WASHINGTON (CNN) -- Dr. Anthony Fauci has seen HIV and AIDS evolve from a mystery disease of the 1980s to an international health catastrophe to a disease that many consider a chronic but manageable condition.
Dr. Anthony Fauci says U.S. numbers show that there's no reason for complacency about HIV/AIDS.
As director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, Fauci is among the foremost U.S. authorities on HIV and AIDS. He sat down with CNN this week to talk about the epidemic, its evolution and why, despite tremendous progress in saving and extending lives, there's still much work to be done.
CNN: In this country we don't hear much, see headlines about HIV and AIDS. Why do you think that is?
FAUCI: Well I think what it is, is a bit of what we call AIDS fatigue, in that you hear about it a lot and it becomes something that doesn't attract or catch your attention the way it used to. Also, we're victims of our own success in some respects, where we have drugs that have really transformed the complexion of HIV.
Whereas a decade and a half ago we had people in hospices, we had 30-40 percent of the hospital wards in inner-city hospitals occupied by people with advanced HIV disease. And now because of the success of the therapies -- which is great news -- we don't have that.
Unfortunately, that has lulled the public in general and even people at risk for HIV into a complacent state, which is very dangerous because we still have over 40,000 new infections each year in the U.S. And the distressing part of that is that number has remained stable over 10 years. Which means we have not been able to crack that wall in numbers of infections. So, we have to be even more creative in our prevention measures.
If you look at the numbers in the U.S. there's really is no reason for complacency. We have now over 750,000 people, close to a million people, who have had a diagnosis of HIV/AIDS. More than half a million have died of HIV in this country. And of the 1.2 million people in the U. S. who are infected with HIV, there are 25 percent of those people -- over 250,000 -- who do not know they are infected. President Bush calls World AIDS Day "a day of sadness and hope." »
CNN: AIDS and HIV is still a major problem. How big a problem is it here?
FAUCI: Well, anything that has killed over a half-million people and is infecting 40,000-plus people each year is a major problem. It may not be perceived because during the '80s, mid-late '80s and early '90s it was a catastrophic situation where we were having hundreds of thousands of new infections per year. People were flooding the hospitals. That is much improved but not to the point that it is now just a trivial problem. It is not a trivial problem by any means.
CNN: Is it a chronic disease?
FAUCI: Well, it can be managed reasonably well with therapy. If that's the definition of a chronic disease, then I guess one can call it a chronic disease. We were in a situation in the mid-'80s and early '90s where we did not have the combinations of therapies that were so effective, that HIV was virtually a death sentence in most people. Now, if you're on adequate therapy and treated appropriately at an appropriate time, you can extend your life span by almost an indefinite amount, to the point of perhaps even being normal. We don't know that yet because we haven't been treating people for that long. But if you look at the people who have successfully been put on therapy, and have had their virus suppressed, many of them are doing very well. So, in that respect it has some characteristics of a chronic disease.
CNN: Who is the face of AIDS in the U.S. today?
FAUCI: The face of AIDS in the U.S. today is a young African-American woman infected by a partner who she did not know ... was infected and had no reason to believe or even means to protect herself. The face of AIDS is a young African-American man who is bisexual, and because of the stigma associated with being gay, superimposed on the stigma associated with being infected, the person does not counsel nor appreciate what [he] needs to do to decrease or eliminate the risk of HIV. So it really has been transformed over the years to a situation where, you have 12 percent of the population of the U.S. is African-American, and of new infections among men, close to 50 percent of the infections are in African-American men, and in women, close to 60 percent of the infections are in African-American women.
CNN: What more do the U.S. and the world need to do to reverse the trend in Africa and Asia?
FAUCI: We need to continue to support their preventive measures. There are a number of organizations' functions that are now going on that have been very successful. The president's new emergency plan for AIDS relief, which started off as a $15 billion program over five years has now morphed into at least a $30 billion program for the next authorization. The Global Fund for HIV, malaria and tuberculosis. Some of the NGOs like the Gates foundation, the Clinton foundation and Medicines Sans Frontieres are all implementing preventive measures appropriate for the particular population you're dealing with. Watch singer Annie Lennox talk about her anti-AIDS efforts in Africa
We need to continue to support those preventive measures, but we also need leadership from the countries involved. It's not easy or even appropriate for people to come from outside, to come in and de facto tell the people who are there in the country what they need to do. They need example by leadership from their own countrymen, from their political leaders, from their community leaders. So we need to work locally with those people to try to change some of the behavioral patterns which are ingrained and have been ingrained for decades if not centuries for some of these populations. People from the outside are not going to come in and change that kind of behavior. That has to be changed from within with direction from the leadership of the countries involved.
CNN: Why should Americans care?
FAUCI: There are several reasons why we should care -- because we are part of a global community. Many people may not want to realize or admit that, but we are. The world is a place that is so interconnected that what happens in another part of the world will impact us. We know that, particularly now with economic globalization and globalization of trade, that what happens in another part of the world impacts us.
There's also the responsibility, which I think is a moral responsibility, for humanitarian considerations when other citizens of the world are suffering and dying in ... ways that can be prevented, that we as a rich nation, we as a nation that is a powerful nation, and one of the leading nations in the world, we do have the moral responsibility to try to help those that are less fortunate. And when I say moral responsibility, I mean global moral responsibility, not just a responsibility to our own citizens.
CNN: What else would you like to add?
Fauci: I think we need to keep our eye on the important picture that although we've accomplished a lot, there's much to do. So, whenever I talk about or discuss HIV AIDS, I always say much accomplished, comma, much to do. And that's exactly where we are. We've accomplished an extraordinary amount over the past 26 years but we still have an awful lot to do. E-mail to a friend