Fear of AIDS Hits Small Towns, Officials Say

Some days Ellen Leahy’s telephone at the Missoula, Mont., City-County Health Department rings so often that she can barely keep up with it. The callers are asking about AIDS.

Only eight cases of acquired immune deficiency syndrome have been reported in the entire state of Montana, and Missoula, a university town of 30,000, did not report its first case until last summer. But the demand for information on the disease is overwhelming.

“We were ahead, taking initiatives,” Leahy, the health department’s director of education, said in an interview. “Now we’re just neck and neck with the demand for information.”

Leahy was one of more than 700 community leaders, doctors, nurses and business executives who gathered at a conference in Chicago this month to learn what they can do to prevent the spread of AIDS in their communities.

Urgent Need for Information

The American Medical Assn. conference, “AIDS and Public Policy: A Community Response,” drew participants from Missoula, from Wichita, Kan., from Indianola, Iowa, and countless other places where AIDS is more a theoretical threat than an actual one. Yet they urgently needed to know more about it.

AIDS is no longer confined to New York, San Francisco and the handful of other cities where it has made its strongest mark.

Surgeon General C. Everett Koop said at the meeting that 17 American cities have now each reported more than 300 cases of AIDS. The disease has been reported in all 50 states, Guam and the Virgin Islands.

A cure for AIDS, or even a vaccine to prevent its further spread, now seem like distant goals, despite earlier optimism, officials say. “As an optimist, I will tell you I am not expecting a cure,” Koop said.

Thus, efforts like those by Leahy in Missoula could be critical. Education is the only effective means of preventing small cities, towns and rural areas from following in the footsteps of the current centers of the AIDS epidemic.

“We really feel we have an opportunity to prevent (AIDS) that other communities don’t,” said Leahy.

Dr. June Osborn, dean of the school of public health at the University of Michigan, said that if information on the spread of AIDS were communicated to the public, “We could abort the epidemic.”

“This isn’t like the flu,” said Dr. Mervyn Silverman, president of the American Foundation for AIDS Research and former San Francisco health director. “No matter how much I educate you, you’re still going to face the risk of flu.”

Means of Protection

With AIDS, however, such practices as the use of condoms during sex and the cessation of needle-sharing by drug addicts could markedly reduce the disease’s spread, officials said.

The need for public education brought Don Flory, a family practitioner in Indianola, to Chicago for the meeting, even though there hasn’t yet been a single case of AIDS in Warren County, which includes Indianola.

“We basically don’t want it (AIDS),” said Flory, when asked why he had come. He and his wife, Marcia, a registered nurse and a member of the executive board of Planned Parenthood of Mid-Iowa, have already begun fielding questions on AIDS.

“We’ve had patients come in to be tested,” said Marcia Flory. “So there’s fear out there, even in a rural area.”

Indianola, located in farm country 12 miles south of Des Moines, is the home of Simpson College, a Methodist college. Half of its 12,000 residents commute to Des Moines and the others are farmers or work in local service industries, said Flory.

Partly in response to the AIDS crisis, the Indianola school board recently approved mandatory sex education classes in kindergarten through high school.

“Because of what we’re seeing around the country, the school board, even though they got a

Complacency a Problem

While coping with the demand for information, however, officials in Indianola have also had to deal with a certain complacency about AIDS, Flory said. “It’s more that it’s not going to happen here,” he said. “Or,” said Marcia, “that it’s only going to happen to homosexuals.”

Much of the financial support for dealing with AIDS in small communities has come from the federal Centers for Disease Control in Atlanta, which administers money to the states to apportion as they see fit. This year the CDC is contributing $29.5 million to states and local agencies for AIDS education programs, said CDC spokesman Donald Berreth.

The agency makes an effort to distribute funds to every state, based on proposals it receives from the states, said Robert Kohmescher, education specialist in the division of sexually transmitted diseases.

Dr. Donna Sweet of the University of Kansas in Wichita notes the importance of AIDS education in states such as Kansas, where only 68 cases of AIDS have been reported. “You could perhaps get more out of your dollar if you spend it where AIDS is not rampant already,” she said.

Doctors in Kansas are, however, taking care of more AIDS victims than the official tally suggests, she said. AIDS patients “get diagnosed in Texas or California where they went to be in a more freely open homosexual community,” she said. “And they get sick and come home to be with family and friends.”

She has treated a dozen or more cases of AIDS herself, most of which were diagnosed elsewhere. “Most of the Midwest is like that,” she said.

Sweet is now speaking about AIDS twice a week in local schools, she said.

Osborn noted that the U.S. Public Health Service has projected that there will have been a total of 270,000 AIDS cases in the country by the end of 1991 and 179,000 people will have died of the disease by then.

Most of those cases will be among the high-risk groups, including male homosexuals and drug abusers, but the number of cases acquired through heterosexual contact will increase from 1,100 in 1986 to 7,000 in 1991, according to the projections.

At least 80% of these cases will occur in people who already have the virus in their bodies, she said.

Education will not help any of these victims. “The best we can do is make 1991 a peak year,” said Osborn, by educating others who are not yet infected.

Education should also be directed at those who are not at risk for AIDS, so they know how to respond to AIDS patients, said Silverman.

“Our enemy is not only the submicroscopic villain but also bigotry,” he said.