AIDS Decade in Review (cont.)

Dr. Marlink: Again, that's the leadership issue. In looking back -- this is Marlink again -- on the past 10 years, if that's the subject -- the one thing that developing countries have taught me or others, again, on the leadership issue is that in certain countries where leaders have taken a stand ahead of the pack, things have happened, even with scant or little resources. In Uganda and in Senegal -- in different parts of the epidemic, Uganda being at the forefront and one of the worst parts of the epidemic early on, really still took on prevention efforts which have helped show in sheer numbers, a curbing of the epidemic. In Senegal, they've prevented what should have been a terrible epidemic from happening. So leadership can make a difference, because it was all dependent on people speaking out and taking an unpopular stand at the time.

Event Moderator: I'd like to remind everyone listening that this is an interactive audiocast, so you may submit questions or comments for our guests by typing into the question line and clicking submit. At that, I'll move on to the next question which is: In which direction do you think that this pandemic is moving, considering the fact that there are rumors of real solutions, and by the way, I am committed day in and day out to this illness.

Mr. Kramer: What rumors of solutions? I haven't heard any rumors of solutions. All I see are actual facts that it's getting worse -- that everything is worse and worse, and that the drugs aren't working, and that people are getting sick from the medicine, and that people are beginning to die again. What rumors that there's going to be a solution? I haven't heard that at all. I have only heard doctors say that -- in fact, only recently there were major doctors saying that the virus will never be eliminated. Who's the dreamer who's hearing these rumors?

Dr. Marlink: The combination therapies, as Larry's been saying, are no solution. They --

Mr. Kramer: How are you supposed to take those? This is Larry. If after only two years, the combination therapies are beginning to make people so sick and kill them, how are you supposed to take them for the rest of your life? Get real.

Dr. Marlink: Well, I mean also in terms of no solution, in that they're basically, at best, holding back the virus within a person or holding it back in general. When you look at the numbers, when you look at AIDS deaths or the numbers of AIDS cases leveling off or decreasing in this country, you're really looking at that holding back the dam. It does not mean HIV infections are decreasing, and it does not mean someone living with HIV is not still living with HIV, so I appreciate the toxicities, and the problems, and the costs, and the complications of taking the medications, but we should also step back and realize that they're not a cure and they're not a solution.

Event Moderator: At that, let's move on to the next question from the audience, which is: Dr. Marlink, any breakthroughs occur in the 90's with regard to better understanding the virus?

Dr. Marlink: This virus is perhaps the best understood organism on the face of the planet. We've understood that it's actually not one virus, but a group of epidemics, and the virus has different types and subtypes. We've understood with the medications or the result of that, that there are certain enzymes and parts along the life cycle which can be attacked, although we pay a high price in attacking those parts of the virus life cycle. We've learned more about the structure and function of different parts from the genetic structure on up of this virus and how it affects our immune system. It is still eluding us overall, and I'm not trying to give the impression that we know everything there is to know about this organism, but we have learned a lot. I think the mixture of the advances in biotechnology in the past three years of automated genetic sequencing -- the same type of advances that are pushing the human genome project forward and being able to decipher our DNA in a much more rapid and sophisticated way than we ever have before has helped us realize that we are not dealing with one virus. We're actually dealing with subtypes of HIV that are evolving under our noses. We didn't realize this several years ago, the fact that Southern Africa and all the way up to Ethiopia and across to India are affected by a subtype of HIV called subtype C, which, 10 years ago, we were not even aware was on the map but now infects more individuals worldwide than all the other subtypes of HIV combined. And it has again taught the lesson, unfortunately, the tragic lesson that we've underestimated this virus again.

When we started this conversation, Larry brought up the fact that we've seemingly underestimated in numbers, but now the dire numbers that were predicted 10 years ago are coming to pass, and new dire numbers up to the hundreds of millions, if not billions, are being touted now. Scientifically, we know more about this virus than any other, but it's only teaching us that we have so much more to learn.

Mr. Kramer: It hasn't been transmitted -- what we know into medicine therapies that seem to work. So every time you read in the paper "oh, this new wonderful thing has been discovered at such and such a place, and it's been tried out in mice," and the next thing you know, they try it out on a person. By the time it's tried out on a person, usually as time has passed, it doesn't work anymore anyway.

Ms. Seele: And we also have not translated that into prevention. We still don't know how to really get people to behave differently to avoid HIV. We are still in a situation where we think that this is a homosexual disease. And that continues to drive the prevention issues, the people just -- well, you know, "I'm not gay so I can have unprotected sex." We have not done a good job on educating our country, our community, the world, about how you get this virus and how you don't get it. And I think this continues to be a problem.

Dr. Marlink: Well, Pernessa -- this is Marlink again -- it's actually been a failure. We can all look at the fact that because new infections in young people, women, and especially communities of color, are not part of the leveling off that is usually thought of in the AIDS epidemic in the United States -- we have failed in prevention. I'm sitting here looking out the window at Boston Latin High School being dismissed and hundreds of kids -- actually, young adults, many probably sexually active or about to be -- over half of the infections in this country occur in people under 25, and they've continued to occur in people under 25. This is a young epidemic usually, and prevention is not working.



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