The next big thing is here

More than 4,000 health workers, government leaders and people living with HIV and AIDS are gathering in Fort Lauderdale this weekend for the U.S.Conference on AIDS which has the sadly uninspired but unavoidable theme of “Looking Back, Moving Forward.”

It was 27 years ago this summer that the growing crisis that was the AIDS epidemic was recognized, a time when not much attention was given on the whole — by government officials, by the mainstream press, by the people who didn’t think they were or would be affected — to either looking back and moving forward.

Back then, the future had to unfold before us, to be clear then — the elusiveness of a vaccine, the epidemic’s seeming jump (as it appeared to people not paying close attention) from one “risk group” to another, as the new patients highlighted old failures in health care systems and social policies, the numbers of new patients ever exceeding by more than half again the numbers put on treatment.

But the past, a history riddled with plagues could have served as a prologue. Then Ronald Reagan wouldn’t have had to wait for the death of his friend Rock Hudson to learn that plagues take tolls that are hard to ignore.

We had learned that already from outbreaks of tuberculosis.

And while AIDS continues to struggle for the spotlight, as attention shifts from national disasters to human-made catatastrophes, the next big thing, lurks, not in the wings but center stage.

And it is, once again, tuberculosis, a disease given new life in the damaged immune systems of untended people with HIV, turning resistant to the modern treatment that chased it out of this country.

Now, in its encore, TB the No. 1 killer of people living with HIV. Still, worldwide only 1 percent of people diagnosed with HIV are tested for TB. As a result people are living with HIV, which remains incurable, and dying of TB. None of the organizations sending money for AIDS relief have required that TB testing be routine for those diagnosed with HIV. In the United States, which claimed about 13,000 new TB patients in 2006, 1,300 with HIV, then, the situation remains unclear.

But, doctors, scientists and public health experts are warning that a worldwide pandemic of extremely drug resistant tuberculosis will be the next big “surprise” to emanate from the AIDS epidemic, if, as we move forward we are not informed by our look at the past.