On Eve of World AIDS Day, Law Professor Reflects on Changing Face of AIDS

When she first got involved in AIDS-related issues in 1985, Duke University law professor Carolyn McAllaster says it was perceived as a disease of gay men -- women then made up only 7 percent of patients diagnosed with HIV.

Today, 30 percent of newly diagnosed patients in the United States are women, and 64 percent of them are African-American. McAllaster says the statistics are reflected in the clients who seek help from Duke Law School's AIDS Legal Assistance Clinic, which she directs.

"Since we started the clinic in 1996, we've had an increasing number of women, many African-American, who tend to be younger and poorer than the men. They also tend to be in poorer health -- they seem to be infected earlier and they get sicker earlier."

What's sad, she adds, is that many women contract the infection while in monogamous relationships with partners who are secretly involved in other high-risk sexual relationships or are intravenous drug users. "The women are totally clueless."

Wednesday, Dec. 1, is World AIDS Day. McAllaster observes that while new generations of AIDS drugs have brought hope -- people are living longer and the numbers of deaths from AIDS have declined in the United States -- there are still hurdles to access.

"You want to be able to offer people the medications before they get really sick. Yet most people who are affected receive their drugs through Medicaid, and in order to get Medicaid, in most cases, you have to be disabled -- you have to already be sick," McAllaster said. "Some states are experimenting with Medicaid programs that allow people to get on the program while they are still relatively healthy; I'd like to see us move in that direction.

"For patients who aren't eligible for Medicaid and don't have private insurance, their options are to rely on patient assistance programs through pharmaceutical companies that are very hit or miss, or the [federal] AIDS Drug Assistance Program (ADAP) which states administer. In North Carolina, a single person qualifies for ADAP only if he or she earns less than $12,000 per year. A person who is working at a job that does not provide health insurance and who earns more than $12,000 would not be eligible for the ADAP program."

The global challenge posed by AIDS is enormous, notes McAllaster, with 40 million people infected worldwide, 70 percent of them in sub-Saharan Africa where treatment is scarce.

"Treatment is linked to prevention. In developing countries, the goal is for people to be tested so they know their status, and so they can be educated about how to prevent the spread of the virus. But people won't come in to be tested unless there is something they can do with that information -- unless treatment is available. That was a big problem in this country before AZT."

At Duke's AIDS Legal Assistance Clinic, McAllaster supervises students who help clients get Medicaid and disability benefits. In addition, students help their clients work out end-of-life and child guardianship issues. The clinic also handles cases of discrimination in health care and employment.

"We're actually seeing more discrimination cases -- not necessarily because there's more discrimination, but because more people are willing to take steps to fight it."

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