Is Isle program being punished for success in research, education?

Our celebration of AIDS Awareness Day tomorrow will be marred by the irony that Hawai'i is losing a vital ally in the fight against this major public health problem.

Dr. Cecilia Shikuma and the Hawai'i AIDS Clinical Trials Unit she leads at the University of Hawai'i's John A. Burns School of Medicine were given good marks by the National Institute of Allergy and Infectious Diseases in a recent review. Then suddenly last week she was called and told that her Hawai'i Center for AIDS Research would not be funded next year — the money would instead go to 40 other centers.

This is shocking and potentially devastating for the people of Hawai'i, who have struggled long and hard to control HIV here and to care for those infected.

The loss of this $2 million-a-year program has short-term and long-term consequences for the medical community, public health, the scientific community, the University of Hawai'i and ethnic minorities who are not understood on the Mainland.

When I joined the John A. Burns School of Medicine six years ago, I was impressed with the resources available for the care of HIV — and the research and support provided by Shikuma and her stalwart band of researchers and investigators. She had successfully taken on the huge administrative tasks of establishing the Hawai'i AIDS Clinical Trials Unit (HACTU) as part of the AIDS Clinical Trial Network.

She crafted a laboratory and consultation center at Leahi Hospital and was producing good research in the neurological and metabolic aspects of HIV — and with a keen interest in the Native Hawaiian as well as Asian-Pacific Islander aspects.

She established the Clint Spencer Clinic for consultations. She attracted clinical trials from industry and assembled a clinical advisory board every month to inform local practitioners of what research the center was doing. She brought new medicines to Hawai'i through the HACTU — which people of Hawai'i would not have had access to for years otherwise. She has also been a significant contributor to national and international studies through her federal funding, and set up a University of Hawai'i research center in Thailand in cooperation with investigators at the Department of Defense.

As an infectious diseases specialist, I saw my first case of AIDS in 1984. At that time, we often turned to hospice services rather than prolonged, tortuous therapies and unrealistic expectations. Our best answers seemed to be a comfortable death if there were not any secondary infections to take on and cure.

Researchers such as Shikuma have helped shine a new light on the disease. The transformation of the insight and care of people with HIV since those old days only a few years ago has been a near miracle. We have explained many of the puzzles and found some of the demons of the disease. We have found drugs and figured out how to use them to the point where HIV need not be any more devastating than diabetes or other chronic diseases for which there is no cure. The AIDS wards in the hospitals have emptied out and are now clinics. Many AIDS housing units have closed. The emotional impact and stigma of being HIV-infected have dramatically waned, and claims for disability based on it are becoming more and more difficult because so many people are going back to work and resuming productive lives.

The scientists who have labored so hard in cracking the nuts of discovery have gone on to apply their insight and knowledge in the developing fields of virology and immunology and many other aspects of medicine. It now turns out many HIV medicines are remarkably good for hepatitis B infection — something we did not realize until only a couple of years ago.

One of the thoughts as to why the HACTU proposal was rejected was that there are not very many people with HIV here, and it is not spreading rapidly. This is certainly a consideration, but it should be noted this is because of our success in controlling the infection. The numbers of infected people are likely a result of the dramatic efforts made in Hawai'i with effective education efforts through the Health Department, the Life Foundation and other community organizations, as well as early implementation of a needle exchange program. This would not have happened without the investment of federal funds in our state. Are we to be now punished for our successes and deprived of funding to continue them and the research necessary to further investigate aspects of HIV that are unique to our people?

We need more than "AIDS Awareness" tomorrow — contact your legislators, speak with your representatives, tell your friends. Act now.

Dr. Alan D. Tice is an infectious diseases specialist for the University of Hawai'i's John A. Burns School of Medicine.