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SARA LOMAX-REESE: Now we are going to look at another sexually transmitted disease. I know not all of the hepatitises are sexually transmitted, but we are going to be talking about HIV and AIDS with Dr. Jody Borgman. Welcome.
JODY BORGMAN, MD: Thank you.
LOMAX-REESE: I like to begin these conversations with a basic overview, like the ABC's of HIV. One of the things that concerns me a lot, as somebody whose been following healthcare issues, particularly in the black community, for a very long time, is that this disease has gotten very quiet. It has gotten very, very quiet. Maybe five years ago, there was a lot of community education, a lot of conversation in schools and now it is just, that money, I know, is not there anymore. So talk to us a little bit about HIV and then we can get into some of the politics of it.
BORGMAN: You are absolutely right. I have been caring for HIV patients since the early 90's and when that was unfortunately the heyday of HIV, when HIV and AIDS were really becoming a major epidemic. There were very few treatments available and we had limited options for patients. Thankfully, that has dramatically changed, especially over the last ten years, and even in the last five years. Our treatments have now gotten a lot better and because of that I think it has moved off the front pages. People don’t consider HIV to be the plague that it was back in the 90's and into the early part of this century because people are being treated well and are living long with it.
LOMAX-REESE: I mean, I guess one of my questions is how much of that is because now HIV is more a disease of black and brown people and people who are impoverished and less - the gay community really amplified and made HIV a very prominent issue within the main stream and now it is kind of the people who are now most deeply affected are people who are most disempowered.
BORGMAN: Yeah, I think that probably has played a part in it becoming less of a hot topic issue, but we are still seeing a tremendous amount of patients now in the gay community. They're still being infected and re-infected and all of the strong efforts that were out in that community to try to prevent sexually transmitted infections have kind of gone away and we are seeing increases of HIV and other sexually transmitted in that community as well. So it's unfortunately it has gone off the front pages, but it is still a serious epidemic in the country.
LOMAX-REESE: Now, Dr. Donee, you are a family physician at Einstein. How much are you seeing HIV and what are some of the things that are concerning you around this particular disease?
DONEE PATTERSON, MD: I definitely see people come in and they don’t know and so they may have high-risk behavior and I counsel them…
LOMAX-REESE: Which is?
PATTERSON: High-risk behavior as multiple partners, some may be using IV drugs, some may have had multiple blood transfusions, things like that, and I get concerned because people don’t even think about HIV anymore and that's why we wanted to talk about it. I mean, you are absolutely right. Dr. Borgman emphasized to me earlier when we were talking about how HIV has actually become more of a chronic disease, something that people just live with once they are treated, like diabetes or hypertension, so people are living with HIV, and that's awesome, but it also gives people a complacency. That's not good. A complacency where they don’t feel like they need to be tested anymore or they don’t need to be - you know, ask their doctor or be aware or wear condoms anymore and so it is continuing to spread. We want to make sure that we wake people up with this talk today and remind them to get tested about multiple STDs.
LOMAX-REESE: Okay. So one of the things that I've read is that the populations that are growing are women and young people. So Dr. Borgman, talk about who is most at risk and who are the people, the populations, that are expanding, even as there are better treatments out there.
BORGMAN: Unfortunately, it's hitting the, as you mentioned earlier, the impoverished communities, so the African American communities, Hispanic communities, we are still seeing rises, but men who have sex with men, again, we are seeing increased instances in that population, too. You know people just need to realize that they need to become aware of what their status is, if they've ever, you know, you asked for risk factors, but ever having unprotected sex, even once, has put you at risk. So that includes most of the population, the adult population and they need to be tested to find out what their status is because we do have excellent treatments now.
LOMAX-REESE: Dr. Donee?
PATTERSON: You asked me about my patients and I actually have a patient who was divorced and she is about 65 and she was a little lonely and wanted to get back on the dating scene and with her new partner she found she had HIV. So I just say that to emphasize that people over 50 are actually about ten percent of the AIDS cases in the U.S. and so that you can't forget it at any age.
LOMAX-REESE: So even if you are not at a risk of getting pregnant you still have to use protection and have candid conversations with your partner.
PATTERSON: Exactly and have candid conversations and be tested before and possibly during.
LOMAX-REESE: Well, that's a cautionary tale if I ever heard one. Dr. Borgman, tell us about the connection between HIV and AIDS because I am seeing more and more references just to HIV, as opposed to what used to be HIV/AIDS. What's the connection?
BORGMAN: Very basically, HIV is the virus that can lead to a syndrome known as AIDS or the acquired immunodeficiency syndrome. People who are chronically infected with HIV will affect their immune system and over time when their immune system gets depleted, they will enter the category of having AIDS. You hear less about it, again, because more and more patients can be treated and treated early and are not progressing to AIDS at this point, but they're HIV-infected, still chronically infected, but they should be able to live their entire natural lives with that HIV infection.
LOMAX-REESE: One of the things that I think is so disturbing, and you referenced this Dr. Donee when you were explaining, is that a lot of people can live with this disease for a very long time and have no idea that they have it, up to like ten years before they actually start seeing symptoms and who knows how many people you could be potentially be infecting during that dormancy period. So talk a little bit about signs and symptoms, both during that ten-year maybe dormancy period, and then what might actually show up after that ten-year period.
PATTERSON: Well, again, we can't always go by symptoms because people just don’t know, but if people were going to have symptoms, often people have these flu-like illness about one to two months after they've been infected, but it often just resolves so they may have, during that time, they may have headaches and they may have some loose stools and they may have pretty intense fatigue and sometimes even fever, but it just could be like a virus, or flu or common cold and they don’t recognize it as them actually being infected by HIV so we encourage people not just to go on their symptoms. If you have symptoms, of course, get them checked out, but don’t just go on that. Make sure that you get tested.
LOMAX-REESE: So where are we, Dr. Borgman, in terms of mandatory testing?
BORGMAN: The CDC, Center of Disease Control, recommends that everyone over the age of 16 to 65 be tested at least once and that if they have ongoing risk factors, and again, I would include anyone that's had ongoing unprotected sex with multiple partners, especially partners that they are not aware of their status, should be checked on an ongoing basis, at least yearly if they are placing themselves at risk because, again, we want to be able to identify this infection at the earliest possible stage because we can control it very simply with a very simple medical regimen. In most cases, one pill once a day and patients can live their whole lives essentially asymptomatic.
LOMAX-REESE: I mean that to me is just, it's mind blowing. As someone who grew up, I was in college when Rock Hudson died from AIDS and just really saw this disease go from this incredible, devastating death sentence, withering, just a horrific kind of progression, to the phase where you had to take this complicated regimen of pills and this and that, and they had horrific side effects to one pill a day. That is amazing. So I just want to see if you can talk a little bit more about the treatment piece of it. Therein lies the rub, as we said before, because sometimes that kind of makes people think, oh, well, it's resolved and I don’t have to be as vigilant, but talk about the treatment.
BORGMAN: That's the most important point here. There is still this stigma that people are afraid to get tested because either they don't think there is anything that can be done about it or that if they have to go see the doctor there is going to be lots of medications and the medications are going to make them sick. That's not the reality anymore. My whole career, I have lived through this whole progression of seeing, having no treatments available for patients to having very complex, difficult regimens, to now very, very simple. We have three different one pill, once a day regimens out there right now, with several other one pill once a day regimens soon to be approved. We can't cure this infection, but we can control it to the point where someone will be asymptomatic for their entire natural life and the majority of the patients that I see now when I do primary care, I am dealing with all their other health issues. Their HIV is the most simple and easiest to control of all their health problems. I am working harder to get their diabetes and their high blood pressure and their obesity and their asthma and all their other health issues under control. The HIV is the thing we spend the least amount of time talking about because they are aware of their diagnosis, they are coming in to see their doctor regularly and they're taking their medication like they are supposed to and the medicines now, again, are simple, easy to take, and almost symptomatic free, without very few side effects.
PATTERSON: I just wanted to inform people that if you have HIV, if you have been diagnosed with HIV or AIDS, that there are centers around the city that can help you get medication if you do not have insurance. Of course, if you have insurance, that's awesome, but if you don’t, there are many centers that have grants, including Einstein, which has a grant and our center is the Immunodeficiency Center. Dr. Borgman is a huge part of it, and if people want more information they can actually call. It's 215-456-3465.
LOMAX-REESE: Well, how expensive is the medication? The medical economics and again the capitalism in healthcare really concerns me. If you don’t have insurance what do you do?
BORGMAN: The medical regimens are very expensive.
LOMAX-REESE: Like how much?
BORGMAN: It can be up to $1,200 to $1,500 a month.
REESE: Wow. Yikes.
BORGMAN: However, the programs that are available currently in the state of Pennsylvania and the city of Philadelphia, almost every patient can be covered, even if they don’t have insurance, or if they have insurance, but it doesn’t cover medications. There are benefit programs that the state provides so I have never had a problem getting any patient, getting them on medications, but they need to come in. They need to talk with our social workers and find out exactly what their economic status is. Again, I know that's one of the reasons people are afraid. They think they're not going to be able to afford their care. The care is being covered, at least in the state of Pennsylvania. So we are lucky by that at this point. It is not a reason people should hide and say they can't get coverage or care because they don't have any insurance.
LOMAX-REESE: Again, going back to the money. Follow the money. My concern when we talk about how efficient and effective the treatment is, is there still an incentive to find a cure because there is so much money in the treatment, I am sure there would be a lot of money in a vaccine though, too.
LOMAX-REESE: So I am just wondering, any insights on where we are in terms of an actual vaccine or a cure against HIV?
BORGMAN: Unfortunately - and there's a lot of money going into vaccine trials. They would be especially important in third world countries where the medications cannot be afforded and where the epidemic still rages. So there is a lot of money and investments going into it. Unfortunately, for many technical reasons, they have not been able to come up with a vaccine that is appropriate, but now turning to more of a philosophy of well, if we can't vaccinate people, if we can get people treated, then we are going to prevent the spread of this virus. It's moving in a lot of studies and a lot of research of going into how can we get more people on care so that we can prevent the further transmission of this and decrease.
LOMAX-REESE: That's my question. So if you are asymptomatic, if you are being treated, does that mean that you are not going to spread it?
BORGMAN: Well, nothing is 100 percent, but when we can control the virus, and we measure patient's viral load, how much HIV there is actually in their body, when we have people under very good control, that level can start at over a million and goes down to less then 20. There's very good data to support that when people have their viral loads under very good control, that the risk of transmission is very small, much less then one percent. However, the same point, we don’t want people to become complacent and just start now…
LOMAX-REESE: …risky behaviors…
BORGMAN: …because they're not only risking getting other STDs, if they don't use protection, but they are also at risk of getting another strain of the virus that is not as sensitive to the medications. There are resistant strains out there. So that has been well-reported that you can get re-infected with the HIV virus. You do need to use, even if you are well, well controlled, you still want to be using condoms on a regular basis.
LOMAX-REESE: It's a very complicated virus for sure. We are going to go to the phones. We've got Hannibal on the line. Welcome to the program, Hannibal.
HANNIBAL: Good afternoon. Can any of these viruses be spread by using public toilets? That's my question.
BORGMAN: No, there is no data. There is nothing out there to support that. It has to be very close, intimate contact, even just gentle kissing, if there's no open sores in the mouth, there is no way to spread the virus.
PATTERSON: It doesn’t live very long outside of a human cell, so it doesn't live very long, but to that point, we were talking about hepatitis. Hepatitis does live a little longer. We don't say that you can get it from inanimate objects, so like a table or a toilet seat, but a blood source, so when people are testing for diabetes, you really do want to wipe down your diabetic testing supplies and you don't want to share those with people because those are blood sources.
LOMAX-REESE: We are going to go back to the phones. Thanks for the call, Hannibal. We are going to talk to Carl from Southwest Philly. Welcome to the show, Carl.
CARL: How are you doing this morning?
LOMAX-REESE: Good, thanks.
CARL: It's afternoon, really. Information I have is that being gay doesn’t spread, particularly doesn’t say that you have AIDS, but it's the special coitus that causes it because of the narrow penetration and the cells in the anal area and the penis, which causes attrition, which provides for inconvenient feeding of the virus into the different tissues. Is that correct?
PATTERSON: That is correct. There is a lot of blood supply. There are a lot of arteries and blood vessels in the rectal area and so they can sometimes break or tear and that can lead to more exposure and there's also statistics about men being uncircumcised, so when they are uncircumcised, that gives more exposure as well.
CARL: Thank you.
LOMAX-REESE: Thanks for your call, Carl.
CARL: Thank you.
LOMAX-REESE: Tina from West Philly. Welcome to the program.
TINA: Hello everyone and thank you for taking my call. I was calling to find out if you can become infected by getting a manicure or pedicure or your hair done?
LOMAX-REESE: Great question, manicure, pedicure, hair done.
PATTERSON: No, it's very rare. So the manicure, pedicure, unless the utensils weren't cleaned and had HIV on it that was not even attempted to be washed, that immediately went to you, like so many different variables would have to happen. You would have to have an open cut and you would have to get so much in. The person would have had to have a high viral load, so so many things that it is actually not really considered…
LOMAX-REESE: It is very unreasonable.
PATTERSON: …unreasonable, right, exactly. To that vein, if a person get s a tattoo and they are sharing needles that could be one way or diabetics who reuse needles or share needles.
LOMAX-REESE: Thanks for your call, Tina. I think that all of these calls raise that question that maybe we should go back over how do you actually get HIV because I think there are questions around oral sex, there's question about kissing, there's questions about bathroom seats and manicures so what are the legitimate ways that you can contract HIV?
BORGMAN: HIV is a virus that will live in the blood or the sexual secretions in a human being. It has to be spread through close contact of those through the blood products or secretions, so any type of unprotected sex, whether that's oral, anal, or vaginal intercourse, certainly can cause transmission, anyone who uses needles and is sharing needles with other people, whether that again, is from IV drug use or even diabetes, potentially could spread that virus. The blood supply in the United States is very well screened and tested so the risk factors are extremely, extremely, extremely small and that would not be a major concern for getting a transfusion at this point if you needed one, but those are the main ways that this virus is spread. Again, casual contact, sharing utensils, drinking from the same cup, again, even kissing and deep throat kissing, as long as there's no open sores, would be almost extremely, extremely unlikely to ever get this infection.
LOMAX-REESE: And then if we look at the prevention side it is really having protected sex and so that leads me to my last question. I have got to get this in. A few months ago there were several schools that had, I think, a high STD rate and they installed machines, condom machines, in the schools and that was kind of a controversial thing because they didn't notify the parents or anything like that. Any thoughts on that whole concept of the widespread distribution of condoms, particularly among high-risk groups of young people or other people, who might be engaging in unprotected sex?
PATTERSON: Sure. In populations where HIV is more prevalent then even casual sex in those populations you have increased risk of getting HIV. The only sure way not to get it is abstinence, but if you are going to have sex, casual sex, we highly recommend people to use condoms so that you don’t pass it back and forth and I know it is controversial with parents, but there's statistics that say, just telling students, telling young people that they should use condoms doesn’t increase the idea that they'll actually have sex.
LOMAX-REESE: Dr. Borgman, final thoughts as we wrap up. Any take aways?
BORGMAN: Well, I think the most important thing is HIV is still out there and unfortunately there is still a stigma about this illness, but people need to continue to try to move past that. They need to understand that if they are tested and find out they're positive, they can be treated, and they can live, again, their entire natural life with an infection that can be easily controlled. The key here is they need to get tested to know what's going on so they don’t spread it to other people and that they get the earliest care they can possibly get.
LOMAX-REESE: If people want to get more information about how they could access treatment they can call 1-800-985-2437 and that's the Einstein…
BORGMAN: That's Department of Health. That's the Philadelphia Department of Heath and they can tell you where you can go to be tested in your neighborhood to be screened.
PATTERSON: Again, the Einstein Immunodeficiency Center is 215-456-3465. We do have gift cards on our Facebook page. You can go to Einstein Health and there is a question about hepatitis. There is a simple question about HIV and you can qualify to get a $25 gift card. I do want to say that there's estimated to be about 500 people in Philadelphia alone that are undiagnosed.