(00:00:00) Paul story produced by the Canadian Broadcasting Corporation and aired originally on their program called Sunday morning on April 19th, Sunday morning is carried in the Minneapolis st. Paul area on ksjn 1330 AM. Dr. Mike osterholm joins us now in the studio. Dr. Auster home is State epidemiologist for the state of Minnesota and has considerable knowledge about what is going on in the AIDS seen here in the state and around our area my comedy AIDS cases. Do we have currently in Minnesota? Do you think just this past week? We climbed over the 200 number so that since 1980 we have had 200 total but more specifically a hundred just in the last 11 months. Mmm-hmm. Now, we have a population in Minnesota of something like 4 million roughly give or take a few hundred thousand here. Are there two hundred or so AIDS patients would you say that aids is an epidemic in the state? I think that by one of the real problems that we have in trying to talk about AIDS in the context of a public health risk is that from the time one becomes infected with the virus until the time that one experiences an illness like Paul did in our piece just now maybe years so that what we're really seeing in terms of those 200 cases is the kind of experience that we had with transmission back in the state of Minnesota in the early 1980s. We estimate today that over 30,000 Minnesota residents are actually infected and that by 1990 and public health terms we look at what are the major causes of morbidity and mortality illness and death and for men under the age of 65. There will be more months of Life lost from AIDS for those men in the 25 to 44 year old age groups and other cause of loss of those months of any other disease in the state specifically will be number two for all men in the state 24 264 only with heart disease having a higher cause Of early death in that group The the numbers for 1990, which is that estimate there will obviously be overshadowed by the number of cases that will occur in 1991 92 93 time period So within a very short time in Minnesota, we are going to see AIDS do what it has done in San Francisco New York and elsewhere. Where do we stand in terms of either a cure for the disease for those who have contracted the virus or a vaccine against it for those who have not let me take the ladder first because I think from a public health perspective again, that's where we look for the future. We're trying to prevent individuals from ever becoming infected at the current time because of the kind of virus that this is and what I mean by that is it has some very unique properties that as virologist or scientists who study viruses concerned us a great deal. We're very concerned is to ever have a vaccine in anywhere in the in our generation and quite clearly It's likely that we will not have a vaccine anywhere within the century. Meaning that when the Surgeon General says that we will hit the year 2000 at least before we even really have any thoughts of a vaccine that will work. I think that's a very realistic estimate Studies have been done already in which we have created a vaccine in other words. We've been able to take the virus disrupt it so it's not alive and injected into animal models such as chimpanzees and we can do that. But the problem is that even though these animals animals such as the chimpanzees develop antibody that that chemical that the body develops to fight off these specific kinds of viruses, even though the chimpanzees developed that when you challenge them with the actual live virus, they become infected and that's a function of the way this virus is so we are going to basically need a whole new type of technology which just isn't here yet that hopefully time will bring but in the meantime, we're going to learn to live with AIDS from a cure standpoint. We have had some advances in this area and I think The piece we just heard with the AZT that that Paul had received. This is a drug that has clearly in some patients caused a slowing down of their illness process, but it is not a drug that will cure them. It's not one that will prevent them from dying with AIDS. And I think that that's again a very pessimistic overview. But in fact, it's the realistic overview my coaster home state epidemiologist who is with us today as we talk about the AIDS problem in Minnesota, and I think we have someone already waiting with the question. Do we not go ahead please you're on with Michael Stern home. (00:04:30) Yes, sir. Good afternoon to you. You just referred a moment ago to the unique properties of the AIDS virus. I think one of those properties that we're learning more about is the fact that it has a high potential for mutation and one of the concerns that medical scientists have the AIDS virus will take on features. That make it more virulent that make more people acceptable to we don't know what that will mean specifically will it for example transmitted through respiratory or salt or through saliva. We have talked about HIV to already my question to you sir is what can the Minnesota Department of Health do? Given the fact that thread is there that's right for change. Hopefully, you know, we're going to err on the side of caution. You people have been. A lot of responsibility and I don't think anybody would say that you have an easy job, but you have been playing some games up until very recently with your cooperation with the gay community and their their interest. That's fine. But you know, everybody's life in the line now, let's get going and you know, I wanna hear some comment about the potential for (00:05:43) change. Okay, let me actually address that questioners comments and in two respects, first of all, let's talk about the virus. This virus does not mutate quickly as the caller suggested in the sense that we think of viruses or bacteria changing into different organisms as such what this virus does is it has an outside coating which is critical in the nature of how you make antibody you try to attach to the outside of the virus and and neutralize it this has a very fluid outer coating that's constantly changing. That's that's very different than the virus mutating as such in terms of the potential for transmission is you'll look at any infectious disease agent, even when there is certain mutations or changes in the agent such as with influenza viruses are others. This does not change the ways are transmitted what it does is it changes their ability to cause disease and unlike what the caller indicated? Almost all infectious agents. In fact, I know of no experience where this is different actually when they mutate as such they actually become less virulent less likely to cause serious disease and that's Nature's Way of having that organism basically come in concert with its host. If the hosts are all dying that agent itself is destined to not have a very long livelihood and so there's an attempt made to to substantiate it we know in for certain animal species, for example, they can become infected with rabies virus and it won't kill the animal that's been an adaption over time so that it maintains the virus and best the same thing will happen with this virus, but will be many generations of humans were looking at some generations down the road in Africa where we now have several of the AIDS virus has identified the caller talked about HIV to and we actually now have several other ones htlv for these viruses are ones that to some degree are the very same as the AIDS virus with very very slight difference are causing the same kind of illness, but In other situations actually, it's the virus that has become more attenuated. In other words. It's actually living in closer concert with the African population not causing disease and that would be the virus that I think with time will show has been around the longest in one that has actually come to be attenuated. As far as the caller is second comment with respect to the Department of Health response. Not just our departments, but Public Health in general, I guess I would disagree with the caller that we've been quote playing games unquote. We were the group that in 1981-82 brought this to the Forefront into this was going to be very serious problem in 1983. We were talking about the possibility of a hundred thousand two hundred fifty thousand cases by the late 1980s and people didn't believe us. They said you're scaring the hell out of people don't say those kinds of things and we've talked about the seriousness of this for a very long time, but I would agree with caller that if it's only talk then you've got problems. We have not and will not cater. You any specific need in the community that is anything other than public health good Public Health in the case of the HIV infection in Minnesota. I think we've taken without a doubt one of the very most proactive Public Health approaches the entire country. We were the first state to make the antibody positivity reportable in the nature of surveillance so that we weren't talking about AIDS cases, but the current infection first aid to set up contact notification, I'll process of helping individuals who are infected notify their Partners the first state to have a Statewide media Consortium developed the first state to have a Statewide risk reduction plan in place a Setter I can go down the list and so I think as a result of that Minnesota has actually become very well known nationally in its efforts to deal with the AIDS issue. I think that I sense from the caller that he was not fully aware of all the kinds of things that have been going on and if you were I'm not sure that he would agree that this is the same issue. I would say that I think that the final thing is There is can be an alarmist attitude which I sense in this callers comments that we have to be very careful about not because we're talking about any one group or any one individual who might be at risk of this in any social comment, but I have a state of neurologists found myself in many occasions spending 10 minutes dealing with AIDS hysteria for every minute that I could deal with AIDS and I think that an overreaction in a way that is not effective that is not going to accomplish the ends of disease prevention is not what we're after and I don't think that they're ultimately the community is really after a brief comment. If you would like on the legislation moving through at the state capital that would allow for confinement of AIDS carriers who apparently continued to engage in sexual activity. Well, actually that bill has gone all the way through both houses now and it has been passed out and it said the governor's desk for Signature. That is an example. I think of again a very proactive effort on our part at the department deal with what is only a very very small. Pardon, the very minor part of the AIDS problem and that is a non-compliant carrier. What do you do with the individual who's in the community who you know very well is infected or you have reason to highly suspect that such as a male or female prostitute and they continue to have high risk activity despite your efforts in a voluntary nature not to have them have that currently in Statute in Minnesota. There's basically a one-sentence line that says the commissioner Health shall do whatever they need to do to protect. The Public's Health. Our attempt here was to basically structure that in in some cases to actually limit it in the way that we can deal with it again. This was an issue not to deny anyone due process, but at the same time protect the public health and so what we've done is added a great deal of definition to what can be done what can't be done. There's been a lot of discussion about this in the community. Unfortunately, some of it has has been discussion, which is not based on the facts. For example, there's been discussion at this now makes contact notification mandatory, which it does not what it actually does is it The contact notification information can't be used in this proceedings. It allows now for a due process for the commissioner to be able to take someone through a series of least restrictive Alternatives consoling and so forth which we've done in some cases and have been very successful. So I think it really is a model piece of legislation that when we do get to the 1990s and we're talking about thousands of cases of AIDS in Minnesota when we still have that rare exception and we'll be there to be used moving on to some more people with questions for dr. Michael stir home today. Hello you're on with him. (00:12:17) Yes. I'm calling in regards to information that my wife was a nurse at a hospital here in Duluth brought home from an AIDS Workshop the pamphlet that was passed out at that Workshop dealt with a new concern about the mosquito-borne transmission of AIDS along the lines of mosquito-borne transmission of malaria, and that the numbers that were given for local cases aids with two to three hundred in the Duluth area, which is equivalent to your number for Statewide. So the Get him out of of cases. And also with the concept of mosquito-borne transmission being considered doesn't that change the attitude from a sexually transmitted disease and those concerns to a more widely potential for infection of the general (00:13:01) population. Okay, again kind of a two-part comment here. I think first of all and talking about numbers. Let me just say that I don't know what the database was for the numbers that your wife obtained when we talk about cases of AIDS. We're talking about people who have diagnosed AIDS which is acquired immunodeficiency syndrome, meaning that they have what we call either opportunistic infections or cancers the opportunistic infections being those kinds of things that normally a healthy individual wouldn't get or if they did it wouldn't be of serious problem that is just the in stage though of what we call human immunodeficiency virus infection or the AIDS virus infection and I would be willing to say that I think in northern Minnesota. There are actually many more than 200 people who are currently infected now, that's the number they were citing. That's one thing if you're talking about AIDS again. I remind you that from the time you become infected until the time you manifest symptoms of AIDS maybe years, so that that's not very helpful to us from a public health perspective to deal with what's happening today with respect to your second comment and mosquitoes. This is unfortunate kind of idea that keeps being batted around out. There is a way to describe what has or what might happen in the future. But actually we have a very very substantial database with respect to the mosquito-borne transmission of this virus and it does not occur. And the reason I say that it does not occur is that before a virus or a parasite can be transmitted in a mosquito mosquito themselves have to become infected and the way that a mosquito transmits the virus for example is in the process of taking a blood meal in this case only female mosquitoes do that taking a blood meal from an individual from an animal whatever that might be infected. The virus is then brought up in ingested and then brought into the mid get of the mosquito only a very very very few specific viruses such as some of the Encephalitis viruses in the case of this parasite. Malaria can will actually then begin to grow in the mosquito and the way the mosquito transmits the Infectious agent then is that the mosquito develops It's what we call a vairy Mia or the virus going throughout the entire mosquito body and it deposits in the fluid that the mosquito uses and injects into you to make sure that the blood continues to flow up that very narrow for viscous of the mosquito though the capillary that the blood comes up if if mosquito did not inject a material into you when biting basically the blood coagulate right away and they couldn't get a blood meal. It's when it injects that material which is also why you get welts with mosquito bites is that you're reacting to that material has been injected unless the Infectious agent is there you can't transmit such as we know. So in fact, we've done extensive work with all what we call the Retro viruses, which is the whole family of viruses associated with including AIDS and several other animal diseases and it's impossible to infect mosquitoes. This data is clearly borne out by the information we have from central Africa there. The disease has been well defined as either sexual transmission number one, which is the primary mode number two, which has become an increasingly important. Mode is that of blood transfusion because of the fact in central Africa so many individuals are still infected with the malaria parasite and need frequent blood transfusions. And because the average cost of screening a unit of blood as in this country is about four dollars and fifty cents for the for the AIDS virus and in when you have a country like Zaire where the per capita Health Care expenditures per year is a dollar and a quarter per person. It's now becomes cost prohibitive to screen blood and so we do have a substantial portion of infected individuals there who are donating blood for purposes of saving in a someone in a more acute episodes such as malaria. Now, we're seeing a lot of transmission with that and finally we had early on seeing some clusters of cases of AIDS in Africa that we couldn't explain in family settings and we thought this does not fit with what we think might or should be happening in terms of this virus what's going on here? Well, it turned out that those clusters of families within families were actually clusters of families. Also who all attended the same Medical Care Facilities. And we were able to find in those facilities that in some cases the same three needles had been used unsterilized for four and five years in a row for many number of different kinds of procedures. And of course now you're talking about a whole different mechanism of transmission again back to the blood into the needle. So to answer the caller's question even in Africa where you'd have the highest likelihood if there were going to be mosquito transmission epidemiologically, none of the data shows that from a standpoint of a laboratory basis the we have every reason to tell you that the mosquito will not transmit this virus. So so that's not going to change the picture at all so we can breathe a little bit more easily about that in - yes in Minnesota relative to mosquitoes right moving on to our next listener. Go ahead. My coaster home is listening. (00:17:43) Hello. The first I would like you to explain what our kids and the second I'd like you to comment on the situation. I had a blood transfusion in 1980 and my lifestyle as such they don't have to worry about AIDS except for that. Although I don't have any reason to believe I have AIDS. I read in the paper a few months ago that they were asking people if they were if they had a blood transfusion within that time frame that they should be checked. So I asked my doctor and he said yes, definitely I should be checked just for my own peace of mind but he's he kindly warned me against getting it at his office. He told me that if I got it there it would go on my medical record and that is what could put me and my whole family in Jeopardy for the rest of our lives in terms of insurance because if we ever had to change insurance companies say on unemployment transfer that insurance company can can see your records. And they can refuse coverage and they don't have to give a reason he told me that I should go to air on an aids clinic and use an alias. I called him a hotline and they verified everything. He said (00:18:59) and let's gonna get Michael's room. Yeah. I'm in on this here. Well, let me first Arc age-related complex, which is a term that we have used in the past. We use it less. Now. These are individuals who have signs and symptoms of the AIDS virus infection such as swollen lymph nodes weight loss night sweats, sometimes chronic diarrhea and in some cases just almost completely debilitated in terms of being able to work every day. Very tired. Very lethargic some cases a memory gaps. So forth what distinguishes these individuals from full-blown AIDS is really just an artificial definition of the difference between whether or not they've had an opportunistic infection and or a cancer that might be related to this we've actually had Who have had only Arc who have become so debilitated physically that they've actually died without ever having an opportunistic infection and cancer. So it's really a fine line definition with respect to your your second point and and I'm not an expert in insurance. And so I want to make that very clear right now at least the Department of Commerce come and take away my insurance license, which I don't have but let me just say that as state acknowledges we've obviously looked at this point very carefully also and I would agree with most of the points that your physician has shared with you. The risk is very very low particularly in your chance of having had blood in 1980. When we look at multiple transfused individuals in the state who got blood in the middle 1980s prior just prior to the Advent of screening even there. The risk is in the neighborhood of 1 to 16 to 1 to 17,000. It's very very low one point. I would make with respect to insurance though is that the fact you have a negative test does not give you the ability to be denied Insurance in this state so that if you really (00:20:45) Were (00:20:46) negative if you were looking at health insurance. That would not be a case life insurance is a bit of a different matter and I really can't even comment on that at all. But I would tell you right now that the health insurance issue is an important one and a number of people are looking into that. But if you were part of a group policy and you transfer to a group policy is you know, right now they're in all cases are no need there is no need for evidence of insurability at that point. If I as a want to change jobs from the state of Minnesota and go to the University of Minnesota different employer different Insurance programs as a group policy. I'm neither me or any of my family members are required to show any evidence of insurability. That is the vast majority of Minnesota residents now in the state either that or through hmos and so that that is not as issue as such and specifically if you had a negative test that would not in any case is be grounds for refusal of health insurance moving on to some more people with questions. We're talking about the AIDS problem today with State epidemiologist. Michael stir home. Hi. Alison now, go (00:21:46) ahead. All right. I have two questions. One of them is what's the current knowledge about which body fluids can transmit the virus. I know blood kin and semen can are there any others that can and the second question is do we know how long the virus can survive if it's in a in a dried state if the fluid is dried. (00:22:06) Let me answer your second question first. This is always one of the more delightful questions to answer about AIDS because I think it surprises people. This virus is extremely susceptible to the environment. In in fact, this virus is much easier to kill than the common cold virus outside of the human body regular rubbing alcohol will destroy this virus quite readily as far as the drying nature of it. The virus also dies quite quickly outside of the human body. It really needs that protective environment. The one difference that we have with this virus that people have a hard time appreciating is that while it's so easily killed outside the human body obviously once it's inside the human body. It's a whole different matter and really raises havoc. Far as the point of what potential bodily fluids a term that public health and other people in the health area continue to use and frankly just frustrates the devil out of general public because they just want to know what the devil is bodily fluids is an exceptionally good question in terms of trying to put the AIDS epidemic into some context in terms of transmission. As you are very appropriately indicated blood and semen really are by far the most infectious of block of of the bodily fluids vaginal secretions and a female rank up there fairly High also, although not as infectious as semen the virus can probably be found and I say probably because we haven't looked at every single little thing yet, but it can be found in saliva. It can be found in tears. It can be found in breast milk. It can be found in in yearn etcetera. The virus can be found in a number of these different fluids, but there are major major differences in the potential for transmission with each of these fluids and let me give you an example. We worked this out with the AIDS virus, but it was really very very nicely worked out. Hepatitis B or the serum hepatitis virus some years ago when the same questions came up and with hepatitis B virus, which is very very similar to the AIDS virus in terms of the potential for transmission. We realized at that time that you can take a tablespoon of blood from somebody. In fact with hepatitis B virus and you can take that tablespoon of blood and you could put it into a railroad tank car saline and mix it up real good and take that table spoon back out and that material was still very infectious for a human. That's how well how far you could dilute it out yet. If you take saliva from that very same individual you could take five tablespoons of it. And in this case chimpanzees are as susceptible to this as are humans and you can use those in the studies. You could take five tablespoons of saliva. You could have the chimpanzee drink it you could Rim it in their mouth with a Q-tip and you actually injure the gums and rub it in or you could cut their hand and rub these 5 tablespoon into the cut and you couldn't transmit. The only way you could transmitters if you basically took the five tablespoons of saliva and injected intravenously into the chimp now, AIDS virus is actually in saliva and a lower concentration is the Hepatitis B virus and while yes semen and blood are very infectious on the other hand. I I do not exaggerate when I say this is a this is a scientific statement. I believe it would take at least 10 tablespoons of saliva injected intravenously in a human before he could transmit. The AIDS virus was saliva. So if you say can it ever happened? Yes, it can the likelihood. Well, there are probably some people out there would do something like that. But in general I think we as a society don't need to worry. So I'd really say it's just those fluids of semen vaginal secretions and blood that are really are the only ones we have really any major concerns about it all moving on to some more folks with questions about the AIDS virus today. You'll go ahead your next (00:25:34) thing that you had on earlier. It was terribly sad, but that two questions for you though. You see we have 30,000 people. Now. How many will we have by the year 2000? And my second question kind of ties into that. What is a sociological impact? I mean, I know there's going to be a lot of money spent taking care of them. But aside from that of having that many young healthy productive people suddenly withdrawn from society, you know, either too sick to work or dead can you know, I realize that you're probably counts but what would that be? (00:26:06) Well, I think that I've stated on a number of occasions and I continue to State it I probably didn't even realize the wisdom of my own words a few years ago. But I've I've said time and time again that I think that aids will tear at the social and moral fabric of this country unlike anything of the century and it's beginning to do that last fall a very conservative group of scientists got together the National Academy of Science Institute of medicine now a group not often known to make outlandish or or very liberal statements and they concluded that aids was very likely going to be the biggest catastrophe of this Century that's given all other things that have happened. And I think that we as look back as a society. We realize a lot of things of great Devastation have occurred in this past Century including a war as a cetera. AIDS is going to be hell and I've said before that what I see with AIDS right now is very very disturbing what I see for the future scares the hell out of me and I think that's true, but I would have to put that in the context again of the fact that we know how AIDS virus is transmitted its transmitted through sex. It's transmitted through blood and it's transmitted from in the one case. It hasn't been mentioned yet from an infected mother to her unborn child. That's it. But that's enough in the society to continue transmission. One of the point that I think is very very important to make is that in this caller referred to this when not necessarily intentionally, I think was they they talked about they I'm telling people right now they need to prepare for this because within a very short period of time within the next four to five to six years This will be touched personally by AIDS will be touched personally not because we ourselves are going to get aids would because loved ones our family is going to find out for the first time that their father that their brothers or that their sons are gay or bisexual. They're going to find out that the needle usage was something that they had no idea was occurred in their family, but it is and I think that we need to as a society realize that this is going to come home to us all of us. It's not a disease of San Francisco and New York. It's not a disease of just Minneapolis st. Paul. It's a disease of the heart land and Rural Minnesota rural Wisconsin. Rural North Dakota. Rural South Dakota roll, Iowa all going to know AIDS and so I have to emphasize that what AIDS is bringing to us as a society are the very two issues that we hate to talk about the very most not Sex and Death and it's basically bringing them together in one marriage and I think that that's a very difficult thing for society. Our generation will not be remembered. I'm convinced for any number of things that we often think. (00:28:45) Will (00:28:45) be remembered for including nuclear war will be remembered for how we deal with AIDS given the disastrous impact that you are that you are talking about here. Why not make some sort of mandatory testing screening of people either when they enter high school or college or prison or marriage or whatever the case might be making sure that there are some safeguards for individual liberties, of course, but why not screen people? Well, actually I would be all for that if it was really going to have an impact, but in fact the mandatory screening is such that you all the ones you just mentioned won't and let me give you some examples recently the issues come up with premarital testing in this state each year. Roughly 70 mm or 36,000 72,000 people 36,000 couples get married. If you look at the whole area of the AIDS virus Transmission in who's currently infected not looking at AIDS. Now, let's look at the studies that we've been doing and I don't think again much of the general reader listeners here may be aware of the fact that we've done extensive kinds of studies in the population in looking at the risk of this infection. We really would pick up very few if any of those 72,000 people is positive. First of all, if the AIDS virus is going to be transmitted. It's almost universally going to be transmitted through sex in that situation. Well, if how many gay men are getting married particularly at that, so that's one issue. Maybe they were bisexual and maybe some heterosexual but the problem is is that if they're gay picking it up from sex before marriage they're going to be infected before they ever come to premarital testing. It's too late to pick them up then if they're not sexually active at all, and there's no reason to test him. So the person you're going to have to really count on a picking up in the premarital setting would be in the marital setting where you have a very sexually active partner one of the partners very sexually active and one not at all and there's no relationship prior to marriage so you can see the utility. There is one that just wouldn't work. Now one could argue well, but you're very concerned about the infected mother transmitting to The Unborn Child and a very legitimate concern one that we've looked at very carefully maybe premarital testing would help with that. Well, if you look to see where the infected children are today out there, who are they born to they're born to unwed mothers who don't have prenatal care at all and present to the hospital at 9 months of pregnancy and there tend to be IV needle users. They tend to be of lower socioeconomic status. So again premarital doesn't have any impact there. So I would agree with you that the kinds of measures that we need are those which are going to really have an impact because this is serious, but we have to think through those and decide what are going to be the Swayze and in I don't mean just best ways and what's going to be convenient. What's going to be one that will be not cost a whole lot of money. I think right now AIDS deserves all the financial attention that we can possibly give it at the same time though spending that money wisely. I mean, there's no reason just to submarine everything out there in terms of finances and and not really have any impact. So again from a state perspective here along with what we've done here and what's been done by the Surgeon General and others and looking at these issues. We have I think identify the ways that we're really going to have the most impact among sexually active adults right now that's going to be getting is those people in to be tested whether they're married or not among our youth it's going to require a whole new process of looking at education and youth and I don't think that we have a right as Society anymore to deny our youth sex education and deny them the right to know about how HIV virus is transmitted what they can do to prevent that that's where we're going to really make our most impact. We have a little less than 10 minutes. With my coaster home. Let's get as many people on as we can here. Go ahead your next with a question for him. (00:32:28) Hi, thank you. Thank you. I think you're doing a wonderful job and I just have a short one when a person is infected and comes into contact and one of the several matters that we've discussed. How long does it take for the infection to manifest in this person's blood chemistry, you know? (00:32:49) Okay. Thank you terms of the antibody which is what we look for today. One of the things that I mentioned earlier in the program we talked about vaccines is the fact that you can make antibody against this virus and it's not protective. Well, in fact because the virus is in such a low level in the human body, even though it's doing all this very damaging kind of work. It's difficult to pick up the virus itself without very costly and extensive testing. So what we do is we look for the presence of the antibody and in almost all cases in humans within six weeks to about 12 weeks following your You will develop the antibody to this virus the vast majority of will probably be within six to eight weeks that then tells you that you've been not only exposed which some people continue to refer to this as but you've also become infected and because this virus has the unique ability to take part of its genetic material and insert that into the host cell genetic material it basically immortalizes itself. So once you become infected you are basically infected for a lifetime and how soon can you pass the infection on then within weeks yourself weeks, right? Okay. All right. You have a question for Michael Strahan. Go ahead, please we're talking about AIDS today. Go ahead. (00:34:01) Hi. What other legislation do you see coming up or would you like to see? (00:34:07) Well, actually I think that we've come into this epidemic from the Minnesota perspective. And in what I would consider very very good shape. We have good Public Health Law's in general with the exception of the non compliant patient, which we've now taken care of from the standpoint of financial support and basically basic support to the department. I think the Minnesota Legislature has been exemplary in that area. They really have have attempted to deal with the issue as a public health issue and not a partisan issue. I think last week's presentations that several of us gave to the Minnesota Senate was a historical moment. Not only for state government for but for the United States to have a public health professional State epidemiologist be asked to spend an hour and a half lecturing to the Minnesota State senator is about AIDS in so forth. There has been real attempt on the part of the legislature to educate themselves and to act in an informed Manner and so I think right now with basic support for programs with The appropriate oversight to know that the funds are being spent wisely that the public health practices are sound. I think that that's what's really needed. I don't see any new initiatives that will be required in the in the very near future from a public health perspective moving on to some more people with questions for Michaels to home you're on with him now. Go ahead. Please (00:35:27) get that girl to whom he referred earlier to the idea that transmitting the AIDS virus by insects or body and sex was with absurd couldn't happen possibly. You should be aware of report filed with the Paris Academy of Sciences, August 21st, 1986, but Professor Jean-Claude Clermont the study pointed to precisely what you said could not (00:35:48) exist. Can I just buy this caller is on here? That's not correct. Let me correct that misconception. Okay, the study done by Sherman, which I'm very aware of and have worked with dr. Sherman in know exactly what the study is that the point that I just made earlier that when an insect takes a blood meal in this case the Sceeto in and brings the blood up into the individual. So in the mid got of the mosquito the viruses there and it will survive within the mosquito for several hours before it completely dies. Now the mosquito doesn't take another blood meal for days many cases 20 to 30 days later. And by that time everything is completely gone. No time is the mosquito become infected. What dr. Sherman's work showed was that yes virus does get up in the mosquito. But in fact, no, it doesn't grow there. That was a report that was not fully covered by the media the media basically just covered the one part that says it's found in mosquitoes. In this case. He also looked at simex, which is the bedbug. Dr. Sherman actually sent two days after this news media information came out a very sharply worded statement to the media saying you have completely misconstrued what I have said, this is what I said, and I said that although we would have predicted the virus does get into the mosquito. It does get into the bed bug it does not survive and it will not transmit. The report that you are aware of were very aware of that report and that study has been by the way substantiated now by least three other research groups. All right, let's lay that issue to rest and move on to another callers concern. Go ahead, please you're on with my coaster home. (00:37:20) Yes, it was earlier mention of Africa and and the transmission of the virus which is infected the population to a large extent and it was discussion about children and that they were possibly getting this virus from clinics where they were attending. Well as I understand the virus has infected equally among the adult and the younger population of Africa. So if we're going to say that the children are getting this sexually are going to a clinic I don't I don't understand the logic that there has to be some other way where these children are getting the virus and I believe that it that is through the the (00:38:02) insects. Okay again, let me reiterate the the data on the insects. I've already stated that. Not yet in terms of the children. There are there are mechanisms that I talked about the children are getting the virus. Number one is from their infected mother. That's by far the number one route of transmission right now from infected mothers, by the way. I might add that the virus is not widespread through Africa as we would think of it is particularly heavily concentrated the urbanized areas of Africa. In fact several good studies recently shown in rural Africa where life styles are very different in sent in the urbanized areas. It's not showing the same penetration at all in the heterosexual in central Africa in the urbanized area. It's not unreasonable for a female or a male who are not serving as prostitutes to have 40 to 50 sexual partners a year. So that that's a very different situation than we see here with respect to the second aspect of white children get it not only from their infected mothers, but also they pick it up from the blood transfusion issue that I mentioned earlier and that has been a big concern children are the ones that are most likely to get malaria because either malaria kills him at a very young age where they have the protection against malaria that's inherently genetically there. So, That the transfusion problem is acute in children Which is less of a problem in adults. And so that the other transmission can be there several very very well-done studies recently completed by the World Health Organization in conjunction with the Centers for Disease Control have very clearly substantiated that that we can explain exactly why these children are picking it up when I referred to the needles. Let me again remind you that far too often. We think about disease transmission from an American culture standpoint in central Africa needles are often used for many many different medical practices that are not used here for children and adults and so that the the opportunity for injection. So forth is very real. Let me give you another case in point among individuals who have sexually transmitted diseases there which are because of the number of partners are frequent the average Pharmacy, which is called a chemist over there will sell penicillin for just pennies the same needle we may be using that Pharmacy for years without ever changing it and so that the person who is also likely to Cap HIV from sexual transmission is also likely to contaminate any of that needle and so if somebody does come along as an adult and has not previously been infected may become infected from the needle, dr. Foster home. I'm afraid we have very suddenly run out of time. This has been very interesting very informative. Thank you for coming and visiting with us today. Thank you very much.