By JESSE DUNSMORE

Senior Reporter

It's been called the black plague of the 21st century.

Annual spending to fight the disease and its effects on low- and middle-income countries went from $300 million in 1996 to $8.3 billion in 2005, according to a report by the UN and the World Health Organization.

Seventy percent of infected people live in sub-Saharan Africa.

But the AIDS epidemic doesn't stop at the shores of Africa.

Reality Check

Imagine that following the terrorist attacks of Sept. 11, 2001, there was an equally deadly attack on the United States about every 46.4 days for the next five years.

The casualties would be roughly equal to the 84,794 AIDS deaths in this country from 2001 through 2005, according to data from the Centers for Disease Control and Prevention.

The OU nursing department sponsored a presentation held Feb. 5 called HIV/AIDS: Devastating the African-American Community. According to Dr. Francis Jackson, an OU nursing professor, there have been 985,000 people infected in the United States since the discovery of the virus, and about 550,000 of them have died so far.

Assessing the risks

Dr. Jackson said that the African-American community, particularly women, is at great risk for infection.

According to data from a Centers for Disease Control and Prevention (CDC) study, African-Americans, who make up 13 percent of the United States population, account for half of HIV and AIDS cases nationally. Jackson said that although only 14 percent of Michigan's population is black, black people make up 75 percent of Michigan HIV cases.

Although black men have a higher infection rate, black women have some unique risk factors, said Jackson, the biggest one of which is that they are statistically the least-likely ethnic and gender group to date outside their race. When the size of a population is limited (in this case the population of potential male partners), a disease like HIV can spread very quickly throughout it.

It could happen to you ... really

What really troubles Jackson is that despite information campaigns aimed at young African-American women, polls show that they still aren't concerned. "For some reason, they still don't feel it is their problem," Jackson said, noting that education isn't the issue. "The biggest problem is getting people to feel susceptible to this."

"Until it actually happens to me or someone around me, I think it would feel far away just like anything," said one female OU student.

When asked what word immediately came to mind when the HIV/AIDS topic was brought up, seven Oakland University students said "Africa."

"I don't hear much about it," said Dan, "so I wouldn't assume it's a big risk in this area."

Dan* has been in a committed relationship for three years. He said he wasn't concerned at all over the possibility of HIV infection.

"It's not really close to home," said another student. "It's really not affecting anyone I know. It doesn't really concern me too much. It's in the back of my mind always if I hear of people having unprotected sex, but I feel it's more in African-American society or gay society."

He said he used condoms "on and off," more to avoid getting his partner pregnant than for STDs. "When I hear [she's on] birth control, I say ‘Good, great' [and don't use a condom]."

Kelly sometimes uses condoms. She said that when she has sex it isn't usually in a relationship.

"I'm not a committed kind of girl," said Kelly. But her partners are usually friends, "Not like a random one-night stand kind of thing."

The less she knows about the person, the more likely she is to want them to use a condom. As far as she knows, no one she knows has HIV.

"I don't think it's that much of a problem around the Rochester area [or] the Metro-Detroit area," Kelly said.

Closer than you think

None of them knew that out of Michigan's 83 counties, Oakland County ranks sixth in rate of HIV infections, and makes up 10 percent of the total diagnosed cases in the state, according to the Michigan Department of Community Health.

Nor did they know that down the street, Detroit is home to 40 percent of Michigan HIV/AIDS victims.

They might not have known that people ages 20 to 29 are in the second-most dangerous decade of their lives for HIV infection in Michigan (the most commonly-diagnosed group is 30-somethings).

"That's kind of scary," said Kelly, reacting to the information. "That's kind of shocking to me, actually." She said that she's been tested, so she knows she's HIV-free, but she'll probably be more insistent on condom use from now on.

There are no guarantees

Augustine Nelson, a 45-year-old mother of three, found that her wedding ring offered no protection from HIV. Nelson spoke at the HIV/AIDS presentation following Dr. Jackson.

Nelson thought she was safe, she said, because she was in a committed relationship, and her boyfriendâ€"and then husband, after six years of datingâ€"didn't use drugs or even drink.

She had no idea he was cheating until her initial diagnosis of gonorrhea.

Eventually, she was diagnosed with HIV.

"I was in my comfort zone," said Nelson. She didn't feel the need to get her husband to use a condom.

She said she initially felt confused after her diagnosis about what to tell her daughter about sex. She had always assumed the best advice would be to wait until marriage to avoid worries about STDs, but now, she's just going to tell her to always be careful, "committed" or not.

AIDS then and now

Risks like this have prompted massive education campaigns targeting a variety of demographics. The information they have to work with now is considerably greater than it was 27 years ago, when AIDS was first discovered.

Since the original patients were gay men, one early theory about AIDS was that it was a male immune response to another male's semen, said Barbara Fabian Baird, R.N., in an interview for "In Their Own Words," an online feature on the early years of research into AIDS. Prior to the discovery that a virus caused AIDS, hospital staff would dress in protective garb head to toe, and sometimes make patients do the same. Even in 1988, the general public didn't believe it was possible for a woman to contract AIDS, as it was still considered a gay man's or a drug user's disease.

Today, the mantra is "AIDS affects everyone." Public service announcements, billboards, and sex education classes work to make people aware of the risk of infection, and how infection occurs. At the same time, early rumors were largely dispelled.

Still, HIV-infected immigrants have been banned from entering the United States since 1987, with some temporary exceptions. And though simple tests can detect HIV in blood, any man who has ever had sex with another man is unable to donate blood.

Getting the facts straight

Avert.org cites a 2006 survey that showed 26 percent of people still believed AIDS could be transferred by kissing. Ten percent thought it could be transferred via a toilet seat.

The education campaign clearly isn't complete.

What is AIDS, exactly? It isn'

t a virus; it's a condition caused by t

he virus called HIV.

Viruses affect the body by infecting cells and inserting their own DNA into the infected cell's DNA. The cell then produces copies of the virus, which repeat the process in other cells.

OU biology professor Susmit Suvas explains that the cells HIV infects are CD-4 T-cells, a major cell type in the immune system.

Normally, your immune system adapts to a new virus, making it impossible for that virus to affect you again.

But according to Suvas, HIV "persists" inside the body of the tendency of newly-produced HIV to have slight mutations from its "parent." No vaccine will offer any real protection, the body won't adapt, and the immune system will continue weakening.

"The problem is, once a person gets infected with the virus, he or she won't know initially if they are infected," said Suvas, "because…it's like a normal flu or normal virus infection. Only with the progress of time, a person comes to know."

With a severely weakened immune system, other diseases that would normally never stand a chance of infecting the body become serious threats. It's at this point, said Suvas, often 10 to 15 years after initial HIV infection, that a patient is said to have AIDS.

What lies ahead

Currently the main treatment used is called highly active anti-retroviral therapy (HAART). Anti-retroviral drugs interfere at various points during the HIV life-cycle, from binding to the outside of a cell to modifying the cell's DNA. But these drugs have side effects ranging from nausea to (in rare cases, said Suvas) cancerous tumors.

Suvas said animal research has successfully kept PD-1 from interfering with CD-8 T-cells. He hopes future therapies will include better anti-retroviral drugs and something to prevent PD-1 binding. In other words, the goal will be to make sure there are fewer viruses in the body, and a tougher immune system to fight them.

But he doesn't expect treatment to win any wars against the disease.

"For any infection, there are two approaches to handle it. One is preventative, and the other is therapy," said Suvas. "Those who are not infectedâ€"they need to take care."

Word to the wise

The majority of infections come from sexual contact, most of which occurs between men, but a significant portion is still attributed to male-female sex acts and use of injected drugs.

Prevention methods are straightforward. If you don't have sex and don't use needle drugs, your chances of contracting HIV are extremely low. Other factors, like blood transfusions, have had their risk significantly reduced since the advent of AIDS.

If you do have anal or vaginal sex, Mayo Clinic says, use a condom, and know how to use it. Lambskin condoms do not protect against HIV, so if you or a partner are allergic to latex, use a plastic (polyurethane) condom.

HIV can be contracted through oral sex. Use a condom on a man or dental dam on a woman.

If it is necessary to inject yourself, make sure the needle you use is sterile.

This lag between infection and symptoms contributes to the dangerâ€"an infected person can have sex with any number of people for years before realizing he or she is carrying a lethal virus. And the CDC says that there 40 thousand new HIV cases in the United States each year, an average of 4.5 each hour.

Setting some ground rules

Britny is an exception to Dr. Jackson's high-risk black female. She always uses condoms. In any relationship, she said she gets tested for STDs before they ever have sex, and she's insistent that her partner does as well. She said she'll get tested every six months in a relationship ("If we last six months"), or three months if she has "suspicions."

Britny said she's just "Trying to keep it clean."

The more you know

Shane feels people need to be more responsible for the sake of others. "AIDS, in general, it's very simple to prevent it. But the biggest problem is that a lot of people are irresponsible with their actions. If people have AIDS, they need to be responsible and realize ‘it's not right for me to go out and have sex unprotected … which could affect somebody else's life and end up killing them. I think it's more of a humanity thing."

OU student Patrick thinks self-education is an important part of prevention. "It is out there, and it's kind of nice to know that it is out there, instead of just being someone who just does things and [doesn't] think about the consequence until it happens."

Patrick believes knowledge is a vital part of prevention. "[HIV/AIDS] is out there, and it's kind of nice to know that it is out there, instead of just being someone who just does things and [doesn't] think about the consequence until it happens."

Celson, another student, thinks ignorance has a lot to do with infection, but he also describes an attitude problem. "A lot of people think that they're invincible, that they can't contract AIDS. They're like, ‘Oh, that's so unlikely that it's not going to happen to me.' But it happens to people every day."

*Note: most students interviewed either wished to remain anonymous or be identified only by first name.