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A Global Picture On World AIDS Day

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A Global Picture On World AIDS Day

Global Health

A Global Picture On World AIDS Day

A Global Picture On World AIDS Day

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Guests

Brenda Wilson, NPR science correspondent
Phil Wilson, founder and CEO of the Black AIDS Institute in Los Angeles
Dr. Elly Katabira, president-elect of the International AIDS Society

2009 marks 28 years in the battle against HIV and AIDS. New infections are down worldwide, and more people live longer with the disease. But over 33 million people around the world are HIV-positive, and reports indicate more than half of those who need treatment cannot get it.

NEAL CONAN, host:

This is TALK OF THE NATION. I'm Neal Conan in Washington.

This is World AIDS Day, a day when we mark nearly three decades of the global fight against HIV and AIDS, and those decades have yielded some big achievements. Worldwide, new HIV infections have fallen almost 17 percent every year since 2001, and with broader access to better treatment more people are living longer with the disease.

But AIDS still presents tremendous challenges. Globally, UNAIDS and the World Health Organization report that more than half of those who need treatment cannot get it. Here at home, more than a million people live with HIV, and despite growing awareness about the importance of testing, many who become infected go years before they find out. And in a perverse reflection of progress, better treatment can lead to complacency.

On this 21st anniversary of World AIDS Day, what's changed - stigma, treatment behavior? Tell us your story. Our phone number, 800-989-8255. Email us, talk@npr.org. You can also join the conversation on our Web site. That's at npr.org. Click on TALK OF THE NATION.

And we begin with NPR science correspondent Brenda Wilson. She's covered HIV and AIDS worldwide and joins us today here in Studio 3A. Always nice to have you on the program.

BRENDA WILSON: Thank you, Neal.

CONAN: And we learned last month that new HIV infections are declining worldwide again this year. What's working?

WILSON: I think one of the biggest successes is that for a long time they could not stop infections of mother-to-child transmission. That has been perhaps one of the biggest achievements. For the longest time it hovered around, like, only 10 percent of cases of, you know, pregnant women transmitting the virus to the child could be prevented. Now up to 45 percent in, you know, in countries in Africa, sub-Saharan Africa, where it was a big problem, are now being - those transmissions are now being prevented.

I think the other thing is that getting treatment to people - it's one of the things they have known, that if people are tested, you can get more people tested so that they know their status, then they're less likely. People who know they're HIV-infected will take the precautions necessary and not infect other people.

If you have - if you know that treatments available, you're much more likely to come forward, and so I think it's a combination of factors that has contributed to that.

CONAN: A lot of that sounds like education, and a lot of it sounds like it's cumulative. It's had a snowball effect over the years.

WILSON: It's including prevention programs as well, yes.

CONAN: Now those are global�

WILSON: I could - I would also say, Neal, that living with the reality of HIV in many of these countries, where it impoverishes people who are already poor, devastates families - if you live where there's so much loss of life, with HIV or from HIV, I think the message gets home.

CONAN: And the message, though, however, is not universal. There are places that are showing improvements, and the greatest improvements, as I understand it, are in sub-Saharan Africa, but there are places where things are not so great.

WILSON: That's true. Eastern Europe they've been slow to respond, and Central Asia, and part of that is that it occurs in populations that those countries would rather just pretend don't exist. That includes injecting drug users, and it's also what was expected to happen seems to be happening. In other words, the injecting drug users have partners, with whom they have sex, and so the epidemic is spreading into the heterosexual population.

In other words, a lot of the transmission now is among people having sex. It started out mainly as an epidemic among injecting drug users. It's also occurring in those countries and those societies among men who have sex with men, and sexual workers, and one of the things that UNAIDS, United Nations AIDS Program, says needs to happen is that there needs to be more of a focus on people like sex workers, men who have sex with men, injecting drug users, even those - these are really high-risk populations.

Everybody is trying to protect the heterosexuals and the children, you know, populations that people feel more comfortable or concerned about, it seems.

CONAN: On this World AIDS Day, we'd like to know from you, what's changed where you live: treatment, behavior, stigma? 800-989-8255. Email us, talk@npr.org. We'll start with Ron, Ron calling us from San Francisco.

RON (Caller): Hi. I hear her comment when she's talking about high-risk individuals and what's happening, and they need to focus on that, and I think conversely in the U.S. we focus greatly on high-risk community, and when you consider that 27 percent, according to Planned Parenthood, of teenage girls have a sexually transmitted diseases, weakening immune systems - HIV/AIDS is a sexually transmitted disease. What we need to have is a broader scope in our population, allowing for testing, overcoming social and cultural stigmas that still affect our nation.

AIDS is stigmatic. It has a stigmatic effect on our population. It still exists, and when we're trying to grow and transcend prejudices between mature adults, sexually transmitted diseases still sustain themselves and still create stigma. Stigma is the number one cause for sexually transmitted infection without going tested in this country.

CONAN: So you're saying that targeting high-risk groups creates stigma?

RON: I'm saying that targeting high-risk groups on an exclusive nature for promoting testing and treatment (unintelligible) organizations in the San Francisco community, we have great testing facilities, but they specifically target high-risk groups, and that represents, in itself, a furthering of stigma in the cultural groups, in the social groups that are not representative of the high-risk groups.

CONAN: What do you think, Brenda?

WILSON: I understand what he's saying, but I think there's a question of resources, how best to use resources, and what in fact you are in fact addressing. It would be nice if you could send a blanket message, but I also sometimes think when you send a blanket message that you are misleading people because the risk, in fact, is greatest where there is a higher pool of infections, among concentrated populations of people. And that being the case, I think you want to reach people who are more likely to come in contact with people who are infected or more likely to have sex with people who are infected.

I just think it's a question of how you shape those messages, what you address in the communities or among the people who are becoming infected who don't feel at risk - what you say to them, in fact. What is it - how, in fact, do you convey the message that they are at risk, that they have worth? I think that's more important because I think a lot of the disease occurs in communities where people don't feel valued.

CONAN: Ron, thanks very much.

RON: Thank you.

CONAN: Bye-bye. Let's go next to Lisa, Lisa with us from Berkeley.

LISA (Caller): Hi, thank you for having me on your talk show today and recognizing that today is World AIDS Day. I'm a 39-year-old single mother with an eight-year-old child who is HIV-negative. I tested positive 13 years ago, and for a lot of us, you know, every day is World AIDS Day, and one of my biggest concerns is the complacency issue, where a lot of people just don't think it can happen to them, and we're seeing more women test positive and even elder people who don't think they're at risk.

So I agree that to have a blanket HIV prevention message doesn't work, and one of my biggest concerns now is with the California budget crisis, prevention funding has been completely slashed if not disseminated.

CONAN: Brenda, is she right on increased numbers of AIDS cases and HIV cases amongst girls and women?

WILSON: Yes. In the United States that is the case. Right now, out of new infections it's about 27,000 among - I think it's about - I'm sorry, I don't want to go for the number - if I - I will check it and come back with that later. But it is increasing among women, that I know for a fact. And the second thing is it is increasing among older populations, and I think part of that is because we target so much of our message to young people, to teenagers, and I think it gives people who reach the age of 24 or something the sense that, okay, they escaped it, they missed it, and in fact that may not be the cases.

CONAN: Lisa, where you live, is there stigma?

LISA: Definitely, definitely, and you know, I'm very out and open about my status because I feel it's important to educate people that, you know, the face of AIDS has changed. It's not a gay white man's disease anymore, and you know, when I was diagnosed in '96, you know, I was basically told I had three to five years to live. The diagnosis came as a complete shock to me.

You know, I was in a monogamous relationship and not an IV drug user, and due to the medications, you know, thank goodness I've - I don't want to say survived. I've thrived - because we don't survive this disease. It doesn't go away, but one of the - I call the it the disease that goes along with the disease, and that's stigma. It still exists. It definitely does.

CONAN: How does it manifest itself?

LISA: Well there's - you know, people feel shame because it's a sexually transmitted disease. People assume that you've done something sexually deviant to get this disease, and that's not the case. We're all human beings. You know, whether we thought we were at risk or not, it happens, and you know, it breaks down a person's self-esteem.

You know, you become isolated if you don't have a support system. You know, I think the more we talk about it, the more we educate people. I think that helps to break down some of the barriers and stigma that goes along with this disease, and I think if people go and get tested and know their status and just get a test like they would a cholesterol test, I think, you know, with general practitioners to promote an HIV test to help mainstream the testing process, I think that will help break down some of the stigma and the barriers.

CONAN: Okay, thanks very much, Lisa, appreciate it.

LISA: Thank you.

CONAN: Bye-bye. Good luck to you. And�

WILSON: I do have that figure for you, Neal, and it is 27 percent of the 1.1 million people with HIV in the United States are women. So that's 27 percent of the cases now.

CONAN: And the other thing - we're going to be talking about this worldwide, and it's a greater problem there, but the number of people in this country who need drugs and are not getting them, that's significant too.

WILSON: It's estimated that about - I don't know how many in terms - are on waiting lists, which is a separate issue. There are 21 percent - it's suspected that 21 percent of that 1.1 million people don't know that they're HIV positive. So a fifth of the people who are infected don't know they're infected, and those are the people who are most likely to transmit it to someone else.

CONAN: Continuing to spread the infection.

WILSON: Unwittingly, one presumes.

CONAN: Brenda Wilson of NPR's science desk is with us on World AIDS Day. We're talking about what's changed. Tell us your story, 800-989-8255. Email us, talk@npr.org. We'll talk more in a moment. Phil Wilson of the Black AIDS Institute will join us. Stay with us. I'm Neal Conan. It's the TALK OF THE NATION from NPR News.

(Soundbite of music)

CONAN: This is TALK OF THE NATION. I'm Neal Conan in Washington. Next month, the U.S. plans to lift its ban on foreign visitors with HIV. This country is one of about a dozen with similar travel restrictions, and for many diagnosed as HIV-positive, the change marks an end to a policy they argue was based on fear and perpetuated a stigma around AIDS.

We're talking today about progress worldwide in the fight against HIV and AIDS and the work that remains. As we mark World AIDS Day, tell us what's changed for you in terms of stigma, treatment, behavior. With medical advances, has complacency set in? Tell us your story, 800-989-8255. Email us, talk@npr.org. You can also join the conversation on our Web site. That's at npr.org. Click on TALK OF THE NATION.

Our guest is NPR science correspondent Brenda Wilson, and let's see if we can get another caller on the line. Let's go to Scott, Scott with us from Phoenix.

SCOTT (Caller): Hi.

CONAN: Hi, Scott.

SCOTT: (Unintelligible) gay man, and the thing that - I'm old enough to remember lots of people who - for whom an HIV-positive outcome was a death sentence, and the thing that amazes me now is the young gay men who are not old enough to remember that, and to them it's not at all that, and their outlook for so many of them is all I have to do is take one pill a day and it's managed and I can go on with my life. So, so many young gay men are having unprotected sex because they just don't see it as a big issue.

CONAN: Complacency.

SCOTT: Yes.

CONAN: Brenda, is this a difficult problem?

WILSON: Yes, it is, and as a matter of fact, that has been one of the areas in which we've seen a resurgence of the epidemic, both here in the United States and in Europe. It's among men who have sex with men.

CONAN: And I meant to ask you also - Scott, thank you very much for the phone call - but he's saying one pill a day and I can get on with my life.

WILSON: I mean, but the fact remains that's one pill a day for the rest of your life, and it's not clear that it's just simply one pill a day, and after a time on these toxic medications, complications from just simply taking the medications arise.

So it's - treatment isn't that simple, and it involves regular visits to the doctor. That said, it is a lot different than it was in the past.

CONAN: Sure. It's no longer a death sentence, but nevertheless�

WILSON: But it's not that simple, no. It's living with a ticking time bomb, essentially inside of you, that affects you in other ways as well. You can manage your health, but it does have other health effects.

CONAN: And there have been stories that one of its effects may be some kind of premature aging.

WILSON: Yes, and I have, in fact, seen that in some instance where people come up with diseases that are more associated with aging. For example, diabetes and heart disease have clearly been established. The question of dementia, I think the question is still out, although some increasing number of cases have been seen. So I can't say for sure that that has been established, but I do know in the case of, like, other diseases associated with aging, yes.

CONAN: Let's go next to Debbie, Debbie with us from Virginia Beach.

DEBBIE (Caller): Hi, thank you for taking my call.

CONAN: Sure.

DEBBIE: Your speaker, Brenda, said that it was a disease of men having sex with men. Well, I'm a 46-year-old lesbian, and I have three lesbian friends that are all HIV positive, and they're exclusively lesbians.

CONAN: And we haven't talked about that specifically, but we have talked about the increase of the infection rate among women in this country, and Brenda, have you heard that this is a lesbian problem specifically?

WILSON: No, I haven't. I mean, it's not that not anyone can become HIV positive. I wouldn't say that that, in fact, protects you against the disease itself. When I was talking about the risk, I was talking about people who were at higher risk. It doesn't mean that everybody isn't at risk. I mean�

DEBBIE: The armed forces has a lot of HIV women that are in it that are concealing their identity of being an AIDS patient.

WILSON: Right, and I believe the military deals with HIV in a different kind of way. I do believe that because of their concerns of closed populations, that they are tested more regularly.

CONAN: And concealing their illness for fear of being called out?

DEBBIE: Yes, yes. Yes, there are quite a few women that are concealing their illness greatly in our community, not just in Virginia, by God, but in quite a few. I travel to New York regularly, and there's a great, strong lesbian population in New York that are HIV positive that you obviously are not tuned into. Maybe you need to visit the East Coast more often.

CONAN: Well, she lives in Washington, but anyway, Debbie, thanks very much for the call.

DEBBIE: Thank you.

CONAN: Bye-bye. Joining us now is Phil Wilson. He's founder and executive director of the Black AIDS Institute in Los Angeles, co-founder of the National Black Lesbian and Gay Leadership Forum and joins us by phone today from New York. And Phil, nice to have you on the program today.

Mr. PHIL WILSON (Black AIDS Institute; Founder): Thank you for having me.

CONAN: And we are talking obviously with a lot of our callers about the problems that we're having with AIDS and HIV in this country, and complacency a lot of people have pointed to as a problem among young gay men and among the population at large.

Mr. WILSON: Absolutely. You know, I think that people in the United States think that either the AIDS epidemic is over or it's happening somewhere else. I'm actually calling you from an event that was just held by the International Center on AIDS Prevention at Columbia University and the Clinton Foundation here in New York City, talking about the epidemic.

You know, the truth of the matter is in some ways we have a problem with HIV in the United States that is comparable to the AIDS epidemic that you see in parts of the developing country. Now, particularly among poor people and especially among black populations in America we have an epidemic that exceeds the epidemics that you see in Botswana or South Africa or Zambia or Zimbabwe or many of the other countries.

CONAN: Why is that, do you think?

Mr. WILSON: There are a number of reasons. One is that when you look at the AIDS epidemic in black America, we see that we have a mature epidemic in which there was a slow response. You see vulnerabilities across black communities. You see high HIV/AIDS rates among young people. Seventy percent of the new HIV/AIDS cases among young people in the United States are black. Among, you know, gay men, 30 percent of the new cases among gay men in the United States are black. Two-thirds of the new cases among women are black.

So you have this situation where we no longer have the kind of attention that we used to pay to the AIDS epidemic. At the same time, we are spending less per capita, per person living with HIV, and people believe that they are no longer vulnerable, and yet people are being exposed every day.

CONAN: There is obviously an element of personal responsibility. There's obviously an element of community responsibility. But the government too has a responsibility, and how would you grade the Obama administration thus far?

Mr. WILSON: Well, I think that the Obama administration came in to office during a very, very difficult time. Everyone knows that we are in the worst economic condition that we've been in a generation. Having said that, we have the opportunity to really turn around the AIDS epidemic in the United States. The president has made a commitment to a national AIDS strategy.

You know, when the United States gives money to other countries, we demand that they have an AIDS plan, and yet we don't have an AIDS plan in the United States, and President Obama and his administration have made a commitment to a national AIDS strategy.

We've done work around lifting the ban on needle exchange. We've lifted the ban on travel. Unfortunately, the area where we need the most support, and that is in the area of resources, we've not been able to appropriately increase the AIDS budget.

The amount of money that we're spending on AIDS prevention, for example, is about 50 percent of the professional estimate of what we need to spend on AIDS prevention in this country if we want to get a handle on the AIDS epidemic, and that's an area that we really need to focus on.

Of course, health care reform will go a huge way in addressing the needs of people living with HIV or at risk of HIV. If we are successful in passing meaningful health care reform in this country, that will go a long way of addressing the AIDS epidemic in this country.

CONAN: Let's see if we can get another caller on the line. Let's go next to Ann, Ann, calling us from Denver.

ANN (Caller): Yes, sir. I worked on a study looking at HIV in the rural Southeast. So that was from Louisiana and the Carolinas, Georgia, Alabama, and so we were interviewing people over time�

(Soundbite of phone ringing)

ANN: I'm sorry.

CONAN: That's okay.

ANN: Interviewing people over time, and this is the rural Southeast, because it was growing so much there, and the one thing I walked away from that with - I walked away from it with a lot of things, but the one thing I walked away with is if the churches, particularly in rural areas, would start talking about this, a lot more would get done because those people in rural areas had no access to information. They had no way to get into the clinic, where they could get free meds, and the church was the center of their social life. So that�

CONAN: And this is - this is both blacks and whites, I assume?

WILSON: Absolutely, yeah - men, women, black, white.

CONAN: I wonder, Phil Wilson, is that something that you're working on?

Mr. WILSON: Absolutely. You know, the faith community can play a huge role in fighting the AIDS epidemic. Unfortunately, sometimes we think that we can solve these problems with a silver bullet or a single solution. AIDS is a complex problem.

I think what your caller is really addressing is the issue around stigma. And the church and faith-based leaders can play a huge role in lifting the stigma around HIV and AIDS. It is clearly not helpful when there are churches and pulpits that talk about AIDS being, you know, God's will or a punishment for sin. Now, HIV is a health issue. It is caused by - AIDS is caused by a virus, and we need to address it in that way. And the church can play a critical role in reducing the stigma.

But before the caller called in, you spoke about personal responsibility and community responsibility. We need to shift from the blame-and-shame paradigm, which is undermining our ability to address HIV and change to accountability and responsibility.

Now, the truth of the matter is, even though it is challenging, the strategy toward ending the AIDS epidemic in an environment where we do not have a cure is for each and every one of us to take personal responsibility for our own health - if we're HIV negative, to make sure that we protect ourselves each and every time; if we're HIV positive, to make sure we protect our partners each and every time.

ANNE: I'd like to comment on that.

CONAN: Why don't you go ahead, Anne?

ANNE: In the rural areas of the Southeast, some of those people didn't know how they got it. Some of those people had no idea what to do about it. They had no resources to get. And I hear you saying that they need to be accountable for their partners. These are not people that live in the cities. This is the rural Southeast. And those churches, they don't talk about sex or sexuality or AIDS or anything.

WILSON: And yet you're suggesting that somehow that they do something that they haven't been doing. I think part of the problem in suggesting that churches do this - I mean, I've been covering this epidemic for some time - since the mid-'80s - and we have been saying that the churches need to be more involved in doing this. And I lost my, I suppose, confidence that that is going to happen in the way that it needs to happen.

If you look at the south, that's where 46 percent of the cases in the United States are. But if you look at HIV as a health condition, as a health problem, that's where most of the country's health problems are as well. They're in the south.

And I think what it points to is that HIV is not just simply a sexually transmitted disease, but it goes along with all the social conditions and everything else that are attendant upon poor health. So that means that education, how people live, whether they have work, how they feel about themselves, all of these things impact upon a person's ability sometimes to take responsibility for themselves. So it has to do with their own vision of themselves that we have to, kind of, provide support and help in regions where they perhaps don't have the resources to do that.

CONAN: Anne�

ANNE: How do you see us doing that in the rural South?

WILSON: I believe it's almost going to happen - have to happen on an activist level. And I think the Obama administration - and I'll let Phil step in here -is going to target those areas. I think that's one of the things that it's doing. It's looking for where it needs to go to do - to make those efforts.

CONAN: You're - we're talking on World AIDS Day. You're listening to TALK OF THE NATION from NPR News.

Mr. WILSON: I think that's why a national AIDS strategy is so important, because if we have a national AIDS strategy, we can identify and target populations and geographic regions that need the most attention. One of the reasons why churches may not be responding in the Southeast is because they do not have the resources, either financial or even the�

CONAN: Oh, I think we just lost the line to Phil Wilson in New York. In any case, Anne, thank you very much for the phone call. We appreciate it.

WILSON: I think what he might have been about to say, they would have to be educated themselves in order to be able to deliver those messages in the right way.

CONAN: Mm-hmm. Phil Wilson, founder and CEO of Black AIDS Institute in Los Angeles, California. And we thank him for his time.

Here's an email we have from Maggie(ph). I'm a middle-aged widow in Massachusetts, age 54. My husband died in 2004. Dating men in their '50s and '60s, none have been tested. They do not want to use protection because most of the women they date cannot get pregnant, although there have been a few surprises there as well. One man I had a relationship with who lives in Florida will not use protection and will not get tested because he says he is selective about the women he dates, and he believes it's not possible that he's at risk for AIDS or any other STD. We broke up. He's 67 and going strong. God help us.

WILSON: Well, she did the right thing, because I think one of the things that people need to be able to do is have this discussion with each other. And if they have not had sex before, be willing, if they've had partners before, to go and get tested - together even. And, you know, it's one of the things I would recommend, so I think she did the right thing.

CONAN: Let's go to Renee(ph), Renee with us from Fort Lauderdale.

RENEE (Caller): Hi. Good afternoon. I'm a long-time listener, and I want to thank you for this great topic today. My involvement with this topic is that I see a lot in my peers, young women, my age and younger and even older, who get caught up in relationships with partners who want to have sex. And the women say, I think you should wear a condom, and the men say, well, you're on the birth control pill, so we're not worried about pregnancy - are you saying you don't trust me?

And the women have this conflict, this internal conflict, this, well, yes, I want to trust you but, frankly, no, I don't. But there's a lot of pressure. Well, what kind of woman are you if you can't get a man that you trust? So they're pressured, socially and directly, from their partners. And this happens with men who have male partners as well, this you-love-me-but-you-say-you-don't-trust-me�

CONAN: Mm-hmm.

RENEE: �it goes to that personal responsibility and that education. We need to educate men that she's not saying she doesn't trust you, she's saying she's concerned about herself and her health.

CONAN: And her health. And yours, for that matter.

WILSON: Would�

RENEE: And his health as well, and her partner's health.

CONAN: Brenda.

WILSON: I think it points to one thing. We always talk about HIV as a, quote, unquote, "sexually transmitted disease," as if somehow sex itself takes place in a vacuum. It's a dynamic. It's a part of a relationship, one hopes. And if not, it - I mean, it involves the whole person and not just sexual organs. So at some point I think we need to kind of understand that relationship is as important as sex, and when we talk about preventing HIV, understand the nature of relationships as much as anything else.

RENEE: Right. Exactly. And here in the Fort Lauderdale area where I live, I took a college course for anthropology/sociology that was research methods. And the research study that we put together had to do with stigma and HIV and homosexuality - homosexuality being tangential to the stigma of HIV and AIDS. And as part of that class, we were told you have a provision where you're living in one of the places in the nation with the greatest incidence of HIV/AIDS transmission. And�

CONAN: Renee, I'm afraid we're going to have to leave it there. But thanks very much for the phone call. We appreciate it.

RENEE: Thank you. Have a great day.

CONAN: We're talking about, well, World AIDS Day. When we come back, we're going to talk about work being done by researchers now, and what's likely ahead on the medical front, and the president-elect to the International AIDS Society will join us. Stay with us. This is NPR News.

(Soundbite of music)

CONAN: In a few minutes, we'll read from your letters. But right now, we're focusing on the fight against AIDS - it's World AIDS Day - and all that's changed after 28 years. NPR science correspondent Brenda Wilson is with us. She covers HIV and AIDS worldwide. What's changed for you - the stigma, the treatment, behavior? 800-989-8255. Email us: talk@npr.org.

And joining us here in Studio 3A is Dr. Elly Katabira. He's the president-elect to the International AIDS Society, which convenes the biennial INTERNATIONAL AIDS CONFERENCE. He's also associate dean for AIDS research at Uganda's Makerere�

WILSON: Makerere.

CONAN: �Makerere University. And thanks very much for being with us today. We appreciate your time.

Dr. ELLY KATABIRA (President-elect, International AIDS Society; Associate Dean for AIDS Research, Makerere University): Thank you.

CONAN: And we learned this week, Washington, D.C. will be host to the 2012 International AIDS Conference - the first time that's been convened in the U.S. since 1990. I understand that's related to the Obama administration's repeal of the travel ban on HIV positive visitors.

Dr. KATABIRA: Yup. It is, and we are very grateful for that.

CONAN: Now, earlier in the program, we discussed the continuing drop in the rise in the infection rate. But might that good news potentially trigger some complacency in various places?

Dr. KATABIRA: Yes, it does, unfortunately. At the beginning, there was a lot of health education, and people rallied behind the health educators' messages on behavior and so on, went out. And indeed, people got concerned, and there was a drop on the newer cases.

But unfortunately in some countries, including mine, there is already a complaint that the numbers are going up and we don't know what we are doing wrong. So (unintelligible) complacence.

CONAN: That's interesting. You say even in your country. Uganda was one of the models of how to do this right.

Dr. KATABIRA: Yes, that is true. And we think that probably people got over -carried away and thought that they had to come over the problem and therefore there was no need to take precautions. But I think the other way around, and of course the other reasons. Currently, as you know, there is treatment, and some people think that if there is treatment why bother - to protect myself, at least I would be available for treatment. But as many people know, treatment is not a cure at the moment, and it is for life.

CONAN: And it is for life. And there are millions in Africa who are unable to get treatment.

Dr. KATABIRA: Yes. And in spite of all the successes that we've had, the (unintelligible) fund and Global Fund, where we've raised our ability to treat patients from two percent in 2003, dropped to 44 percent. But still, 30 to 44 percent, 56 percent is still there, not on treatment.

CONAN: And there has been a recommendation, recently, from the World Health Organization, that said that HIV positive began drug treatment much earlier than previously - than they do currently. And that's going to, again, call for more resources, more drugs and, well, more people to show that kind of discipline?

Dr. KATABIRA: Yes, and to start with, when we started rolling out antiretroviral therapy, our health systems were in a bad shape. They are coming up, but not adequately to take care of all those who need to be on treatment. And of course, the race over the starting point, from 200 and as it was before to 350 CD4 cell count. That means that there will be more, much more people requiring antiretroviral therapy. But probably, that's not the big issue at the moment.

The other one is to do with adherence, because initially when you were starting people on treatment, they were very sick, and so they were very motivated. Many of the people with a CD4 cell count of 350, some of them may actually have not serious symptoms, and therefore may not have regarded themselves as very sick, requiring to be put on treatment indefinitely. So that might affect our adherence, which has so far been very good.

CONAN: All right. Let's get another caller on the line. This is Ken. Ken with us from Minneapolis.

KEN (Caller): Yes. Hi, Neal. Thank you for taking my call. I enjoy your show.

CONAN: Thank you.

KEN: Neal, I lived in South Africa for five years and was certified there as a pre and post test councilor. We used the ABCs, abstain, be faithful and condomize(ph). And unfortunately it was condomize, condomize, condomize. And codomization simply does not work.

If we had abstinence and faithfulness, AIDS would stop being a pandemic within the generation.

I don't say that to stigmatize, or to moralize or to judge, but simply that is the way that this thing that we call HIV and AIDS can be killed.

CONAN: Brenda�

KEN: It will be here but not as a pandemic.

CONAN: I understand.

WILSON: I guess, I would ask Ken something and that is, in the United States where we have had federally funded abstinence programs, and where we have followed those programs, they have been in effective, for example, in controlling teenage pregnancy rates. We've tried that here. And it doesn't seem to have been effective.

And in fact, I think, in Mr. Katabira's country, we sort of carried out a wholesale debate that is going on in our country, a debate over what our policy should be with both ABC people and the people who are distributing condoms -sort of at loggerheads in one country. And here in Uganda where this debate was going on, we saw a resurgence of the epidemic.

KEN: I think we have a difference in when you're talking about the program failing. That doesn't mean that abstinence would not be the answer. It means that the approach to getting people to abstain is failing. But that doesn't negate the fact that the way that this can actually be stopped is through abstinence and faithfulness. Those two things would end this pandemic. And we keep circling around and saying, well, yeah, but then people feel judged and feel moralized; and, well, but we need to get more condoms out in bathrooms and at bus stops and everywhere else. And this simply doing symptom management rather than problem�

CONAN: Well, I'm�

WILSON: I guess I see it as a big if; you said if we could get people to do that. And to a certain extent, we have not yet somehow come up a way to kind of get people to systematically use condoms. And they also have to be there.

CONAN: Or systematically be abstinence or systematically faithful.

M1: Or systematically be abstinence and faithful, yes.

CONAN: Dr. Katabira, this is, as Brenda was mentioning, a very live subject in your country.

Dr. KATABIRA: Oh, yes indeed. Supported by many. Indeed, the issue of abstinence is supported by very important people in their country. And being faithful is equally supported. But also the use of condoms is also supported.

Our theory or our line is that to use all of them. Certainly, we recommend that you should abstain. And if you can't be faithful, but if you can't do all of those, both, then use a condom. And they will have a reason to do this.

For example, it is easier to tell a 14-year-old girl that she can abstain. But somewhere, she's growing, and the impact of her life and the socialization and peer pressure - somehow, somewhere, she's going to introduce herself to having a relationship. Well okay, if that happens, let her be faithful and stick to one. But of course, the decisions are made (unintelligible), 14, 15, 16. But remember, sex is there for the next 50 years and something must happen.

So we need also to introducing condoms. Should we fail to be faithful, then use condoms. And we have seen this. For example, we know internationally the divorce rate is growing up. That is an indirect indicator about faithfulness. People start off being faithful, but somehow, somewhere, they fall apart. And this must be recognized, and therefore address the three issues. If you can't abstain, you can't be faithful, then, for heaven's sake, use a condom if you can't do any of those two.

CONAN: I just want to read this email from Amjad(ph) in Denver. In some Arab countries and cultures, especially societies that consider themselves conservative. It is considered shameful to talk to your doctor about HIV or testing for it. This obscures the true number of who has the disease and reflects huge challenges for fighting this disease. And I think that's - we have to acknowledge that that's probably true.

Before we go, Brenda, we just have a few minutes left. We have been talking about the world as it exists in terms of the retroviral drugs that are being used for treatment. Are there promising courses ahead for medical researcher? Is there hope, eventually, for a vaccine?

WILSON: There any number of them. He probably - Dr. Katabira would be even better at this than I am, but there are prophylactic treatments, I mean, giving drugs as a way to kind of protect people before they become exposed to the virus. There are still attempts to come up with the microbicides that women can use independently in connection with these anti-retrovirals to protect themselves against the virus.

And so - I mean, yes, there any number of technological innovations that people are working on at this moment to add to, I suppose, all of the behavioral elements that go into prevention, for example, as well as new treatments, as well.

CONAN: Dr. Katabira, let me ask you to weigh in on this. And also, even if they come, they will not be a silver bullet?

Dr. KATABIRA: Certainly not. We have good examples of very successful vaccines but they are not 100 percent. So, usually are not, and they've been around there've been a lot of technology. So I wouldn't expect an HIV vaccine to be 100 percent. So, certainly, either approved effective strategies need to be kept in mind. And they need to - they should be very beautiful. But, of course, as Brenda have said, there are many people out there working on a vaccine. It will be probably much easier to have the vaccine. But unfortunately, the vaccine has eluded us over these years. Some issue - I think last year or I think this year - there were some good news from a study done in Thailand, but even then, that was a study (unintelligible) proof of concept, there's still a lot more to be done to come back and say it is successful.

CONAN: We just have a minute left with you. And I wanted to ask you, if we have you back one year from today, on the next World AIDS Day - what would you think would have one thing that would be the most promising thing you could report one year from now?

Dr. KATABIRA: Well, with the current crisis, economic crisis, I hope when I come back one year today, it will be a thing of the past and there will be a lot of funding for health care support and the IRT(ph) and programs as there had been and we will not be worried about where will the next dollar come from. I hope�

CONAN: The resources issue.

Dr. KATABIRA: That's right.

CONAN: Our resources issue - it also comes down to�

WILSON: The dollar and the euro and the franc and, you know, and the lira.

CONAN: Dr. Elly Katabira, all of us wish you extremely well in your new job. Dr. Katabira is president-elect of the International AIDS Society, which is based in Geneva, and convenes the biannual International AIDS Conference. And we thank you for your time today.

Dr. KATABIRA: Thank you for inviting me.

CONAN: And we'd also like to thank all of you who wrote in and gave us a call. And our thanks, as well, to NPR science correspondent Brenda Wilson here in Studio 3A.

WILSON: All right. Thank you, Neal.

CONAN: You're listening to TALK OF THE NATION from NPR News.

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