Barbara Hernan has a good day when she scares the socks off somebody.
The new regional AIDS educator for Harford, Cecil and Kent counties tries to convince residents of rural communities -- from teen-agers to jail inmates -- that the acquired immune deficiency syndrome isn't just a big-city problem.
People tend not to believe her, though, says the petite 24-year-old, who sports tweed suits and pearls as she insists to jail inmates that using a condom won't ruin their sex lives.
Many county residents have ignored the publicity generated this month -- National AIDS Awareness Month -- convinced that in Harford County they have nothing to fear, Ms. Hernan says. She battles prejudice, misinformation and total ignorance, she says, and the statistics are not on her side.
The setting for AIDS to spread in the county exists in a contingent of intravenous drug users who live along the U.S 40 corridor, she says. With only 35 cases of the disease on record in Harford, the numbers aren't enough to worry most people, says Herman. But she sees a potential for the disease to spread rapidly in the county unless county residents take prevention very seriously.
Hernan -- who has watched close friends die of the disease -- wants to make county residents worry.
The numbers -- or in this case, the lack of them -- don't mean much, she says.
"The (Harford) statistics don't begin to touch cases not reported by the doctors, or the large number of infected people who go into Baltimore City for treatment."
In fact, support groups of HIV positive patients run by the county health department exceed the number of recorded AIDS cases, Ms. Hernan says. Add that to an incubation status of five to eight years, meaning the majority of the infected population are asymptomatic, and there's plenty reason to worry, she says.
But the public she encounters isn't buying it, Hernan finds. So the young woman, who arms herself for weekly speaking engagements with videos and the latest medical information, pulls out more unpleasant realities from her bag of facts.
Among them:
The bulk of heterosexual AIDS transmission within the last year nationally was transmitted by intravenous drug-using sexual partners.
Harford's proximity to Washington, D.C., which has the highest per capita rate of AIDS cases in the nation, and a significant drug traffic through the county, means county residents have reason to be careful about sex.
"People want to ignore that we're close to this little hotbed of AIDS in Washington and that it spirals out," she said.
Another unpleasant reality people would rather ignore is that 16 percent of the inmate population in Maryland is HIV-positive, meaning they're infected with the Human Immunodeficiency Virus.
Even more frightening, many prisoners at detention centers Hernan visits -- including work-release prisoners -- don't seem to really understand AIDs transmission, she says. "They'll have heard the terms, but they don't realize exactly what's happening."
Also, contrary to the opinion of many males Ms. Hernan addresses around the county, men can get AIDS from women. In fact, most HIV-positive cases recorded in Harford County are women, possibly because AIDs screening is advised for pregnant women attending public health clinics, AIDS case managers say.
The AIDS educator, who began her job this past June, takes her spiel all over the three counties she handles, from community groups to high schools.
She's had practice in health education before, first as a student in Health Science and Policy at the University of Maryland and then with Baltimore Medical Systems, state operated non-profit clinics in east Baltimore.
Now, as when she worked in the clinics, she finds young people's sexual behavior especially worrisome.
"It's hard, reaching the heterosexual population, especially in a rural area where they may not personally know someone with AIDS. Teen-agers, especially, feel immortal and with drug and alcohol use, often throw their inhibitions out the window. First sex is often unplanned," she says.
Parents compound the problem by assuming their children receive all they need to know in 9th grade AIDS education courses at county public schools, she says.
"But I find kids ready to leave for college who aren't always that informed. For example, they'll be sexually active but not really know how to use a condom safely," says Hernan.
Hernan is working on a project to arrange for an HIV-positive patient as a guest speaker in county schools to drive home the reality of the disease.
Hernan is trying to find a county AIDS patient willing to talk to students.
The bottom line, though, is that "you can't be with the kids when they're on a date in the back of a car," she says. "You do the best you can."
She shows videos, hands out brochures and lectures on modes of transmission and safer sex with condoms. She describes other sexually transmitted diseases such as condyloma, or genital warts. At most talks, she'll pre-test her audience with a quiz of questions, and then test again after she speaks to see if they've learned anything. She says she answers questions until she feels like the Dr. Ruth of sexually transmitted diseases.
And constantly, says Hernan, she feels frustrated that people may not change their sexual behavior, even after they're properly informed about AIDS.
"I don't know if they just go out and do the same things," she says.
"You can give people information, and do your best, but do they actually use the information?"
She shakes her head. "It doesn't always seem that education is working.
But it's such a fatal disease, and so painful."
Meanwhile, Hernan has a new remedy in mind, a painful sort of show and tell. She's encouraging students and community groups to visit the wards of AIDS babies at hospitals such as Johns Hopkins in Baltimore. Many times the mothers, who often are drug addicts, don't come back for the infants.
"If people would just go see these little babies trying so hard to live, suffering from this disease . . . it can bring home the problem. It can make you sad, and it can scare you, and maybe that would make people listen."