Wednesday, July 28, 2010
What is our county government doing to combat the spread of HIV? We speak to Health Reporter Kenny Goldberg about local HIV prevention efforts, and discuss the big news stories that came out of the International AIDS Conference in Vienna, Austria.
MAUREEN CAVANAUGH (Host): I'm Maureen Cavanaugh, and you're listening to These Days on KPBS. The 18th Annual International AIDS Conference wrapped up last week in Vienna, Austria. Policy makers, researchers and people living with HIV gathered to assess and to chart a course forward. The attendees discussed topics ranging from the effect the worldwide economic crisis is having on AIDS programs to the latest scientific breakthroughs. KPBS health reporter Kenny Goldberg attended the Vienna conference. He's here to tell us what stands out on the international battle against AIDS, and give us an update on the fight closer to home. And, Kenny, good morning.
KENNY GOLDBERG (KPBS Health Reporter): Good morning, Maureen.
CAVANAUGH: Welcome back.
CAVANAUGH: Now before we talk about the International AIDS Conference, let’s talk about what’s happening locally here in San Diego. San Diego County wants to set up mobile HIV testing units in the next couple of months. Why does the County want to expand its HIV testing capabilities?
GOLDBERG: Well, health officials say that not enough people are getting tested and they’re not getting tested early enough in the disease. A lot of people are showing up for testing when they already have symptoms of HIV, and at that point it’s late in the process. It’s like if you have heart disease and you don’t show up to the doctor until you’ve had a couple heart attacks. I mean, early intervention is the key to managing HIV like any other chronic illness.
CAVANAUGH: So what kind of testing resources are currently offered around the county?
GOLDBERG: Well, you can get tested at the county health clinics, you can get tested at a community health clinic, you can get tested at your doctor’s office. But what advocates say is that testing has to be more convenient. I mean, it’s got to be mobile. It’s got to be quicker, less of a hassle. I mean, if you have to go to the doctor or make an appointment to get tested, that’s going to be a lot more difficult than if there’s mobile testing available and that it’s just rapid testing, it’s quick and it’s easy.
CAVANAUGH: Tell us a little bit more about why governments around the state are encouraging people to get tested for HIV.
GOLDBERG: Well, in the United States, the Centers for Disease Control says about one out of five people are unaware of their status. And check this out, they say that people who are unaware of their status, they’re the cause of 50% of all new HIV infections. So that’s a real heavy impact.
CAVANAUGH: And what about the – Why isn’t this taking off the way that health officials hope that it will? Is there a certain hesitancy involved in making HIV testing routine and widespread?
GOLDBERG: I think there is and I’m not sure why it is. It’s in the public at large, it’s within the medical community, and I spoke to a woman—her name is Terri Ford—at the AIDS Healthcare Foundation in Los Angeles. And I asked her, you know, why isn’t HIV testing more routine?
TERRI FORD (Senior Director of Global Advocacy, AIDS Healthcare Foundation): You know, why can’t we present it as something that’s normal. Cancer used to be something that was whispered; it had that stigma, too, like somebody has cancer. That’s gone. You know, and we have to jump ahead like that.
CAVANAUGH: Do we know how many people in San Diego County are infected with the HIV virus? Do we have any – Is there a wide kind of an idea? Do we take a head count?
GOLDBERG: Yeah, through the end of ’08, the County says about 3800 people, as of that date, were diagnosed with HIV. HIV tracking began in California only a few years ago. Prior to that, it was just AIDS cases. But through the end of ’09 – I’m sorry. Yeah, the end of ’09, we had about 14,000 cumulative AIDS cases in San Diego, and about 7,000 deaths.
CAVANAUGH: Is there any population that is seeing an increase?
GOLDBERG: Well, the populations that are most effected by it in San Diego are the same elsewhere in the United States, men who have sex with men, injection drug users. Among women, heterosexual contact is the chief method of transmission of the disease.
CAVANAUGH: And, again, the people who have HIV and don’t know they have it, what can – what are health officials speculating about that population, and how much that the disease may be increasing if they don’t know they have it?
GOLDBERG: Well, there’s no question that it’s – that they’re spreading infections if they don’t know they’re infected. I mean, there’s just no doubt about it. And that’s why the Centers for Disease Control a couple years ago said, look, let’s make HIV testing a routine part of medical care just like when you go to the doctor, you get your blood pressure checked, you get your cholesterol checked, so you don’t even worry about it. So more and more states including California are taking out the – that you have to opt in to get HIV testing and instead saying you have to opt out. In California, doctors can give you an HIV test and they ask you, hey, we’re going to give you an HIV test, is that okay. And then if you refuse, then they won’t do it. But – Do you know what I’m saying?
GOLDBERG: So they’re trying to remove some of these barriers but we’re not there yet.
CAVANAUGH: Instead of having you come up with the idea yourself, you have to actually refuse it. And that’s better for public health and it’s better for your own health.
GOLDBERG: That’s right but, as we were saying earlier, there still are some stigma or whatever else it is that’s preventing HIV testing from becoming completely routine. Let me give you an example. When a person gets married in California, they have to get a syphilis test. It’s required. Well, nobody makes a big deal out of it. It’s just – it’s just par for the course now. So people say, all right, you know, we don’t have a cure for HIV. We have a cure for syphilis. But, nonetheless, why can’t we just make it routine? And that’s the goal.
CAVANAUGH: Now, as I say, you’re just back from the International AIDS Conference in Vienna, Austria. What was the focus of that conference?
GOLDBERG: Well, there were so many different foci…
GOLDBERG: …I can’t even begin to tell you all of it. But the biggest story that came out of the conference was they did a clinical trial in South Africa in one of the most hardest hit areas of the world of HIV, and they tested a vaginal gel on women, volunteers, that had an anti-HIV drug in it that’s actually manufactured in California. And what they found when they compared the use of that gel before and after sex with a placebo gel, that it protected women against HIV infection 39%. So what that means is for every 10 infections that would’ve occurred, four HIV infections were prevented, which is enormous.
CAVANAUGH: Now I know that the people who are well versed in HIV and AIDS prevention around the world are incredibly excited by this. Tell us why.
GOLDBERG: They’re excited about it because this is the first woman-controlled method of HIV prevention. You see, in many of the countries hardest hit by HIV in Sub-Saharan Africa, for example, women have no control over their sexual experience. They cannot initiate sex, they can’t refuse it, they can’t ask their sexual partner to wear a condom, they can’t ask their husband to wear a condom. And so the goal of researchers long has been let’s see if we can find a woman-controlled method, a discreet method of HIV prevention that a woman can have discretion over that they don’t have to get their partner’s permission. So this, for the first time, shows evidence that, hey, maybe researchers have come up with something.
CAVANAUGH: Now the research is there. How about getting this gel to the people who need it? Is there any – was there any movement on how that’s going to work? You know, we’ve heard so much about prescription drugs for AIDS being dispersed in places like Africa and so forth, trying to get the costs down. Do you know anything about how women are going to get access to this new research?
GOLDBERG: Well, first of all, there needs to be another trial that proves the efficacy of this gel. They have to have a confirming trial, a broader-based trial. This was a trial of about 900 women in South Africa. So they need to do another trial. If they see same or better results, then I think we’ll move quickly to try to get this kind of product to the market. I think the regulatory agencies in some of these countries hardest hit by HIV are a little bit more – their standards are a little bit lower than the FDA in the United States in terms of proving the efficacy of a drug before you put it to market but we’re talking about a disease that’s just ravaging people. I mean, in the part of South Africa where this gel was tested, by the time women are 25 half of them already have HIV, and that’s how serious it is. So as soon as they can get this product out on the market, believe me, they will.
CAVANAUGH: And, Kenny, give us a little bit of the feel and flavor of this international conference, if you will. How big was it? What kind of people gave keynote addresses, that sort of thing.
GOLDBERG: Well, it’s a gigantic conference, 25,000 people. The conference center in Vienna itself is two subway stops long.
GOLDBERG: So you can take a subway to one entrance and take another subway to another entrance. I mean, that’s how giant it is. And Bill Clinton gave the opening speech in a hall that probably sat 15,000 people. I’ve never seen anything like it. And there’s just researchers and advocates from all over the world, and they have a separate section of the conference, it’s called the HIV Global Village, where you have communities of people that are affected by the disease. Some people that are living with the disease from all over the world gather and try to raise awareness and have little booths and presentations, give plays, hand out materials, try to fundraise. I mean, it’s really quite something.
CAVANAUGH: I know that this was too big for you to give us a real temperature on whether or not people were, you know, upbeat or downbeat about – but did you – did this AIDS conference get – give you the feeling that there was a certain momentum in the – in applying new research and new techniques to really try to do something about AIDS globally?
GOLDBERG: I think so. And I think this – the development of this vaginal gel was the absolute impetus to making people excited about it. At the same time, they’re critical of the G8 countries, like the United States, for not meeting their commitments for HIV and AIDS funding. And Bill Clinton, in his opening speech, was sort of defending the Obama administration. He says, look, yeah, Obama made these commitments to spend this much on HIV/AIDS but then the economic crisis hit so what’re you going to do? So he was trying to inject a little bit of reality there but, nonetheless, there were a lot of protests and a general feeling that the G8 countries just are not stepping up to the plate about this thing.
CAVANAUGH: Did you see any protests?
GOLDBERG: Oh, I saw quite a few of them.
CAVANAUGH: And what were they like?
GOLDBERG: Well, there are advocates with drums and whistles and signs and there was – I remember one protest where people were dressed up like homeless people and had blackened their faces and put fake scars and blood on their faces and sat all over the floor and said, hey, we’re the homeless, you know, what are we supposed to do with HIV? I mean, it was pretty dramatic. And they were just tromping all over the conference raising hell.
CAVANAUGH: Do you think that influences the people who attend conferences like that to see protestors put on these dramatic protests?
GOLDBERG: Well, I don’t know. I mean, you know, these researchers and policy makers are pretty seasoned professionals so they’ve seen it all before. But just to be on the safe side, a lot of these protestors barged their way into the media room and staged these big protests in front of all the press and so, ehh, that’s a TV friendly environment so, certainly, they got coverage and that’s what they want so…
GOLDBERG: You know, so I don’t know.
CAVANAUGH: And they got coverage from you. We were so excited that you were able to go, Kenny. Now before you leave, I know that you’re working on a feature about the population of those infected with HIV that’s getting older. Can you give us a quick preview of this story that you’re working on.
GOLDBERG: Well, this is something I’m going to be working on and it stems out of this conference where I learned that by 2015, in the United States half of all people with HIV will be over 50. And so that – You know, what does that mean? What are the consequences for our health system of people living with this chronic illness that have been taking a lot of medications, some for 20 years, what does that mean to their future healthcare needs? We know that HIV, when a person’s been on anti-HIV drugs for years, it increases the likelihood of osteoporosis when they get in their older years, heart disease, kidney disease, so, I mean, this is a big deal and it’s the aging of America when you couple that with the aging of people with HIV, there’s a lot of areas to explore there.
CAVANAUGH: Yeah, it’s a fascinating and important topic. We’ll be looking forward to that, Kenny. Thank you.
GOLDBERG: Thank you.
CAVANAUGH: I’ve been speaking with KPBS health reporter Kenny Goldberg. If you’d like to comment, please go online, KPBS.org/thesedays. Coming up, the ethics involved when elected officials support ballot measures. That’s as These Days continues here on KPBS.