Foust shines light on a dark disease

Evelyn Foust would have been happy to be out of her career by now.

As North Carolina's chief HIV and AIDS fighter, Foust has seen firsthand how the virus has morphed from seemingly isolated cases among gay men to a worldwide epidemic that infects 33 million people. In North Carolina, an estimated 31,000 people have HIV or AIDS.

On Monday, World AIDS Day focuses a passing spotlight on the disease. For Foust, who heads the state's Communicable Disease Branch, the disease is a daily pursuit.

For Foust, the disease became concrete one day in 1985, when a young man walked into the public health clinic in Charlotte where she worked. Sitting knee-to-knee with him, she broke the news that he faced a fatal infection.

"I remember his face to this day," she says. "Beautiful big brown eyes. He said, 'My test result is positive, isn't it?' And I said it was positive. And he looked at me, and I looked at him, and I didn't have anything I could offer. The only thing I knew to do was reach over and squeeze his hand. And I said I was sorry."

Too many similar conversations followed.

Since those early days, when the disease seemed to concentrate among gay men and intravenous drug abusers, Foust has worked to bring attention to the disease and find ways to stop its spread. It has been a daunting task.

"The early days of HIV were fraught with the unavailability of science, and also fears, discrimination, job losses, family disruption," recalls Dr. Leah Devlin, state health director. "Evelyn really cares about all these and experienced these from the beginning. She not only has the expertise and compassion but also the historical experience."

And the disease has proven a wily foe for those in public health. By this century, it had moved from urban centers to rural areas, hitting Southern states in ways much different from cities such as New York and San Francisco. In North Carolina and elsewhere in the South, poverty, a history of segregation and other social factors created a different epidemic. Women were being hit hard, and blacks accounted for almost two-thirds of cases.

"Looking at the [infection] maps just blew us away," Foust says. "We realized the South had the greatest number of AIDS cases, which means people were sicker when they came in for testing, and the greatest number of people dying."

Foust founds coalition

Armed with the data showing the broader impact of the disease, Foust helped enlist HIV and AIDS leaders in other Southern states in 2002. The group, the Southern AIDS Coalition, asked Congress for a change in the way federal money was allocated for prevention and treatment, and in 2006, it won funding. Foust also led the charge for more federal money in North Carolina to pay for drug assistance programs, which help pay for expensive medications.

"She has been working tirelessly on this and has had a dramatic impact," says Dr. Peter Leone, medical director for the state's Communicable Disease Branch and an associate professor at UNC-Chapel Hill. "In the South and nationally as well, she embodies everything -- she's passionate about life, and personally takes into account the impact of HIV in communities."

Leone and others credit Foust with being able to work easily among patients, community groups, public health leaders and national policy makers. That knack stems in part from her background.

She began her career in public health as a state public health investigator in 1984. She was assigned to track down people who had tested positive for sexually transmitted diseases. When she found them, she was supposed to encourage them to get treatment.