AIDS 25 YEARS LATER

In the U.S., cases and deaths have declined dramatically. A
Philadelphia program illustrates why further progress will be hard-won.

The man in the clean white kicks leaned forward at his desk and
addressed his 15 classmates.

"I've heard that this is a plague and a curse that God sent down on
us. I used to think that, too," he told the group. "But that's a lie,
because I know I am not cursed. I'm taking care of my health. I'm
more considerate of people. I have a lot of blessings."

Standing at the front of the classroom five floors above Center
City's gayborhood, teacher John Bell looked pleased. "That was so
cool," he told his student.

Last Wednesday was the next-to-last session of Project Teach Outside,
a course for people recently out of jail and "poz" - diagnosed with
AIDS or the HIV virus that causes it. For five weeks, the group had
gathered at 1233 Locust St. twice a week, three hours a day, to learn
about treatment and side effects, living healthy despite HIV, and
strategies for dealing with life "on the outside."

"People arrive feeling it's a death sentence and it's their fault,"
said Jane Shull, executive director of Philadelphia FIGHT, the AIDS
service organization that runs the Teach program. "They leave with
the beginnings of a new identity, thinking it's OK to take care of yourself."

Twenty-five years after the first AIDS diagnosis, with the American
death toll at more than 530,000, infection rates have dropped
dramatically from the mid-1980s peak, and death rates have plummeted
since the mid-1990s.

"Twenty-plus distinct drugs developed in 20 years. That's pretty
amazing, and it's because we as gay men fought and caused trouble and
demanded something be done," said Bert Pannapacker, 58, FIGHT's
administrative assistant and senior peer educator.

But over those 25 years, the nature and face of the epidemic have
changed in the United States. Project Teach reflects those changes -
and shows why making further progress against the disease is so difficult.

Originally a scourge of young, middle-class, gay men, HIV/AIDS now
predominantly afflicts the marginalized poor, especially African
Americans. Blacks account for more HIV and AIDS diagnoses and deaths
than any other racial or ethnic group; in 2004 alone, half of AIDS
diagnoses were among blacks, even though they represent only 13
percent of the U.S. population.

What's more, African Americans are more likely than whites to be
uninsured or publicly insured, and to postpone medical care because
they lack transportation, are too sick, or have even more pressing
needs such as finding housing, a federal study found. This, experts
say, is a big reason why a third of blacks are diagnosed in advanced
stages of illness.

During Wednesday's class, these troubling trends were apparent. Of
the seven women, seven men, and two transgender women, only two were
white. None looked younger than 30; two used walkers.

Project Teach recognizes that for them, taking the drugs that have
transformed AIDS from a relentless killer to a chronic illness is
just a small part of surviving. Indeed, the program has evolved in
response to the daunting needs of its graduates, who now number 1,800.

The program began in 1996 as a nine-week course focusing on health
care, nutrition, alternative therapies, stress reduction, and peer
support for HIV/AIDS patients.

That led to Frontline Teach, a five-week condensed version for
patients' family members and people who work in the HIV/AIDS field.

Still, a vast constituency - those in local jails - was not being
served. That was the impetus for Project Teach Outside.

The void in Philadelphia was hardly unusual. About 80 percent of
inmates in state and federal prisons have serious addiction problems,
and more than a quarter have been arrested for drug-related offenses,
federal data show. Their rates of HIV/AIDS are far higher than those
of the general population - yet testing and counseling policies are
varied and inadequate, activists say.

In Philadelphia jails, which offer voluntary HIV testing to inmates,
about 7 percent test positive - a higher rate than at any of the
city's health clinics and agencies that offer testing, Shull said.

Even so, Project Teach Outside might not exist if not for Bell, 59.

He left Baltimore for Philadelphia in 1997, a decorated African
American Vietnam War veteran, longtime Amtrak employee - and an
emaciated, alcoholic, drug addict fresh out of jail.

"I had lost the will to live," he recalled.

But detoxification treatment, followed by enrollment in Project
Teach, led to "a positive spiritual experience." He became a
crusader, devoting his time - without pay or sponsorship - to helping
the incarcerated find a new kind of freedom.

"I realized I had to make sure as many people as possible were aware
of this [Teach] program," Bell said.

In 2000, FIGHT hired him to launch Project Teach Outside. Bell's
co-teacher and surprising alter-ego is Laura McTighe, a 28-year-old,
white, Haverford College graduate with a degree in religion and peace
studies. A summer internship with FIGHT and volunteer work in prisons
gave her a perfect resume.

"There's a point a lot of activists get to where they think the
problems are so awful and intractable that they just feel
overwhelmed," McTighe said. "What these classes have given me is hope."

On Wednesday, Bell and "Shorty," as he calls McTighe, spent the first
hour fielding questions that showed how far their latest students
have come - and how deeply distrustful and angry some of them remain.

"To me the government is just using us as lab rats," one man
declared. "They probably got a cure but just ain't giving it to us
'cause they're making money off us."

McTighe tactfully rebutted this, first acknowledging that racism is a
problem in the health-care system, then rehashing scientific
information, much of it included in the three-inch binder each
student receives.

Bell added, "Even Magic Johnson, with all his money and fame,
couldn't get better HIV drugs than I got."

Enrollment in Teach is voluntary, but not automatic. Each applicant
is interviewed to assess his or her commitment. Those who faithfully
attend and do the homework receive a stipend - $100 for Teach, $150
for Teach Outside.

"A lot of them say they started out coming just to get the stipend,
but by the end, that's not what motivates them," McTighe said.

Jaci Adams, 49, FIGHT's outreach specialist, says Project Teach
"changed my life."

A runaway from her abusive father at age 9, Adams says she spiraled
into a life of "shame" as a heroin addict, petty criminal, and
transgendered woman.

"I thank God for AIDS," she said of her diagnosis 20 years ago. "Had
it not been for AIDS, I'd probably be dead or trying to rob you."

Adams is now a frequent speaker at AIDS conferences, an activist on
behalf of transgendered women, and FIGHT's ambassador to the newly
diagnosed in jails.

"For so many years, I was told I was nothing," she said. "I'm now
helping people in the jails I was detained in."

Stigma and discrimination remain huge problems. A woman in
Wednesday's class said she was sure she was infected by a blood
transfusion because "I never did needles or the other stuff." The
teachers cautioned the class not to dwell on how infection may have
happened, because it can lead to judgmental behavior.

"Don't ask yourself, 'Is it my fault I'm infected, or am I an
innocent victim?' " McTighe said.

The class closed with a guest speaker, a Community Legal Services
attorney who talked about how to get public benefits despite a criminal record.

And then, the final homework assignment: prepare for graduation. The
well-dressed affair, complete with a diploma ceremony and luncheon,
is held at a nearby church.

"It's a big, big deal - the first graduation some of them have ever
had," Shull said. "People cry all through it." Contact staff writer
Marie McCullough at 215-854-2720 or mmccullough@phillynews.com.

Benchmarks in the 25-year history of AIDS

In just a quarter-century, AIDS has changed the world. It has
inspired unprecedented cooperation to identify and develop treatments
for the HIV virus. But it has also unleashed a pandemic now
concentrated among the world's poorest people, still rooted in fear,
stigma and misinformation.

1981: U.S. Centers for Disease Control and Prevention (CDC) reports
rare forms of pneumonia and skin cancer among young gay men.

1982: CDC uses the term acquired immune deficiency syndrome and says
male homosexuality, intravenous drug abuse, Haitian origin, and
hemophilia are risk factors.

1984: Dr. Robert Gallo and Dr. Luc Montagnier codiscover HIV.

1985: The first HIV test is developed. Actor Rock Hudson dies of
AIDS. Hemophiliacs' HIV infection leads to screening of blood supply.

1987: AIDS has killed 40,000 Americans. First protests by gay
activists - ACT UP - against government's handling of AIDS crisis.
First HIV/AIDS drug, called AZT, is approved by Food and Drug Administration.

1990: Indiana hemophiliac Ryan White, 18, dies of AIDS after a brave
struggle against AIDS-related discrimination. Congress passes the
Ryan White CARE Act to provide health care for people with HIV.

1991: Basketball player Magic Johnson announces he is HIV positive.

1993: Philadelphia wins Academy Awards; Angels in America wins Tony
Awards. Tennis player Arthur Ashe dies of AIDS contracted from a
blood transfusion.

1995: First protease inhibitor ushers in second class of HIV/AIDS
drugs, turning HIV into a controllable infection. AIDS has killed
300,000 Americans.

1996: Third class of HIV/AIDS drugs, reverse transcriptase
inhibitors, is introduced. Annual death toll falls for first time.

2001: Half of new HIV infections in United States are among African
Americans. United Nations devotes special session to AIDS.

2004: HIV infects 40 million worldwide. Rapid HIV test comes on market.

2005: The World Health Organization; UNAIDS; and the Global Fund to
Fight AIDS, Tuberculosis and Malaria say increased drug distribution
in developing countries has reached 700,000 people.

2006: UNAIDS estimates death toll of 25 million since 1981. Of 40
million living with HIV/AIDS, 96 percent are in developing countries.
Africa has 12 million AIDS orphans.