Title: Frontline: The Age of AIDS

" This is the WGBH four on network. Yeah and GPH. Who. Generously supported the -- overall -- here's the development and and for this event to. But mostly thank you for coming it's a weakness the scrutiny when we really appreciate it. The some title of this event is engaged the expert straight. So what we'd like to do is get quickly to that the expert sir of course not only here but there in the audience and want to make sure we have plenty of time forgiven take. In fact we structured the evening like good producers and three yeah so the first that is a clip. The second -- will be a panel discussion will talk about some overarching questions and then third act as you. They'll be microphone so we can do mechanics of that. Thank you might -- after. It happened from the people living. Right now still as we speak grinding away in the editing room. Greg barker who is the director of the second knight's comments. To my knowledge he made me in this room but I think she's in the editing and -- the film continues up to the present. And we can't bear what's called the next wave of aids course he knew what that is it says the virus moves to moves into China and India and Russia. Most populous very important countries. And we also covered -- tremendous political debates about how to spend. The money that's now available in the global community there's about twenty billion dollars strain on the table. And there's tremendous debates about having. How to spend money we should get it comes that's so. It's a complicated film but let me introduce the panel. -- William. W. You'll recognize him from the clip. He's been HIV. It's been HIV positive for ten years and since then he deserves the applause he's been involved. With clinical trials Anderson so we thank him. I think doctors to union camp. Is the chief of the division of social medicine and health inequalities of Brigham and women's. He came back to Boston recently from Geneva. Where he was director of the world health organization's HIV aids department. Think I'm just -- read the rest of his intro. When he was at WHO he focused on initiatives that help developing countries scale up their treatment prevention and health care programs. He's a founding trustee in the former executive director of partners in health and yesterday. Here's what had to read the rest of he was named by time magazine as one of the 100 most influential Americans and we're thrilled. To have. Like infant. Doctor -- Next to him as the founder and executive director of the prevention and access to Caron treatment project. Here in Boston. Yes and unique program that employs the community health promoters. -- promoters. To advocates for the health and well being of the inner city residents who are infected with or at risk. Of HIV. Conducted their cruise is also -- of the Brigham and Women's Hospital and assistant professor at Harvard medical school and has really focused her career. On health issues of the urban -- thinking. Doctor cal Cohen is the research director of the community. They're very much. And moving day. -- film about sitting around thinking how willing. Help my friends were kind of I'll have stories like that term. He has served as co chair of the scientific advisory committee. The -- community based clinical trial network. And it was a co investigator of the Harvard aids clinical trial unit. Doctor Cohen has also co principal investigator of the New England -- education training center. And is a co investigator and member of the scientific planning council for the community program for clinical search on me it's very complicated Akron. But it won't read and sun reported by the NH and those very important. When I was thinking from. And just doctor David home. As the founding director. And the scientific director and chief executive operating officer of the Aaron diamond aids research send. For the community of -- them the full. C pulled the city of pain free. You know places get so. He's been actively engaged in aids -- search for 24 years. And aside from the work that you signed in that clip doctor -- been pursuing new strategies. With HIV vaccine development. And as well for major public health initiative and children. I'm so those introductions to spread your professional lives but. I do relate to start with a question about how you took those first steps. On this long. They know how did you first -- when did you first encounter any. --"

" To be precise Lewis. Point five years and seven months ago I was. Senior medical resident in Los Angeles. And I happened to see a case with PCP. Cut supplies. And numerous other infection you know -- and the -- Well at the time. These infections would -- in that person who was not. Otherwise you know compromise. And is that case puzzle me a great deal and then in the ensuing months we saw a few more than two of those cases were included in the and in the WR. That by Michael."

" So that was the report women doctors when. Salaries and a few other colleagues got in touch with the CD thing. In June and in many perhaps of 1981. The film we see something really strange going on here. It was clear that he positions the infectious disease physicians who."

" Seen cases. Handful UCLA and or it cedars Sinai Medical Center on the west part of Los Angeles. And there was some despite -- request forward got called pan which was used to -- PCP and since CDC notice that and send. What's calling the IS officers down to Los Angeles to investigate those cases would then put together. And Michael god made the seminal contribution of measuring there. Keystone cops using monoclonal antibodies that would just developed in this product prior year or two."

" Two against -- yeah and then he -- account code two pound vigorous the immune system is just in case when. --"

" Right and then he made the observation that common denominator it was a little before he said."

" So that was when you first encountered him right at the beginning I think Colin."

" Both about the the same story really I think I was a medical student so a little bit younger."

" But only a little bit and and so during medical school -- trading I was in the Bronx. And it was 1981. And so the rest in some ways is predictable from there and so like the David we receive our own versions of the story in the Bronx. Of people. In our case showing up with these odd purple boxes. And winding up in in the hospital and sign up something we didn't understand. And knew I was part of the medical community -- gone to medical school thinking I was going to -- tackle the current great killer meant time with his heart disease and what could be -- in the heart disease. And and there are a couple of cases of these funny -- boxes and then it got a name of course it was first prisons here as your film goes into. And we don't know what to do of course we were wearing gowns and using alcohol has been a stethoscope as we didn't know what we're up against but it became clear from the beginning that a few of us. We'll going to stay and fight this one. While a lot of my colleagues decided they they want they get this far from the -- as possible. But -- I did anyone have -- to make that wealth and I think there are a number of reasons certainly. At that time it was pretty clear that this was happening to my community was happening to community that was. In some ways on its own at the very beginning of saying what are we gonna do about this one and so we. Those of us who had some medical skills probably could. And talk tormentors who were going to try to shed some light on this one and create a partnership that was a really a profound time because it's certainly in my medical training years. That partnership was at the beginning of so many unknowns. And the attitude amongst people who are interested positions interest and HIV. Was different from any other field because we weren't competing with each other we -- a small group of people who are going to be drawn together. Fight this -- together. And there was a come on down feeling to it like. We need all the help we can get if your interest in common ground and then there wasn't there was some colleges so to finish the -- story. Eugene brown well I agree -- they're great leader of cardiology in Boston. When a colleague a year ahead of me in medical school training went that you do it if completion restraining its and so we want to via I'm one of the economy obviously -- said great just what the world needs another car. That wasn't what we had an HIV aids and HIV was exactly the opposite which is we need everyone's interest. Come on."

" During the and we feel a bit of these hundreds of them related -- of scripture. So -- expressed in panic HIV can really in medical school class where. This was in the early ninety's when the virus was really presenting -- isn't. Incredibly powerful. Pain. An and I think it is continue to be. Real challenge for us in the sense that. It's this painful has figured out if you can -- system you know go for the soldier you go for the lieutenant. And it wiped it out and people get sick and immunology at its very complex the treatment of it was very complex. I just say that the first time I think I really in -- aids was done in the -- a patient. When I was a resident and this was after that the cocktail was available. Indeed home visit in in Roxbury which is a community here in Boston. And sun 84 Europe eighty point pound. You know 27 you know black women. Dying from aids within walking distance of some other premier institutions. Medical institutions in the world. And being alarmed you know here we are living in a society where. We have the technology. And yet. This is an issue necessary to access for the utilization. And realizing that HIV Levy. Is a very harsh. -- reflecting societal. Ills and there's as a wolf there. The champions. In terms of physician at because -- making sure that the technology we have available to us is diffused to every one today. And I think -- is. Really been a clarion call for those of us who want to exploit that part. Healing from --"

" I was a medical student first of medical student in 1982. And we've all been hearing about HIV -- and then how are class started something called introduction of clinical medicine. And one of our one of the students. In -- as a dental student. Was assigned to. Two patient with aids. When a local hospitals and we all remember. Can describing what he had -- put on me it was basically where the outbreak sort of here. And that he he was terrified. And I just remember thinking you know if this young guys terrified you know what this person going through and was sitting in this -- People in treating him or it was him time. In such a way. And then soon after that that that -- that she's and I went off and didn't Ph.D. in anthropology rested in the pharmaceutical industry actually. Then midnight. And then I came back best interest that always. And access to generic drugs. I stated pharmaceutical industry in Korea as a very active generic industry and gave me some ideas about. -- drugs might be made cheaply and and they -- them to everybody. But then I really experienced and in different women Haitian community yes begin working with Paul farmer in 1987. And we can see that -- station and racist images of Haitians. As aids carriers -- on I'll never forget. That one -- when it kids we've we've made a film about. About that HIV and it was it was basically a film about. And ten -- fighting against the racism the patients were going to there was also an aids education filtration. You. And and there was a there was a student written a wonderful essay for four high school. And you were inaccurate. -- can affect anyone we should have compassion for people -- I know people who live a living with aids. And they they they deserve not to be discriminated against no one knows where it came from. But we're Haitians are -- going to stand against aids. And the teacher wrote we we we still have a copy of this. No this is wrong my doctor told me we do know -- comes from the comes from Haiti because Haitians have sex with monkeys and here. For now you know. There are no monkeys in Haiti. And and a Pena and so that was the second phase and and I really got involved. When the access to drugs issue really came around this was this was my mind my thing and of course with a three by five initiative we've really tried to. Do that we could to expand access absolutely. --"

" For me there's."

" medical connection how I learned about it there was I was living in France. And."

" I'm here they're not candidate. And it should be what was the much talked about openly that was with good about it my. You hear whispers about in her good friend Jerry you. Or this other friend or this designer. And then suddenly. My friend would recommend start. So when I returned back to United States and and the non news. You know you and a couple of years and I won't be here completely. So it's just a personal connection. It. But it was an abstraction. -- Sort of person."

" Maybe you -- very careful about your own behavior and yet because in North Carolina I mean I grew up in North Carolina. But I think you can give you an idea I graduated from high school in 1984. And I've from a generation that was not -- promiscuous -- today had there early edge it. So my kind of sexual behaviors -- established right. The evening news with covering this report and it was very scary through. I kind of made the decision to news conference. Just in logical and not to make an exception for because it can start making exceptions and you start walking greater."

" Hey well I was thinking about the contrast between god does experience. That we saw in the clip. And some of their experiences thank you. Observed have been part of with you're with your client's -- How do you make sense from them."

" I think that. You know we can read all the statistics mean if you if you really look at. The epidemic can straighten stargate. In a community community. Gain came home's community. But it -- epidemic is really started to shift both globally as well as here. -- that it is becoming more and more a disease of people who are poor. And marginalized. Either by the basis of their color was -- class. You know poverty and opportunity as well. And we're seeing it become more and more than phase of women. When more people were being. Infected through heterosexual transmission. And if you look now for instance. Who almost two thirds of people who have aids we have to consider that there is HIV but then. If you don't get appropriate caring get -- which is more advanced disease two thirds of those people in this country it's -- color. Despite the fact that they only comprise 12% of the population. And if you look globally in the world 95%. Of people -- struggling with me that people report. And I'm so we're seeing this this shift and I think this thing that is. Concerning neither is disproportionately. High mortality rates we know what we need to do to treat people. And what is standing in the way of the treatment and hopeful talk a little bit about that because anything. This is our challenge now is how to diffuse this technology. And how to make sure that every one. Not only has access to -- can effectively utilize. The resources."

" Available wouldn't. And -- you've been doing working China where there's. There's there is some machine inflate food in some ways starting with a country that has only ingredients. That it would need. To make those kinds of drugs available to everyone. Tell us about what's happening man."

" In China you know. Well China has a substantial epidemic in fact it has to -- it. Appendix 1 and central part of the country and bad epidemic was was caused by. Unsanitary blood selling blood collection practice. And we don't really know how many people infected but there's one province called Hunan. Which by the way has about 100 million people. And about 89% of the -- bonds. And we know that the epidemic can -- and villages in Hunan. Is as severe as what we see in certain applicant's situation. The Chinese estimate would be a few 100000 cases but. There's a huge or -- sort of problem. So we know it's it's quite devastating. In southwest China. Near the Burmese Indian and Vietnamese border there's a separate epidemic. Propelled by injection. It's very cheap it's very profitable to the golden triangle. And that epidemic is still spending it. Much great. And these. Prevalence among injection drug users is as high as 70%. Soon count. So that's sort of the epidemic in China there's now. Increasing transmission via sexual contact both heterosexual homes back. But that's more likely -- and sending him in the eastern seaboard. More prosperous parts of China."

" And it's an interesting thing to think about China in relationship to their being is kind of two epidemics. The one would have this sort of poor baby intravenous. Drug and heterosexual spread and they threw. More affluent. Doctor -- you're telling me about that other epidemic. Because in China and in there are the two epidemics was also the machinery to make the drive. And the political authoritarian and some to get get them out there. If it happens but. Just on the general theme of relating to global pictures from the local picture. Confident with your thing."

" So certainly. As we've talked about. -- HIV hit at least in the western countries in the states and and Western Europe was. Largely through the sexual transmission amongst people. Whom didn't always have money but certainly by and large were -- middle class upper class people who could travel people who could be on Jackson won big in New York and it's been LA. It was a time in which affluence book travel for fun import it what the ability to kind of enjoy life. And it was it was certainly a wonderful decade the seventies in the sense that sex actually used to be a good thing there was a time in which that was in fact possible to consider it."

" But at least there was not."

" It is. But it didn't -- consequences. If at least the next morning and you've got an access issue in Africa that things so that's an and so there was this this wonderful time in which people live with cash. Would certainly be able to kind of enjoy life and so the parties in the fire island in the sunset from the rockets and stories and all of that was part -- in some ways the crystals around which the first vision of HIV pit. Because it was a vision. People who were having wonderful. Tragic endings. To all of that society could do in which all of resources to bring to bear and and that is certainly still -- today recently. That as few as some of us for not in the reception earlier. Realizing that we're still at a time in which -- in part because of the success of treatment we're now seeing another wave of people. Who are once again experiencing that -- ability to injury to his company is a good thing and forgetting. That this miserable blanket on so many lessons and we're now seeing this. This return to what was always there which is the ability to -- jobs companies and the fear that part of the success that we are now enjoying. May be allowing us to see yet another wave. One of opportunity happened on top which of course are at yet another way of party drugs and the kind of the loss of of -- around sex and so. There is there is this kind of ongoing vigilance in this in this epidemic that there really was a sense it in and obviously an hour to. That -- is almost over it's just a couple of drugs and cop -- away from being done. And so many times in this epidemic we're reminded that each of our communities. How that sense of almost done had that Spielberg be an analyst at ten year old kid. Who's gonna say off hot if this in the whole thing is overall going to go back -- wonderful life. And this epidemic is this constant reminder of how far we keep getting from that even though we also keep getting some of close to being able to contain it. -- in -- just it's been burned and further out of our reach and all the people here on each of their parts to try to get us ahead of the curve. While we just watch yourself losing progress of this thing."

" I. That kicked him what. Can you do that -- taken from the boot local for the global and and perhaps backing candidates here are you defendants. -- it just to becoming a couple appointees."

" You know China what's really interesting is. When they decided to take action boy did they take action so for example. They just announced a little while ago maybe a year ago that they're gonna offer methadone maintenance therapy. And sterile needle exchange for every one. So I went there as that it shows. Represented message you know. How did you do this how did you how did you convince the people don't people make arguments -- like it's immoral. And they said well we just look at the evidence these are the two most effective. Prevention --"

" He never had. And we told everyone that if we don't do this if people are gonna die. I said exactly. And in it it gets feedback I mean when I said when I made that comment. You know Texas a good thing and lots of Africans are having lots of sex. And I don't know that. Moralizing. And blame me and accusing has ever done us any good in this epidemic so in fact you know for example in Russia. I. I -- I'm you know when I was -- division I met with ministers of health and I confronted the Russian minister I said you know you guys happened to. Offer methadone and you have to offer clean needles. Is as well you know is not as part of it is not what the Russian culture. And I went campus image in other Russians are very scientifically oriented and -- as -- as well we just. Can do it in and and so if Russia doesn't do it it's hard to get the Ukraine to do it it's hard to get -- to do this because expenditures tend to do it. And people aren't just dying because of these. You're saying these are degenerates question we give free needles to these these this this doesn't work. Telling people to abstain from sex telling people to be faithful. To their husbands when in fact marriage is the highest. Is the biggest risk factor for becoming infected with -- HIV. We have to just know -- we have to know when moralist but when realization. Or or pointing fingers doesn't work and it doesn't work so often. So sex is a good thing people having lots of sex how we figure out. Ways of making kind of news more effective how do we figure out. How to stop the spread of the disease and now how do we figure out how to deliver. This beautiful triple. Combination cut to the doctor hope. Discovered how to make this available to everyone it. It doesn't in either here in the United States or anywhere else. The thing that I've learned is that. Sitting back and making moral judgments it's just not helpful to get their real data and information."

" Heidi and I were talking before him and sometimes those blocks the current the very. Community leveling -- telling me about some of your own my own efforts to make. Think prevents him."

" TI -- I think when it things that the that we learned through this epidemic is that you can't separate prevention treatment. You know in and it's interesting to hear that the fluid exchange between the two rounds because. Is one. Disease where you really have to tackle -- at the same time. And you know one of the struggles that we have here in northeast particularly -- injection drug use. It's a major reservoir of new HIV infection particularly among women. 60% have women in Massachusetts actually. Got their HIV infection through contact. Through injection drug use. So it's a huge issue and you wanted to things that. We haven't done like China you know there's still a federal ban on needle exchange in this country. And there -- many states where needle exchange programs even in terms of the city and state there under commander's vehicle fortunately. I'm here in Massachusetts. There there are and you exchange programs. Could be more robust. But we're dealing with the issue of funding and also that that cents a -- political commitment as well so that there. Challenges that we face. For -- and we have injection drug users group that goes out into the street and does. Little exchange. In the community -- Latinos. Huge need. And you know where we -- blocked because of these issues around politics and finances. And done it's it's very frustrating for -- at the epidemic is. I'm spreading among populations we know what we need to do and can't and."

" So when this one little thing on treatment and prevention you know. We had these really stupid debates for a long time and I don't mean to to denigrate anyone who got was involved in them but we were talking about. You know in in developing countries is -- treatment and prevention treatment versus prevention and you know I. I have to say that I watch very carefully. Gay men's health crisis act out these groups. People like I'm mr. dodge. Who put their bodies on the line to get these drugs. Tested and approved. And you know it wasn't long after we started getting some sense that these drugs are going to be effective. The people like Eric Sawyer great insult -- in my Carrington started screaming that if they're going to get the drugs every once you get the drugs. I think that what the gay community in the United States concerned with the HIV aids did. In terms of reaching out their solidarity with the people in Africa. Is one of the great cultural stories about time I think it's one of those moments and anthropologists to study. And I and I I and I hope to write about this because you know when I was at WHO. It was Craig and mark -- those -- the go to -- that you know they were always the ones that we call. And they were always the ones who would just put anything on the line to take the next step you know whenever we needed to do. You personally it's it's a source of great pride of the nation Americans about this for cockpit. Because I don't think our community has been anywhere close in terms of showing the kind solidarity that. That that was shown and is still being shown and I mean Greg Gonzales to send a note out he's going to South Africa after all these years of a working games of caucuses. And you know the thing that's also. A great lesson is that that when you are a community that's fighting for your life. And you've got nothing more to lose you can scare. She excuse my language yes I. Out of powerful people. Because powerful people are extremely thin skin -- you know so the fact that that that. Do the activists were ready to do anything. To get there cost out there and and not just drugs for themselves if that was all it was and it stopped there and I don't and I think we would succeed -- I'm very self interested in and predictable kind movement. But they were so far beyond that now I I just wanted 100. About that and we've been criticized those of us who have quote treatment activists because we're taking attention away from prevention we'll let me tell you. In developing countries there was no attention to prevention -- It's it's a complete myth that there was all this prevention going on and all the same treatment came in and took it away that's not what happened. It was only after we began talking about treatment in developing countries that we got the money we needed to do we had to do. And for the first few years both the global fund and set -- spend more money on prevention. -- And we still spend billions now and you know just to give you an example during the 1990s. -- Helen Epstein wrote an article in the New York review of books. That the average amount of money spent by the US government on prevention and developing countries was about seventy million dollars year. Which is exactly the same amount that had been allotted. For Viagra for the US military right and I am so so we were not and now we have billions. But the reason we have billions because it tripled the triple combination therapy saving life of any orphans. That somehow clicks in people's minds and that's always been the story. If you can treat if you can save -- people can get behind it understand it and give money for. It was behind the treatment activism that we were able to finally get enough money competitor for prevent."

" Well yes -- talking about -- have I just want to follow up on what can just I think on. I word now I wear two hats one in the US basic scientists working on this problem in China I work public health. And in the US -- book on HIV. Vaccine development which is arguably the most important thing scientifically to. To address this epidemic on the prevention so. But it what you and just says what's been said I quickly we would. You know we we went to China some six years ago with the research agenda to develop taxing -- taxing them. And and concurrently we had to cancer prevention issues. But. Hold those efforts were rather meaningless. When the immediate issues. Training people building infrastructure and getting patients treated were much more -- And and therefore over the last 56 years with the public have health hat on. We started to do things more in the treatment side and now. The consequences on prevention side real just as an example we have. In two different provinces in China a number of mother to child transmission programs fairly straightforward. We know. Rather efficacious based on. Data. Generated in in the west. But as we do that now. The spin -- is now in in one province every. Pregnant woman is tested and everyone applying for marriage licenses that's it. And an associated with testing there's some local of these -- BC -- familiar with here US. But it's a perfect example of how treatment. --"

" They could have been involved basic TV voluntary testing and counseling. Always going together that's another issue that's global and local right because we have announced -- with the move to. Report names and I know does have some very strong feelings about. What. Should happen once."

" Reporting and yes. I think you're not going to get people. I mean we're reliving."

" I'm not a conspiracy -- on any level but."

" We're living in a country where our data collected over time. I data collected from you got car that grocery store Wal-Mart. Acquiring -- stated that thing. And then after that with food. You know we can -- we're going to report. I mean she I really don't know what they're gonna do with the data but you report the name connect the names with department. Negative or just having been tested. Situation. And what can that be used for and and what would like the current administration's. Use -- for."

" So as a person who put yourself in someone to going to protest I just would I would do it."

" I'd go to another effect. Now. Or find some other way to do it."

" And I'm nothing and I got what are our public health and no one could say anything that would make you feel secure enough to take notice they don't just come."

" I don't trust them you know it's it's. This country over and over has used. Information against people I mean the McCarthy hearings. It's just something that that popped his head up. Off then and HIV is still very much to let that thing --"

" And how important -- to him how important it is testing to know. What."

" You know there there is no simple answer on testing -- I think I think. It looks different in different places I mean right now I'm working on a project and and the country -- to. Where and let me be very specific about the language the project is to try to offer voluntary counseling. Confidential voluntary counseling testing to everyone in the country. And and they have anywhere from 25 to 30% of the adult smokers are not men it's -- it's the offer. But before we knew that the way that we've drawn up the plan is that protection of human rights is that the core of that plan. No community will go forward with this more routine shall we say or or. Perhaps more proactive. Program of offering voluntary counseling testing unless we get certain human rights issues really clarify this is terribly difficult. Because it's not is that there's no real clear answer I think you know. If 11 of every three adults is infected with HIV aids and the death rate is just skyrocketed. The most important human rights seems to need him to be live and I think. I think no it is their way of of building hierarchy. Human rights you know I don't know the answer them not a philosopher. But I and I and I know that that the kind of death rates for seeing some of these countries require us to do something else now to me the beauty. Of saving yourself a real target for voluntary counseling testing. Is that it forces you to put both prevention and treatment services in place for voluntary counseling testing can be that critical link. And what I think it's gonna do and seek to. This just give pace and rhythm to the process of scaling up with HIV prevention treatment and then you gotta have both in place if you didn't give. You know and offer voluntary test every. It's been misunderstood and I have been personally excoriated on the list list serves for four supporting this initiative. But you know I'm there I'm watching all these that's them I'm the only growth industry is a funeral homes."

" And the people there are telling me we don't do something quickly we're going to be extinct in twenty years and I'm so tired you know I think the human rights issues critical we've got to protect human rights we've got to think about it in every step of the process. But we've also got to be creative and we've got to think about. Countries like Swaziland and Sandia and and Lesotho and South Africa that face true collapse if we don't do something much more active we're doing right now."

" And in fact had to I think when it says that things that is and most powerful and certainly partners to help his experiences. And done Jim alluded to this is that you don't start doing counseling and testing until -- half treatment available. There's no reason for someone to go and get tested and know they're positive they're not gonna have access to treatment. And I think you know we've certainly learned that."

" That you can go into a place where there is no treatment available people don't come and get passage but he tells them. We can treat you we can help make you healthy we can help you prevent your baby from from getting infected. They'll come and get tested. And I think he is saying you -- interesting things about this attitude is that you have to look act. You know there full track of infection in these individuals are getting infected because. They had the -- of below mine workers in this in South Africa. And don't -- means of a regular incoming being infected and bringing it home so when you talk about human rights you're also talking about making available economic opportunity. Dealing with issues of gender you know inequality all of those issues that allow someone to get to the point where. Taking care of themselves taking care of others becomes a possibility. For and done and I think taking a comprehensive approach to treatment. And David was talking about building infrastructure. HIV and some weird way is forcing us to do that -- and into the Obama."

" we do want to have some questions from the audience. So. Let's just let's -- we can bring lights up a little bit. We just touched on some of the issues with some very dense. And subject and we hope we can get in a borrow in a little bit of the Frontline staffers have mics in the house. And here's the procedure you raise your hand if you have a question -- passing the -- And then you keep him in the air now. Candidacy yellow microphone going in here. Any -- you want to identify yourself. Fine and if not that's -- too."

" I'd be glad to do it on -- scientists. I want to thank you for what you've done tonight. This is an incredible night. An incredible anticipating it was fabulous. The age of ages is 25. The years 2006. And as a man of color and immigrant an -- and it would -- a lot of things I am. I'll say that. I feel a little bit like the person who came to dessert and then. I was may be wanting a little dinner in what I mean by that is I just need to say with the most."

" Proper and due respect as I I am respectful man there are no dark people on your stage."

" There's got to be room for receipt for a man or woman of color. That our state our country is affected extremely by Latinos and African Americans blacks."

" And that Obama's successor and and all of you our fantastic. And I learned a lot and I appreciate and -- Calhoun knows."

" But I need to say that that that it is. I would be remiss if -- like being here I am not offered that it's if you do this other cities I hope that you include the communities that are most affected."

" Who -- most marginalization wonderfully pointed out."

" And I appreciated pixel anchor and a."

" Anyone know."

" Aren't -- I hear me because. Hi and thank Gallagher. My question -- guess my comment first is. In keeping with what -- just said it it seems that the Pulte Homes. Around the at the epidemic is she is shifting as it's shifting in the minority communities and while we had -- years where as account described you know you're it was solidarity in the people who are providing care. We eight together drink together cried together and and it seemed like that community was very strong and able to provide. What the patients needed as the epidemic has moved into the minority communities. We don't have the providers of color. We are losing a lot of the providers who have been with the epidemic a long time since. And and I guess my concern is really about the tone and how we can try and reversed this this movement toward. More punishment more moral judgments. We we have moved to -- names all of a sudden because the majority of the patients are our people of color. Is it tone of we think Ryan might also lets welcome finally they acknowledge -- called entitlement zero and that has summoning I expected to anybody count each of these my direct."

" So my question to."

" You think that's true that as an attitude shift and it's because of the people who."

" Well I think that -- a lot of fear in certainly in the medical training community that there are not as many. Clinicians. Coming into medical school at the same passion as -- say HIV is my career path I'm gonna join the fight and are seeing fewer people interested in. This is certainly in this country there is a fear that. That's sense of community. Had around HIV to fight it together is getting fractured and I think that there are many reasons for it certainly. One of the stresses in the community. Right now is as you point out it would -- reporting. How can a community trust reporting names from government if the next speech from the government is. By the way if the two of you men are going to send an account too much TV together that threatens my marriage. How can we trust you -- my name if something as simple as that is considered a threat why when I trust you. And so of course we're we're living through an era unlike -- that Clinton tried represented in which he symbolized. The ability to bring people together. Around the community of caring for each other. Mean he came when he came to Boston. A couple of years ago he came passion our audience or medical instead -- a conference is that you know all of you in the medical world. Get it get this try to figure out how to treat this virus right and -- all of us in the political world get this right and get the treatment to the world. And one of these days maybe HIV will flow more blood in port district where you belong. And inspiring him what I -- and yeah when a message he gave us. To work together to get this behind us Ireland and now where it's such a different era in which in some ways this is the symbol for this area is. You know you're gonna go on a list and we're gonna make sure you -- you pay the price for. Four for your errors of their ways and it's such a different tone -- I have another question of the young life great here."

" Yeah lining it's that simple storage. My question. It is an open question to anyone and it's is basically. What I've seen and heard it's that the the epidemic has -- has always been about power disparities and between haves and the have nots and within the past when in fact here's that's just gotten stronger. And I'm wondering. What. Measures. We can. See can think take to address that. In the next. Hope that less than 25 years. To an epidemic or just to to think about why it's moving from. The position where is to even more between people who have money who have power. -- importance to people -- none of us cents."

" Sure please send it here. If you just look at the amount of money that has been spent on various public health efforts all of smallpox medication costs 330 million dollars. All of polio eradication from 1988 still ongoing enough for five billion. And we've got ten billion dollars this year to fight HIV aids in developing countries. You know hats off to everybody in this room I'm sure has has really fought to try to get more attention to this problem and for some reason. You know bush Iraq. Blair all the great leaders. Have made this huge commitment to tackling HIV aids and I I think there's a reason for it. If -- is that if this the southern African economy collapse is -- going to have consequences for everybody but somehow just caught people's attention and so. You know the fact that we've got a triple drug combination that should give people for the rest of their lives. And that requires some kind of a functioning public health system. Has allowed us. To use this money to finally. Build those public health systems that we should have -- long time. So I truly feel that this movement toward treating what people in preventing more infections. Is helping us offset the balance I think you know we -- finally moving in the direction that we should have been moving for a long time. But you know you hear all the time while you know we're spending three billion this year which is great get a pet farm program spending -- bill that's great. But you know we have to make good choices either helpful or Medicare why is that the choice. Why -- why those two things that -- so since the beginning of the Iraq Afghanistan stroke. Afghanistan's struggle or wars we've spent 400 billion on that and those -- stand. This year -- defense budget. Without including Iraq and Afghanistan is over 400 billion dollars. So I think that's the comparison we need to make. And what we're doing behind the the is this spending your money and HIV aids is giving women jobs we're we're we're -- we've now I think convince the world. That community health workers for men or women. Need to be paid. People living with HIV -- on medicines and doing well now should be paid as health workers bringing them into the health system in building the infrastructure. That frankly we promised Africa from pre colonial times during colonial times during the period of structural adjustment we promise we build it all those times we never did. So if it's -- that finally lets us build this this is great that's the optimistic side but let me tell you. In another three or four years we face a real threat they're gonna say well you know this kind of difficult pin him down. It's ten billion dollars is just too much money and so all the you have to be ready. And my own sense is that because the medicines that are are so could now. That we're not going to lose our greatest warriors and people you know like that -- that the market. Craig can solve these guys are not going to quit. And when people start backing off you all have to be ready to say no. It's not just about the virus and about aids but it's about social justice and people having -- decent quality of life finally. If aids is the ticket in one room."

" Absolutely."

" my name's David. He didn't talk about certain aspect of you HIV virus and aids. Late in the Philly act. In down. Between 78 need they have a test. So any bodies of HIV. Aids since the end I tainted blood -- In. Maybe overly nervous right now. 9500 hemophilia contacted in the US suits me. Me and so 1000 married. In and I want to thank god and country. What provide an easy to any drugs online at cocktail right now. And I don't have any -- constellation -- that it would. -- If I generate responses. Like you know that -- different people aspects of the people that can get. Begin with Brian white than -- ready for others thing he's. That's good effects in the film community to."

" Paper and read them -- partners and children. When you look at the numbers and thank you for goes until about 30000 people who. Our recipients of tainted blood products in this country or their sex partners for their children from book. In the first night of the series we covered that extensively and we covered me. The meeting at which can be activists including Don Francis from CBC of course. So new literally was pounding the table saying we've got to do something about -- of me. Covered before missiles and claim them because blood banking of course is a for profit industry and so. It's it's it was an interesting. Segment to include pharmaceutical company differences."

" We have to acknowledge that the infected us. You need to unite in this day book they don't want to be liable. You'll see some things that you know all of the compassion in the rural people on me differently they have aids and how they got it. -- I just hope everybody can live longer. The end. Healthier lives through drug therapy that's they waited to thank you so much."

" time."

" And I'd like to note because couldn't dress what doctor Cohen talked about earlier the possible resurgence of this due to a false sense of security."

" We have -- gotten me embarrassed to talk about some of his experience and street race for."

" When I'm content to be quite honest I'm getting quite frustrated. Especially with you today. When I was coming along. You know you -- purple spotted and and you sold 85 pound man and and it's quite scary thing. And oh. You know I think that anymore."

" And -- know we -- in this situation. Where. He used condoms. Sometimes. When it's appropriate. How do you have the me yes yes how do you know it's appropriate and them well don't count on me and I'm like why why would that. The reality facilities HIV positive it's very different from the reality. Of -- HIV negative I'm not to separate the violence. I've got from the -- but I'm not afraid of and that is my reality so I don't my heart doesn't believe a lot for. So you're gonna be honest with me you know could you might infect me and yet they use condoms because they believe in them. But I'm kind of appalled that the emphasis put on. The presents positive. To protect the whole world because a lot of people who are positive. They're. And so you know if there's you can look anyway you can look on the Internet. And that my favorite that is always drug and disease for UB -- Yeah Heidi you know you're you're how do you know you're disease for a and because no one really bad that there -- they know what they've got down nothing really for. And that and I unfortunate."

" Aren't."

" Please stand payments regrettable -- and now. Because they -- For a lot of years. And I certainly admire that each and every one -- but. I -- detective slightly up congratulatory. Phone. At the 25 anniversary of the eighth when I think we will still treat -- standing up screaming and shouting and I would like to know what percentage of cases in which she -- minister you know wonderful drag. That they failed to work with the patient become resistant. And they going to live pretty. She lives. And second. Of all the people in the world who are cut or -- currently infected. What percentage. Not. 25."

" is in this epidemic. I'm getting enough children and I -- us David -- because we -- and covenants of the back end of the serious about. The rate at which people become. Resistant would that there virus mutates it. 50% and five years on a particular cut him."

" I think it could completely depends on your patient population I think. If if you have a a drug that previously drug -- population coming in for the first time you get great results. In the first week of five years with a majority. And that could range from. Slightly over 50% all the way to 8090% depending on population and the drug's use so. If there is clearly. A failure rate. I don't think we're here to talk about all the specifics. Got treatment and I think if we conveyed a self congratulated. -- tall though -- totally inappropriate. I think yes we have made significant advances on the treatment side. And yet we have much more to do."

" I think. --"

" Well well -- a 100% eventually I think that's something that people don't don't don't data but that at this time I think. But I think we really need to. Point out that so many challenges. That lie ahead if you look at the the epidemic book. For Africa since 1996 and it. So called cocktails became available. It grew exponentially as if the therapeutic advances and nothing."

" Had no impact concepts and Africa and southeast Asia. And and we've been struggling to come up with a vaccine since 198384. When the virus was identified nicely. We we have not. Even come close to achieving that so there are many many such struggles they had and I know that. In that in in the peace. It will be. Reasonably well covered. Up. It is my."

" good -- and ask well what -- what would we see 25 years from Tibet and that."

" I actually. Was asked more or less a similar question. Doing the --"

" for the for this Frontline piece."

" Hi I see that we will have better therapeutics. I hope we will have a but these are partially protective vaccine point five years. But I also see that. You know we have had vaccines that protect against polio and many other important pathogens forward. Many decades and yet these diseases are still with us and I I I certainly. Would say that I actually was by accident there at the beginning of the visible part of the epidemic. But I won't see the end of this epidemic and I doubt if my truth -- the end of this that. Because there's so many obstacles in the way and then it takes so long so much. Work and resources to to implement even if the end to a protective."

" Permanent take home message is we really want people to take from the serious is the fact that the treatments it's not insulin. That as a diabetic -- HIV positive person you have -- that they know will. Ameliorate your condition for the rest of your life it's it's very difficult this is a very clever buyers than mutates. And so. It -- requires constantly changing. Ray machines and constantly updating I have time for one more question."

" I'm very PLO. Yellow light."

" Hi can you stamp can thank."

" I'm -- O'Leary and I'd like to have you speak to the stigma and how that differentiates this disease from every other disease. You know when I moved here in 87 and I it was an eight but people here remember the first and they hit it was. These people aren't dealing with aids -- even with everything but aides and it still seems to be that the question about. Testing names requirements and things like that and you know and the African countries and just want to see. How you address that is an impact."

" Statement."

" Well -- die then only because I actually do want to. Address we'll read is comment as a way to get to yours. Our best regiments are working so far with the five years experience we have and in some seven years experience. In which 3% of people have developed resistance to some of our best combinations when all goes well. The drugs are actually progressing to the point that we are doing good work. And that. Only 3% and one study and in another study only 5% have developed resistance so we are went all those well able to do would dramatically better job. And even we had -- five to ten years ago these regiments have evolved. All has to go well we have to picket wells and if that take it well and feel well enough to take it. But also to -- community that supports it because part of what I think unravels around HIV is as you point out. Is the stigma so why is this different from a diabetic who says you know but it insulin Harden and now -- insulin -- The differences is that nobody's ashamed to say on the -- that. And people are ashamed to say you know certainly there were there are lots of pieces of history to this but. It's so we're not we're only HIV is just the virus but what this did is that it was a lands on people who unfortunately were in a society in which. They wear stick with ties and that's for each -- the exploded worsens the -- communities and so in sexual minority communities. In injection drug -- communities in in the communities and our culture in the poor who are disenfranchises so HIV hit. And spread in the communities in which people were already statements as those communities and so. It's it's that HIV just travel right along those lines and exploded in the communities in which it just created this shameful piece rather than a disease that humans were going to band together for the."

" Right right we've we have found we ran out of time unfortunately it was this sort of tragic."

" Yes and yes please my name is any note from which PRI. -- board. And I have got two questions on one part of what we know there's there's some film -- on. And -- does this film deal with the onset of that that -- Chris on my crystal meth because I believe that that's going to take this into another level they have -- what they are actually from the."

" Instead of film about crystal meth for a few of weeks ago. Though that's true it. Executive producer David fanning me and and Peter Staley was in that film and made those points and we did not covered in this in this episode. They had some of the health two 82 -- the good friend and -- my life flash before I. But. Yes so we didn't cover that and then if and how this series thank you have a series ends. Is currently on the note that -- when -- when -- was asking about what's the reality of the future of this of this epidemic. And we have some of them the voices. We have. You know -- saying. Young generations forgotten my purple spotted 85 -- looks like we have been listening. But you sit here and various other scientists and that -- can. I think what it's it's a call to arms it's to say that this is a preventable pandemic is always ones. In all we have to do is you know get out there and can be education. Fight stigma and denial is bad. Good leadership is good and prevention works so that's been --"

" You know. I think that if there was a sense of self congratulation it is really not. What we should say I mean. We we started this initiative to get three million people on treatment we failed miserably and I just talked all the time about our failures and people get mad at me for that. But let me just say that -- that they be continued existence of stigma here in the United States. I think what it points out to is that because. Aides went down the phone lines of our society is and it continues to go and on the phone lines before the marginalized. What it gives us is the most fantastic challenge and opportunity. For two things for basic human solidarity. That the wave that that people living with HIV aids have been able to show such enormous solidarity with -- others. And this opportunity we have not use this money for social justice. This is the opportunity that gives us that makes me optimistic. In 25 years I'd like to see functioning health systems everywhere. I'd like to see an intellectual property regime that makes sense that that leads to real innovation -- the same time giving everyone access. And you know it's -- that helped us. Really tackle those questions. And you know. I think I'm not saying it's a good thing it's horrible thing. But if we don't grab this opportunity -- days to work on building consolidating work on social justice we really going to have lost."

" You know active women the cool thing. Comments in the series is from psychiatric -- the South African activist says Tim was mentioning before and he says we cannot in the war against states. HIV infection seventy million people worldwide we cannot win but in fighting that we can. Mitigate the disaster and we can show our humanity. So but you know that's another with a -- Take home and I'm sorry I have to wrap up I have to thank our panelists very much for."