Dr. David Satcher on 20 years of AIDS

CNN Moderator: Welcome Dr. David Satcher to CNN.com Newsroom. We are pleased to have you with us today.

Dr. Satcher: Hello. I'm very pleased to be with you today as part of our recognition of the 20th anniversary of the detection of the AIDS virus in this country. I think it's an appropriate time to pause and reflect.

CNN Moderator: AIDS was once thought to be strictly a homosexual disease. Which groups are most at risk today?

IN-DEPTH It's been 20 years since AIDS was recognized. How far have we come?     MESSAGE BOARD AIDS prevention     ALSO Read a transcript of Jennifer Kates, of the Kaiser Family Foundation, discussing American attitudes toward AIDS and HIV     RESOURCE The Surgeon General's HIV/AIDS Web site

Satcher: Well, it is true that at the beginning of the AIDS epidemic it was a disease found primarily among white gay men in this country. That did lead some to think of it as a gay disease. It was even referred to as GRIDS -- Gay-Related Immune Deficiency Syndrome. However, over the years, it has become clear in this country and over the world, that the AIDS virus can be spread homosexually and heterosexually in the presence of unprotected sex. But it can also be spread through any other means that transfers certain body fluids from one individual to another. So people who inject drugs and share dirty needles are at increased risk for AIDS, and certainly AIDS can be transmitted from mother to child during pregnancy and delivery. Having said that however, in this country men having sex with men still represent the predominant mode of transmission of the AIDS virus. But globally, almost 80 percent of the AIDS cases are transmitted heterosexually.

Question from chat room: What is the current survival rate among AIDS patients?

Satcher: We actually don't know. We know there are people who have been living with this virus now for more than 20 years, but we don't know how long they can live. We still view AIDS as a fatal disease, despite the tremendous impact of antiretroviral drugs.

Question from chat room: What more can be done to sensitize the African-American population that AIDS "ain't no joke"?

Satcher: Number one, I don't agree that the African-American population views AIDS as a joke. The Kaiser Foundation studies would suggest that African-Americans and Hispanics are more likely to view AIDS as the nation's number-one health problem than are other groups in this country. Likewise, African-Americans and Hispanics are the only ones who view the epidemic as becoming a more urgent problem now than in the past. Despite this concern, however, AIDS has become increasingly an epidemic of people of color and of women and the young in this country. I think the real question is: How do we get clear prevention messages to populations that are most marginalized in this country, those people who are most likely to be pushed aside and uninvolved in our day-to-day deliberations and who don't see themselves as being important or valued? Young gay men are difficult to identify in our population, because they don't identify themselves. That is especially true of young gay men of color. Because of the stigma surrounding homosexuality, young gay men of color, as well as bisexual men of color, don't always admit to themselves the nature of their sexual orientation, and they certainly do not admit it to other people, including their partners, in the case of bisexuality. So the real challenge is to find a way to motivate this population to change their behavior.

Question from chat room: Dr. Satcher, why is it that drugs that are known to help AIDS patients are too expensive for most people who need to acquire them?

Satcher: If you were to ask the pharmaceutical companies why they charge what they charge, their general response would be twofold. One, they would talk about the investment that it takes to bring a new drug to market. Those figures go as high as $500 million or more. Two, they would talk about the need to recover their costs in order to continue to engage in research to produce new drugs. I think a real question here is: Do we as the general public recover the costs that we invest through NIH and other federal agencies in research to produce better drugs, and whether this public investment should not allow a more public involvement in the cost of drugs? Most of the time when we talk about the cost of the AIDS drugs, we focus on the difficulty that the most impoverished countries, such as sub-Saharan Africa, have in accessing these drugs. However, of the 900,000 estimated people living with AIDS in this country, only one-third are on antiretroviral drug therapy. Another one-third know that they are positive for HIV/AIDS, but are still not on treatment. And another one-third (300,000 people) are infected with the virus and don' t even know it.

CNN Moderator: What is the current state of AIDS vaccine research? I have heard that several research programs have shown promising results.

Satcher: It is true that several programs have shown promising results toward the development of an AIDS vaccine. And as we speak, there are Phase III (late-stage) AIDS vaccine trials taking place in different parts of the world. Most of them are supported by public agencies or private foundations in the United States. However, most experts would agree that we are probably still more than five years away from an AIDS vaccine. This is a difficult virus, because of its ability to mutate or change.

Question from chat room: How safe is our blood supply? Some people with HIV can have levels so low in their blood that it is not detectable, so how can the blood supply be considered safe if you can't detect it?

Satcher: I think our blood supply is probably the safest in the world, and certainly much safer than it was in the early 1980s, when over half of the hemophiliac population was infected through blood transfusion. Our blood supply is not perfectly safe from the AIDS virus, but the risks are very small -- such as 1 to 2 per million. We continue to do research to further reduce the risks of spreading the AIDS virus through the blood supply.

CNN Moderator: Do you have any final thoughts for us today, Dr. Satcher?

Satcher: One point I want to make is that as we come to this 20th anniversary of this epidemic -- now pandemic -- we may be dealing with the worst infectious disease outbreak in the history of man. Already, almost 60 million people have been infected, and more than 22 million people have died from AIDS. This is a global problem that demands a global response. And just as globally, the AIDS pandemic has tended to concentrate in the most impoverished developing countries in sub-Saharan Africa and Southeast Asia. In America, our epidemic has become increasingly concentrated among the poor and disenfranchised and marginalized populations. The challenge is to reach those populations with information, motivation, and mobilization.

CNN Moderator: Thank you for joining us today, Dr. Satcher.

Satcher: Good bye. It's been great being with you on this very important and sobering occasion.

Dr. David Satcher joined CNN.com Newsroom from Maryland. The above is an edited transcript of the interview on Monday, June 04, 2001.

Check out the CNN Chat calendar
Post your opinion on our message boards