This is the fourth story in a five-part series on Duke's 20 years of research and social work against AIDS.
Over 8,000 people around the world die of AIDS every day, but there is growing concern that many North Carolinians have little knowledge about the causes of the disease and methods of prevention.
"In rural areas [of the South], people still don't know if it's safe to hug you if you are HIV positive," said Kathryn Whetten-Goldstein, assistant professor in the Terry Sanford Institute of Public Policy and the Center for Health Policy. "These people don't have the energy to change things. This makes care fantastically difficult." To combat this trend, several specialists at Duke are working together to promote awareness and serve those suffering from AIDS.
"There needs to be a big public push," said Rachel Stevens, project coordinator of the Duke Rural HIV/AIDS, Substance Abuse and Mental Health Cost Study. "We need to make our voices heard."
Patricia Bartlett, a clinical social worker at the Duke AIDS Research and Treatment Center, said education about the characteristics of HIV and AIDS is a key ingredient to increasing awareness. "The education level of the area in terms of the understanding of the disease and the type of medications available is woefully inadequate," said Bartlett, also a liaison to the Community Advisory Board Outreach Program.
Duke has been a leading actor in providing a conducive environment for AIDS education. For example, the University is involved in a peer education training program, enabling people with AIDS to teach each other about the disease and the types of available treatments. The Partners in Caring initiative, part of the Medical Center's pastoral care program, supports AIDS patients and is working to reduce the stigma of the disease.
Duke University's Red Cross Club also provides community educational programs, and the Student Health Center offers free confidential HIV testing for students Tuesdays and Wednesdays.
"For a while Duke had stuck its head in the sand with regard to AIDS issues. But now there have been a number of changes, particularly with the education aspect," Bartlett said.
Experts hope that by teaching the public about the spread of HIV and available treatments, they can effectively contain current cases and prevent further infections. "We have got to go out there and tell people about the situation," Whetten-Goldstein said. "This is a call to arms--something has got to be done. We're not yelling at people; I consider this more of a cry of desperation."
In addition to offering educational opportunities for those affected by HIV and AIDS, the University is providing more comprehensive patient care.
Robin Swift, project director of the North Carolina HIV/AIDS Training and Information Center, pointed out that substance abuse, stress, psychological disorders and post-traumatic stress disorders are all complications associated with HIV-positive patients. "It's important to understand that HIV alone is not the only problem," Swift said. "From the screening data, close to 40 percent of the people [screened] are triply diagnosed [with HIV, substance abuse and a mental disorder] and 70 percent are dually diagnosed."
The Center for Health Policy and the North Carolina AIDS Training Center at Duke are participating in a national study to show how the social and medical issues of HIV treatment are interrelated. Additionally, Duke's infectious disease clinic cooperates with the University of North Carolina at Chapel Hill to screen for mental illness and drug abuse.
The South is the nation's fastest growing area of reported HIV and AIDS cases, and North Carolina has the region's third-highest incidence rate, especially among those who are economically disadvantaged and live in rural areas.
Experts identify education programs such as the ones initiated by Duke as the key to clearing the stigma associated with AIDs and halting the spread of the disease. "It's a sad commentary to think that with all the years we've known about HIV and AIDS, these are still central problems that haven't been overcome," Bartlett said. "I don't know any other disease in which people are so afraid--people are afraid of it and afraid of disclosing it. It's the only disease I know of like this."
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