Jan. 3, 1983. A 28-year-old man from the west side became the first person in Greater Cincinnati to die of a mysterious illness the world had just begun to call AIDS.

        Less than two years before, on June 5, 1981, federal health officials published their first warning about the disease, which at the time struck homosexual men.

        At that time, it seemed more of a New York or San Francisco problem; Ohio had only seven cases. But Dr. Evelyn Hess, an immunology expert at the University of Cincinnati, knew the toll here would rise.

        “In the early days, people were dying like flies, and there was not terribly much interest from what might be called the medical establishment,” Dr. Hess recalled Monday.

        Much has changed in 20 years. AIDS moved into the national spotlight and stayed there. More than 420,000 Americans have died of it, including more than 1,200 in the Cincinnati area, and as many as 900,000 more Americans have contracted the virus that causes it.

        Two decades of progress and promise — from new HIV medicines, to better detection and prevention — haven't changed one thing: AIDS still kills, and there is no cure.

        Dr. Hess was among the first to sound the alarm in the Tristate.

        After that first local death in 1983, and a second three months later, Dr. Hess convinced a group of medical experts, public health and social service officials to launch a task force that ultimately became the AIDS Consortium of Greater Cincinnati.

        The public would need information to protect themselves, she reasoned, and hundreds, maybe thousands, of local patients would need intensive hospital care.

        Dr. Hess used her influence as a professor in academic circles and in the Academy of Medicine of Cincinnati to sway private practitioners. From her seat on the Cincinnati Board of Health, she cajoled reluctant politicians into making controversial preparations.

        Through her influence, Cincinnati started one of the nation's first anonymous testing sites for AIDS in 1985, less than a year after researchers pinned down HIV as the cause of AIDS.

        “It's always hard to measure prevention, but if we did prevent a greater burden from AIDS, a lot of it was due to her involvement,” said Judith Daniels, now medical director at the Cincinnati Department of Health.

        “She was a lady of real vision about this issue. Few people really understood the implications early on.”

        With the transmission process of AIDs still unclear and effective treatments nonexistent, some experts were predicting an epidemic more deadly than bubonic plague. California researchers estimated that up to 3.3 million Americans would contract AIDS by 1988.

        Cincinnati's consortium tapped UC's old Holmes Hospital to become the city's AIDS Treatment Center, allaying concerns that AIDS victims might be treated in community hospitals among other patients. If Holmes filled up, Plan B called for taking over Drake Memorial Hospital, now the Drake Center.

        It never came to that.

        Over the years that followed, researchers figured out how HIV is spread, the public learned about safer sex, and drug makers developed treatments that don't cure AIDS but hold its ravages at bay.

        Dr. Hess went from spending a third of her time on AIDS during the 1980s to hardly being involved now. She still teaches, treats patients and is a world-class expert on arthritis, but she left the consortium two years ago and has stepped down from directing UC's immunology department, and consults only on complicated AIDS cases.

        Today, much of the medical establishment views AIDS more as a chronic, controllable disease, rather than a massive public health threat.

        “In the first 10 years, there was a big effort to educate the medical community. There were dozens of lectures per year,” she said. “Now, you hardly hear the word mentioned.”

        In Ohio, the annual AIDS death toll plunged from nearly 500 in 1995 to less than 150 in 1999.

        The UC AIDS Treatment Center still cares for about 1,600 patients, but few need hospitalization.

        Several years ago, the center moved its inpatient services to University Hospital, leaving Holmes Hospital to other uses. Come June 30, the center will close its specialized inpatient unit.

        The few AIDS patients who do get sick enough for hospital care will be treated on regular hospital floors, said associate director Dr. Judith Feinberg.

        “It's astonishing,” she said.

        “I was in L.A. in 1982, and it's like two different countries. Back then we had young men coming in and dying in droves. Now, I have patients with HIV who have never been sick.”

        Looking ahead, Dr. Hess said, she is still worried.

        National statistics on new HIV cases indicate that young people appear less serious about practicing safe sex, she said. Now some people's anti-viral cocktails are wearing off, leading to illness.

        And the face of AIDS is gradually changing, shifting away from the highly visible and politically active white, homosexual male patient group to African-American men and women, gay or straight.

        Though community groups have made efforts to focus AIDS prevention toward those groups, Dr. Hess and Dr. Daniels said they wonder just how hard they will push our nation to fight a disease that increasingly targets minorities.

        “We need to keep AIDS on our radar screens, because it is still an infectious disease for which we still do not have a cure,” Dr. Hess said.

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