In the shorthand of journalism, it is known as the changing face of AIDS.
As the epidemic enters its second decade, the deadly syndrome is striking more blacks, more Latinos, more women, more children--and, proportionately, fewer white gay men.
Some of the new faces of AIDS were evident at a conference in Los Angeles titled "Latinas and AIDS: Nuestra Respuesta." Here are some of their voices.
* Margaret: "When I found out, I felt scared, lonely. I couldn't go to nobody. I have five brothers and two sisters, but the only person who sticks by me is my mother. My husband has it, too. He's in the hospital now. I had a little girl, but she passed away. It's hard."
* Maria (not her real name): "The first thing I did was to get on my bicycle and go for a ride with my eyes closed. I hoped a car would hit me. My mom wasn't much help. I wanted her to hug me, but all she did was judge me: 'How many guys have you slept with?' I'm 18. I never listened when they talked about it in school."
* Jennie: "I love my church. I know the archbishop, and I know how much he cares. But I have lost my son Eddie, and I cannot lose another child. I wish I could say: 'Just say no to sex.' But I must protect my children, so I tell them: 'If you are going to have sex, please, please, use a condom.' "
Words about life and death, words about courage and fear, words about acceptance and rejection. Words about sex, drugs, church, community, conscience, family and faith. Words, in short, about AIDS.
The recent conference was a milestone, bringing together 120 health-care providers, many of them Latinas who serve other Latinas.
Their aim was to learn, to network, to build skills and to empower themselves in their ongoing struggle to save the lives of people in their communities. Simply put, their goal was to develop "nuestra respuesta (our response)."
Implicit in that goal was the understanding that Latinos must develop their own response to the epidemic. Because of cultural differences, Latinos cannot simply borrow the successful AIDS prevention models pioneered by Anglo gay men.
The conference was long overdue. AIDS has long exacted a disproportionate toll upon minority-group women--and too often has imposed a deadly code of silence upon minority communities.
"This is a disease with so many emotional aspects that we find resistance to learning at all levels of the health care system--and at all levels of society," said Dr. Peter V. Lee, chairman of USC's department of family medicine, the conference sponsor.
"We have to go out into our community, to tell them: 'This can happen. This can happen to your families,' " said Jennie Reyes, a secretary whose son died of AIDS.
"We must dispel the myth that AIDS is only a concern of men," added Eunice Diaz, a member of the National Commission on AIDS. "We must educate our women. We must empower them to be assertive in protecting themselves."
It is a formidable challenge, Diaz acknowledged. Latino culture is permeated from top to bottom with machismo and taboos against frank discussions about sex.
Fear of deportation also keeps many undocumented aliens away from the health care system during the early stages of infection, which is caused by HIV, the human immunodeficiency virus.
"The statistics are bad," said Dr. German Maisonet, chief of HIV services at Vacaville's Correctional Medical Facility. "They are going to be getting worse."
- 38% of the babies and children with AIDS in Los Angeles are Latino, more than double the Latino share of adult AIDS cases. Many of the children contracted the virus from their mothers.
- Latino men and women accounted for 21% of the new AIDS cases reported in Los Angeles in 1989, compared to 12% of the cases reported before 1985.
The focus of the two-day conference was how to keep these numbers from getting worse. "Providing information is not enough," said Milagros Davila, director of San Diego County's prenatal care guidance program.
"We tell people: 'Learn the facts. Learn the facts.' Most Latinas can already recite the facts. But learning the facts does not mean that women are capable, willing or able to deal with prevention," Davila added.
Latinas who suggest that their husbands or lovers use condoms, for example, could be asking for trouble. "They risk verbal or physical abuse at the hands of their partners," said Dr. Aliza Lifshitz, a member of the Los Angeles County AIDS Commission.
Davila has prepared a list of objections that men often make when asked to wear a condom, along with suggested replies for women. For example, "If the man accuses the woman of not trusting him, the woman should reply: 'You could have been exposed without knowing it.' "
Davila said Latino men and women must face squarely some simple truths. Among them: That bisexual behavior among Latinos occurs far more often than commonly acknowledged.
"Go to MacArthur Park, and look at all the heterosexual men . . . turning tricks with gay men to support their families," Maisonet said.