AIDS: A Regional Report

That. Yeah. So. I think well actually. Learn more. I'm going to. Join us now for AIDS a regional report. We'll take a look at the scope and impact of this troubling public health problem in this region along with our distinguished panel here

tonight. We'll explore why and how AIDS is spreading here. What's being done about it and what issues concerning aids are troubling the public most. Perhaps there was a time when AIDS was someone else's problem. But today that's no longer true. Stay with us. AIDS in Maryland is no less a public health problem than anywhere else in this country. Since January 1st alone 71 new cases of AIDS have been diagnosed here bringing the total to five hundred seventy two. That's a figure that ranked Maryland to 11th in the country. If the infection rate grows as it's predicted to the number of AIDS cases in Maryland will increase by an alarming 800 percent between 1986 and 1991. Those groups most at risk from AIDS include homosexual and bisexual men intravenous drug users

heterosexuals with multiple partners hemophiliacs and transfusion recipients. For reasons that are still unexplained the rate of AIDS infection is much higher among blacks than whites. In Maryland black men are three times more likely to contract the virus than are white men and black women are 12 times more vulnerable than are white women. Concern about AIDS is growing in this state. In fact a recent survey conducted for Maryland Public Television by the University of Maryland found that about 70 percent of us were very concerned about AIDS. Ninety percent favored AIDS education programs in the public schools. Forty three percent wanted testing of the general public for the disease and 46 percent admitted to having taken steps themselves to prevent exposure to the disease. Interestingly given the high AIDS infection rate among blacks 64 percent indicated that they are very concerned about their chances of contracting AIDS. That's as compared with only 34 percent of whites. A difference of almost two to one.

Dr. Edward Brandt is chairman of the governor's AIDS Advisory Council and a nationally recognized expert on the epidemic. John Grassie you recently spoke with him. Your report projected that the number of AIDS cases in Maryland would increase by approximately eight hundred percent between 1986 1991. What is being done in this state to help prevent your predictions from coming true. Well on Thursday there's another thing we can do about it because of prediction was based upon the estimated number of infected people. And at the moment we have no way of interfering with regression. I think the general public is quite aware of the potential threat. My concern is that they may be overly anxious about it. I still hear from members of the public concern about shaking hands being in the same room with someone who is infected or other forms of. So-called casual or social transmission. In spite of all of the studies

and solid scientific studies that demonstrate that that's not possible. Well the people who are at risk go. Specifically those who use intravenous drugs who use heroin intravenously and use contaminated needles. The second group are those who have had sexual contact with someone who is already infected. Whether this be homosexual contact or sexual contact. Therefore people who engage in what I sometimes call casual sex with are certainly putting themselves at risk just one half of the confirmed AIDS cases in Maryland occur among blacks. Infection rate for black men is three times that of white men. The infection rate for black women is 12 times that of white women. Why do you think this is the case. Well I think it's quite frankly. Unknown at the moment why the success it is not. Restricted to any one

risk category. It may be that we have been less successful I think it's clear that we have been less successful. In getting the message to the black population about protecting themselves from further infection from the collection at all by the use of condoms or other steps. I think we have to intensify our efforts in the black population to make sure the educational message is getting there and that. And that it is effective and repeated. What specific steps we. Would you like to see undertaking in the state Standley the spread of the AIDS epidemic. A lot of it is already being done. I think number one we have to get a curriculum into the schools without the baby. That ought to start. It certainly has to be in the high schools and it ought to be just one way middle schools. The question of how far back in elementary schools is one that can be debated. Second I think we have to continue to educate the. Health.

Professionals. So that they can educate their patients their patients and others that they'll be fully informed about this disease and how to get ways to go about educating people. Steps are being taken in that direction as well. And I think we need to keep the message coming to the public and we need to keep it going all the time and it ought to be done as protection through advertisements also through the kind of program that you are having as a matter of fact. I hope that the media. Including the print media as well as the broadcast media will continue to have programs like this so that people can really begin to understand. This problem and therefore protect themselves for those who already have AIDS the disease is more than a health concern. As of now it is a death sentence. Jodie Mayer has AIDS and is working to help all of us better understand the disease. Well AIDS is nothing if not. Constant change.

The first infection I had was with pneumonia. And. It's. As. If. You have the rug pulled out from under you. As you lose your footing. And the waters become troubled. And you feel as if you're. Participating in the decline of your body and you have no control over it. And then which was about. The end of last July at the beginning of August. Until little. Has been. An act of sheer will or a. Continuous project to be as healthy as I possibly can at any given. Any given moment. And in that period I gradually developed a stability. And that continued all the way until the beginning of this year when I started taking AZT. Which. Just sort of. Really. Firmed up the stability. And restored that an incredible amount of energy for and I've been able

to be very active in the public arena. Before you knew that you had AIDS. Did you ever think you would get it. No. I used to play what if games. Do you regret your past. Absolutely not. Because what we're talking about. At least in my particular instance. Is. Risk that comes from. Acts of Love. And how can you regret that. What do you think it will take. In order for the general public to finally understand the potential threat from AIDS. Most people spend a great deal of effort. In separating us from them. The innocent from the guilty. They keep telling themselves. Well I'm not say I'm not.

White. I'm not. A drug user I'm not you know fill in the blank with whatever characteristic you want. You lie. They don't realize that it's neighbors who have AIDS that it's friends who have AIDS. That it's people right there next door in their communities that have AIDS. And that the numbers continue to grow and grow. And it's not going to go away. Before we begin our discussion remember if you have a personal question about AIDS or where to get tested you may call our hotline at 1 800 6 3 8 6 2 5 2. We have counselors standing by to take your toll free call off the air. The number is 1 800 6 3 8 6 2 5 2. All right let's begin our discussion here in the studio by welcoming Dr. Gary noble who is on leave from the Centers for Disease Control in Atlanta is now serving as the public health services AIDS coordinator. Doctor Seven years ago nobody had heard of AIDS. Now within the last two years it's become a national it's become a

national obsession. It's it is of course a tragedy are the numbers that you're seeing nationwide. Progressing geometrically or has medicine done anything at all. To stem the spread of AIDS. It's estimated that there are now about one and a half million people infected in this country and since we can predict that a 20 to 30 percent of them will become full blown AIDS patients within five years. The projection is that by 1991 that is in the first 10 years of the epidemic there will have been a cumulative total of two hundred and seventy nine thousand patients with AIDS and 170000 of those will have died. There is some evidence that the message on how to reduce the risk of infection is getting out. However studies coming out of California for example are showing marked reductions in the number of sexual partners and a much increased safe sex behavior.

Maybe we ought to define the problem as far as medicine is concerned. There are lots of viruses that that we all have that are around us all the time. Why is AIDS such a tough one why haven't you been able to crack this one yet. Well it's a new virus is nothing really like it that we've faced before. We don't really know its origins but it's clear that it's a new problem in the 70s at least. When you look at serious stored in freezers from various parts of the world you begin to see evidence of infection in the 70s. It's a retrovirus. It's a different kind of virus. These viruses weren't even known in humans until about seven years ago. Do we know much at all do we know even where this thing came from in the first place. I mean you've heard stories of it came from Africa. It came from genetics laboratories at Fort Detrick. Do we have any idea where it started. Well it's a one of a family of viruses. We we do know that there are related viruses in monkeys and it's clear that there are

variants of this virus in the human population. So first of all we can say very categorically it's not created in the laboratory. We don't have the skills to create such viruses de novo. Whether it began in any particular country is really pointless to discuss. I think it may have mutated from the monkey virus and passed into man. It may be a human virus which has mutated and taken on these biological properties. Let me introduce Scott Stanford who is with the Maryland Department of Public Health and state Department of Public Health. The number of Maryland cases as we've already said among blacks is double the national average black females have an alarming 12 times 12 times as likely to contract AIDS as are white women. Why is Marilyn hit so hard and why are black Marylanders hit so hard. Well the statistics in terms of black cases hold true nationally as well. The black community nationally has felt a

harder impact from this disease in Maryland than looking at the cases that have occurred here. There seems to be a correlation between drug abuse which primarily takes place in the inner city and the inner city population has a larger black population as a result of that you have dual transmission in the black community in that you have transmission through I.V. drug use and then that individual can transmit the disease sexually to their sexual partners. I might make point out that all of the children in Maryland that have been born with AIDS have been black children. Most of the mothers in fact I believe all of the mothers if I remember correctly either were drug abusers themselves or the father of the child was a drug abuser who then impregnated the mother and transmitted the virus. So you're saying in Maryland the problem of the spread of AIDS among blacks is primarily I.V. drug use and

heterosexual sex and not homosexuality. No I want to say that the virus doesn't discriminate based on sexual orientation. Certainly black gay and bisexual men have come down with AIDS. There's no question but there is a larger number of black citizens where we can link the infection rate back to the drug use. I don't think that's inherent in the black community by any means. It's simply an urban problem. We certainly have white I.V. drug abusers who also have come down with the disease. Let me introduce Abigail Trafford who is the health section editor for The Washington Post. I suppose I suppose you could argue that aids would not be as big an issue as it is were it not for the media and let's include television as well as newspapers have the media handle this whole story fairly concisely completely accurately. Yes. And let me elaborate a little bit. I think we have to look at what the role is for the media. And it's interesting to play a game and it's say leap a hundred years

from now. And if you look back and think what has been the effect of this new disease if we look back in history we can look at Black Death which in the space of two years wiped out what was it one third of the population between India and England and that no one is saying that AIDS is anything like that. It's slow and it has only affected a small proportion of the population. However it's a new disease that has an enormous impact. It affects our health care system. It is stricken so many patients it is now a political issue. It's an economic issue. It's like the patient said it's pull the rug out from under us. That's a story. And I think the media has covered it. Aggressively. It's gone after all aspects of the disease because announcements come out sort of like a waterfall. You're constantly on the run with what's new about this disease. And I think the hardest part is in being fair and in putting the latest information in perspective. Let me also introduce Dr. John Bartlett who was chief of infectious diseases at Johns Hopkins Hospital.

Before we went on the air I asked you what were you doing in infectious diseases in your department five years ago and compare that with what you're doing now because here we have a brand new disease AIDS. How much time does it. How much of your time is AIDS take now. Well for me personally it's most of the time it's 90 percent of my time for people in the infectious disease community. It's become a new subspecialty within the subspecialty. We've created an entire separate service. We now have a 20 bed unit strictly for the use of for AIDS patients. And this is something new isn't it an infectious disease specialist you said are not used to too long term treatment of people not used to following patients that closely for that long. But I'm not sure who's going to pick up the care of the AIDS patient I'm not sure who is going to be the recipient of the role of primary care provider for an AIDS patient. But in many communities it will logically fall on the hands of the

infectious disease specialist It is an infectious disease. Most of the complications are infections of various sorts and it is managed like an infection with anti-viral chemotherapy and potentially vaccines as well. So we're going to treat it like an infectious disease that I think probably people in our ranks will will take care of it. But there's only about two or three thousand infectious disease specialist and in New York or San Francisco. That's not going to be nearly enough. So I think that it's going to have to be a joint effort with a lot of primary care providers getting involved and in those areas that have lesser numbers it might fall in the hands of infectious disease that may fall into other disciplines as well. It's also being handled by like by doctors like Dr. Joseph and Kuan Yew who is a. I guess we could say a street level doctor you're you're you're out there. OK and the folks are and you treat a lot of AIDS patients. One thing you we're seeing a lot of nowadays is newborns babies born with AIDS being transmitted from the mother to the baby. Is AIDS a disease that already has a

foothold in the next generation. Definitely. By virtue of the biology of the virus itself it could be easily transmitted. From mother to child and therefore. The next generation is definitely threatened. The risk of cause is the part of the fragment of the population that is being the teenagers who are having initiation into sexual activity and who apparently are not well informed. So they start an extremely high risk because of irresponsible behavior which in most would be due to ignorance and innocence. So we really are dealing with a generation that is at risk and threatened. Let me also introduce day Stone who is executive director of hero of health education resources organization correct resource resource organization you are some of the folks whose job it is to get the message out the message about prevention

testing and so forth. How good a job are you doing at getting the message out. And and. Well let me start with that first. How good a job are you doing. Is the message getting out. I think that the messages is getting out. I think that one of the ways that we have of telling that our message is getting across is with. Our age information and referral line which are the people who are answering the hotline tonight that the increase in our number of calls has been dramatic so that we're getting close to 2500 telephone calls a month. We know some of that Avigail is from what's happening in the media and we also know that when a TV show is on or when there's a newspaper article or when there's one of our public service announcements we also know when different of our education staff are doing programming that we will get calls on the hotline. So one way we have to measure the sort of message out there is through certainly our needs information and referral line. Another way is because we have an increasing

number of requests for education programming throughout this state. I think Scott will also be able to attend to that that we know he also is responding constantly to education messages. Let me hit you all with a thing that had everybody square in the face last Wednesday the CDC came out with a report saying that that three health care workers contracted the AIDS virus through skin contact with blood from AIDS patients in three different cases. It scares a lot of people because that seems to be. A jump. In what we've been saying what you have been saying the experts have been saying all along about how. How violent the disease is how easily transmitted it is. Should we all be as concerned as we apparently are about that report that three. Hospital workers got it not through being pricked by a needle and not through sexual contact but by skin contact with blood from an AIDS patient.

There's one thing I think that needs to be set up front in terms of that this is this is obviously a very unusual occurrence and probably would occur rarely. And the majority of the public need not concern themselves that an AIDS patient is going to cut themselves on a knife or run over and bleed all over them. What the public needs to be focused on is what is their personal risk. Are they engaging in sexual behavior that could potentially transmit the virus. Are they engaging in use of I.V. drugs that could transmit the virus. The difficulty with reports like this while they're important for healthcare workers to understand routine infection control practices is currently in place in hospitals would prevent the very kind of transmission that occurred in these cases and I think Dr. Noble can probably address it. Well yes and I would also add that the study that has been done in many many centers with people with a known needle stick exposure have been followed now for many months most of them for a year or more. And

out of nearly a thousand health care professionals with a documented exposure they've only been two with infections so the risk is like point three percent in workers with a known exposure. The other thing I should add is that. There is no evidence that the kind of casual contact in a social setting or even in a household where one of the patients is a non sexual contact with AIDS. You just don't see infections 450. Household members living with an AIDS patient and without sexual contact. None of those have shown evidence of infection. So it's not easily transmitted. There there are two levels of worry about the AIDS virus. Why is it that some people get the virus and never develop the disease or it takes years and years to develop it and some people get it in and within what's the quickest they can develop it after after contracting the virus. It's highly variable but it averages probably around four or five years. I'm not sure we know exactly

the kinds of figures you're asking for because remember that we've had just a six year snapshot of this disease and I'm not sure that we really know what's going to happen in the long run. We know that if you contract the virus today that the average patient will probably not develop AIDS for four or five years. We do know that the figure that was quoted 20 to 25 percent of those who acquire the virus will eventually develop AIDS within five years. But we don't know what's going to happen with the other 70 or 80 percent. It may be that they all eventually develop AIDS once we've had an adequate time span to view the natural history of this infection. It may be that it will level off at 30 percent all right we will continue our discussion on the side of the studio in a few moments. Two political issues though that cannot be separated from any thorough discussion of the AIDS crisis. The controversy surrounding AIDS education in the public schools and mandatory public

testing for AIDS. John Grassie looks at these issues. Today it's virtually impossible to avoid information about AIDS. Rarely does a week pass without the appearance of a new report a finding about this serious public health threat. Would you like to hear how Surgeon General Dr. C. Everett Koop says you can help protect yourself against AIDS. The best protection against the infection right now barring abstinence is the use of a condom. A message is clear during sex. Age is preventable if you know the facts. Anyone. The public education about age is becoming the major thrust of national and local health organization to protect most of the information is coming from the airwaves. Hotline's with counselors pamphlets by public service announcements films and tapes are readily available to inform and assist the public here. Age is preventable. Age spread sexually by men and women. Some very specific ways Id drug users who share needles can also get AIDS. That's sick. If you don't know the facts it's time to get an

education. But sex education in the classroom particularly AIDS education has been marked by intense controversy. But I've got to tell you AIDS is not going to go away. It's going to be with us for the rest of our lives and we're going to be dealing with its consequences for the rest of our lives. Now for some time to come. Currently AIDS instruction is being offered in a few school systems in Maryland usually beginning in the eighth or ninth grade. While support for education in the public schools regarding AIDS and safe sex practices may be growing opposition to such instruction remains strong. Diana Gordievsky is executive director of Planned Parenthood Maryland and supports AIDS education in the public schools. Father Robert Friday teaches at Catholic University and wants to see instruction in moral values accompanying AIDS and safe sex education in the schools. Diana what is the purpose of the so-called

safe sex education programs that are offered in some schools. Isn't there a danger that they may be very little more than just instructional programs for kids. Absolutely not. I think it's very important to distinguish between safe sex and AIDS education AIDS education needs to include a lot more than just instruction about safe sex. It needs to include talking about responsibility about caring within intimate relationships. It needs to talk about learning respect for oneself and one's body and one's friends and associates and partners. The use of condoms they involvement in relationships in monogamous relationships all is part of AIDS education AIDS education is a lot more than just talking about safe sex. Fine. But Father Friday I'd be interested in your reaction to that. Isn't that much of what's included in went down and just mentioned an acceptance of sexual activity among teens in the schools. Well it could be. I mean that's always one of the fears that we would seem to be

advocating or maybe sort of knuckling under to the flow of the time that says well we can't win on this thing. So let's make it as safe as possible. But I don't disagree with Diana certainly totally. I mean I think that the emphasis has to be on the responsible use of human sexuality. I would not want to just do with AIDS education apart from that wider subject of education in human sexual expression. Recognize we are sexual persons. And my fear is that if we only focus on AIDS or even if we only focused on pregnancy or something like that we're really then beginning to equate sexuality with genitalia. You know I think that's a real mistake that I think that has to be seen within the fuller context that we are sexual persons we must be responsible in the use of sexuality. Well correct me if I'm wrong. Am I not hearing what sounds very much like if you will a moral quotient in

some of this education schools I don't think that you can divorce the mortality from it because I think that any attempt to deal with sexuality in a value free kind of situation simply says there are no values in sexuality and that's a value education in itself. So somehow we've got to come to grips with with the value dimension. Now you can call it moral values if if you wish but I think it is simply value as such that one needs to emphasize and I think Diana picked it up with a sense of responsible relationship. You know this development of a real personal kinds of dimensions in relationships. And not to simply let this thing flow which is sort of the genital plumbing. But I think the important point that we have to realize and I don't think we're that far apart when we're talking about what age education needs to involve. But I think something we need to acknowledge is the reality of the lives of our young people today in our schools and throughout our communities. Millions of teenagers all over the United States are already

sexually active. Millions of them are being exposed to sexually transmitted diseases every day they're engaging in risky behaviors that lead to pregnancy that lead to drug abuse. We're not talking about just sexuality even when we're talking about what our teenagers are like. And like it or not that's what the reality is. We used to talk about teenage pregnancy and issues around venereal disease and we were talking about 16 and 17 and 18 year old we're talking about 11 and 12 and 13 year olds that are getting pregnant and we have to accept the fact that if they're young enough like it or not ill advisedly or not to become pregnant at 11 they're young enough to get AIDS and possibly die at the age of 11. All right well let me let's get back to AIDS and let's stay on that subject. There's very little information to indicate that sex education in the public schools has done anything to diminish the interest or the activity of teens in sexual affairs. Is there any evidence to suggest that AIDS

education in the schools would do anything to slow down sexual activity of these very same teens. I disagree with your earlier statement. That studies have shown all over the country that sexuality education does not increase the likelihood of young people becoming sexually active as a matter of fact. It has been shown in a number of studies that when young people receive sexuality education particularly early in a junior high school years that there is a tendency for them to postpone beginning a sexual relationship. We also know that young people that have had sexuality education also have a tendency to be more responsible when they choose to become sexually active. They tend to have fewer intended pregnancies and they tend to use contraception whereas they would not have a we think they would not have if they had not had that exposure. Now we don't know a lot about AIDS education we're talking about sexuality education having to do with a broader set of issues. But I would I would guess I would

surmise that the same kinds of findings would apply to AIDS education in schools. Father are you comfortable with the idea of this this kind of education being offered to very young kids 11 12 13 year old. Well I think that sex education should be in the school. But again I'm going to move it into the fuller context of human sexuality that we are sexual persons. And I think personally and I know that there would be money perhaps in my own tradition that would disagree with that. I think that if I were to put together a course in human sexuality for the schools and not to mention like condoms or something like that I think that I would be incredible. You know I mean I I think I need to mention that but I would also want to say that perhaps While some experts say that this is one way to avoid contracting AIDS etc. but I'm not really comfortable with billing that is safe sex because I'm not sure that that is always the

future. I mean there's a there's a real failure rate there's a risk grade with the condom on and especially if it's used to you know intercourse it is far more riskier than it does in our regular active intercourse. So I'm very uncomfortable with with not getting a fuller picture on this whole and limiting perhaps to areas that I think the public schools have done. We are simply a biological general. Diane A final quick comment. We were running out of time. Are you comfortable with the kind of curriculum with the kind of program that father daughter was just describing. I think that we're not that far apart. I think that we both are concerned about what was earlier called a of at risk. And I think we probably both feel that we owe our children information that's going to help protect them and possibly even save their lives. We might frame that information in somewhat different ways but I think what's important is getting the information out to them. Thank you.

Another controversial and still unresolved issue concerns the testing of the general public for AIDS. Before we debate a number of the issues surrounding the testing controversy. Let's first look at an actual testing procedures involved. Well Tonya Bailey has this report. The basic mass screening test for AIDS is called the license which tests for the presence of antibodies when the virus infects a person the. Blood. Cells in the blood. They develop antibodies to the virus and so. The antibody detection is a method of determining if somebody has been infected by the virus. Once the blood is drawn it is put through a series of steps which determine whether or not antibodies to the virus have been created a negative result means that no bodies have been created by a positive result means that antibodies have been created or blood donated to the Red Cross is tested for the presence of AIDS antibodies if positive a sample is tested again twice

using your life's a method is still positive. It is tested once again using the Western Blot test. This test kit developed by biotech research laboratories in Rockville gives more specific information and is used to confirm positive results. The paper strip indicates the presence of very specific AIDS antibodies and those with shaded areas are positive. How accurate are the AIDS tests that are being used now. It's extremely accurate. If you use the manufacturer's specificity and their sensitivities it's over 99 percent. Even if the accuracy of the tests has improved and if such results can now clearly identify those harboring the virus the question remains. Is it right to require testing of the general public for AIDS. Joining me now for discussion of this issue are state senator Margaret Traynham who recently introduced a bill requiring all those applying for a

marriage license in Maryland to submit to AIDS testing. And Stuart Comstock gate executive director of the Maryland chapter of the American Civil Liberties Union. He opposes mandatory testing on the grounds that it is an invasion of privacy. Senator Schweinhart your bill would require all those applying for a marriage license in the state to submit to an AIDS test. What business is that of the states. Very serious business. The health of the community is at stake. It's a matter of life and death actually. And I I am concerned primarily with the coming generation. The picture of a little child of six not being allowed to go into school when we when the panic stage about this AIDS problem. Touched me very deeply and even though our grownups today can be responsible for their own actions. I deeply resent the fact. That a little child should bear the burden of their actions and therefore

I believe the marriage ceremony is the first step toward procreation toward children and therefore we should go into it with a clean body at least. And I think it's absolutely necessary. Even though it's a small step John it's a it's a very small step in this whole spectrum of the fear we have now of a great plague. It is a small step. It doesn't interfere with anybody's prophecy. It doesn't require. That the bill I put in doesn't require. That there be notification of the result of the test merely that they have taken the test and therefore Then title to the license. STEWART How do you feel about such a premarital checkup. Well I don't like it one bit as the senator well knows. It's not a small step. It's a small step in terms of helping us solve the AIDS crisis but it's a big step in terms of the government stepping into our lives and saying you will have this test taken. We may not be watching you but you will have it taken in somewhere. And whenever the government is

going to be taking tests like that or wants to impose an across the board invasion of privacy they have to have a very good reason to do that and they have to show that that the public good is greater than the loss of individual liberties and in this case the number of people you'll be helping by requiring these tests are very few. Most of the children who are born with AIDS on the latest study I saw anyway were were born out of wedlock so we're not even getting to those kids. Most kids start sexual activities when they're teenagers and get married not until they're in their 20s. So we're not really getting at the community of people the next generation that Senator Schweinhart wants to reach. So we don't like the test one but I'm not stupid. If you object to this to the civil liberties union object to the states that had tests for a venereal disease that's been going on for many many years that have I don't recall hearing any particular position over the years with respect to the neural disease and here's that disease far more deadly because we don't have a

cure for it. We now have a cure for it. So I mean how do you differentiate between the two. We don't differentiate between the two you've always got a balancing test. And if this test is by testing people who are going to be married we were going to be able to stop the disease. We would say well that's the way to go after it but it's not going to stop the disease. And there's no intention to stop the disease through this mechanism. The intention is that you cut down on the on the on the real problem of transmitting the disease to the next generation. Now that some 80000 people were married in Maryland two years ago I believe the latest statistic the head needs 40000 women 40000 men and it seems to me that while this bill touched that very small segment nevertheless it's a very important segment and in no way does this bill interfere with privacy the right of confidentiality and no way the only confidential aspect in this bill was that existing between the Doctor and his patient which already exists. But you and

I you know Stuart I'm sorry I don't I don't want to take your time but why doesn't the Civil Liberties Union when it finds a measure that does not impinge on their philosophical position. Why don't they back it. This is a measure they cut back. No no it isn't because you've still got the state requiring a test you've still got the state imposing on people's lives even if it isn't the state standing there watching the test you're requiring people to submit to an invasion of their body fluids to have their blood taken from them for a test when it's not really going to affect the problem in any significant way at all. Education is what we need. Voluntary testing sure when you're going to get your marriage license they ought to encourage you to get tested. We have no problem with that. Fine. But. Given the fact that AIDS is well-documented it as a general public health threat. Is it fair to potentially endanger the rights of the general population in an effort to save the rights of one individual but that's really

not the issue and I think I think that's the way the debate has been framed many times but it's really not an issue of between civil liberties and public health. These tests these mandatory tests will do so little to get at the problem of AIDS. They also you create the records and there's a lot of discrimination against people who have AIDS. You discourage some people from going to places where they might be tested because they're afraid of being found out and then being discriminated against losing their job losing their house losing their insurance for those reasons. It weighs the other way it weighs against testing. Senator final word but what about the discrimination issue. There is no discrimination here. You know I feel so discouraged about this the medical profession doesn't know what to do about AIDS. That's that's a fact. They don't know the answer. They are hunting and they probably will find it but they don't know. Today we're talking about the matter of life and death. That's what we're talking about not only of the present population but of the generations to come. And when you have a matter of

life and death then it seems to me if you take the smallest step as Admittedly the Senate bill did it take the smallest step at least you'd have taken some steps to protect people. And I can tell you if my daughter is getting married today believe me they and their potential husbands would take the test. And I hope that Stewart's daughters would too. While it's unlikely that either the public education or the mandatory AIDS testing issues will be resolved soon. It is important that all of us consider the basic questions being raised and then decide for ourselves where we stand. Thanks John. Let me remind you again of the phone number to call if you have a personal question about AIDS. That number from anywhere in Maryland is 1 800 6 3 8 6 2 5 2. There are counselors standing by right now to take your personal confidential off the air phone call if the line is busy and you can't get through to night. Go ahead and call tomorrow. And if you have a question for our panel here we are opening the phone lines right now we'll put your questions and the answers on the air

if you will give us a call at a different number 1 800 2 2 3 3. As in Maryland Public Television That's 1 800 2 2 3 3 am. We'll take your questions right now. The senator said that medical science doesn't really know what to do about AIDS. One thing that has been that the medical science does know is the only drug that's been approved by the government for treatment AZT. How effective has it been in treating it and how close is it to a cure. It is not a cure but how close is it. Well we've got a limited experience with retro here but what we know so far is that it does seem to sustain life. It does seem to improve the quality of life and it is a potentially very toxic drug so that there are many patients that simply suffer such toxicity that they can't take the drug. We find our patients almost falling into two categories some seem to do very well with that drug and seem to almost Reserve almost restore normal

health and live functional life and other patients go on to develop the same opportunistic infections they would have had without the drug or they develop such severe toxicity that they can't take the drug. So I think it's very uneven but some patients have had notable success with extra retro vear or the generic name AZT doesn't reverse the process of AIDS does it. Doesn't that kind of hold it where it is but not necessarily reverse it. Well what happens is the number of virus particles we we measure it with a test for the amount of antigen and the blood decreases. In direct proportion to the amount of AZT taken. And as soon as the drug is stopped it goes back to its previous level. So it is temporising it does not cure the disease and was never alleged to cure the disease. Another problem and let me ask any of you doctors about this. Another problem with AZT is that it is known to create anemia in the patient. And there are those who are sitting

thinking now what about 10 years from now when it's if AZT is so widely used that that these patients develop anemia. They all need blood transfusions and they cause a real run on on the blood banks. Is that is that a likely scenario of a scenario that you can see happening or not. Well certainly. There is going to be an increased demand on. Blood banks the need for transfusions and this is a good time to put in a plea for people to give blood. There is no risk of getting AIDS from giving blood. And so people do need to give blood because there will be an increased demand as more patients go on AZT. There are also some newer drugs that are being looked at currently that may not have serious side effects. As AZT. Dr. Bartlett. Is beginning work at Hopkins looking at sort of a distant cousin of these E.T. called DDC that

seems to hold some promise. Under new FDA guidelines you can now use experimental drugs in treatment of AIDS patients if they're currently under some some recognized clinical testing. How much hope does that give you that that ruling just this past week. We're not enamored of that ruling really. We think that the new drugs droid drugs ought to be tested under controlled conditions with specific scientific question and proper control so that we can develop information. We've had an awful lot of drugs that have reached the marketplace through one circumstance and I simply don't work and it's taken us a long time to sort that out. So when you're out there having a patient who's going to die of a disease for which there is no cure or trying an experimental drug you have two problems. One is they will and it's understandable they will resort to anything that they feel may offer promise. And one of the problems is that they'll get drugs that maybe be to do them potentially harm. And they'll use

drugs that have no merit. And there are a number of entrepreneurs who will get into this business and sell their services or their drug or whatever they have which has been a problem in other countries. We've gone through this before we went through with Les troll a number of other compounds vitamin C and so forth. We'd rather not have the public get led down a garden path without the proper restraints and proper drug testing. All right let's go. Go ahead. Just for one thing that keeps happening whether it's in talking about rhetoric there or whether we're talking about new legislation for you know ways to use new treatments and that is that we forget the human factor in this disease that you know we're talking about people's lives and when you know Dr. Birol will say we don't want people to know the people with AIDS right now will hold on to any kind of hope that they can get. And no I really are and I think that as we try and depersonalize this issue we really do a disservice to people to the people and to we can't we

can't leave that out. Let's inject one other person into this conversation. Let's go to Fred. Online 3 Your question please. Mike Mike you're you. Did you say. All right. Is there evidence that that the the virus is transmitted through saliva. No evidence that I know of that the virus is transmitted through saliva kissing although it is recommended. That. French kissing not be done simply because of the theoretical risk but you're quite right. No epidemiological evidence virus is present in very low concentrations if at all in saliva. In 81 patients with AIDS who were cultured for the presence of virus in this live only two had detectable virus in the saliva compared with over half in the bloodstream that were

detected on a single test. OK let's go to Janet on online for your question please. Yeah I just want to say attack or do. You want to repeat your earlier statement a couple of minutes ago. Well I would say that it's comparable to being struck by lightning. Now that the testing of every donor. Is in place since 1985 and there is ample opportunity for self deferral even if you feel compelled by. Peer pressures to go and give blood. You can anonymously say that you should not use my blood. So that coupled with the testing which is very sensitive to detect infected people makes the likelihood of becoming infected from the transfusion nowadays equivalent to being struck by lightning.

Now that would apply to everybody who has received transfusions since the testing started in April or May of 1985. All blood units in Maryland have been tested since May of 1985. So anyone receiving a transfusion from that point forward has little or no concern in terms of infection people receiving transfusions. Previous to that may have some concern but I wouldn't be jumping out of windows. You need to think rationally and determine and probably talk with your physician if you had a lot of units of blood you may want to discuss having the test with your physician. Hospitals that do not allow And there are a lot of them that do not allow specific people to come in and donate to specific people insist on going through the Blood Bank are they. Our hospital is going to have to change that policy just because of the scare the AIDS scare. You mean the designated donor. Yeah. Well blood banks don't wife the designated donor and I can understand why they need to protect the blood supply in order to have a

sufficient quantity of blood. They need to have the donor pool that they currently have. It's also very unrealistic for a major portion of the patients that require multiple transfusions if you have a coronary bypass you need more blood than you've got friends. So for a lot of situations that's unrealistic. All right let's go to Cynthia's question. You're on line 10. Hi. Hello. I think there was a mosquito bite. They suck your blood and make you go from person to person and just doesn't die. Doesn't that question the answer is No. If anyone like to fill it then I answered it so many times. You cannot get AIDS from mosquito bites. We just happened to have written the memorandum on the subject today. To summarize the information. There is no evidence studies done epidemiological studies done with a random door to door sample in Belgrade Florida. Studies done in Africa. Where there are plenty of mosquitoes in both of these communities. There are AIDS patients and yet

no infections were found in children between 5 and 12. There are a lot of reasons why mosquitoes shouldn't transmit. AIDS. In contrast the malaria or yellow fever where the parasite actually multiplies in the body the mosquito and is introduced into the person the mosquito is biting with the saliva. AIDS virus doesn't multiply in the mosquito tissue. There's very little blood. Likelihood that that blood would contain an infected white blood cell because the white blood cells infected with AIDS virus are not in very high concentration and in AIDS patients body. All right let's go to Linda online in your question try to find that. Hi everybody. Hi. Hi. That's a big problem. The standard I think answers that antibodies can form anywhere from two weeks to three months after exposure and that you need to recognize that if you have been tested today and you had sexual intercourse you shared needles

last night that you in fact need to wait another three month period in order. And not share needles and not have sexual intercourse in order to know what the true result of your testing. Are you finding people who you may test and they come up positive for AIDS are surprised and then and are not aware that you know. This may be from a sexual experience six six weeks ago or if I'm safe from six weeks ago I could be infected from yesterday and it's going to take six weeks to show up. Well I think most of the people I'm not very familiar with this with the timeframe within which show once test could become positive and I think that throws more light to the discussion that we had earlier on as to whether we should have mandatory testing before marriage because it is really a snapshot of one moment in the lifetime of a person and doesn't really reflect the potential to transmit this virus if you had a negative does a day for weeks in your marriage to use you because

your seroconversion become positive you would still you know you would see the positive risk. We see lots of patients all interested in being screened after a bit of exposure. And in that case we we we follow them over it maybe a 90 day period to really satisfy them if they are very very concerned. All right let's go to a online. Hi. What's your question. Hi. Hi. Hi. I'm sure it's possible. We have that technology I don't think it's a good idea. You know I was going to say the problem with that is. What do you do when your test shows a positive in your home alone you need counseling you need

somebody to talk to you need to understand what that means you need to have it verified with a more reliable test. You need to know how to avoid transmitting the infection to others etc.. I find it also important to also recognize that when we're talking about testing what we're really talking about is counseling and that testing is an adjunct to counseling that counseling is not an adjunct to testing and that we go off on all kinds of issues around mandatory testing or not mandatory testing and we really need to talk about counseling and that to have a home testing and have you know I know where those calls will go I know where those questions will go is to our AIDS information I've referred to the difficulty with AIDS testing is that that oftentimes people have in their minds. Well Will test and then if we get a result we can do something. The problem is with HIV infection there's nothing to do except understand that you don't want to potentially

infect a sexual partner or if you're shooting drugs sharing needles. That's all we have is prevention. There is no treatment. There is no cure. So testing in and of itself. Is not necessarily. A good thing to do. If someone is interested in having this test if for some reason they're concerned that they've been exposed. There are 26 sites throughout the state of Maryland operated by the state health department where anyone can go receive counseling have the test at no cost. They can call the hotline number that was given tonight that information about a testing site in their local area will be provided to them. All right. Quickly a question from Doris on the line. Hi. Hi. I give pretty much that age and I notice that that you know what is the worst thing about them. You know are there any symptoms that you know that you had at home maybe somebody had with everything here. I could tell about symptoms.

Kind of like the flu is admitted in the beginning. When our reluctant to talk too much about symptoms because everybody has had the symptoms and starts to think they have AIDS. But I think to be to answer the question directly the most common thing we have is a cough which we just heard from Scott. We have patients who have been short of breath for extended periods of time and it's usually associated with fever. We get worried about patients who are a risk are known to have the positive antibody test who have fever for two weeks or longer. That's unexplained diarrhea unexplained weight loss and all of those symptoms go on for an extended period of time. Patient that has a bad cold or the common kinds of things that we see in daily life is usually not the presentation for. Let us wrap up this hour of information by asking you Mr. Stone to tell us about some some conferences going on in Baltimore where there is even more information available. OK. Tomorrow we are having a conference of the on the international hotel in

Baltimore. The State of the state the state of AIDS in Maryland where we are and where we're going. You will hear some of the same people who are on the panel tonight as well as some of our other physicians who are working directly with AIDS patients here in Maryland. The second conference that is open to the public and it starts at 9:00 o'clock tomorrow morning. The second conference is the first national symposium on AIDS prevention on education strategies and techniques that takes place on Thursday and Friday. Also at the on the. There is a fee for that conference. There is registration at the door if people call our hotline or our business number tomorrow we can give you more information. Very quickly my thanks to all of you for being here and providing your insights tonight. If there's one thought we want to leave you with it's this. AIDS is a growing problem but it is a preventable one. There are steps and measures you can take to protect yourself. Remember none of us is immune to the disease. So all of us must be concerned.

If you have not been able to get through the hotline number is 1 800 6 3 8 6 2 5 2. If you can't get through tonight try again tomorrow. Coming up next is the AIDS show a drama that chronicles the confusion and pain and the mystery and fear that AIDS injected into San Francisco's gay community early in this decade. It's an absorbing look at a disease once thought to discriminate in its selection of victims. Confining itself we thought to the world of homosexuals while that of course has been disproven now. Now that AIDS has entered other segments of society but that doesn't change the fact that gays are intimately aware of the disease and its finality. As you will see in the AIDS show next I'm Dave Dorian. Goodnight. The