With Dr. Paul Zeitz Director, Global AIDS Alliance Monday, July 28, 2003; 5:00 p.m ET
The number of Americans diagnosed with AIDS increased 2.2 percent in 2002, the first time the incidence of the disease has risen since 1993, according to preliminary data from the federal Centers for Disease Control and Prevention in Atlanta. Why is the incidence of AIDS infection in the U.S. rising? What can be done to bring the disease under control again? Dr. Paul Zeitz, director of the Global AIDS Alliance, was online Monday, July 28 at 5 p.m. ET, to discuss AIDS in the U.S. Editor's Note: washingtonpost.com moderators retain editorial control over Live Online discussions and choose the most relevant questions for guests and hosts; guests and hosts can decline to answer questions.
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Somewhere, USA: AIDS has been alternately been described as a very difficult disease to trasmit, and also as one of the fastest spreading diseases in history. Yet, those two comments do not necessarily conflict. Would you please explain, in layperson's terms, how a disease that is difficult to get is so widespread? Is it that people engaging in risky behavior are statistially more apt to be infected? Is the body is able to fight infection and it as repeated infections build up that AIDS develops, or is it that a one time infection means a person will likely get AIDS?
Dr. Paul Zeitz: Thanks for your question.
HIV is a very fragile virus that only survives in bodily fluids like blood, saliva, and sexual fluids. The virus is only transmitted through these fluids. It can be transmitted through blood, via blood tranfusions, needle sticks. While the virus is found in saliva is very rarely if at all causes an HIV infection. The most common form of HIV is through sexual fluids. Other viruses like the flu, are air born and can spread by breathing in the virus, thus it is must more easily spread.
As sexual behavior needs to change to stop HIV transmission, HIV/AIDS is spreading rapidly in many parts of the World, including here in the USA.
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washingtonpost.com: Dr. Zeitz, thank you for joining us this afternoon. The number of new AIDS cases in the U.S. has risen for the first time in a decade. To what can the sudden rise be attributed?
Dr. Paul Zeitz: Thanks for having me online. The CDC reported this week that HIV spread is on the rise in men who have sex with other men. Also, about one-third of HIV infections in the US occur through injecting drug use (IDU). Racial and ethnic minorities have the highest rates of IDU and HIV infection. These minorities include African Americans and Hispanics.
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Vienna, Va.: How far along are we in finding a vaccine? What is the current update on AIDS research and the funding that goes into it?
Dr. Paul Zeitz: Thanks Vienna for your question.
There is alot of work being done to develop an AIDS vaccine. Some prototype vaccines are being tested in humans. Unfortunately, the HIV virus is a tough opponent and it's structure and it's ability to mutate are making it hard to find an effective vaccine.
While no one is sure, it does not seem likely that an effective HIV/AIDS vaccine will be available for at least another 5-10 years. We need to invest more resources in getting these vaccines to market.
Also, you need to know that most of the vaccines that are being developed now are for strains of the HIV virus found in the USA and Europe. Vaccines that protect people from the strains of the virus circulating in Africa and Asia are much further away from being developed.
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Fairfax, Va.: What is the most common way that Americans are contracting AIDS? Is it sex? If so, then what about all the sex education programs that I thought was taught at every school? I thought we were very open about condom use in public health?
Dr. Paul Zeitz: In America the most common ways of contracting HIV infection are:
1. Men who have sex with men;
2. Injecting drugs users;
3. Heterosexual sexual activity
In the past there was a high risk of HIV infection from blood transfusion and mother-to-child transmission. But these risks are now extremely low in the USA, but remain a major problem in other parts of the World.
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Virginia: What country has the highest number and what country has the lowest? For the country with the lowest number, would there be a public health model that we could learn from?
Dr. Paul Zeitz: Thanks Virginia for your question. The countries in southern Africa are the worst affected from AIDS. In places like Botswana, for example, almost 40% of the adults have HIV infection.
While the number of cases are increasing in the USA, the overall infection rates is amongst the lowest in the World.
There are public health models from the US can be used in other parts of the World and visa versa. In fact, there are alot of exchange programs underway that share lessons learned between Africa and USA and visa versa.
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Washington, D.C.: I've heard that it is actually difficult for a non-drug using heterosexual man to contract the disease from vaginal intercourse with an infected woman. Is there any truth to this? It seems the high rates of infection in Africa amongst heterosexual populations would counter this.
Dr. Paul Zeitz: Thanks Washington DC. A heterosexual male can contract HIV infection from vaginal intercourse with an infected woman. There are factors that can increase or decrease
the likelihood of infection. For example if the man or the woman has genital ulcers or sores, then that can increase transmission. If the sexual activity leads to micro-tears in the vagina, then that can increase transmission.
If you are having sex with a woman who is a new partner and you don't know there HIV status, then please always use a condom, as that is your best protection.
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Portland, Ore.: What are the ins and outs of the new CDC approach for tracking HIV inferctions that is being presented today?
Dr. Paul Zeitz: The CDC released a report on July 18, 2003 that focuses on increasing prevention efforts of persons already living with HIV/AIDS. While this is a worthwhile endeavor, there is some concern in the community of activists that the US government is decreasing it's support for funding of prevention programs for gay and bisexual men and for ethnic and racial minorities who are at great risk of becoming infected.
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Bethesda, Md.: The number of persons living with AIDS has increased as deaths have declined. Do you think this leads people to think they are not going to die from AIDS -- and therefore just don't worry about protection any more?
Dr. Paul Zeitz: Dear Bethesda, Thanks for your question.
As people with HIV infection obtain access to lifesaving AIDS medications [antiretroviral drugs] they are able to have an extended high quality life. Also, they are less likely to tranmit the HIV virus because their viral load goes down to zero.
I believe that the increases in HIV transmission that we are seeing are not because already infected people are getting treatment, but rather because our prevention programs are becoming weak and complacent. Strong prevention programs to protect the most at-risk populations need to be expanded. We also need to make sure that all HIV-infected people have early and complete access to lifesaving AIDS drugs.
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Rockville, Md.: Thanks for being with us.
It seems to me that it is more profitable, in fact highly profitable, for pharmaceutical companies to "manage" the disease with high priced drugs as opposed to curing it. Will the development of a vaccine or a permanent cure of HIV/AIDS signify a loss of revenue for U.S. pharmaceutical companies? Anyone will see why most of the research is geared toward new drugs as opposed to finding a cure. We have the examples of cancer and other diseases where profit dictates the angle of research.
Dr. Paul Zeitz: Rockville: Thanks for your interesting question. It is true that the American pharmaceutical industry takes aggressive actions to protect it's profits. Investments in AIDS vaccines is lagging behind and they definately need to be increased. The experts that I've consulted believe that an AIDS vaccine that protected people against the AIDS virus in the US/Europe, as well as, in Africa and Asia, is feasible and possible and can be done in our time. We think that the pharmaceutical industry will be able to make sufficient profits, while at the same time they can develop and globally distribute an effective vaccine. Their profits cannot be the only interest addressed or protected.
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Dr. Paul Zeitz: Thanks for having me on this chat! I hope to talk with you all soon. Please check out our website at www.globalaidsalliance.org
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