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--Poster-- "World AIDS DAY 2009: Working Together"
Now, I had prepared remarks, and both of them said, please just do the two-sentence introduction.
So what I will do is say that both of these powerhouse women walk the talk.
There's been a shift in urgency in other words in the past thirty years.
When Indiana teenager Ryan White contracted the virus through a blood transfusion for his hemophilia
and became a national advocate for *** awareness and compassion, at that point the entire country
knew about this new disease. Mostly then they were frightened.
At the same time, that fear was translated into anger and into discrimination.
Through the course of his illness, Ryan White's courage and determination
during that very unsettlingly period of time in our nation's history gave birth to the Ryan White ***/AIDS Program.
I'm also old enough to remember a time when we diagnosed a patient in July, and we basically rung our hands
as one complication after another came along, as we pushed one more toxic medication after another,
and they died by Christmas.
I'm old enough to remember when we actually asked patients to set an alarm clock so that they could get up
at two o'clock in the morning to take their Zidovudine, and look at them quizzically
when they weren't grateful that we somehow had this drug that they only had to take fourteen pills of it a day.
It didn't matter if it gave you headaches, throw up, dropped your white count, or anything else.
This is something you need to do.
This epidemic isn't going away. Those of us who care for people living with ***, and many of you know
that I continue to treat patients, and there is no shortage of people presenting for care.
Absolutely no shortage. And while we can be thankful
that we averted as many infections as we have, and we know about this thanks to the work of people
like David Holtgrave at Johns Hopkins and his colleagues, there's no questions that we have a
solid residual core of *** infection in this country and the world. You've heard some of those
statistics earlier. It's hard to remember that sixty million people have been infected with *** since
this virus was first recorded, and already twenty-five million have died.
And while data from the globe and UNAIDS shows that the number of new infections has slowed, it's not ended
So that means that our prevention messages have to be more targeted. They have to be more culturally and
and contextually appropriate. And testing must be more widespread and With treatment and prevention support available.
And the reason why I talk about the importance of these things being contextually appropriate because I think it's
all too easy for us to talk about using condoms, or using barriers, or using latex, or putting in this,
when at the end of the day, whether your talking about drug use or sex, this is a relational issue.
*** transmission hits at the core of relationships, and for some of those relationships,
using a *** means you no longer trust me, for others it means, if we can't share works, you're not down with me,
you're not my homey. And so then people are being forced into choices that, I'm not saying are unreasonable,
but they are difficult. Second, we're going to need novel therapies. You know, we're working with a foe here
that's very smart. We have a virus that's capable of mutating many times.
We know that from the minute someone comes infected, they have rapid multiplication.
And there's over a million different subspecies that appear in the blood stream.
So this is not a small foe. And then to complicate matters further, we appreciate that people
co-infect with other things. So that, for example, we have problems such as Hepatitis C.
Over 90% of our drugs require being metabolized by the liver. Hepatitis C destroys that organ.
That limits our therapies. And it's further complicated by the fact that some of our therapies for Hepatitis C
work better in certain populations than in others, mainly working better in Caucasians than compared
to African Americans and Hispanics for a number of reasons.
So it's going to take closer coordination of efforts between CDC, NIH, HRSA and all of our others agencies
that will help us to do this. So that our messages are consistent, that they are delivered to the right leaders,
and the appropriate Federal counterparts have a candid and honest discussion about what is really needed
to limit *** transmission, and what it's going to take to get the job done.
Because in the absence of an effective microbicide or vaccine, I suspect that this is going to mean that
we're going to need combination prevention therapies, a cocktail if you will, of prevention efforts.