|AIDS IN AMERICA|
August 31, 1999
Dr. Helene Gayle, director of HIV prevention at the Centers for Disease Control and Prevention, talks about recent trends in AIDS, as reported at the 1999 HIV Prevention Conference.
JIM LEHRER: The latest on AIDS, and we get that from Dr. Helene Gayle, who directs the AIDS program for the Centers for Disease Control and Prevention in Atlanta, where a CDC conference on AIDS is now underway.
Dr. Gayle, welcome.
DR. HELENE GAYLE: Hi.
JIM LEHRER: I understand the most significant news from your conference thus far has to do with numbers, a leveling both in the rate of incidents or the new cases of AIDS and in the death rate, is that correct?
DR. HELENE GAYLE: Yes. Those are clearly two very, very important findings, and there are several important findings, but I think that is clearly information that ought to wake us up and shake us out of some of the complacency that I think has developed around HIV.
JIM LEHRER: All right. Well, let's go through it. First of all, the new cases of AIDS. What are the numbers, what are the clean numbers on the new cases?
DR. HELENE GAYLE: Well, what we're seeing is that although the new cases of HIV infection, the new cases of AIDS continue to decline, they are not declining as rapidly as they were when the new drugs were first introduced. For instance, in the first two years that the drugs were introduced between 1995 to 1997, there was a 30 percent drop in new AIDS cases. In the last year there's only been an 11 percent drop in new AIDS cases. We're seeing similar things with AIDS deaths. AIDS deaths declined by almost 70 percent between 1995 and 1997, but only 30 percent between 1997 and 1998. So while we're still seeing important declines in AIDS deaths, as well as AIDS cases, it's starting to slow down. And I think that that's real cause for concern.
|The reasons for less decline|
JIM LEHRER: What is the reason?
DR. HELENE GAYLE: Well, there probably are multiple reasons. First of all, as we would expect with the introduction of any new drugs, you're going to see the biggest impacts in the very beginning -- when you reach most of the people who know that they're infected and who would profit from these drugs. So we feel like we have reached most people who know they're infected. On the other hand, that means that we have not reached people who don't know that they're infected and that means that people now, more than ever, ought to get out and get tested to know whether or not they're positive for HIV, so they can take advantage of these very, very powerful new therapies. There are other things, though, that also account for this slowing. Resistance is developing to these drugs, and as resistance develops, it means that these drugs just don't work as well. People have to get changed to new medications, and we only have a certain number. We also know that these are --
JIM LEHRER: Excuse me. Let me interrupt there. Why has the resistance developed to these drugs?
DR. HELENE GAYLE: Well, resistance develops for a couple of reasons. One, because the virus continues to mutate, and that's something that we see in viruses, and HIV is no exception. The other thing is that people don't adhere to this complex regiment of exactly the way they're supposed to take drugs and take drugs -- perhaps forget to take some sometimes or take themselves off of drugs because of side effects. This really encourages the growth of resistance in viruses. So these two factors lead to resistance.
JIM LEHRER: All right. Now, give us a profile. First of all, the new cases, who are the people who are getting AIDS in the large -- just break it down for us.
DR. HELENE GAYLE: Yes. I think that's important. Let me talk about HIV infection, which is really where we want to put the focus.
JIM LEHRER: Right. Because you have to -- HIV infection comes first, and that can and doesn't always, but that leads to AIDS.
DR. HELENE GAYLE: To AIDS, exactly.
JIM LEHRER: Right.
|The most at-risk groups|
DR. HELENE GAYLE: Well, of the new HIV infections, 50 percent of those are among African Americans, keeping in mind that African Americans only make up 13 percent of our population -- so clearly a disproportion impact among African Americans. 30 percent of new HIV infections are occurring among women. Now that's up from less than 8 percent of AIDS cases were women in the beginning of the epidemic, so more women.
JIM LEHRER: Why more women?
DR. HELENE GAYLE: Well, more women for several reasons. We know that 75 percent of women who get HIV infection are infected heterosexually. Some of that is because their partners share needles and so some of it is indirectly related to injection drug use. We also know that there's an increased risk of a woman getting HIV if she has another sexually transmitted disease. And in some parts of the country we're seeing heavy rates of STD's in women who therefore also are at great risk for HIV. We also know in some of the studies that we're presenting at this conference show that the role that men who have sex with men an also have sex with women plays is increasing. So, bisexuality is also contributing to the heterosexual spread of HIV to women.
JIM LEHRER: What explains the high incidents among black Americans?
DR. HELENE GAYLE: I think there are multiple factors. First of all, we know in this country, overall, African Americans have worse health status across the board on most major public health issues. And HIV is no exception. Some of the reasons for this: Racism, poverty, lack of access to quality health care services, lack of education, et cetera. On top of that, for HIV, there are some other factors. We know that the fact that this was characterized initially as a white gay disease lulled the African American community into a sense of false security this. This was not our problem. This was somebody else's problem. So there was a lot of denial that this could affect the African American community. And then I think two other important factors: The role that substance abuse plays in fueling the spread of HIV in the African American community is great. And injection drug use is important, but other substances that cloud judgment, that lead to increased sexual risk behaviors plays an important role. And then lastly, other sexually transmitted diseases, the rates of other sexually transmitted diseases are higher in many African American populations, and other STD's greatly increase your risk of acquiring HIV or transmitting it if you have it.
JIM LEHRER: Now, what is happening? What's the updated information on what's happening within the white gay male population?
DR. HELENE GAYLE: Well, we know that among the older white gay men who were part of the first wave of the epidemic, if you will, there was a lot of mobilization for of HIV prevention and behaviors did change and rates did come down. But we are starting to see a resurgence in high risk behaviors in younger gay men, including younger white gay men. And so we're starting to see fairly high rates of unprotected anal intercourse; multiple partners. And we are starting to see increases not only in HIV but also in other sexually transmitted diseases. But the impact even among gay men is still disproportionately high among African American and Hispanic young gay men, young men under the ages of 25, under the ages of 22.
JIM LEHRER: You mentioned the word right at the beginning -- complacency. What's brought this about?
DR. HELENE GAYLE: Well, I think several different reasons, but perhaps foremost is the fact that with the advent of these powerful new therapies, I think people relaxed a lot. People felt, well, you know, we now have this great treatment. HIV is not such a bad disease. It's not so serious. If you get it, you take some pills and it's not so bad. I think if you talk to anybody who has HIV infection, they are happy that they have better and better therapies and can live a better quality of life, but anyone that you ask would still say it's better not to have HIV infection. It is still a very serious disease. There are a lot of side effects to these new medications. And we can't be lulled into a sense of complacency. But I think we have been.
|JIM LEHRER: And is that what this conference you're having
is all about, is to try to turn the prevention thing back on -- the light
DR. HELENE GAYLE: Yeah, I think that's perhaps the main thing that we hope that comes about as a result of this conference -- that people wake up, that this is a wake-up call - that prevention is more important than ever. We've got more people living with HIV today as a result of the new medications. That means we have more people living who can continue to spread HIV. We've got to remember that there is no magic bullet, and it is always going to be better to prevent somebody from getting HIV than to go through the heartache and the complexity of having a very serious disease.
JIM LEHRER: Does it still qualify as an epidemic?
DR. HELENE GAYLE: Yes, it definitely does, it definitely still qualifies for an epidemic. It is diversifying, affecting different populations, and clearly, if we look at what is going on throughout the world, this is clearly an epidemic -- a pandemic. In this country we have higher rates of HIV infection and other sexually transmitted diseases than any other industrialized nation. We are still number one, if you will, when it comes to HIV and other sexually transmitted diseases.
JIM LEHRER: But in other parts the world, it's even worse though, right?
DR. HELENE GAYLE: Yes. Definitely. Definitely. If you look at what's going on in Africa and in Asia, particularly those two continents, HIV is really raging out of control.
JIM LEHRER: All right. Well, Dr. Gayle, thank you very much for this update.
DR. HELENE GAYLE: Okay. My pleasure. Thank you.