By Tim Bonfield
The Cincinnati Enquirer

At the global level, AIDS is a full-blown plague that has decimated a generation in sub-Saharan Africa and has begun ripping into Southeast Asia.

But in Greater Cincinnati on World AIDS Day 2002, AIDS has evolved into a chronic illness that threatens to drop off the public radar screen even as the virus cuts deeper than ever among African-Americans and increasingly strikes women.

VIGIL TODAY

What: A candlelight ceremony, speeches and testimonials. When: 3 p.m. Where: The First Lutheran Church across from Washington Park, Over-the-Rhine.

"In the U.S., the epidemic has stabilized. But it's not going away, either. We still see newly infected people all the time. And people are still dying. I had two patients die last week," said Dr. Judith Feinberg, director of AIDS research at the University of Cincinnati.

Since AIDS emerged in 1982, the virus has killed 1,254 people in Greater Cincinnati. Another 1,537 area residents are living with AIDS or HIV infections, state health officials say.

However, these numbers underestimate the true scale of the problem because no one knows how many infected people have never sought testing. It can take years for an infected person to get sick enough to seek medical care, where tests could spot the virus.

In fact, statistics about year-to-year changes in new HIV infections are so unreliable that Ohio reports them only as a three-year running total, and Kentucky doesn't report them at all.

"We think the infection rate has been fairly stable from year to year. The changes we're seeing could reflect quirks in the reporting process more than any change in the disease trends," says Dr. Elizabeth Cross, an epidemiologist with the Ohio Department of Health.

While AIDS kills millions per year in Africa, the disease doesn't make the top 20 causes of death in Ohio, Kentucky or Indiana. Heart attacks, cancer, car wrecks, influenza, homicides and suicides all claim more lives.

But overall death statistics mask the deep blow the virus strikes against African-Americans.

Among blacks in Ohio age 25 to 34, AIDS is the fourth-leading cause of death, behind homicides, accidental injuries and heart disease, according to the Centers for Disease Control and Prevention. Those rates among younger people are powerful enough to make AIDS the 15th leading cause of death for blacks of any age.

In Hamilton, Butler and Clermont counties, the percentage of black men living with HIV/AIDS is nearly five times higher than for whites. The infection rate among African-American women is 10 times higher than for white women, according to an epidemiological profile produced by the Ohio Department of Health.

While many people familiar with AIDS trends have known for years that the disease was striking blacks harder than whites, the scale of the gap may still surprise.

From 1999 through 2001 in Ohio, the number of blacks testing positive for HIV has outnumbered whites - 780 to 758 - even though blacks comprise just 11 percent of Ohio's population.

"The general public, including African-Americans, still believes that HIV is a virus that predominantly impacts gay white men," said Pamela Mullins, a board member of AIDS Volunteers of Northern Kentucky. "In the African-American community this is something that's not talked about much at all. We have not approached the virus with the same openness that others have."

This continuing sense of denial is partly why this year's World AIDS Day theme focuses on stigma and discrimination, said Geneva Logan, chairwoman of the Minority AIDS Prevention Alliance in Cincinnati.

"The main problem we have in this city is that people don't want to talk about sexual issues. As a result, there's a lot of fear and stigma surrounding it," Ms. Logan said.

She says alarm bells should sound because young people in Hamilton County are suffering high rates of gonorrhea and chlamydia, not just HIV. High sexually-transmitted disease rates indicate that people are having unprotected sex, which translates into a higher risk of catching AIDS.

"These are the kids that didn't see what we saw in the '80s (when deaths from AIDS were far more visible). We aren't giving these kids good information about sexual issues, and these are the results," Ms. Logan said.

So this year, instead of holding the annual World AIDS Day functions on Fountain Square, activists moved the center of activity to Over-the-Rhine. A candlelight ceremony, speeches and testimonials will be at 3 p.m. today at the First Lutheran Church across from Washington Park.

The message: Not enough people are protecting themselves. Not enough people are getting tested. Too many people are waiting too long to seek treatment. And not enough people are talking about it.

"There's a lot of resources available that minority individuals aren't accessing," said James Whitfield, a board member with the Minority AIDS Prevention Alliance.

E-mail tbonfield@enquirer.com