Op-Ed: AIDS Must Be Fought At Home, Too On World AIDS Day, researcher Robert Gallo salutes President Bush's successful efforts to fight the disease overseas. But with infections on the rise in America's inner cities, Gallo argues that similar strategies must be employed in the U.S.
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Op-Ed: AIDS Must Be Fought At Home, Too

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Op-Ed: AIDS Must Be Fought At Home, Too

Op-Ed: AIDS Must Be Fought At Home, Too

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This is Talk of the Nation. I'm Neal Conan in Washington. And here are headlines from some of the other stories we're following here today at NPR News. The National Bureau of Economic Research says the U.S. economy has been in recession since December 2007. The private organization is a group of academic economists who determine business cycles. In somewhat shorter-term news. The Dow Jones industrial average down 441 points right now on Wall Street. And in Thailand, the prime minister stayed away from the capital Bangkok. Today, he has been able to quell a politic crisis that's paralyzed his government for weeks now and shut down the capital city's two main airports. You can hear details on those stories, and of course, much more later today on All Things Considered. Tomorrow at this time on Talk of the Nation, a closer look at the targets in Mumbai last week and what they tell us about what the terrorists wanted to accomplish.

Now, the Talk of the Nation Opinion Page. In 2003 President Bush launched a program called PEPFAR. The acronym stands for the President's Emergency Plan For AIDS Relief. Robert Gallo, the well-known HIV and AIDS researcher describes it as the largest global health initiative in the history of mankind. And he credits PEPFAR for making the first real dent in Africa's fight against HIV/AIDS. In an op-ed in the Washington Post, Gallo challenges the incoming Obama administration to create a similar program here at home. PEPFAR planned to help America's inner cities, some of which he says face the same rising HIV/AIDS statistics as some third world countries. Robert Gallo joins us in just a moment. We want to hear from those of you who work on this issue. How should we allocate limited resources? How do you choose a top priority in the fight against AIDS?

Phone number 800-989-8255, email talk@npr.org. You can also join the conversation on our website. Go to npr.org and click on Talk of the Nation. Robert Gallo directs the Institute of Human Virology in Baltimore. He led the co-discovery of the HIV retrovirus as the cause of AIDS and the development of the HIV blood test. And he joins us now from the studios of member station WYPR in Baltimore. Nice to have you on the program today.

Mr. ROBERT GALLO (Director, Institute of Human Virology, Baltimore): Thank you. Nice to be with you, Neal.

CONAN: And your op-ed emphasizes both the scale and the accomplishments of President Bush's program on AIDS. Did he at that time have his priorities right? Is that where the United States should have devoted its funds?

Mr. GALLO: Well, I can't at a glance say there should be more money put this way than that way. For me, the greatest problem facing much of the world is drug addiction and that contributes greatly to HIV and AIDS as well. In the absence of solving that, we'll have constant problems that are beyond infectious disease. So if I had to list something with priority, I'd probably list that first as it impacts families throughout the world actually.

However, for a disease and for developing nations specifically with knowledge in hand that we know the cause, that we have it in hand, that we know an enormous amount about the virus perhaps as much as we know about any microbe in the history of medicine, that we know a great deal about the disease, something can be done. There is for the first time in the history of medicine for a viral illness. Before we had only either prevention by vaccine or nothing. It was extremely difficult to avoid looking at the international scope of this problem particularly in Africa but not limited to Africa and not get more deeply involved.

Indeed, I think there have been many positive spinoffs from major research to many areas of science, but I also think there have been positive spinoffs socially. First, a much greater tolerance of differences in sexuality, and second, a greater connection between north and south and particularly between the United States and Africa. If you do nothing, this was threatening global security, and there was a tremendous - there still is a tremendous tragedy going on particularly in Africa.

And the program I was advocating in the Washington Post I don't think necessarily has to cost new monies. I think it could be taken out of the existing PEPFAR program which parenthetically had the support of both parties and ideas coming in from both parties, and think will be the greatest legacy of President Bush, and has drawn us much closer to many of these countries. So, I'm exceedingly positive about it. I've seen what we can and did do, and I think we're going to do still more in its - in our ultimate interest if we think even selfishly.

CONAN: To mark World AIDS Day today, President-elect Barack Obama delivered taped remarks this morning from the Saddleback Civil Forum on Global Health here in Washington D.C. He praised President Bush for his leadership on the fight against HIV in Africa as you did. And he said his administration would work to continue that.

President-elect BARACK OBAMA: But we must also recommit ourselves to addressing the AIDS crisis here in the United States with a strong national strategy of education, prevention and treatment, focusing on those communities at greatest risk. This strategy must be based on the best available science and built on the foundation of a strong health care system.

CONAN: Robert Gallo, you have some of the best available science. Where would you think the president-elect ought to direct that?

Professor GALLO: Well, I think one is the direction that I suggested. Though I, personally, am more, even though a physician by background, I'm much of a laboratory scientist and interested in some of the mechanisms and interested in developing a vaccine and making therapy simpler, more effective, new approaches to therapy. Nonetheless, I have to acknowledge that the education, the preventive types of programs, the help medically and paramedically to the inner cities in the United States has to be regarded as a top priority.

So if we had an inner city PEPFAR, I'd rank it right at the top, and it doesn't take a lot of the highest quality science right now. We know enough to make this effective and what would it do? I think in one stroke, it would acknowledge that we have the problem. We would be more brethren to the people that we're supporting. Prevention measures and therapy measures in the developing nations. It would say we're not just paternal, we're also fraternal. We are your brothers in this global problem.

And secondly, it would bring to some of the poorer regions of the United States, particularly east coast major cities like Miami, New York, Philadelphia, Baltimore, Washington, New Orleans, Jacksonville, spilling into rural black southern communities. It's not limited to those places, but this is what comes to my mind first. It would bring to them both medical and paramedical greater sophistication and involvement which I think would spill over into helping the bioterrorism programs which there's a lot of funding for.

You know, what's the first line of help in a bio-terroristic attack? It has to be standard medical capacities, standard medical education. I think helping inner cities of the United States and adding them to the PEPFAR list would be an enormous contribution from the incoming president. And I'm sure this is in his radar system. I've been talking about it on and off for about five years. I think now is the time to really push it a bit harder.

CONAN: And we'd like to hear from those listeners who work in this field. What should the priorities be in terms of AIDS, and given limited priorities, where should those resources, given limited resources, where should those resources be directed? 800-989-8255, email is talk@npr.org. Melissa is on the line. Melissa calling from San Francisco.

MELISSA (Caller): Yes. Hi. Nice to be able to speak with someone about this, especially on World AIDS Day. I work at St. James Infirmary which is a community health care clinic for sex workers, and we're based in San Francisco. And we've been involved with being allies for sex workers doing HIV work around the world to get PEPFAR funding. One of the things I'm concerned about if we were about to have a PEPFAR-like plan in the United States is that there is a certain requirements to getting PEPFAR funding overseas that I wouldn't want us to have export into the U.S. or yes, imported.

So for example, sex workers aren't allowed to get HIV funding out of the PEPFAR plan if they don't agree to condemn prostitution which creates a kind of a bind. You can't do work with sex workers to prevent HIV if you're having to condemn prostitution. So organizations that we're doing, condom availability, community health care clinics around the world. They've lost their funding to do HIV prevention work because they don't subscribe to the ideology of the Bush administration.

So, my hope would be that the Obama administration in bringing forward something like PEPFAR especially in the United States and around the world wouldn't carry forward these ideological constraints. And the United Nations, the UN AIDS, they recognize that sex workers are absolutely crucial in fighting HIV. To exclude them from this work is really damaging and is only going to increase the spread of HIV.

CONAN: Robert Gallo, I wonder what you think.

Professor GALLO: Yeah, I can't totally disagree with that, but I would like to point out a couple of things. In the first place, you don't have to follow exact same pattern. For PEPFAR, as has been done abroad. It doesn't have to be with a new administration. But to compare what PEPFAR has achieved compared to some of the programs the caller just described is in my view, comparing a marble to a mountain. PEPFAR, our institute alone, is treating 11 percent of the total people treated in Africa. We're treating hundreds of thousands of patients with drugs that make their disease into something that's no longer a sure fatality.

And if you go and visit some of the clinics there, for example, we have 320 people from our institute alone that directly work through the PEPFAR funds there. Along with some organizations on the ground, it has some exceedingly positive points. You have to work from people within universities that have an idea how to treat. If this money went anywhere, just let's say the normal WHO or the normal this or the normal that, it's different. It's not an ABC formula for treatment. That's how it was being looked at by organizations at the beginning as if we knew the exact treatment.

Treatment has to be evidence-based. This is exceedingly complex and it requires knowing the local population, knowing what drugs, new ones included are best for this population, which ones have least drug resistance if you're in an area that's likely to have a lot of drug resistance and in an area that doesn't have the technology to do this or that. It has to be studied by medically qualified people, experts in medicine and to a certain degree in the science of HIV. It's not just something like here's a small pox vaccine, go give it. It requires thought and care and study in each place.

PEPFAR allows for that because it demands that you work with people who are accepted in the country that are on the ground, and it demands that you are effectively a university-based highly experienced group who competed successfully. It's not just our Institute of Human Virology at the University of Maryland but it's Harvard, Columbia, the University of California, San Francisco and Emory that are also involved, all with extremely sophisticated programs.

To bring in about the part about, well, it demands that you don't help the sex worker is a regulation that may be involved in PEPFAR, I don't know the details of that. It would have to be with my colleagues but that's not something you need to have. The apply to PEPFAR in the United States, moreover, the caller didn't mention that sometimes, it's the countries themselves that criticize people who advocate more liberality in sexual practices. There are some nations that blame western paternal attitudes for fostering on them habits and ways of life that they really don't want, and they take a more conservative approach. We've just seen that in some African countries.

So though I agree with the caller that there has to be modifications in some ways and this needs to be discussed openly not just by scientists or doctors of what's best for the United States, it certainly doesn't preclude what PEPFAR has done. And it would preclude some of the things the organizations she mentions do because in my view, they don't know anywhere near enough about the therapeutic programs and have the sophistication to pull it off properly.

CONAN: Melissa?

MELISSA: My response would be my focus is in prevention and education. We do work with researchers around the world. Actually, I work with U.S. staff in San Francisco. We have clinicians from St. James infirmary who've done studies with them. Our practice, when we talk about prevention, we talk about education. It's care-base and community-centered and absolutely evidence-based, and this is our frustration with looking at how PEPFAR has been applied around the world.

There's no evidence that taking condoms away from sex workers, taking programs away from sex workers to treat their own community, to do community education, to spread messages of positive health in their own community, that those do anything to prevent HIV.

And what we've seen is money for any programming that organizations do around HIV prevention if they serve sex workers is being taken away from them under PEPFAR. It's called the anti-prostitution loyalty oath, and it's been a part of PEPFAR since 2003. We've been fighting this. We have allies around the world, on the ground in different countries and the strongest around this Cambodia, for example, has a hugely organized community of sex workers. So, there's India, Argentina, Mexico. We just had a significant gathering at the International AIDS Conference in Mexico City with 200 sex workers fighting for the repeal of this oath in PEPFAR.

Professor GALLO: If I can comment on that.

CONAN: And if you could keep it brief because we want to get on to some other subjects here.

Professor GALLO: OK, once again, I mean, I think that was all redundant. I don't disagree. I already said that. They could be modified accordingly for prevention. But I'm talking about life-saving therapy. They don't have the qualifications to do that. The doctors at UCSF do. And PEPFAR demands that for therapy, I'm talking about therapy, I'm talking about the major impact that the program has had. I don't want to give credit or lack of credit to this one or that one. The fact is it has begun an enormous and historical positive therapeutic program that no one can deny and that no organization began to achieve before. Period.

CONAN: We're talking with Robert Gallo today about his op-ed that appeared in the Washington Post. He's a professor at the University of Maryland School of Medicine, director of the Institute of Human Virology in Baltimore. And you're listening to Talk of the Nation from NPR News. And let's talk with Michelle. Michelle with us from Henderson in North Carolina.

MICHELLE (Caller): Hi, thanks for taking my call today.

CONAN: Go ahead, please.

MICHELLE: Thanks for donating time for this subject. I'm a physician, and I provide medical services for HIV-infected people in rural North Carolina. My clinic is federally funded, and on the question of where I would like to see money spent, it would definitely be on education. Keeping in mind, HIV is a multi-sectoral issue, not just money in one area is going to eradicate the disease.

However, I think, comprehensive sex education would be definitely top of my list and comprehensive sex education for example, people would learn the proper use of condoms, learn that condoms save life as opposed to asking. There are programs where they don't talk about condoms or misinformation is given and that seems to be a key with our young people, not being appropriately educated about sex and how to protect themselves.

CONAN: Thanks very much for the call, Michelle. Appreciate it. And Robert Gallo, you also talked about the important of education in your op-ed, and I think you probably endorse of much of what she said. But the other question that a lot of people would have is can you tell you us how close we are to a vaccine that would seem to, if it is successful, that would obviate the necessity for a lot of this?

Professor GALLO: Yeah. You're right. I'd certainly advocate for more education and one would hope and believe that even in a routine household and a routine high school, by now, people would know about condoms without spending zillions of dollars on it. But apparently, it is not the case. And I'm in no way against that education. The moral for it, talk about it all the time with myself but I'm not in the position to be an educator on it. But I think it's important because we sometimes drift apart. Those people involved directly and solely in education and behavior versus the, let's say, research scientist.

Let's keep in mind that your listeners, the callers, that nothing that's positive in HIV and AIDS has been other and what has come out of basic research. Remember, without basic research, we don't know the cause. Without basic research, my colleagues and I would have never developed a blood test and grown the virus for the first time. In growing the virus, enabling the blood test for the first time gave us not only the preservation of our blood supply but it also allowed us to know when a person had the infection, not waiting 10-15 years for the person to show up with disease symptoms.

Thus, we could educate. Without the blood test, we couldn't educate. Without the evidence and the proof of this virus causing AIDS, we couldn't educate. Without the basic science, we couldn't know who to intervene to block mother-child transmission of virus. We couldn't protect our blood supply. We wouldn't have therapy. In short, we would have zero of the practical advances that we have today including all education. So the fundamental research on how to get rid of this virus including by developing continued approaches to new therapy as drug resistance occurs. The continued research, on developing a vaccine are essential to this, not just the programs of education and the social awareness. Where we are in the vaccine is simple, we are not there yet but it remains a significant possibility and today research…

CONAN: I hate to cut you off but we're out of time. Robert Gallo, thank you so much.

Professor GALLO: No, that's OK.

CONAN: It's NPR News.

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