Positive Developments In HIV/AIDS Research

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Guests

Jon Cohen, correspondent, Science magazine and author of Shots In The Dark
Steffanie Strathdee associate dean of global health, University of California San Diego

Many of the 20,000 participants at the International AIDS Conference in Vienna fear the global recession will mean less funding for HIV/AIDS prevention and treatment. But panelists revealed a number of positive developments that suggest new methods to fight the deadly virus are more promising than ever.

TONY COX, host:

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

AIDS researchers, advocates and activists cheered big news last week from Vienna's International AIDS Conference. After years of failed attempts, scientists have developed a gel for women that may help protect them from HIV. Some women in the study cut their risk in half.

The new gel was a groundbreaking development, and there was other good news from Vienna, as well. But many of the conference's 20,000 participants fear the global recession will mean less funding for prevention and treatment programs just when opportunities to fight the deadly virus might be more promising than ever.

Later in the hour, comedian and actor Jonah Hill you know, the guy from "Superbad" and "Get Him to the Greek." First, though, advances in the fight against HIV and AIDS.

If you work in the field as a researcher, a service provider, an advocate, what changes have you seen in the fight against AIDS since the last International AIDS Conference in 2008? Tell us your story. Our number here in Washington is 800-989-8255. Our email address is talk@npr.org. And you can join the conversation at our website. Just go to npr.org, and click on TALK OF THE NATION.

With me now is Jon Cohen. He is a correspondent for Science magazine, and he just returned from covering his 14th International AIDS Conference. He is also the author of "Shots In The Dark: The Wayward Search for an AIDS Vaccine." He joins me from the studios of the University of California, San Diego. Jon, thank you for coming on. Welcome to TALK OF THE NATION.

Mr. JON COHEN (Correspondent, Science; Author, "Shots In The Dark: The Wayward Search for an AIDS Vaccine"): Thanks so much, Tony.

COX: First thing, it's still early, in the early days I should say, for this vaginal gel, but just how important is this development?

Mr. COHEN: The presentation was extraordinary at the meeting. There was a standing ovation. The woman next to me was sobbing. I think after all the failure that people have seen in this field, the fact that there's a finding that the researchers aren't arguing about, it looks real, is a tremendous event.

This isn't ready for primetime. It's not going to be rolled out tomorrow, but the mechanism is clear, the efficacy looks real, and you can build on it.

COX: Is this the kind of thing that a woman can afford, that people can afford once it becomes available, do you think?

Mr. COHEN: The cost estimates are yes. I mean, it looks like it'll be about 50 cents a dose or so, and, you know, that's a little premature to talk about cost because the big cost here is the applicator.

It may be that in many countries, you can reuse an applicator, and the cost will plummet dramatically, and as you scale up anything, costs plummet. So I think the bottom line is if you get a better version of the same thing, cost isn't going to be a big issue.

COX: One of the concerns that has been raised by some scientists, Jon, is this: Could a preventive gel like this one actually lead to drug-resistant strains of the virus?

Mr. COHEN: It's a great question, but remarkably, they didn't find any drug resistance, and it looks like the reason is is that the gel, it has an anti-HIV drug in it, the drug doesn't get into the bloodstream very much. So it stays at the site, in the mucosal surfaces, and that doesn't give the virus much chance to create a resistant strain.

COX: The development of this drug, is it to the benefit, or was it done by one particular scientist or group of scientists, or was it in some ways perhaps an international effort?

Mr. COHEN: Oh, this is absolutely international. I mean, the drug itself is on the market. It's tenofovir. It's used by people who are infected with HIV. And then the groups that put this all together included FHI, Family Health International, and CONRAD, a nonprofit that does contraceptive stuff, as well as USAID funding it and then this group in South Africa that ran the trial, called CAPRISA.

COX: Scientists have also been searching for an HIV vaccine for many years. As a result of what's been happening at Vienna last week, are there any new developments in this area?

Mr. COHEN: There wasn't much real vaccine news. There have been some advances over the past year that got a lot of attention at the meeting. This meeting often amplifies what has happened during the past year, but there was nothing I heard that made me turn my head or frankly even write about it.

COX: We often talk, as we are doing now, Jon Cohen, about vaccines and/or antiretroviral drugs, gels even. But something that we don't hear a lot of talk about is this: The cure for AIDS, is that changing? Are people beginning to say the dreaded cure word now?

Mr. COHEN: Huge change. I think a lot of people who don't follow the field closely assume that HIV/AIDS researchers have been hunting for a cure from the beginning.

The truth is for many, many years, they just wanted treatment that worked. A cure just seemed too far distant a dream. But over the past few years, a cure has moved to the front plate, and it's moved to the front plate both because of research advances and because we see the limits of the very good drugs that do exist, as well as the financial limit in terms of getting those drugs out to people.

COX: This is TALK OF THE NATION, Tony Cox sitting in for Neal Conan. If you'd like to join the conversation, call us at 800-989-8255. Our email address is talk@npr.org. And we are looking for people who can talk about the subject matter from the perspective of being perhaps a researcher or a service provider or an advocate. What changes have you seen in the fight against AIDS since the last International AIDS Conference in 2008? We want to hear from you. So contact us.

Why has the idea, Jon I want to talk a little bit more about this cure thing why has the idea of a cure been so taboo for so long?

Mr. COHEN: Because for many years, you couldn't offer anyone anything. There was nothing. I mean, when I started doing this, there really weren't any good drugs to help people live more than a year of life. So people just wanted to extend lives.

Come '95, '96, good drug cocktails come forward that let people live for decades with the virus. So now, those people are saying okay, what's next?

In addition to that, in poor countries of the world, there are 10 million people in need of antiretroviral drugs today who can't get them because there's not enough money to get it to them.

So think about what a cure offers: It gets rid of antiretroviral drugs, the need for them. That's the tremendous hope.

COX: You know, you talk about the length of time that we have been dealing and living with this. The world has been fighting this disease for almost 30 years, and you have been covering it, Jon, HIV/AIDS, for two decades at least. How have you seen the public conversation around the virus change in that amount of time in the U.S., as well as around the world?

Mr. COHEN: Well, the conversation has become much more sophisticated. I mean, in the early days, there were still people questioning whether HIV causes AIDS. That argument is just dead and gone. Anybody who's questioning that today is either not paying attention to reality or has some agenda that's separate from reality.

There was also a lot of anger in people who were infected because there was nothing to offer them, and they wanted research to move faster. The anger has largely shifted into a completely different realm, and that's getting all these good things to other people who can't afford them. It's a much different equation.

Also the research questions, there's been when I started, there was no real biomedical preventive. We can basically prevent mother-to-child transmission now. It occurs very, very rarely when women who are pregnant and HIV-infected receive the right treatment.

So there are a whole slew of things, and there's also this new idea that treatment itself is prevention because you're lowering the amount of virus in a population, so there's less virus circulating. That wasn't even conceivable, you know, 20 years ago.

COX: Has the rumor mill slowed also? I think you made some slight reference to it, and I'm thinking of this in connection with the fact that I don't want to call it a fact, but perhaps a rumor even, getting back to the concept of the cure that there was a guy in Germany who was supposedly cured. Are we getting away from all of the rumors associated with this?

Mr. COHEN: Well, the person in Germany, this was reported in the New England Journal of Medicine. It's a very real study that shows that a person likely was cured, and that has given the cure field so much momentum.

What happened with him isn't applicable to others. He had leukemia and received a very, very serious ablation of his immune system, which was wiped out, and then a transplant of another person's bone marrow. That's not going to be done routinely. But it does appear to all the experts in the field as though he likely was cured. He no longer needs antiretroviral drugs.

Have rumors gone away in general? No, of course not. People love gossip and love rumors, and there are always conspiracy theorists. But there's so much more evidence now to combat the rumors with, and with the advent of the Internet, you see it working in both directions. You see more rumors flying around and more counterattacks coming out very quickly.

COX: One of the areas that the fight has been waged against HIV/AIDS has been with finances and the support internationally and the fact that some of that support has begun to dry up.

We're still deep into a global recession, and this year, many activists are worried, are they not, about global AIDS funding, that it's going to take a hit and that upcoming donors, you know, will be fewer and farther between.

Mr. COHEN: That was a huge issue at the conference. It has taken a hit. There was a study that came out from UNAIDS and the Kaiser Family Foundation that shows that funding has plateaued for the first time in several years.

So we have hit a ceiling here, and as you mentioned at the top of the show, it's a time of great opportunity. So people's frustrations are running incredibly high, and throughout the meeting, you heard people wringing their hands not just about bringing new people into the fold and treating them but sustaining what's already started.

COX: One of the complaints that I read, Jon, about the conference itself was along the lines of what we are talking about now, the lack of funding. There were complaints directed toward the United States, and yet at the same time, the evidence shows, does it not, that the U.S. is still the leading nation in terms of funding efforts to fight this?

Mr. COHEN: Yeah, the U.S. is putting in 58 percent of all funds that go to helping developing countries. But we're the rich uncle, and we're always targeted and attacked for not doing more.

I think people look to the U.S. for leadership, and if the U.S. did more, they think others would do more. I think that's where the frustration comes from.

The remarkable thing at this meeting was South Africa.

COX: Tell us more about that.

Mr. COHEN: Well, South Africa's always been the pariah at the meeting from its government's standpoint, not the researchers. They're well-respected. But the government was run by Thabo Mbeki, who questioned whether HIV caused AIDS, and he had a health minister, Manto, who advocated lemons and garlic to treat HIV. They were the laughingstock of the meeting for years.

This has all changed with the presidency of Zuma, who has put in a really well-respected health minister, who spoke at the meeting. Their budget has been increased by 30 percent, and 83 percent of all the money that they're spending on HIV/AIDS, which totals over $2 billion, is coming from the government.

And they've started a massive new test and treat program. So they've become a model for how a country and they have more HIV-infected people than any country in the world, over five million how that country can take the lead.

COX: That would be an important development, I would think, and presumably, it will spread up through the rest of the continent. We know that in Uganda, they have already made some progress.

Let me ask you to hold on. We want to continue this conversation. We are talking about the recent advances in the battle against HIV and AIDS.

If you work in the field, as a researcher, a service provider, an advocate even, what changes have you seen in the fight against AIDS since the last International AIDS Conference in 2008? Give us a call, 800-989-8255. Email address: talk@npr.org.

Up next, we'll find out why some of the top AIDS researchers in the world last week called for an end to the war on drugs. Stay with us. I'm Tony Cox. It's TALK OF THE NATION from NPR News.

(Soundbite of music)

COX: This is TALK OF THE NATION. I'm Tony Cox in Washington.

The new gel that appears to protect women from HIV infection was the big news out of last week's International AIDS Conference. In some ways, the scientific developments overshadowed one important theme of the conference: a strong stand by conference organizers against the war on drugs.

Injection drug use is one of the main drivers of HIV transmission worldwide, and the Vienna Declaration calls for drug users to get treatment and clean needles, not jail time. We'll talk more about that in just a moment.

If you work in the HIV/AIDS field, as a researcher, a service provider or an advocate, what changes have you seen in the fight against AIDS since the last international conference back in 2008? We want to hear from you. Call us at 800-989-8255. Or email us at talk@npr.org. And you can join the conversation at our website. Just go to npr.org, and click on TALK OF THE NATION.

We are talking with Jon Cohen, a correspondent, Science magazine. He also wrote the book "Shots In The Dark: The Wayward Search for an AIDS Vaccine."

We are now joined also by Steffanie Strathdee. She is associate dean of global health at the University of California San Diego, where she studies HIV prevention among marginalized populations, including injection drug users. She is also one of the co-signers of the Vienna Declaration we just mentioned, and she joins us also at the UC San Diego studios. Welcome to TALK OF THE NATION, Steffanie.

Dr. STEFFANIE STRATHDEE (Associate Dean of Global Health, University of California San Diego): Good afternoon, Tony, thanks for having me.

COX: Let's tell people again: What is the Vienna Declaration? What is it about, and what does it call for?

Dr. STRATHDEE: Well, the Vienna Declaration follows on the heels of the Durbin Declaration that Jon just mentioned a few minutes ago, which was the earlier declaration that was, you know, proving that HIV caused AIDS.

This time, we really took a different stance, and 13,000 scientists and people from the community from all over the world, former heads of state, even the first lady of the Republic of Georgia, signed a document to say the war on drugs has failed. We need a science- and evidence-based approach to drug policy reform in this world, and we need to treat drug users like human beings.

COX: Was there a contentious debate over this, or was it fairly unanimous, the support for this declaration?

Dr. STRATHDEE: Well, I was sad to see that the Canadian government stood out against the Vienna Declaration when we had so much resounding support from other camps, including the director of the National Institute on Drug Abuse.

But I was very happy to see that it was mentioned throughout the whole week. Former President Bill Clinton stood up and mentioned it. It was mentioned by Annie Lennox, who attended the conference. And it was signed by 13,000 people, and their voices are being heard.

COX: Before we go to a caller, let me as you as a follow-up, Steffanie, what does your own research show about the effectiveness of these measures?

Dr. STRATHDEE: Well, my own research and that of my team is really around other aspects, such as the effectiveness of needle exchange programs and the evidence that they really do reduce HIV infection, and they reduce needle sharing.

And that's one of the tenets of the Vienna Declaration, which is harm reduction, that we really need to look at the problem of drug abuse as a medical issue and not a moral issue, and unfortunately, a lot of different drug policies are really stemming from a moralistic approach that really ignores the science.

COX: You used the term harm reduction. What does that mean?

Dr. STRATHDEE: Well, it's really looking at the problem of drug abuse from a public health and medical perspective in that if people are going to use drugs that, you know, we tell them it's not good for you, but if you're going to go and use it, then you need to protect yourself and protect the people around you.

So, you know, why should we let people inject drugs with dirty needles and infect themselves with HIV or viral hepatitis? They're only going to turn and have sex with their partners and pass on the virus, and that virus can be passed on to their children. And that shouldn't happen.

You know, it costs 10 cents to buy a needle, and we in this country until very recently have made it very difficult for people to get sterile syringes if they're injecting drugs.

I'm very happy to see that the president's emergency plan for AIDS relief now endorses needle exchange and harm reduction when it hasn't in the past. And the National AIDS Strategy in the United States, which was unveiled a few weeks ago, also embraces this important principle.

COX: Let's go to the callers and see what they have to say. Our first one is John(ph) from Grand Rapids, Michigan. John, welcome to TALK OF THE NATION.

JOHN (Caller): Hi, thanks for taking my call. I just returned from being a Peace Corps volunteer in South Africa for two and a half years. There I was working in the community HIV outreach program.

And I would like to say about this new gel, I'm very excited about what it promises to do, but I think just as important as getting this new gel out there is educating people on what it does to them and how it will prevent the medicine and stopping any rumors before they get started.

I can just see a lot of people getting the rumor out there that this gel makes you sterile or does something else to your body, and that could do a lot of damage to this new, very good tool against HIV/AIDS.

COX: John, thank you very much for the call. He mentioned, Jon Cohen, we talked earlier about rumors, and we have another caller I'd like to go to and then get you, Jon Cohen, to respond to. This is Michael(ph) in Midland, Michigan, talking about rumors. Welcome to TALK OF THE NATION.

MICHAEL (Caller): Thank you. Yeah, I'd just like to say I spent most of 2005 in Tanzania in East Africa, and most of what I did there was actually community outreach. A big problem, a huge problem, is the stigma of HIV, and people just did not want anyone to know that they had the disease and really would just keep it a secret to their own detriment.

But I had a doctor I was connected with who had the retroviral drugs, and so I would go out into the community and try to let people know that it was available and what a great medicine it was and how healthy - it could let them live a healthy life for a lot longer.

And I was just in a smaller village, and just there letting people know about this drug reduced the stigma a lot more because it made people feel like they could be a part of the community again. And I'd just like to say that.

But, you know, apart from the medical value of the drugs, I found that it's really starting to reduce the stigma in communities.

COX: Michael, thank you very much for that. What about that, Jon, the stigma, and how important is it to be able to reduce or lessen the stigma in order to move forward with development and hopefully a cure?

Mr. COHEN: Yeah, those are both, I think, excellent points. When you introduce a new intervention like a gel that has an anti-HIV drug in it, it's inevitable that people are going to be wary. And the people who introduce it have to be extremely careful to listen to people who are receiving it about complaints and fears they have and to put out accurate information about what the risks are.

Fortunately, it looks like the risk from this gel with the drug in it are very low right now. But as you roll it out to millions of people, things could change, and you have to be honest about whatever happens.

In terms of stigma, what we've seen again and again in countries that have antiretroviral drugs introduced is that at first, there is a lot of apprehension, and then as more and more people do it, that apprehension starts to dissipate.

And as people see that their friends and family are living longer lives with the antiretroviral drugs, the stigma eventually attenuates. It never fully disappears anywhere.

COX: This is TALK OF THE NATION. If you'd like to join the conversation, we're talking about HIV and AIDS, and if you have some experience as a researcher or a service provider or an advocate, or you have seen some changes in the fight against AIDS since the last conference, international conference in 2008, give us a call. Our phone number is 800-989-8255, and our email address is talk@npr.org.

Steffanie, I'd like to bring you back into the conversation to ask you this question, and I thought of it because of the two callers who we had talking about Africa and AIDS in Africa.

The conference was actually held in Europe, in Vienna, in part to push Eastern European countries to address HIV among injection drug users. What is how would you describe the status of the fight against HIV and AIDS in Europe and particularly in connection with the conference in Vienna last week?

Dr. STRATHDEE: Well, if you look at Eastern Europe, you know, some of the countries most affected by HIV and drug use are Russia and the Ukraine. In fact, Jon's done a lot of work there recently, and we see injection drug users in Russia and the Ukraine having HIV prevalence around 80 to 90 percent in some cities. I mean, it's just staggering.

And unfortunately, Russian delegates were virtually absent from the meeting, and it's a real shame because Russia is a country that actually bans methadone maintenance, and opioid substitution therapy is a proven, you know, intervention that can really reduce, you know, injection drug use and really be a weapon against the HIV virus.

COX: So what's the problem? What's their problem?

Dr. STRATHDEE: Well, I think that they see methadone as just another drug, and they really haven't looked at this problem in a medical way. And they have a very punitive response.

After the United States, Russia is one of the countries that has the highest per capita people that are incarcerated. And if we criminalize drug users rather than embracing them and providing them with drug abuse treatment and access to prevention, we're only going to see more HIV, not less.

COX: We have another caller from Fort Wayne, Indiana. It's Tim. Tim, you're on TALK OF THE NATION. Welcome.

TIM (Caller): Yeah. In fact, the comments about methadone might kind of segue in with this. I was wondering if your guest has seen any studies on whether - what effect needle exchange programs have on the sexual transmission of HIV by addicts, since many addicts use sex as a way to either get drugs or money for drugs.

COX: That's an interesting question. I would think, Steffanie, that's right in your wheelhouse, isn't it?

Dr. STRATHDEE: Absolutely. I mean, needle exchange, obviously, provides a sterile syringe in exchange for contaminated ones. So it primarily focuses on reducing needle sharing. But needle exchange programs, when they're supported adequately by governments and by volunteers and staff, they can be a source of condoms and HIV testing - voluntary counseling and testing, that is - and really can be a conduit for reduction of sexual transmission, as well.

Unfortunately, when we make needle exchanges illegal or we don't support them, then those important ancillary services are not able to be provided. And we're hoping now that we've seen in the U.S., finally, an overturn of the congressional ban that prohibited federal funds from being used to support needle exchange, we'll be able to see more needle exchanges and more ancillary services like condom provision.

COX: Thank you for that last call. Let's go out to Portland, Oregon and talk to Josh. Josh, you're on TALK OF THE NATION. Welcome.

JOSH (Caller): Hi. I was hoping to shift the conversation back to some of the science and ask your guest to comment on an article that was published in Science in April this year about using other viruses as potential vaccine vectors, specifically cytomegalovirus, if he's familiar.

COX: All right. Which - Steffanie, I'm not sure if you or Jon would be the appropriate person to tackle that question. I'll let you decide between the two of you.

Mr. COHEN: Oh, I can tackle it. Basically, making HIV vaccines has led to researchers using other viruses to deliver pieces of HIV to the body to stimulate the immune system. There are a dozen or more different viruses that experimentally have been used as the vehicle, as the vector to shunt in the HIV genes. So this is just one more idea.

COX: You know, put in perspective for us, the both of you, if you can: Now we talked at the beginning of the conversation about the importance of the development of the gel. We talked also about the fact that the idea of the cure is one that is continuing to evolve, and we further talked about what the relationship between the international community and the efforts to fight HIV and AIDS are. But we don't have a sense, I don't think - and I'd like to get you to give this to us right now - a sense of where we stand at the moment. Have we made significant progress to the extent that over the next five, maybe 10 years, we'll be very close to something that could be considered a major, major breakthrough in the fight against HIV and AIDS?

Dr. STRATHDEE: Well, we've seen some terrific advances. I mean, if you look at Africa now, about 40 percent of HIV positive people have access to antiretrovirals, where a couple of years ago, a couple of conferences ago, the infrastructure of the health care systems in many African nations was so weak that we couldn't get the drugs to the people. And so PEPFAR and the Global Fund really ramped up and have made huge strides to improve that.

But where - I think our biggest battle right now is one of complacency. We see that many people, especially young people in the United States and other countries, aren't concerned about HIV anymore. In fact, it really concerns me that young gay men, especially young gay men of color, are having very high rates of HIV infection. It's back to, like, mid-1980s level incidence rates. And we need to get through to them. They're not seeing their friends die like we saw the older generations. And so prevention, until we have a cure, is the - is going to be the only way to really break into these communities.

Mr. COHEN: And there's also a big picture fact that I think is really illustrative of the problem. You have five people becoming infected for every two people going on treatment. You can't keep up. You can't win the battle that way. And countries have to learn lessons from other countries. Russia and Ukraine are great examples of countries that aren't learning.

You can stop transmission in injecting drug users by providing harm-reduction packages that include everything like needle syringe exchange and opiate substitution treatment. Those things just aren't being done aggressively. And you also have things that we know work, like preventing mother-to-child transmission with anti-HIV drugs. It works. It's phenomenally effective, and it's not being applied aggressively enough.

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

I think we have time to get one more caller in. Let's go to Clinton, Connecticut. Skip, you are on TALK OF THE NATION. Welcome.

SKIP (Caller): Hi. Thank you for taking my call. I was inspired to call because I heard the person talked about the needle exchange programs. I'm a Meth Anon patient in New Haven, Connecticut, and the programs worked great for me. But along with that, they were a forefront of needle exchange programs many years ago. And what I've noticed with my friends that I've been involved with in this organization is that it's helped immensely with AIDS and drug abuse. And from what I can see, that's a harm reduction thing that'll work anywhere.

COX: Skip, thank you very much for the call. Let me end our conversation by asking you to briefly respond to this, Jon, if I might. The next conference, the next AIDS conference, as I understand it, is going to be in the United States in 2012. What do you expect - really briefly - from that?

Mr. COHEN: I expect that the world will turn to the United States for answers like never before, and will turn to the United States for leadership like never before because it's on our own soil.

COX: Is the United States in a position to provide that leadership, do you think?

Mr. COHEN: Oh, absolutely. We again and again have the research dollars that are spent in this country outstrip the rest of the world combined. And when we have political leaders that care about it, which isn't all of the time, they can make a great difference.

COX: I appreciate the conversation. It's been very interesting and insightful. Thank you both very much. Steffanie Strathdee is associate dean of Global Health at the University of California San Diego. She also joined us from the studios there. Jon Cohen is a correspondent for Science magazine. His forthcoming book is titled, "Almost Chimpanzee: Searching for What Makes Us Human, in Rainforests, Labs, Sanctuaries, and Zoos." He also joined us today from the studios of UC San Diego. Once again, to both of you, thank you for coming on.

Mr. COHEN: Thanks so much, Tony.

Dr. STRATHDEE: Thank you.

COX: Coming up, actor Jonah Hill has carved out a niche, making awkward, even creepy characters really, really funny. His latest movie, "Cyrus," is out now, and he joins us next.

I'm Tony Cox. It's TALK OF THE NATION, from NPR News.

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