Treating people with HIV and AIDS and preventing its spread remains a challenge, especially in eastern North Carolina, where rates of sexually transmitted disease outpace the rest of the state and nation as a whole.
“We are right in the middle of an epidemic of HIV and AIDS, and I don’t know how many people think about that or know it,” Dr. Thomas Kerkering said during a Nov. 15 Department of Pediatrics grand rounds lecture at the Brody School of Medicine at East Carolina University.
HIV, or human immunodeficiency virus, is the virus that causes AIDS. AIDS is a collection of symptoms and infections resulting from specific damage to the immune system caused by HIV. People are diagnosed with AIDS when a certain type of white blood cells called T cells drops below 200 per microliter of blood or makes up 14 percent of all lymphocytes in the blood.
In eastern North Carolina, the HIV/AIDS rate is highest in Edgecombe County, where 252 cases among 54,129 people result in a rate of 465.6 cases for every 100,000 people, the common measurement.
Kerkering said eastern North Carolina not only has rates of HIV/AIDS that are similar to countries in Africa, where the disease hits hardest, but also northern and western cities in the United States, where the disease was first diagnosed in this country.
“It’s more and more a heterosexual disease in eastern North Carolina, and that’s how it is in developing countries,” said Kerkering, a professor of medicine and chief of infectious diseases.
The HIV/AIDS clinic at the Brody School of Medicine follows approximately 1,700 patients from 30 eastern counties. Twenty-five years ago, HIV/AIDS was described as a disease of homosexual men. That’s no longer the case. At the Brody clinic, women make up the majority of patients between 24-29 years old. Among patients 30-39 years old, men and women are equally split. Among patients 18-24 and 40-49, male patients outnumber female 3-to-2.
Overall, 58 percent of eastern North Carolina HIV/AIDS patients are male, and 42 percent are female, similar to the ratio in developing countries. Kerkering added that while male patients won’t say they had homosexual sex, they will acknowledge having had sex with “men or women,” Kerkering said.
“No one has ever said, ‘men only.’ That’s still a huge stigma in eastern North Carolina,” Kerkering said.
Kerkering estimated 5,000-6,000 people in eastern North Carolina would test positive for HIV/AIDS if all residents were tested.
Kerkering pointed out other facts about HIV positive patients seen at ECU:
• 81 percent are black.
• Two-thirds have government insurance such as Medicaid.
• One-fifth have no insurance.
• 87 percent have annual incomes of less than $15,000.
• 60 percent have less than a fourth-grade reading level.
As in a developing country, many HIV/AIDS patients in eastern North Carolina have little access to health care and no means of transportation.
“When gasoline got up to $3 a gallon, you should have seen our cancellation rate,” Kerkering said.
HIV/AIDS patterns follow those of gonorrhea and chlamydia, sexually transmitted diseases that are also reported to public health agencies. The rates of all three diseases in Pitt, Edgecombe and Perquimans counties are near the top of all eastern North Carolina counties.
Though modern drugs have made AIDS more of a chronic illness than a terminal one, a study in the most recent issue of the Public Library of Science’s journal Medicine said AIDS could become the world’s number three killer in the next 25 years. Currently ranked fourth behind heart disease, stroke and respiratory infections, AIDS accounts for about 2.8 million deaths every year but could near 120 million by 2030.
ECU is in the final stages of receiving $1.6 million in federal Ryan White funding to treat people with HIV/AIDS, Kerkering said. Earlier this year, Kerkering received $100,000 from the Kate B. Reynolds Charitable Trust to care for people with the disease. Increasing access to care and education are important next steps, Kerkering said. “We’re all responsible for taking care of these patients and helping prevent it,” he said.