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HOUSE CALL WITH DR. SANJAY GUPTA

A look at the AIDS Epidemic WorldWide

Aired July 17, 2004 - 08:30   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.


DR. SANJAY GUPTA, HOST: Good morning, and welcome to HOUSE CALL.
We're here in Bangkok, Thailand covering the AIDS conference. We've been covering the story all week and the news has not been good. Every day 8,000 people die of AIDS. And while the treatments have improved dramatically, the world still gets a failing grade overall in dealing with the worst epidemic of all-time. More troubling for many is that the face of this disease is starting to change.

(BEGIN VIDEOTAPE)

GUPTA (voice-over): The face of HIV AIDS. Michelle Lopez has seen it every day for 14 years. In the mirror. Her story, all too familiar.

MICHELLE LOPEZ, HIV POSITIVE: I ran into this guy that I knew downtown Brooklyn, and I was involved with his brother in the past sexually. He told me his brother had just died from AIDS.

GUPTA: She had already seen the virus first hand and wasn't surprised when another sexual partner got her pregnant and gave her the AIDS virus which she, in turn, passed on to her daughter.

LOPEZ: My daughter's diagnosis was really the -- I was devastated. I was devastated.

GUPTA: Michelle was infected in 1990. Back then, AIDS in the U.S. was seen as a white gay man's disease, referred to as the gay plague.

LOPEZ: Gay men, that's all I knew of. This was about gay men. I knew of no other women infected. I had no type of peer support.

GUPTA: The face of HIV AIDS has changed. Twenty three years after the first diagnosis, gay men are still infected the most, but it's rising fastest in African-Americans. And other minorities.

DR. THOMAS COATES, PROF. UCLA MEDICAL SCHOOL: African-Americans are about 12 percent of the population, but about 50 percent of the AIDS cases. Hispanics are about -- 14 percent of the population, about 20 percent of the AIDS cases.

GUPTA: More and more, it's women like Michelle.

COATES: I think the other big way that it's changed is that it's become more feminine. So that about 27 percent of cases are now women.

GUPTA: Michelle is joined by nearly 40,000 newly infected people every year in United States alone. Right now, about 1 million people in the U.S. have HIV, and a quarter of them don't even know it, and could be passing on the virus. Michelle and her daughter are doing well. Taking the powerful AIDS cocktail medicines that have kept HIV from turning into full-blown AIDS. There's a good chance they may live a normal life span. But for now, they are the new faces of an old disease, the face of HIV.

(END VIDEOTAPE)

GUPTA: When we first heard of AIDS, there were no treatments. There was no hope. It really meant a death sentence. But over the last 10 year or so, researchers came up with a drug cocktail which works pretty well, extends the lives ever those with AIDS, but sometimes it involved taking 20 or sometimes 30 pill as day with all the concerns about drug resistance. More recently, it's dropped to below 10 pills a day. Researcher, excited about a one pill a day regimen.

Christy Feig has the details.

(BEGIN VIDEOTAPE)

CHRISTY FEIG, CNN CORRESPONDENT (voice-over): This Dr. Bruce Rashbaum has been on the front line of the fight against HIV AIDS for years. Both as a doctor and a patient. He knows firsthand the pain of battling the disease and the complications of treating it.

DR. BRUCE RASHBAUM, INTERNAL MEDICINE: In 1997 I took 20 pills. Other patients certainly could have taken more than that. Some people probably took 30 pills.

FEIG: That's every day, but now, that's changing. Pharmaceutical companies are combining the drug cocktail into fewer pills. So patients could get the same powerful medicine with only one or two pills a day. There are currently three of these combined pills in the U.S. waiting for FDA approval, and there is talk several different pharmaceutical companies could join forces and combine their drugs, and create even more. But it wasn't the big U.S. pharmaceutical companies that spurred this trend of combining medicine. It started with the generic drug companies in Asia and Africa that were making cheaper versions of the U.S. drugs for countries most desperate for them. However, in those developing countries, many people can't read, and experts say some are not taking the complicated drug regimens properly. Now the goal is to combine simplicity and safety.

DR. JIM KIM, WORLD HEALTH ORGANIZATION: That's the holy grail in terms of treatment, that you try to get a one a day pill that you can give to patients.

RASHBAUM: These make it very simple. Once a day with or without food, minimal side effects. Lessens the chance of resistance.

FEIG: And less resistance to medicine means patients can live longer, better lives.

Christy Feig, CNN, Bangkok.

(END VIDEOTAPE)

GUPTA: Thanks, Christy.

When HOUSE CALL continues. From treatment to prevention. How are we doing?

Stay tuned.

(BEGIN VIDEOTAPE)

UNIDENTIFIED MALE: People aren't as afraid as the disease as they once were. People aren't -- just as scary as it was.

UNIDENTIFIED FEMALE: Are we doing enough in the United States, or is this deadly disease making a comeback?

Plus.

UNIDENTIFIED MALE: I was supposed to die. Plus I had no money to buy this (UNINTELLIGIBLE).

UNIDENTIFIED FEMALE: Millions of people are dying because they don't have access to the drug we take for granted. We'll bring you an inside look. But first, take today's "Daily Dose" quiz -- when and where was the first case of AIDS diagnosed in the United States?

The answer, when we come back.

(END VIDEOTAPE)

(COMMERCIAL BREAK)

(BEGIN VIDEO CLIP)

UNIDENTIFIED FEMALE: Checking the "Daily Dose Quiz," when and where was the first case of AIDS diagnosed in the United States?

In the summer of 1981 in s Angeles. By October of that same year, the Centers for Disease Control declared the new disease an epidemic.

(END VIDEO CLIP)

GUPTA: One of the most troubling findings at this aids conference here In Bangkok is that the disease appears to have a resurgence in developed countries like the United States (AUDIO GAP). Spoke with a Dr. Thomas Coates he's a professor at the University of Los Angeles. He's treating this disease for 23 years.

I started by asking you how has the face of AIDS changed?

(BEGIN VIDEOTAPE) COATES: People are living longer now, and when the new treatment was were first introduced, we weren't sure how long it was going to last and how long it was going to be beneficial. But the benefits are holding out. The disease in the northeast, very early on, was heavily driven, not only by men having sex with men, but also by injection drug use. And from injection drug users, then through heterosexual sex to their sexual partners. In the south, it's a combination of men who have sex with men but also heterosexual driven. Some pockets in the south have high levels of heterosexual. In the west, it's mostly a disease among men who have sex with men.

GUPTA: Do people talk about curing AIDS or is it just really talking about treating it?

COATES: The scientific talk is about treating it, managing it, keeping it suppressed. Even the question of whether or not we'll ever have it truly, a preventive vaccine, some people are saying, maybe not. That maybe we'll have a vaccine that will allow the body's immune system to control the virus, but it seems to be one of those viruses that, once you have it, it's probably not going to be curable.

GUPTA: You know, the sense I think most people get is that they've actually done a fairly good job in terms of treating AIDS. Turning it from a death sentence into a chronic disease.

But, the other side of that, some are the victims of our own success.

How so?

COATES: Paradoxically, what happened after the new treatments were introduced is, is we saw new infections starting to go up in certain populations. And that's been a little heartbreaking, because we worked so hard to put prevention programs in place. And people were very vigilant. And that's eroded. People aren't as afraid of the disease as they once were. People are -- just not as scary as they was, but there are medications available, people can live longer.

GUPTA: What does the future hold for United States in terms of HIV AIDS?

We're going to be at a lot of conferences, probably you and I both over the next several years. 10 years from now, what's are we going to be talking about?

COATES: I hope 10 years from now we're not talking about the same issues. I hope we're not talking about disparities in health care and how this disease has become a disease of further a disease of disadvantaged people. I guarantee you, we won't be talking about a world without AIDS. We won't be talking about a world without HIV. HIV is here. HIV is here to stay. Will we have a vaccine 10 years from now? I don't think so. If we do, we'll be very happy about that.

(END VIDEOTAPE) GUPTA: In the United States, while we are still struggling with HIV AIDS, the majority of people can get medications. Around the world, though, it's a different story. Often those most in need have the least access. That's 6 million people who don't have access to the drug that often works so well. Why is that, and how do they get it?

Is it simply they cannot afford it?

(BEGIN VIDEOTAPE)

GUPTA: As, the 15th international AIDS conference kicks off. There are protests. And there are warnings.

KOFI ANNAN, U.N. SECRETARY-GENERAL: AIDS is far more than a health crisis. It's a threat to development itself.

GUPTA: The reality of that threat has devastated SubSaharan Africa. 25 million are infected, 20 million have already died. Wander Samson wife was one of them, leaving this Ugandan father to care for his three young daughters alone, while caring for his own HIV.

WANDERA SAMSOM, WIFE DIED OF AIDS: I was supposed to die, because I have no money to buy drugs.

GUPTA: He it only alive today because he's part of a U.S. Government sponsored trial to get the powerful AIDS cocktail available in the U.S. to the most remote parts of Africa.

DR. PETER SOLBERG, CDC CLINIC, TORORO, UGANDA: The main purpose of the study is to look at different ways of monitoring people when they're taking these drugs. Trying to find out whether we can prehaps, get away with using less laboratory tests.

GUPTA: For now, he gets the drugs for free, at least until the trial is done. But he's concerned how he will afford them in the future. Most clinics, such as this one in the Ugandan capital, Kampala, make the patients pay for the medicine.

DR. PETER MUGYENY, JORO DIRECTOR: It is our belief that free is not sustainable. You cannot have the program that is best on free things.

GUPTA: And the price tag on the drugs that keep patients like Jennifer Aryem alive is high. About $30 every month. She only makes $33.

JENNIFER ARYEM, JORO PATIENT: Whatever little money you get, you have to save it, in order not to break the medicine sequence.

(END VIDEOTAPE)

GUPTA: And that is a theme that we've heard a lot at this conference. These drugs need to be cheaper so that more patients can get access to care.

When we come back, orphans and AIDS.

We'll look at how this disease is ravaging a generation. Stay tuned.

(BEGIN VIDEO CLIP)

ANNOUNCER: When HOUSE CALL continues, stories lose and of hope. These are the faces of children paying the price for the AIDS epidemic. We'll bring you their stories.

Plus, how low should you go when it comes to cholesterol. New guidelines may have you adjusting your ideal cholesterol levels.

(END VIDEO CLIP)

(COMMERCIAL BREAK)

GUPTA: Welcome back to HOUSE CALL. We are living in the largest generation ever all-time. More than half the world is younger than 25 years of age. It's the youngest of these that have been hit the hardest by AIDS. There are millions of orphans out there. So many, it's more than the combinations of New York and Los Angeles populations combined. Amazingly, most countries don't have any kind of policy in terms ever dealing with these orphans.

(BEGIN VIDEOTAPE)

GUPTA (voice-over): As with most wars, there are innocent bystanders. In the war of AIDS, which claimed 25 million lives, it's robbed 15 million children of one or both parents. Like these three boys, age 12, 7 and 5, from Cambodia. Within a span of two years, they first lost their father, and then their mother to AIDS.

UNIDENTIFIED MALE (through translator): I feel sorrow, because I don't have anywhere to support my family.

GUPTA: And as if losing their parents weren't enough. For most orphans, the situation goes from bad to worse.

CAROL BELLAMY, UNICEF: The status of these children as outcasts make them easy targets for violence, for exploitation, child labor, exclusion from school, gender-based discrimination.

GUPTA: These boys are more fortunate than most. A local community program has taken them in.

UNIDENTIFIED MALE (through translator): School material they gave us, and school uniform.

(END VIDEOTAPE)

GUPTA: Programs like this one are touted at the 15th international AIDS conference in Bangkok, with the full recognition while they're good, there's simply not enough.

(BEGIN VIDEOTAPE) ANN PETERSON, UNAIDS: The news today is that global effort is only reaching a small fraction of those in need.

GUPTA (voice-over): And the number of those orphans in need will likely grow to more than 20 million by the end of this decade. But behind awful those numbers are the stories. Like the one ever these three boys, they are orphans, due to AIDS.

(END VIDEOTAPE)

GUPTA: Sad stories, and many researchers suggest that this orphan crisis could leave many countries strapped for leaders in the future. Many of these children aren't even getting the basics schooling that you saw these boys getting in the story.

Stay tuned for more HOUSE CALL.

(BEGIN VIDEO CLIP)

UNIDENTIFIED MALE: In some countries one out of five households is head by a child because parents are dead, have died grandparents.

ANNOUNCER: When HOUSE CALL continues, we'll talk with someone on the front lines ever this global fight, plus tell you where you can get answers to your questions about HIV and AIDS, and more information on the global effort to fight this epidemic. Stay tuned.

(COMMERCIAL BREAK)

GUPTA: Welcome back to HOUSE CALL.

Lets take a look at this week's medical headlines in this edition of "The Pulse."

(BEGIN VIDEO CLIP)

HOLY FIRFER, CNN CORRESPONDENT: New government guidelines are out for bad cholesterol that will affect millions of Americans. Those at medium to high risk of heart disease should get their LDL, or bad cholesterol, as low as it can go. For people at very high risk, the optima LDL is 70. For those at high risk, aim for 100. This means millions more patients may have to get on cholesterol lowering drugs called stalins to get their blood levels in check.

Plus, a new study finds anxiety in pregnancy may put kids at risk of childhood disorders. Researchers followed 71 women from the beginning of pregnancy to when their children were 8 to 9-years-old and found anxiety during pregnancy may put children at higher risk of hyperactivity, acting out and anxiety disorders. The highest risk to children, anxiety occurring between the 12th and 22nd weeks of pregnancy.

Holly Firfer, CNN.

(END VIDEO CLIP) GUPTA: Welcome back to Bangkok. The International AIDS Conference is drawing to a close. You know, the human toll of this disease is sometimes just incomprehensible, 21 million people died, 38 million are currently infected and we're starting to get a glimpse of what the future may look like if we don't do something about AIDS.

I had a chance to sit down with Peter Piot, he runs a U.N. program, joint program on AIDS. I started off asking, how do you get the world to star caring about these children who are orphaned by AIDS?

(BEGIN VIDEOTAPE)

DR. PETER PIOT, EXEC. DIRECTOR, UNAIDS: Orphans, a neglected issue. I'm actually surprised by that, because you would expect that people would be far more moved by 50 million orphans in some countries, one out of every five household is headed by a child, because the parents are dead, the grandparents have died.

GUPTA: You know, they think about the health problems ever AIDS, but it's not a health problem. It's a national security problem. It's a financial problem. It's a problem of all sorts of different magnifications.

How do you relate orphans to things other than health?

PIOT: When you have a heterosexual epidemic, as is the case in Africa, where every adult dies, there are two, three, four, sometimes six, seven orphans left behind, I can imagine very well that in countries where there would be civil unrest, even civil war, and where you have a whole generation of children without a future that first warlord who comes and, you know, with a collection cup that these kids are ready to be whole reserve for militias and all that. That's another aspect of security.

GUPTA: When you say it, seems obvious.

It's the number one epidemic our world has ever seen. Why don't people get that?

PIOT: I would say that, I always wondered, why don't people grasp it?

What you need to know more . In 20 years time, that 60 million to 70 million people became infected with a new virus with a disease that didn't even exist before, 20 years time. And now I think that on the one hand, is still a difficult issue for many people, including world leaders, because it's so serious, with sex, in many countries the drug abuse, and that makes it a difficult issue. This whole stigma, this whole shame. And secondly, I think, also, that maybe we have not done the best job in say positioning, in defining AIDS, that it's not just a public health problem, a medical problem, but it's also a major obstacle to economic and social development. That it's destabilizing the society, of entire societies.

GUPTA: Fifteen billion over five years that's what the United States government pledged. There's been a lot of criticism. Ambassador Tobias (ph) had a hard time getting through this speech.

Is the money so far going where it should be going, in your opinion?

PIOT: We in UNAIDS, we have been pushing very hard for -- to fund fully the global help. That means $12 million that we need per year for developing countries, for treating people, preventing HIV. And the U.S. Government, so called (UNINTELLIGIBLE) is very important element, in fact. Congress only voted the first branch (ph) in January, so the jury is still out how effective it is.

GUPTA: Say that you get the money that you need. The scientific developments and progress progressed as you hoped, where are we going to be 5 to 10 years from now.

PIOT: With all the new money that is coming now. (UNINTELLIGIBLE) the commitment, I think we have for the first time in this epidemic, a good chance to break the back of the epidemic, certainly in Africa. For me the biggest worry I have is, will Asia wake up, will eastern Europe wake up.

(END VIDEOTAPE)

GUPTA: If you want to help fight the international war on AIDS and HIV, go to the following Web sites. The United Nations Foundation, at www.apathyislethal.orq. There you would make a donation to help people in need.

And if you are in the U.S. and wanted to get tested for HIV, click on www.hivtest.org. You can search for testing sites in your area or call CDC's national AIDS hotline, 24 hours a day, at 1-800- 342-AIDS.

Well, that's all the time we have for today. I hope you've enjoyed the show coming to you from Bangkok, Thailand. Tune in next weekend, we're going to be talking about Alzheimer disease. Lots of new studies out there, interesting studies that give hope to those suffering. From new treatment to new ways to look inside the brain to look at the disease as it develops. That's next weekend, 8:30 Eastern. Remember this is the place for the answers to all of your medical questions.

I'm Dr. Sanjay Gupta, stay healthy, and stay tuned now for more news on CNN.

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