of people. We can also ensure that those disabled by AIDS have access to our programs.

First we have to agree to accept some basic assumptions.

Let us agree that AIDS is caused by HIV and that it is transmitted by sexual contact with someone who is infected or by sharing needles and syringes with an infected person. Babies of women who are infected with HIV may be born with the infection because it can be transmitted from mother to baby before or during birth. All of these transmissions are preventable.

Let us agree that HIV is not transmitted by casual contact and that it is not transmitted through sweat, tears or saliva in spite of the fact that small amounts of HIV have been found in these bodily fluids. Therefore, associating with people with AIDS should not cause alarm regarding HIV transmission.

Let us agree that more opportunistic infections associated with HIV are treatable, that AIDS is now considered a chronic disease, and that people with chronic diseases can benefit from recreation and leisure service programs.

Let us agree that "few other diseases produce as many losses - loss of physical strength, mental acuity, ability to work, self-sufficiency, social roles, income and savings, housing and the emotional support of loved ones," and that recreation and leisure services provide opportunities to assist people with AIDS in reducing the impact of these losses.

Let us agree that many people with HIV and AIDS experience stigmatization and discrimination. This is not surprising when one looks at the unique features of the AIDS epidemic. According to Flaskerud and Ungvarski, "AIDS is a relatively new, communicable, sexually transmitted, fatal disease. It was first identified and occurs most frequently in socially stigmatized groups: homosexual men, intravenous drug users, and ethnic and racial minorities. The diagnosis of AIDS is a traumatic event because the disease is known to have a progressive course, no curative treatment, and an extremely poor prognosis." It is the stigma and discrimination associated with the disease, however, that is a barrier to effective HIV/AIDS prevention education and services to people with HIV disease.

Let us agree that AIDS is becoming a disease of those whose needs tend not to be met by mainstream American institutions. Historically these were the types of people the recreation profession served in such organizations as University Settlement, Hull House, and the Society of Parks and Playgrounds in the late 1800s. The HIV/AIDS epidemic provides the profession with the opportunity to renew its commitment to serve those who are experiencing stigmatization, discrimination and psychological trauma, many of whom are of low socioeconomic status.

What can we do? First, we should incorporate HIV/AIDS prevention education into our recreation and park programs. Second, we should make certain that people who are disabled by AIDS have access to our programs.

The HIV/AIDS prevention education programs should be age-specific, i.e., children, teenagers, adults and senior citizens. This is important. For example, we learned during the first decade of the epidemic that messages developed for preventing HIV infection among adults are not appropriate for and have not worked for adolescents. The education programs must also address the diverse groups of constituents whom we serve, e.g., male and female; heterosexuals; gays, lesbians and bisexuals; and people of diverse ethnic and cultural backgrounds. We have learned also that "fear tactics" may be effective in promoting changes in community norms, but they do not necessarily motivate individuals to adopt AIDS risk reduction behaviors.

Recreation and leisure professionals have the capacity to provide equality and freedom to people with HIV/AIDS through leisure. Through leisure experiences individuals with HIV/AIDS can enhance their feelings of self-worth, self-esteem and integrity. In addition, they can achieve a sense of intimacy, intrinsic satisfaction, empowerment, and hope. They can also learn how to cope with free time in spite of joblessness, separation from families and significant others, loneliness and loss of identity and declining health.

The challenge of HIV/AIDS faces us as do the faces of people with HIV/AIDS. Will we stand on the sidelines and watch our constituents become infected? Will our profession renew its historic commitment to serving those who are in need? Will history state we assumed our responsibility in the HIV/AIDS epidemic, or will it recall our abdication? The choice is ours, individually and collectively.

AIDS Resources, Help and Education

Use community resources to help design HIV/AIDS prevention education programs and to assist in enhancing services to people with AIDS: * HIV/AIDS hotlines * HIV/AIDS speakers bureaus * Programs/services for gay, lesbian and bisexual

people * Condom availability sites * Alcohol and drug rehabilitation programs * Needle-exchange availability sites * Medical and health services specializing in

treating people with HIV/AIDS * Counseling services for people with HIV/AIDS * Experimental Protocols for people with HIV/AIDS * Support groups for HIV positive individuals and

those with AIDS * Suicide prevention hotlines * Programs providing financial, house and legal

assistance for people with HIV/AIDS * Programs providing food services for people

with HIV/AIDS