“The Age of AIDS” by frontline is an apt study for two reasons. First it details the process of identifying a disease which was new and mysterious; second in doing so it gives us insight on how epidemiology plays an important role. This gives us an understanding of epidemiology and its basic concepts in force while executing this role. The objectives of epidemiology of identifying the cause of disease, in this case AIDS, extent to which it has penetrated. Finding records for similar cases for further investigation which would help in finding the origins of the disease.
Evaluating preventive and therapeutic measures, in this case the drug “AZT” was monitored and after sometime was found ineffective, because the HIV virus had formed immunity to this drug. This was possible to know in short span of time due to accumulation of data from all the test cases and assessing them regularly. One other important objective of epidemiology was indirectly explained, the objective of providing foundation for developing public policy. The program implicitly tells how ignorance from government led to transforming a disease with no cure, to a disease with no hope.
There is a difference in not having a cure and not having hope. When there is no cure, it can be due lack of medical advance, which in due time might and will catch up, to bring forth better preventive measure and possible cure. Now not having a hope is not as simple as it sounds. It implies being alone, reduced to utter dejection from society and feeling helplessness. In early days, neglected by government to avoid controversies, detested by religious groups, feared by masses for possible chance of infection, people with AIDS were reduced to such helplessness and utter dejection, which I am sure, might not have any equal.
This was possible not only because of indifference from government, but is also reflected in ignorance of CDC by administration and also discrimination not just by conservatives but even by the then president. An example should be taken out from Uganda’s approach through TASO, and Mechai Veravaidya’s condom promotion. If CDC would have been properly funded or even heard, a lot of social stigma would have been avoided. Even better preventive measures would have been possible. Like in Thailand, where condom campaign reduced AIDS in sex workers, by about 90% in a span of decade.
Even in Great Britain, though they too had a conservative party in power. The disbursement of syringes so as to curb spreading of AIDS by sharing of syringes was implemented. Epidemiology helps to monitor patterns of community health conditions. If CDC’s MMWR reports were not present to label AIDS as a rare pneumonia, the fact that in was AIDS and was not just an epidemic but was pandemic in nature would not have been possible, at least not in such a timeframe. In due time we were able to discern that only primary prevention was possible, with no potential cure or vaccine and containment.
Epidemiology also contributed in clinical practice. It told doctors what they were dealing with and kind of education to be imparted on masses. In fact educating the masses was only logical approach as there was no cure and society was not civil to even hemophiliacs, let alone AIDS victims. The program is effective in displaying the epidemiologic approach from observation to preventive action, which in early stages of any new disease is very essential as to find cure and vaccines takes time. The program also helps to understand epidemiology’s role in understanding transmission of disease.
It helped to understand that AIDS was sexually transmitted and that blood transfusion was also a major factor. This would have helped to prevent a lot of misunderstanding and prejudice against hemophilia and AIDS victim if promoted at that time by the administration. The program also touches on Iceberg concept of infection. It details the difficulties in detection of AIDS and also points out that a carrier of AIDS does not realize it till it reaches the critical point where body immune system is damaged beyond salvation.
In fact it also helps us to understand the nature of disease. That patient is not killed by HIV virus, he is killed by any opportunistic disease, which in presence of normal body defenses would not be life threatening, CDC helped in this aspect. The concept which is most useful for me being a MHA student is the providing the foundation for developing public policy. Like with AIDS, it was possible to research new medicines in proper direction as we knew what the disease was how we needed to tackle it.
Without this data it would be impossible to judge in which direction the drug research should go. I am from pharmacy and I know the significance of clinical trial data. It takes a lot of funding and time to bring out one effective drug, mostly decades. Epidemiologic approach in the performance of trials helps in channelizing drug research. In case of hospitals as in case of early days of AIDS providers could predict the course of the disease and where well equipped to tackle to some extent patients, not just therapeutically but emotionally too. I again want
to emphasize if an open minded approach, free of religious superstitions and fuelled by rational thinking, would have been taken. The severity and spread of AIDS would have been better controlled. One insight that I had through this presentation is that even though epidemiology is very integral part of health and life sciences, it alone is not sufficient. No matter how well we research data, and how well we present it. Until and unless we empower agencies like CDC, we will still be in stalemate. This is essential so that we don’t face same dilemma as we faced with AIDS.