(00:00:00) Today I will cover with you a little bit about what AIDS is what it is and I will attempt to give you some very basic information about 15 minutes and if I leave you with no other thought first of all, let me make it clear that aids is not a disease of New York City or San Francisco. AIDS is a problem that is here in Minneapolis. St. Paul. It's in the state of Minnesota and it's a disease problem. That is only going to continue to get worse as a public health person who is either had the luxury or the torturer. I'm not sure which of being involved with numerous things like toxic shock syndrome Legionnaires disease and any number of a sundry outbreak investigations and public health problems. I can tell you with it. Not at all been an emotional pitch just a very clear scientific evaluation of the issues. I am convinced that in my lifetime. I will never see another public health problem of the magnitude that aids is and will be in the future nor do I believe that mankind has probably ever seen A problem like this before and we can take plague and smallpox and leprosy and put them all together. And in fact that may give you some setting for the seriousness of this particular problem. First of all, let me Begin by saying that the disease AIDS acquired immunodeficiency syndrome is literally the tip of the iceberg of a very serious infectious disease problem when I say tip of the iceberg when I'm talking about are those people who get this very serious disease or only but a few of those who become infected with a specific type of virus now known as the human T-cell lymphoma trophic type 3 virus or htlv 3 as you'll hear me talk about it. It's also known as lymphadenopathy Associated virus or lav. And finally it's also known as AIDS related virus very RV for sake of today's presentation. I'll call htlv 3. As I said this virus we now recognize is a virus that is particularly a problem in humans. It may infect monkeys. And in fact, we think that originally this Came from monkeys from central Africa and made its way through a very complex route via central Africa to the Caribbean to the United States in the late 1970s for the sake of time. I can't go much more into it than that, but would be happy to take some questions about that yet when it is a problem in humans. What happens is the virus attacks a part of the body's immune system the immune system is that arm of the body which makes sure that we don't get infections that keeps us from getting Cancers and so on and what happens is there's a little cell in the body called the T Cell which floats around and basically is a surveillance officer in our body attempting to keep out that which shouldn't be there. This virus attacks that particular cell and basically destroys it such that it renders our body then susceptible to all these other infections and Cancers. So the person who gets AIDS is an individual who has a life-threatening infection or cancer that then kills them but it's not the AIDS virus that does it it's not the virus that causes the T Cell disruption. Equivalent situation might be the person who has cancer for another reason and receives chemotherapy which in part affects the body's immune system during the time that that person's receiving chemotherapy. They're very susceptible to infectious diseases. Well, what happens here is that once you become infected with the AIDS virus you develop almost a permanent type of immunodeficiency. So it we the problem we have today is we can treat the infections we can treat the cancers at these people get as a result of having the reduce T cells, but unfortunately don't reverse that process of these reductions and T cells. So these people remain susceptible to these kinds of infections and Cancers and this is where our problem lies today and that we can Traverse that some of you may have recently heard, of course about some of the drugs that were being investigated in France. And in this country. This was particularly brought to the Public's attention with mr. Hudson's recent trip to France for treatment and what this particularly these drugs do is they attempt to reverse Process of this infection with the htlv three virus and I can tell you right now at best they've been unsuccessful what they may do is temporarily halt the production of this virus, but they do not remove it from the body the drugs are so very toxic that you can only take them for a short period of time and after you've been off of them for several weeks again your back producing the same level of virus that you were before so that there does not appear to be any magic bullet in that particular area. One of the thing I might say about this virus which makes it a very difficult problem is that those people who are not familiar with virology or the study of viruses who are not familiar with public health measures say well, why don't you go get a vaccine for it. We get a vaccine for everything else and people are chomping on the bit for a Magic Bullet. Let me tell you right now that based on the very complex biology of this virus and for reasons that are quite complicated. I personally along with I think almost all of my colleagues would tell you that a vaccine is at best many many years off and If we suddenly get some new and otherwise previous undescribed technology at our hands and if that doesn't occur I would suggest that it may not be in my lifetime that will ever see a vaccine against this virus. It is one of these very unique viruses that has the ability to constantly change itself. So that in fact in the human body if we try to develop a vaccine which would produce what we call an antibody to the virus so that in fact, it stops IT and kills it that's fine. But at the problem is this virus changes so quickly so fast that no vaccine will be effective against it and we have had this experience with a similar type of virus in animals for with another disease and much research has gone into that and we've been totally ineffective and creating a vaccine for those viruses and animals and we think the same will be true in humans. So we're faced with here is a new disease and one that we have every reason to think is going to be around for a long time. Well, this brings us into the next point. Is this really a serious public health problem. Jeez. We don't really That many cases here in Minnesota so far. We only have approximately 40 cases that we know of of the serious AIDS problem Nationwide. There are now 12 thousand five hundred cases. You say well, you know people more people than that get killed per month and our highways in this country. Is this a real problem? Well, I think in fact it is and the reason is is because that for every case of AIDS that we now know of there are probably 20 to 50 individuals out there who are infected with the virus that may very well eventually develop AIDS or we call aids-related complex type of illness that does not mean they have the serious life-threatening infections yet and they may not ever get them. But in fact that there's evidence of the virus is working on the body's immune system and causing some problems. If you start looking at those numbers, we now estimate in this country that up to a half million individuals are currently infected with the virus and just as the case numbers are doubling every 10 months right now. We believe that the number of infected people will almost Continuing to rise in that same kind of picture. So what we're talking about is in January of this year there had been seven thousand cases reported to this disease Nationwide during the first four years of the outbreak today. I'm talking about 12,500 cases to give you an idea just what has happened since January and I think that picture is only going to continue Nationwide. What is happening is that the virus has been transmitted through several different mechanisms particularly through sexual contact. It's found in a number of different body fluids specifically semen vaginal secretions saliva tears cetera, and it appears. However, though it's only transmitted largely through the sexual contacts. I indicated its transmitted via an illicit needle usage or sharing of needles among drug users. It's also transmitted from mothers to unborn children during the pregnancy or shortly after pregnancy and last but not least. It's also in the Past has been transmitted through blood products IE transfusions concentrate products at persons with hemophilia and other individuals of such would get I'm happy to report that the blood problem is largely one of the past in the terms of the transmission with the new screening test that is available to screen for the antibody to this virus, which the human produces we can now we think take out most of those units that are infected or contaminated so that in fact this will be a rare very very rare item before people any additional new cases occurring as a result of transfusions today. I would point out. However, we now recognize that the incubation period for this disease is anywhere from two to seven years so that we will continue to see transfusion cases because of course people were transfused with contaminated blood right up through 1984 in early 1985. So two new cases Associated the transfusion will continue to occur up into the 1990s, but those are almost All going to be in the category of prior to 1985 transfusion situations. Let me just also emphasize to you why we think this is a very very serious problem in in terms of the number of cases that we could see again. I have to emphasize to you that we pretty well know the mechanisms for transmission here. We're talking about contact between gay men. And for those of you that feel well, that's not a problem in Minnesota. Let me just remind you of the fact that in San Francisco. It's estimated that there are approximately a hundred thousand gay men who reside within San Francisco that is a community of course of only 400,000. However, that particular group in San Francisco has almost brought the health care delivery system in that Community to a halt in terms of the number of cases of AIDS there now diagnosing roughly case and a half to two new cases per day of AIDS in the city and that roughly one person today is dying. May not seem like a big problem. But when you realize what we're talking about in a community that size it gets to be very big. The other thing I might add is if you think that healthcare costs have been an issue that have been discussed publicly before it's now well documented an average AIDS case which will live approximately two years from diagnosis till the time of death will cost the medical care system anywhere from 80 to a hundred twenty thousand dollars per case. And so you can also see what we're talking about there in terms of the potential for impact in the on the healthcare cost system, but getting back to the San Francisco situation. Let me point out that in Minneapolis st. Paul we estimate in our community of 2.2 million that there are also a hundred thousand gay men in this community who many of them are sexually active weather recognized as gay or bisexual or what we call the closeted gay and I might add that some of our cases to date have been married men with children at home. Who was the wife. First inkling that they might also have bisexuality status as the time of their diagnosis with AIDS so that I think we have to be very careful about being very stereotypical about this particular problem and it is affecting across the board. Finally. I might add that in terms of the heterosexual potential for transmission. It's very real right now studies throughout the United States are documenting very very conclusively that this is an increasing problem in female prostitutes the Minneapolis st. Paul business person or medical care person. Whoever that goes to New York City or San Francisco and also frequents prostitutes is today at a very high risk of Contracting this disease that also goes true for our individuals here in town. So that in fact we also are now seeing some transmission to the heterosexual population. Although I have to emphasize again. It's a largely an almost exclusively through sexual contact, but this is not a gay disease. It's a disease. It does affect gay men as a high-risk group. But you and I or anyone else who might participate in any of these high-risk activities are just as much at risk to get this disease if in contact with an infected person as anyone else, I can't emphasize enough today though that in fact while this is going to be and will continue to be a significant problem and it would not surprise me in Minneapolis st. Paul to see the doubling of cases every 10 months as we are now seeing we do not need to develop a phobia over this disease. Those people were at high risk are basically known to themselves that they're at high risk. If you're not in one of those activity groups that I just discussed then you are not at high risk and do not need to be worried about this disease as far as your own personal health goes what that means is that you can work in a day-to-day basis shoulder to shoulder with someone who's infected with this virus, whether they be seriously ill or merely have the infection and not even know it and you are not placing yourself or Our colleagues at risk of Contracting the disease recently. There's been a lot of concern expressed about that very thing clearly not all the information is in not everything is black and white like we'd like to have it and for that reason while we still have questions about saliva in some cases in the risk that might be associated with transmission of saliva all the data we have would almost say it is black and white the risk is not there the risk is through largely through sexual contact or sharing of needles or finally as in the past and not today is being the big problem has been receiving blood and blood products. That's a very quick overview of a topic that would otherwise take a two to three-hour lecture with slides and so forth to give you a better handle for the disease, but I think that sets it up for for mr. Floyd who has worked with the Minnesota AIDS project. And in fact was one of the organizers of that group here in the Twin Cities. I'll let him tell you what the AIDS project is. I can only say I've had the opportunity to work with Morris over the Several years in this problem and I can honestly say that we're very fortunate the Twin Cities to have someone with his dedication and his knowledge in this area of working with AIDS and I'll turn it this point over to Morris. (00:14:17) One of the neat things about following Mike as a speaker is that you always get such a gracious introduction. Thank you. When the Minnesota AIDS project was founded in the winter of 1982 or 83. There were only about 650 cases of AIDS being reported nationally and only two cases here in the state of Minnesota. Today is Mike's been indicating. Both of those numbers have increased by a factor of about 20. There's no reason to expect as he's already said in the near term at least that the numbers will do anything but continue to increase it's easy though to get lost in numbers. It's easy to get lost in viral acronyms wrangling about who should get scientific credit for what grant writing and budget crunching all of those are important things, but it's important now and then also to stop and take take take a look at the human face of AIDS and that's what I'd like for us to do just briefly. A diagnosis of AIDS can mean losing your job and your health insurance it can mean that your family your roommate your lover will be unwilling to have you continue to live with them and that you may be unable to find another place to live. It can mean having to come out share the news that you're gay with family or others before you or they are ready already to do that or it can mean attempting to hide your diagnosis so that you don't have to share that information with anybody. A diagnosis of AIDS can mean feeling angry or guilty or both or shameful? Because you've been taught that it is wrong to be gay and because scurrilous preachers have been telling you that this disease is God's Revenge. AIDS can mean the loss of a beloved aunt long-anticipated daughter or son. It can mean trying to figure out how to treat your friend or your lover who may be dead in less than a year. It means wondering how long you have to live and how you will die. Hey, it's also means that hundreds of people in Minnesota and at least a hundred thousand across the country face the uncertainty of a diagnosis of AIDS related conditions and now because of the widespread testing for this virus htlv 3. We're creating a whole new class of people are being told that they're infected by the virus believed to cause AIDS and in the and that in the absence of good evidence to the contrary. They have to assume that they are infectious for that virus that is that they can spread it to others. And for those people that will mean very severe restrictions in their sexual lives. And for those who are heterosexual. It may well mean things like giving up the possibility of having a family. Gay men who have not yet been infected by htlv three are in effect being told that they must treat every potential sexual partner as if he were infectious with the virus at the very least. This requires radical alterations in accustomed intimate activities. The total effect of that kind of reality on the gay male subculture is still it seems to be impossible to estimate at the bottom line what age means to increasing numbers of us is that we are watching our friends died. We are holding each other as we weep over the diagnosis or the death of a lover a roommate or friend and each of us is wondering whether we will be next. Around us. The rest of society is reacting to age with an unprecedented level of fear unprecedented least in this generation every new bit of information in the Press generates to an AIDS hotline dozens. If not hundreds of calls from people who are worried about whether ages communicable on the seats of public toilets from a co-worker at the next desk from someone to whom you were giving mouth-to-mouth resuscitation from a waiter in the restaurant taught to see gaze has perverted dangerous and evil many have displaced Their Fear their legitimate fears about this deadly disease to the group most likely to become its victims or worse yet. They have seized opportunistically if you will on this tragedy as a way of reinforcing their perverted prevalence of prejudice. That's the context in which those of us who are working against AIDS are doing our work. Because of this context we have not been surprised at the still inadequate levels of response to the crisis from the federal government when the president of the United States employs an important staff position a columnist who wrote of AIDS is God's Vengeance against gays it was it is no shock that original budget recommendations for AIDS research and fiscal 1986 were incredibly less than they were in fiscal 1985 and that it was only the result of incredible pressure from Congress and others that that recommendation was increased nor is it surprising when the health of when the Secretary of Health and Human Services makes clear in her statements that age is the number one Health priority primarily because it threatens to spread into what she calls the general population as if those presently most affected by the epidemic Were Somehow unexpectable. It is also consistent that there has been so little Federal leadership in developing Research into treatment and that the response at the federal level to the need for risk reduction education among gay and bisexual men has been too little and much too late. Into this Gap around the country have Arisen local groups like the Minnesota AIDS project volunteers are the heart of these efforts which are mostly lesbian and gay community responses. And in many ways the Minnesota AIDS project is typical of those groups. It's had two major areas of work support to people who have AIDS and educational efforts about AIDS. A volunteer Committee of the Minnesota age project called services to persons with AIDS has collectively spent thousands of hours being trained and in service. Sometimes those volunteers need to become advocates for their clients with otherwise unresponsive health or governmental bureaucracies. With distressing frequency these volunteers are called on to find a place to live for persons who are being discharged from the hospital but have no place to go either because they have have our without sufficient financial resources or because their homes have now become unavailable to them. Our volunteers are working with hospitals to improve the discharge planning process and to develop protocols for home treatment of people with AIDS. But because of the problem of people having nowhere to go after discharge from the hospital that committee has been searching for nearly two months now for a landlord who would rent us an apartment so that we would have a place to House people who need to be housed owner after owner after owner has simply refused to discuss that possibility one landlord reneged on an agreement after it had been made We are asking local governments to address housing needs on a long-term basis and we're making our own preparations in the event of an inadequate response from these sources the kind of frustration and powerlessness experienced by people with AIDS themselves is probably the only thing that is greater than the sense of frustration and powerlessness of these volunteers who work with them and try to help meet these needs and it's amazing to me that they are able to keep at it. The educational activities we've been doing have been of two main types providing General AIDS information to the press and the public through a variety of community and professional groups and working to educate gay and bisexual men about how the epidemia all about how AIDS is transmitted and about how they can reduce or eliminate their risk of transmitting or acquiring an infection. That latter task requires us to talk frankly even graphically about gay sexual activities since the virus is transmitted primarily in semen blood and to some extent perhaps in saliva. It means telling gay men to avoid those activities which involve the exchange of those body fluids. It suggests the use of condoms in anal sex the avoidance of contact with semen or pre-seminal fluid and oral sex and unless and until it is demonstrated to be safe the elimination of intimate wet kissing. He's a radical changes for most people to make changes. They will not make without explicit information a clear rationale adequate motivation and social support for their changes. The project is implemented a campaign using literature and posters to get the information across beginning this fall safer sex seminars will be offered two groups of gay men across the state. Those seminars have been made possible in large part by a grant from the United States Conference of Mayors and we'll aim not only at providing information but also at reducing the various Psycho Social barriers to behavioral change, but they will not be enough. The Minnesota AIDS project is ask for support from the cities of Minneapolis and st. Paul from Ramsey and Hennepin County's and from the state of Minnesota to support the broad educational efforts that will be needed. We've joined with the state and applying for a share of the first round of federal funds that has become available to support Innovative risk reduction education. But even if we had all the money and all the energy that might be provided it would still not be enough. There are tens of thousands of men both within and Beyond the metropolitan area who are having sexual contact with other men many of these men do not identify themselves with or participate in the activities of the gay community their only contact with that Community is sexual these men are not reading the gay and lesbian press they not belong to organizations, which will host safer sex seminars, but they are at a very high risk for AIDS many of them have wives or female lovers who will be at risk as a result of their friends behaviors. And we need the help of the Minnesota. Press to reach them with information about reducing their risk. We ask those in a position to do so to put aside editorial policies which prevent you from providing explicit information about risk reduction. We asked you to make it your responsibility to get that information out and not just in the Twin Cities, you will get complaints from offended readers listeners and viewers. You will be accused of condoning date a gay sex. You will also be guilty of saving lives. Sensational shaming Stories won't do it what is needed are sensitive portrayal of the variety of people who get AIDS as a way of heightening the sense of vulnerability to AIDS among those who are at risk combined with succinctly and clear statements about recommended ways to reduce that risk. With only a few exceptions the treatment of AIDS by the organization's represented in this room have been important contributions to the overall effort to to reduce hysteria and to make useful information broadly available that needs to be acknowledged and I want to close with one other acknowledgement. Given the lack of leadership by the national Administration. It's been especially gratifying to find the Co-operative spirit that has existed in Minnesota with local and state governments an initiative by mayor Minneapolis mayor Donald Fraser LED two years ago to the formation of an interagency task force involving people from st. Paul and Minneapolis Ramsey and Hennepin County's in the state of Minnesota variations on that group of people in various settings over that time have resulted in important joint planning coordination of effort and sharing of resources in a very important way the recent appointment of a state task force, which emerged out of a meeting called at the request of the Minnesota AIDS project by Senator Allen Spear and attended by representative Karen Clark in addition to the state Commissioner of Health and her staff offer a similar opportunity for the continuation of that kind of cooperation. And finally just along those those lines of word about my coaster home van hoose. We could really wish for no one better in terms of his work with groups like the Minnesota age project in a collegial and supportive way. There's no doubt that the challenge of AIDS in Minnesota will get much much worse before it gets any better. It will not be easy for us to watch our lovers and friends and family members live with this disease or die from it. We will be impatient and frustrated and sometimes angry about the circumstances. I am praying praying against Mike's recommendation for that magic bullet that there will be a treatment and a vaccine soon. But until there is will have to do the best we can. Thank you. We'll open it up for (00:27:57) questions right now. And if I may like to ask you a question that you both can speak to I'm sure because we have driven this underground I suppose in the sexual Community is this a danger to transmission and the spread of this disease? Let me again re-emphasize a statement that I made my presentation. Is that while this is a very Dynamic transmission process we're seeing thousands of people become infected with this in a monthly basis Nationwide. We know how its transmitted to almost a hundred percent of all the transmission that occurs and so we can tell people that in fact if you are having sexual contact with another individual who is infected or if in fact you are sharing needles for illicit needle purposes. If you are in fact an unborn child born to a mother who was positive. However, she may have acquired her infection. Then you were at risk of Contracting this particular infection. However, if you are a person who works in the same work setting you are a family member you are a sister or a brother or a father or a mother of an individual with AIDS. You are not at risk from loving and caring in holding and in being in contact with that individual So I think that's an important point to emphasize we are basically face with a double-edged sword that double-edged sword is at one hand getting information to the general public about the seriousness of this disease dynamics of the disease and how if we do not do the kinds of program activities at Mora spoke of this disease will continue on the kind of Rampages. It's on however at the same time. We have to be very very careful with that other edge of the sword not to create phobias and fears in the population out there who need not be worried or at risk about the disease and so we are faced with a very difficult Challenge on one hand to provide the motivation and the information to prevent transmission at the same time not taking the whole community and shaking them into a fear that is needless or unwarranted. (00:30:12) To pick up on another part of that question. I think it is absolutely true that the fact that talk about homosexuality and about gay sex has been driven underground to use your words has created a climate in which this virus can continue to be transmitted. It's precisely the fear in my view the fear of talking about gay sex in a way that will appear to some to condone it that has been responsible for for example, the federal government's failure up until now to take any leadership in educating people about risk reduction. It's precisely that those kinds of fears which will make it difficult in many of the settings where this question needs to be addressed for example schools. You know, how do you how do you go into the junior high school of the senior high school and talk seriously about the risk for AIDS and preventing the transmission of AIDS without talking openly about gay sex. Can't be done. You got it may also be impossible to talk about gay sex in those in those same environments My Hope Is that those who were concerned about those issues will at least be open to the pragmatic reality that this is a very costly disease costly in terms of dollars costly in terms of lives and energy and that the prevention of this disease through educational means which is the only means we now have available to us will be worth justifying those kinds of strategies. (00:31:56) Well, let me begin with your first part of your question. What makes this disease very unique. Number one is that it sets up in a chronic carrier State meaning that once someone is infected for all intents purposes. They're infected for life for as long as they live with the disease or die from other cause that's quite different than all the other kinds of illnesses that we had in the past even smallpox while very devastating swept through a community and was gone in one developed a lifelong immunity to it in the presence of that situation tuberculosis leprosy or what we now call Hansen's Disease. We're diseases were very difficult to transmit. And in fact, even if one did develop the disease you may not have all been infectious and therefore over a lifetime and chances of having TB and having a serious outcome or actually very small so that in fact that was not a dynamic process like we're seeing here nowhere in the world. Have we had an ability to infect? 500,000 people with an infectious disease that's chronic carrier life-threatening in a matter of five years, even with smallpox during its major ravages that that did not occur. So today when you add in the modern lifestyle of today's individual the ability for travel the ability to communicate as we do the potential is very very real as far as quarantine quarantine individuals who have AIDS that's like trying to shut the Barn Door after the cows already out for all you know, there are two or three people sitting in this very room or htlv 3 positive who you have no idea htlv 3 positive both men and women. And in fact, it's this group of individuals that serve as the major risk for transmitting many cat times people who have AIDS are too sick to have sexual sexual contact. And in fact, it's the healthy individual out there who have no idea who is potentially capable of transmitting this particular disease and so that to set up any kind of situation like that would have absolutely little to no public health impact on this disease. It's the healthy individuals. The individual who to date has not yet developed his or her severe case of AIDS. That is the person who is transmitting. They are serving as a source in the community and will continue to serve as a source in the community. That's not quite what the seven percent number stands for. You're actually correct and quoting seven percent of the cases do not have a high risk contact noted in the case report at the CDC. However, that includes net 7% individuals who were never interviewed because they died before the fact we had a chance to interview them find out about high risk activity. Also within that group are individuals who I personally can speak to this fact having personal you had the such a situation is the 47 year old businessman who's respected member of the community has a wife and three kids two of them are in college and one of them sings in the church choir, who also when he goes to New York twice a month in business frequents prostitutes off of Times Square and will disavow any kind of high-risk activity right up until the time he dies in denial that that in fact is the case and yet we have evidence. In fact, we can support Cooperative evidence that that kind of activity takes place. But if he denies We in fact cannot say that he had a high risk contact. This has happened also in the gay community among individuals who we have every reason to suspect and an even fact may have Cooperative evidence that in fact, they did have high risk contact but deny it that includes that group when you actually look at the seven percent group. However, and you see where the majority of these cases are from they tend to be males from New York City and San Francisco. And in fact when you break it down, we can really once we get down to it account for out of the twelve thousand five hundred cases reported all but I'm talking about literally less than 15 or 20 cases that we can really have good evidence on so, I think that 7% number is in part A misnomer to anyone out there thinking that in fact, we can address this question and we feel very comfortable with that kind of thing. And that's why we don't worry about things like mosquitoes and so forth and part not only of biologic evidence that transmission doesn't occur, but we also have the support of evidence here. Your second question was in Fact it appears that from some source of which is unknown to me where these numbers came from the 60% number you cited 60 percent of gay men thought they had been exposed and therefore were immune to this disease. Let me just say that in fact, we don't know how many have been exposed Nationwide. We do know that it within certain groups of gay men particularly in areas of San Francisco New York it up to 80% of them are now infected and actually have evidence of the virus, but they're far from immune. They both are capable of transmitting the virus we think in most cases and secondly, they also are still in that potential category of having AIDS and as I indicated earlier the incubation period for this disease may be years. And in fact not only years in terms of the first infection that you have but now we're starting to see a whole new series of illnesses coming out of people who have been infected with this virus for years including such things as dementia syndromes new kinds of cancers that we didn't even know existed among AIDS patients. Just a year ago. That in fact if that I've not heard that number before I've not been party to any area in the in terms of gay education with AIDs that suggests that 60% of men think they are immune and so I can't comment beyond that but I would I would suggest that that's not the general consensus among gay men and maybe Morris wants to comment on (00:37:32) that. The only comment I would make is that I also don't know where those figures come from but it's certainly conceivable to me that there might exist that kind of understand misunderstanding out there among some groups of gay men about what it means to have been exposed to this virus because by analogy to some other viruses exposure does in fact produce a kind of immunity and that's part of the barrier that we have to overcome and getting out the risk reduction information is this mistaken belief that at least as far as we know now that that one infection will produce immunity. It isn't clear that that's the case. In fact the evidence seems to be the contrary to that (00:38:21) Yes, in fact you can but before everyone rushes out and does that we would suggest they contact their own private physician and discuss the the obtaining that test and the implications for that (00:38:33) test. (00:38:39) yes, the community are speaking about is Belle Glade Florida, which is located northwest of Miami where they currently have 42 cases of AIDS documented in a community of 8900 which makes that the highest incidence of AIDS anywhere in the continental United States for any one Community there were several people and I think some of the news media was guilty of this of trying to Hype that into the point of making it seem as if this was all unexplained we in public health have been concerned about Belle Glade but also have done some very extensive studies there and unfortunately because when you're in public health, you are constantly confronted with the issue of confidentiality and information about cases and because in a community of 8,000 you could imagine if there are 40 some cases people know who people are it's difficult to comment on cases without identifying them but suffice it to say that the investigations have shown that these cases have large Occurred among a very very low socio-economic group in groups of individuals largely black and they have been associated with prostitution illicit needle usage and heterosexual contact within that group and that we feel very confident that the cases can be explained even in the children who are born to mothers who were infected as a result of other activities that they participated in and think that that's quite explainable. To deal with your first question first. Where did this virus first come from or what is the time frame? We're talking about here in terms of number of infections the data that we have on that is well more solid today than it was yesterday is still as mixture of scientific fact political conjecture in some cases. Just some good ties between the two we are very aware that there were a number of Haitian Nationals who were in the Belgian Congo the area of Zaire Rwanda and so forth and central Africa through the early 1970s. In fact, some of those individuals were mercenaries sent there by Castro's part of the infiltration that Cuba had in these early government's these individuals did have contact extensive contact in the bush area in the jungle area, which if is mankind knows if you want to create the kinds of virus infections that are Severe and frightening you go to the inner jungles. That's where Lassa fever came from into Bola fever. Any number of very serious diseases come from the inner jungles. It was also in the late 1970s that Haiti along with several other Caribbean islands served as major resort areas for gay men both from the east coast of the United States and the west coast along with in some cases gay men from Europe and what we believe happened was is it in those individuals going to Haiti there was contact with local or native Haitians, whether it be through through sexual contact, even in some cases prostitution or licit needle usage that seated the virus in both New York and San Francisco. We in the Upper Midwest and other parts of the countries did not have nearly kind of contact the kinds of tourist industry travel agent arranged trips to to Port-au-Prince and so forth that they had on either Coast which then brought the virus back seated it in those groups to give you an idea as we know now the first transfusion Associated case of a This occurred in a Swedish Diplomat who was in an automobile accident in Port of prince in 1979 developed AIDS in 1981 back in Sweden and died from it. Then of course on recognizes to what he had at that time, but well-recognized retrospectively. So in fact, it's from that connection that it came back here some supportive evidence to say that in fact, that's the case is that if you look at Haitian Nationals who have come to the United States prior to 1977, there is no difference in the risk of them having her Contracting AIDS and there is in the general American citizen with or without participation high-risk activities. If you look at Haitians who have immigrated to this country after 1978, in fact, that's quite different and that we believe that again AIDS is a problem in Haiti that comes from a combination of different activities. But again all high risk activities that we can explain once here in the United States. It's taken its course as we've described already. Modok Morris make money. (00:43:08) Well, I was just going to respond to the other question about the Texas anti sodomy law. I don't know the question was will that be helpful as a prevention technique I take it that was the thrust of your question. I don't know that that that law has been passed or not been passed. There was the law was there was has been along the book in Texas for a long time to that effect, which was repealed a few years ago. And as a result of what I would regard as inappropriate hysteria about AIDS fueled by basic anti-gay sentiments that the repeal of the repeal has been proposed in Texas. And for all I know may will pass their the comment about that of the observation about that is just to say that the legality or illegality of sodomy which is defined variously in different jurisdictions, but the legality or illegality of that Going to have seems to me at least little or no impact on the transmission of AIDS sodomy is illegal in Minnesota to and it goes on quite frequently among both heterosexual and gay and bisexual persons so that it seems to me that the legality or illegality of a particular act like that is not likely to have much impact on the transmission of eight. It's likely to have a lot of impact on how people like gay men and bisexuals are treated in those jurisdictions, but that's a separate (00:44:34) question. If I could I just follow up in that same question. I think that one of the points that we sometimes fail to realize in dealing with this disease is that in fact, if we attempt to become moralistic and judgment about the way we deal with those populations who are at high risk, we in fact maybe right when it comes to morals, but we're going to be very wrong when it comes to prevention of disease and that I think is probably at home best when I as a father of a young boy who is now four years old realize that he has a one in ten chance of growing up to be gay and that I can honestly say as much as I loved that little boy, I don't want him to have to face a world full of AIDS and that's a possibility right now and I think when we start driving it home to our own loved ones in realizing that in fact, we do have brothers and we do have sons who are who are going to be gay despite the fact we don't understand why despite the fact that we may not even approve despite the fact we'd like to make Different it's not going to be and I think that's when it really gets hits home. That's when it hits the bottom line. And I think the point we need to deal with is how can we prevent AIDS from occurring? No one deserves to die of AIDS. And the reason I say that in part is because ultimately we're all going to die. All of us are going to die in this room someday, but I can't think of a more horrendous a more disfiguring in a more painful death than AIDS. I have watched people die of AIDS. I have watched them in the pain with the pneumonias the going blind with the infections of the eyes the herpes lesions the size of basketballs all over their bodies their insides literally just totally torn apart from the various kinds of infectious diseases that occur the cancer is it take over and disfigure your body so badly that your eyelids are now swelling shut because you the cancer has spread all over your face. It is a painful death. It is a very disfiguring in very very poor way --four 12 have to pick to choose to die. And if for no other reason I can tell you that We got to get beyond the questions of whether it's right or wrong the way people get exposed and get onto the ways of preventing the transmission. Question is regarding the case. It's currently occurring in Indiana with the young boy who happens to be a child of haemophilia of which in this very State we estimate that 90% of the haemophiliacs are now infected with this virus including some young boys in our own State. And the question is is it appropriate for the school board in this Indiana Community to have required that child to stay at home and be educated via the telephone as you know, school districts have a legal obligation to educate children through Federal legislation. And therefore they do have to find a way to provide education. I happen to have some more direct involvement with this than just the Minnesota connection. I'm serving a National Committee right now to develop guidelines for the care and management of children in child daycare foster homes and schools who have AIDS it's estimated right now. For example there over 2,000 children in New York City alone that are either in foster care or should be in foster care who currently are infected with this virus. To answer your question on Indiana. No, there's no need for that child to stay at home unless there's a problem with the child picking up an infection that you are. I might give him and he does not appear to be that seriously suppressed at this point that that's the case. I might add that in children. I'm more concerned about the child who is five years old who has this infection who comes in contact with the chicken pox virus with Jew and I would not seem too concerned about and he dies as a result of that. We've had a number of cases in children like that. I think the problem we have here is that we had a parent reaction which was so significant and which was largely an appropriate based on the facts that the school board had no other option if that same situation occurs in Minnesota, I'll tell you right now is a public official. I'm going to take a stand at that child deserves to be in the school and that in fact if that does occur the only thing that will make me change my mind is the risk of that child picking up an infection that you or I or another student may give them (00:48:44) just quickly to add a word to that the On that you're describing with the young person in Indiana is really in some ways symbolic of a much larger problem about the ways in which age is a very isolating kind of disease partly because of people's fears about it partly because of the stigma associated with the fact that more than 70% of the people who have AIDS are gay and so forth and in terms of both public policy and good health practice. It seems that the thing that we need to be working for is to minimize that isolation precisely because in some ways isolation breeds contagion not in this particular sense, but in the sense that it makes people less likely to behave appropriately and and furthermore. It's not good health care for that for the individual (00:49:32) involved. I would say at this point. I hope not and I really believe it won't but I guess obviously can't say it won't but I don't think it will and I think the reason that it won't is because I do think that there are some very responsible media people in this country who whether we want in this group. I'm sure would love to believe this has a great deal of influence on the thoughts and considerations that the general population have about any one topic and I think if we provide responsible journalism portray, the facts is facts say, you know, when there's a problem where the first to say. There's got to be a problem there but we have the data to support that young children don't transmit AIDS virus to other young children. We have now followed over a hundred children who have had AIDS or AIDS related to transfusion where there was no other risk factor in the family setting in filed those family members and none of them including the mothers and fathers that change their diapers and wipe their nose and kiss them. Good night. Have you been infected with this virus? We can support the fact the claims we make are not Just wishful thinking but scientific evidence if that kind of information gets shared simultaneously with the kinds of very devastating information that also goes with this outbreak and I don't think there'll be a panic. I think that there will be more responsive and yet sometimes frightened group, but I don't think there will be a panic.