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The Anatomy of an Epidemic

Hein was savvy about adolescent health issues partly because she had been medical director of a juvenile detention center in New York City in the 1970s.

There, she had treated adolescents who had sexually transmitted diseases, were abusing drugs, and were engaging in
other risky behaviors. The diseases among her patients at the detention center were "like a beacon for what's going to become news, or happen in the community on a larger level," she says. "Long before heroin was known to be an epidemic for young people, we had kids who were using heroin detoxing in our infirmary."

As soon as researchers determined that AIDS was a sexually transmitted disease, Hein realized that adolescents were at risk. "Part of the rationale for concern," she explains, "was that if teenagers were getting HIV, they probably look healthy, they probably wouldn't even know they were sick, and they wouldn't get sick until they were in their twenties." But no one listened. "Then, lo and behold, people in their twenties started getting sick."

In 1987, Hein opened the world's first comprehensive AIDS program for adolescents. Even by then, some of her colleagues were skeptical. "They made fun of us and called us the 'emperor's new clothes clinic,'" she says. They thought "we were making a big deal out of nothing." Before long, however, similar programs were started in San Francisco and Washington, D.C.

Hein worked tirelessly to build awareness about HIV/AIDS in adolescents. She published abstracts, articles, and book chapters; spoke at numerous professional meetings; and collaborated with the New York City Board of Education to expand AIDS education in the public schools. In 1989, she published an explicit book for teens titled AIDS: Trading Fear for Facts. "We became the ambassadors, or the Johnny and Joanna Appleseeds, for AIDS awareness," she says.

In 1991, she met basketball player Magic Johnson—shortly after his public announcement that he had AIDS. Hein began counseling Johnson on his
AIDS-education activities. Soon, with his star-power behind the effort, "the issue went from being invisible to high

"None of us realized at the beginning that this would become a worldwide pandemic," says von Reyn, the chief of infectious disease at Dartmouth-Hitchcock. Today, he is the leader of a
project based in Tanzania, where the HIV infection rate is 10% in adults and 30% in pregnant women.

visibility," recalls Hein. She also began training interested teens in how to talk effectively to the media.

But even though awareness of adolescent AIDS was growing, Hein was disheartened to see the familiar issues of denial, stigma, and discrimination play out on the adolescent stage. A few years later, the same issues would surface on the international stage.

Although now retired, Hein continues to be involved as a volunteer in HIV/AIDS initiatives around the world. In countries with effective education and outreach efforts—including condom availability —"HIV rates are plummeting," she says. But in other countries, "when people die, they don't say what they died of. So it's almost like the 1980s all over again."

Looking ahead
"There was no way of knowing that AIDS would sweep through the world like it did," says Dartmouth faculty member Ford von Reyn. "But once you began to see that it was occurring by blood transmission, by sexual transmission, and by mother-infant transmission, and once it was recognized how common it was in central Africa, then it was really clear that the world was facing a huge international public-health crisis."

"I don't think in our lifetime that AIDS is going to go away," alumna Karen Hein concludes sadly. "Skipping ahead 100 years, when they look back on our lifetime, . . . I think we'll be known for a pandemic—and it's not going to be bird flu. "I think it's going to be AIDS."


  • The International Conference for People Living with AIDS is held in Africa for the first time ever.
  • President Clinton hosts the first White House Conference on HIV/AIDS.
  • Four new antiretroviral drugs are approved for clinical use in the United States.
  • The FDA approves a new class of drugs—protease inhibitors—that helps make the disease a more manageable illness for some patients.


  • Time's 1996 Man of the Year is AIDS researcher Dr. David Ho.
  • FDA approves the first HIV home-testing kit.
  • The number of new U.S. AIDS cases declines for the first time.
  • The Joint United Nations Programme on HIV/AIDS (UNAIDS) begins work.
  • Magic Johnson returns to play basketball.
  • A triple "cocktail" treatment, known as highly active antiretroviral therapy (HAART), is announced. AIDS no longer means certain death—it is now becoming a chronic, manageable disorder.


  • AIDS-related deaths in the United States decline by more than 40% over 1996, thanks to the AIDS cocktail.
  • The U.S. Agency for International Development reports that it is estimated that 40 million children in developing nations will lose one or both of their parents to AIDS by 2010.


  • First large human HIV vaccine trial starts.
  • The first case of infection with a strain of HIV resistant to the most powerful antivirals is reported in San Francisco.
  • There are reports of treatment failures and side effects from HAART.
  • Sub-Saharan Africa is home to 70% of the people worldwide infected with HIV.

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