Looking Behind Closed Doors, Private Guys - AIDS

Ray, welcome. Glad you're here. Let's give Ray Ponce a hand. Good evening. Can you hear me okay? Okay. It's a real pleasure to be here this evening. And thank Jay for inviting me to speak a little bit. What I do is I am a specialist in infectious diseases. And what that entails is a little bit of training. I'm an M.D. I went to medical school in Philadelphia. I did training in Philadelphia after I completed medical school. I did a residency in internal medicine for three years. And then following that, I did a few more years of training in infectious diseases. What my job entails is primarily I see patients who have problems with infections or fevers. And most of the patients I see are referred from other physicians. So I really do more of a consulting type of business. I work with a number of other physicians in my same field. I'm also involved with some teaching. I give lectures. And I'm on the faculty at the University of Pittsburgh School of Medicine. But that's just a little bit about me. I know many of you don't know who I am. So I thought I'd fill you in a little bit. Tonight, we're going to talk about AIDS. And what I'm going to talk about AIDS are a few things. I certainly can't tell you everything I know about it. And we in the medical world don't know everything there is to know about it. I have to be quite honest about that. So I may not have all the answers this evening. But I am going to try to tell you a little bit about what AIDS is. I'm going to tell you how it's spread. I'm going to talk a little bit how we might be able to prevent AIDS and try to stop the epidemic from increasing. I'm going to talk a little bit about what the future holds in the medical world with AIDS. And finally, Jay asked me to talk a little bit about my perspective as a Christian and a physician and some of the ways that I perceive AIDS and perceive those people who are infected with the AIDS virus. Now, AIDS really is the first infectious disease that is fatal, the first epidemic of a fatal infectious disease that we've seen in our generation. Certainly, it's not the first one that's occurred in mankind's history. There have been many, many epidemics of infectious diseases that have been fatal and have been incurable. But in today's world of modern medicine, this is really a novelty to us that we have an epidemic going on and we don't have a cure. And it really is quite disconcerting and it is quite devastating, particularly to those people who have it. But there have been epidemics of plague through the Middle Ages. Christopher Columbus took an epidemic of syphilis back to Europe, which ravaged Europe. In 1918, we had a worldwide epidemic of influenza, which killed many, many people. So, epidemics have visited us and have created havoc with us throughout man's history. This is really nothing new. We don't have to go too far back to see that this has happened in the past. But AIDS is something new. It's a new disease on the face of the earth that has come to visit with us, something that people before our time, before our generation, did not have to deal with. Can I have the first slide, please? I'm going to show a few slides. Can I have a second slide, please? This slide, I'll read it to you because it's probably going to be the hardest one to see. It says, A worldwide AIDS epidemic will become so serious that it will dwarf such earlier medical diseases as black plague, smallpox, and typhoid. That's from a former Secretary of U.S. Health and Human Services, Dr. Otis Bone. And that's true. This slide is an old slide from the mid-1980s and certainly his prophecies come true. Can I have the next slide, please? This is a photograph of the AIDS virus. This is the cause of the AIDS disease. This is the culprit. This is a virus which did not exist, as far as we know, before the mid-1970s. I don't have it, but other people have blood samples that go back to the early part of this century. So they can actually tell. When we discover a new disease, we know if it was around before we discovered it. We know that when we discovered Legionnaire's disease, the Legionnaire's disease has been with us as far back as we have blood samples to test for. That goes back to the 1900s. We know that most of the diseases we've discovered have been around. We just didn't know about them. We were not smart enough to know about them. There are other diseases that do exist today that we have not yet defined. We'll discover those. We'll know if they've been around or not, too, because we have these blood specimens. We know that this disease is something new. Where it came from is anybody's guess. I'm not going to get into that tonight. Next slide, please. I don't know the answer. This slide just shows you the ever-increasing number of people who have come down with AIDS. Now, in our country, there are well over 200,000 people, and that's probably an underestimate of people that have developed AIDS. Can I have the next slide? I only have one slide ahead. Let's go back to the other slide. Can you go back a slide, please? For every person who has AIDS, who is sick with the HIV virus, and that's the name of the virus, the human immunodeficiency virus, there are many others who are not sick. The incubation period, on the average, is six or seven years. Those people feel perfectly fine and may very well not know that they have it. I'm going the wrong way here. It's all right. Let me tell you what that virus does. You can hold it right here. This is fine. The virus infects a certain cell of the body called a T-cell, a T-lymphocyte. That lymphocyte is very important in controlling the immune system of a person. Once that T-lymphocyte goes haywire, the immune system follows suit. Your immune system will not work anymore if those particular T-cells the virus infects don't work. Unfortunately, this is a huge problem because this virus loves to infect those T-cells. It goes in, and there was a slide earlier that showed a little line going down. That's what happens to the T-cells in a person over time. They become infected, and gradually the number of T-cells goes down until their immune system isn't working anymore, and they start to get various unusual infections, various unusual types of tumors. That's how we found out about AIDS. We found out in 1981 that there was a group of patients, young men who were homosexuals, who developed a very unusual type of pneumonia. This pneumonia prior to that time had only occurred in very sick individuals with cancer who were on chemotherapy, and it really shouldn't be happening to this group of people. That's when we found out about AIDS, and we started to see more and more of these cases develop. This slide points out the fact that, and this is from May of 1985 in the Wall Street Journal, but what it shows you is the tip of the iceberg. In May of 1985, we had 21,000 people with AIDS. We have about ten times that many now. At that time, they estimated 1 to 2 million people had been infected with the virus. That was an overestimate. There's probably over 1 million people today, but in May of 1985, there's probably less. But even so, most people infected don't know about it. They go through their daily routine not knowing that they have it. Once they're infected, even though they don't know it, even though they have no symptoms, they still have the virus in their bloodstream, they have the virus in their body, and they are capable of transmitting it to others. And that's the bad part, is that many people are transmitting the virus today. Most of the transmission going on is going on by people who don't know they have it in the first place. This slide shows how long it takes after you're infected with the virus before you become sick. And the average is about seven years. That's the slide on the left. You see that line going up, and on the bottom is years. You may not see it in the back. It can be anywhere from seven years, but it may be longer than that. It may be shorter than that. Some people may be six months. Some people may be 12 years. We really don't know how long people can go and be asymptomatic since the disease hasn't been around that long. But we do know they can go a long time. But 50% of people that become infected, it appears today that 50% of the people will have the disease AIDS by the time six or seven years is up. Next slide, please. These are just some of the infectious diseases. There are some big names. That one on the top is a certain type of pneumonia, and that's the one that is the most frequent killer in AIDS patients, pneumocystis pneumonia. And that's the way AIDS was first recognized. Next slide, please. Okay, this is a funny type of tumor, skin tumor, that occurs in patients with AIDS. And this was one of the earliest things after that pneumonia that was first noticed, that young men, homosexual men, were coming down with this type of tumor. It's called Kaposi's or Kaposi's sarcoma. I'm not going to quiz you after this. You'll have to remember these things. But they get these lesions, and not only does it go on the skin, but unlike the way we ever knew about this tumor before, which was always limited to the skin, now it invades the internal organs. It goes through the lungs and the liver and creates all kinds of problems. Next slide, please. Now, this slide is interesting. This is the most recent slide from the Centers for Disease Control showing the distribution of people who develop AIDS. And you can see the largest part of that circle, which is over half, 57%, are homosexual men. Now, it used to be that that was around 80% when the AIDS epidemic first started, and it has shrunk. And the reason it has shrunk is because homosexual men have become well-educated about the AIDS virus and have taken precautions and have really changed the way they behave. Not many years ago, there were bathhouses where they had anonymous sex and all kinds of immoral things were going on among homosexual men. Today, those places are out of business. These guys have learned that they cannot do that anymore, that they are killing themselves off, and as a result, through education, that percentage of the pie that has AIDS has shrunk. But other percentages have gone up. The other big group is IV drug addicts. IV drug addicts are 23%. That is increasing. The homosexuals can learn, but the IV drug addicts do not change the way they behave. And as a result, they have increased in their part of the pie their percentage. The other group that's increasing is heterosexuals. Heterosexuals are 6% on this. This is an 89. That's one of the fastest growing. That's one of the ones that I see more and more of. I saw a patient today, just today, came back with a positive test, and I see patients, I generally now have two or three patients any one day in a hospital with AIDS. This patient, I didn't think that he had it, but we did the test, and today we found out that he was positive. His only risk factor is that he had five sexual partners in his lifetime, heterosexual partners. So we're seeing that happen. I know of three teenage girls that live in a town nearby here that have become infected with the AIDS virus, 18 years old. They will probably be dead within five or six years. So this part of the pie is getting bigger, and it is something that is obvious concern to us. Heterosexual relationships can be quite dangerous today, and that's something that we all need to take to heart. Transfusion recipients have shrunk drastically. Most of these are left over from the pre-blood screening days. All the blood since 1985, March of 1985, is screened. The chances of getting it from a unit of blood are much less than the chances of you getting killed on your way home tonight driving your car. So his blood supply today is very safe. It's not 100% safe, but it's really close to it. Next slide, please. Okay, now how is AIDS spread? We talked about sexual contact, and certainly sexual contact between homosexual men and between men and women is an effective way to spread the disease. This is the way it is spread the majority of the time, and that's what we need to know is that this is a sexually transmitted disease. The other way it can be spread is through needle sharing. Those people who share needles and abuse intravenous medicines, intravenous drugs, can spread it through that way. That is the primary way that health care workers get the disease is by sticking themselves with a contaminated needle with blood. Fortunately, that doesn't happen very often, but there have been a number of cases where it has. A mother, if she's infected, will infect her baby up to 50% of the time. So if a mother is infected with the HIV virus, she has a 50-50 chance that the baby that she has will be infected. Blood transfusions, as I mentioned, have shrunk drastically in this country, but in developing countries, in Africa, for instance, this continues to be a problem. They can't afford to test all their blood, and it's still a problem in other parts of the world, but not here in the United States. Next slide, please. Okay, now I get a lot of questions on how you can catch the virus. Some people ask about mosquitoes or insects, and the answer there is no. They've done studies on this, and if it happens, it has to happen so infrequent that nobody will ever find out. So don't worry about the mosquitoes. You can get Lyme disease from ticks, but you're not going to get AIDS from a mosquito. Next slide. You can't get it from your hairdresser. People ask me about hairdressers. You can't get it from your hairdresser. Next slide. You can't get it from plates, from silverware, from toilet seats. You just can't get it from inanimate objects. You get it through sexual contact, and you get it from blood. Those are really the key ways that the disease is spread. Next slide, please. Okay, now we talked about what AIDS is and talked about how it's spread. What I want to do is talk a little bit about prevention. I think we can have the slides off. That's my last slide, and let's just remind me it's my last slide. So let's turn off the slides. Bring up the lights, please. Let's talk a little bit about prevention and what we can do to prevent it. Well, obviously, if it's spread through sharing needles, we want to not share needles. Certainly, abusing drugs, intravenous drugs, is something that we don't want to do, and it is very risky to share needles with anybody. And if anybody is contemplating it or knows anybody who does it, this is one good reason to try to quit. And it's easy for me to say to quit, and it's harder for people to do it when they're addicted. So you have to realize that there are many people out there who abuse IV drugs who want to quit, and I see those people all the time. But it's an illness. It's an addiction, a physical addiction, where it's very difficult for many to stop. The other thing which affects many more of us is sexual relationships. And, you know, there's quite a bit of talk about safe sex. What is safe sex? Well, I want to tell you right now that the only surefire way to keep from catching a disease is to not have sex, to abstain from sex. That is the only surefire way. Now, we can talk about safe sex, and I'm sure that many of you have heard about the use of condoms and barrier contraceptives to decrease the spread. And it does decrease the chances, but it doesn't bring it down to zero. The way I look at that is, I think of that as a car with and without an airbag. If you're in an accident, the chances of dying are less in the car with the airbag, but you still can get killed. So that's just to say that condoms are not the answer if you want to be sure about preventing transmission through sexual relationships. All right. What does the future hold as far as the medical world is concerned? Are we going to have a cure for it? We certainly have medications. We have many medications now that we treat our patients with that help the patients. And we can make our patients live longer. We can keep them at work longer, give them a more productive life and a better quality of life. But we still do not have a cure. And when we're talking about that, we're talking, we can make them live longer by a period of months, not even a year, with drugs like AZT and other new drugs that are available. So we're far from a cure. Many researchers don't feel that a cure will ever be obtained. And one of the reasons is because that virus I showed you, when it infects your body, it takes its own genetic material and puts it right into your genetic material, into your own cells. And that means that you can take a drug and wipe out all virus and you still can produce more virus from your own body cells. This is a real major obstacle to getting a cure for AIDS disease. So we are not looking. I doubt if we're going to see a cure. If we do see a cure, I certainly can't see it in the near future. And many other experts agree with that. The biggest hope is a vaccine, that a vaccination can help to prevent people from getting it who have not yet been exposed to the virus. But there's a lot of problems with this virus in developing a vaccine, and nobody is yet ready to come out with a vaccine that's going to work. There's a whole lot of problems, technical problems. I can't get into those problems, they're too technical. But it's going to be very difficult to develop a vaccine for the AIDS virus. The last thing I want to talk about, probably the hardest thing for me to talk about, this is all very easy stuff because it's all straightforward, but how should we as Christians, and how do I in particular as a Christian physician, look at patients with AIDS? And it's very hard not to be judgmental. It's very hard not to be prejudiced against many patients who develop AIDS because they come with obvious sin in their life, IV drug addicts. Certainly many people are prejudiced against homosexuals, and certainly it's my feeling that homosexuality is also a sin. But all of us are sinners, and I think we need to know that. The Scripture says that all have sinned and fallen short of the glory of God. And we need to be careful about judging. And the Scripture tells us also, Jesus himself said, Judge not, lest you be judged. Now I take that out of context a little bit, but I think we need to be very careful about judging. We have to think that in God's eyes, is IV drug abuse any worse than materialism? Or is homosexuality any worse than pride? I mean, all of us have some sin in our life, and God knows it. We know it. Scripture tells us that. There's no question about that. Anyone who looks honestly at themselves knows that they have sinned. So I think we have to be careful about judging that. Now, these are not unforgivable sins, according to Scripture. These people can be forgiven by God, be brought into God's graces, and I think that's important. Now, the other thing we have is, we have Scripture, God's Word, that tells us, We know that there were social outcasts. We know that there were lepers. Lepers were unclean. They couldn't be around regular people. They were unclean in many ways. Ceremonially unclean. And how did Jesus approach them? What did he do? He made specific instructions to his apostles to cure the lepers, to cure all kinds of sickness. And I think it's my job, particularly, and all of us, to look on people with compassion and to try to help them, and to think that this patient is no worse than J. Passavin. If he comes into my office, an infected male, he's a sinner too. And I have to look at them and say, I'm not going to be judging them. It's not my job to judge. It's my job to have compassion, as Jesus had compassion. And that's hard. I can say that up here today, but I don't always do it. And I can tell you that people in my office don't always do it, and we backslide. But I think that, scripturally, that's what we should be doing. The other thing that's hard to rectify and to think about, you know, is this God's judgment on us today, the scourge of AIDS? And Jay's going to talk about this a little bit. But we look at people. I have seen people in terrible straits. I have had a patient. I've had a number of patients that are just heart-wrenching stories. I know a woman. When I was doing teaching when I was at Presbyterian Hospital, a woman came up to me and said, you know, her husband was dying of AIDS. He was a hemophiliac. And hemophiliacs now, all the blood products are screened for them, but they were one of the highest groups of infected people. Most of the hemophiliacs got infected in the early 80s because they took all these blood products and pooled them together. Well, her husband was a hemophiliac. He was dying of AIDS. Her baby, she had been infected with the virus and her baby had died from AIDS. I mean, she's worried about him dying and how long is it going to be. Meanwhile, she's infected and doesn't know how long she's going to live. So, you know, it's, you know, you can't judge somebody like that. You know, God loves her and God loves all of us, the scripture says. And again, those are some of the things that I think of. And the other thing is the prejudice and the stigma associated with AIDS can be devastating to a family. I know another case of a schoolteacher. The schoolteacher was, oh, late middle age. He had a heart surgery done one month before they started screening the blood, one month before, in February of 1985. And that gentleman contracted AIDS from that blood transfusion. Now, his immediate family, and the way he presented, he presented with dementia. His mind was going. And this was a man who prided himself on his intellect. And this was very devastating to his family. His family didn't want to tell, the immediate family wouldn't tell all the family members because they were worried about judgment, that they would be outcasts of the family because this guy contracted AIDS. It had nothing to do, he didn't have, it wasn't of no fault of his own. But again, I think we need to be careful. We need to have compassion. We need to have the love and compassion that Jesus would have in the same situation. You can't see Jesus throwing his people out. He came to save the sinners. And that's the way I look at it. But in any case, those are some of my thoughts on AIDS. I'm going to give Jay some time up here and at the end we'll take some questions. I think we'll go ahead and take some questions now. Just to mix it up a little tiny bit, I think we'll take some questions now for Ray because as his information is fresh in your mind. Okay. So if you could stand and let me slip the microphone so everybody can hear. I'm Chris Allen. My question is growth rate. We saw the curves heading up. Are they heading up? Is that rate increasing or is it starting to fall over a bit? That's a good question. The rate of climb is decelerating. And it was accelerating, accelerating and now it is kind of plateauing. It's still on the increase but the rate of increase is going down. So that's the answer to your question there. Rick? My name is Rick Brennan. My question is what are the reasons for and against being tested? My feeling is that if you at all suspect that you could be infected, you should be tested. And the reason for that is because we have things to offer people who are infected and asymptomatic. We start people on therapy now before they become symptomatic, before they develop any signs of illness. We follow those T cell counts I talked about. And if we institute medication before they get sick, we can make people feel better and live more productive lives. And that's the reason to be tested. And that's probably the most important reason to get tested if you're at all suspicious that you might be infected. And you can go to the county health department. They will test anybody free of charge and anonymously if they wish. What would be a reason to not be tested? Well, a reason to be not tested, if you're going to get a life insurance policy, there will be one reason there. I mean, you could talk about people have lost their insurance, have lost their employment, have lost their job, or employment obviously, but have lost their housing because they're tested positive for the virus. And living in today's world, people are afraid to be tested because of the stigma associated with a positive test and the way it can impact them socially and economically. Okay, good. Ron? More recently, there's been a lot of controversial talk on the spreading of AIDS. Some suggest that it's even been on Christian radio and TV. And I believe Pat Robertson was one show that had a brief program on it that passionate kissing and so forth and through the body saliva and body fluids that it sometimes can be transmitted. And there are so many arguments about it. What is your answer to that? That's not a good question. Tough questions coming up here. Can AIDS be transmitted through less intensive contacts and more casual contacts such as kissing? Deep, heavy kissing. Okay, let me correct that. Real deep, heavy kissing. There's a guy at the University of Pittsburgh. His name is George Pazin. He's an infectious disease guy like myself. He's very much into deep, passionate kissing as a possible cause for transmission for AIDS. I can tell you that in the saliva, and I don't want to downplay this either, but in the saliva, we know how much AIDS virus there is in the different bodily fluids. That's something we can measure. The saliva and almost all body fluids will have a few blood cells in them. And inside the blood cells are these lymphocytes, which are in the blood. And they get into all the body fluids to some degree. So you can find virus in saliva if you look hard enough. The amount of virus in saliva is many magnitudes lower than it is in other bodily fluids, particularly blood, semen, those kind of fluids. There has been one documented case in the medical literature of an impotent elderly couple who has felt that the wife contracted the virus from kissing. There is no other case that I know of where it's happened. I am going to tell you that it can possibly happen. Theoretically, it is possible. In actuality, it is probably extremely uncommon. But again, this is one of the fears about condoms and the way condoms may not work is that, could it be transmitted through passionate kissing? Theoretically, yes. Does it happen very often? Very, very rarely can it happen. But again, it is a possibility theoretically. That's true. And there may be one documented case to date. And when there is one case, there are probably others that haven't been documented. Okay, yes. So you are asking was the disease intentionally caused? It was intentionally caused. I have seen and read about different theories about how it's been caused. Probably the ones I read about more are in Africa where they were doing research on vaccines in Africa. And in Africa, it seemed to develop earlier in sub-Saharan Africa than it did anywhere else. But no one knows for certain how the disease got started. And could it have been something that developed in a laboratory as a mutation? Was it a natural mutation? Was it just God's judgment? I don't think, I certainly don't know the answer to that. You are going to hear all kinds of stories. But are they based in fact? None have proved out that I know about. So I would say that's a story. It could be true. I can't say for certain. But I would be very doubtful about that. I would be doubtful about any story unless I heard it backed up by other people. Okay, over here. The question is when a person gets infected, how long will it be until they begin to feel some of the symptoms? That can be, again, very variable. And it's extremely variable from person to person time-wise. Now, some people will feel sick right after they're infected. They'll get like a mononucleosis type of illness that will last for a period of a few weeks and go away. And they'll be fine for months or years until they start to get the usual symptoms with AIDS. Now, what are the usual signs and symptoms of AIDS? Various things. One thing is the lymph nodes swell up. So you may have your lymph nodes swell up. You can feel these glands in the necks and other parts of the body. They may swell up. You may develop fever for no obvious reason. You can develop certain types of thrush or vaginitis, particularly with yeast as one of the earliest symptoms that won't go away. It just keeps coming back. And then many, many, probably the most common way that it will present itself is with a certain type of pneumonia called pneumocystis pneumonia. That's the most common way it presents itself. But some people, I've seen all different things happen. Some people feel perfectly fine, and all of a sudden they're sick with AIDS and they have pneumocystis pneumonia. Some people just kind of dwindle and they have diarrhea. They have sore throats. Their lymph nodes go up. They have fever. They go on like this for months and months and months. They really don't have AIDS yet. They have what's called ARC sometimes, AIDS-related complex. And there's other classifications. But it's very variable how different people present, and it's hard to predict, but they can present many different ways. Right from the time that the final stages of AIDS begin, about how long is the life expectancy? Okay, once somebody develops full-blown AIDS, how long do they usually live? As I said, the medication you give now can prolong their life maybe six to eight months on the average. But probably 50% will be dead within 16 months or so, and by two years, it's up to 70%, 75%. Some people can live on for five, six, seven, eight, nine years with AIDS. That's the minority. Most people, the majority will die within two years of the onset of the illness. Okay, one more question on this. I want to have a few minutes, and then we'll come back. The question is, can you have the disease? Let me rephrase this question. Can you be infected and have a negative blood test? Is that what you want to ask me? And the answer to that is yes. The blood tests are good, but what the usual test looks at is to see if you have any antibodies in your system to the virus. Now, it takes your body a while to develop antibodies to any type of infection. So most people, when they're infected on day one, they aren't going to have a positive blood test until a few weeks go by. Most people will start to have positive tests within four to six weeks. The majority will develop them within four to six weeks of the first infection, the usual test. There's other kinds of fancy tests that can catch it even earlier, but the standard test, the cheaper test, will give you this. There's a short incubation period. There's a very rare few people, few percentage, that don't test positive over a longer period of time. So that can also happen. It's like anything else. There's no hundred percents here. But the great majority of people will become positive within four to six weeks. Okay, well, thank you very much. Let's appreciate that. I'll use that microphone. Why don't you all stand for just a moment. We're going to come back and give Ray a few more moments to answer some questions. I want to just bring a couple of observations. So if you learned one thing tonight, lift your hand up a little bit. Okay, all right. We'll put the other one out there and praise the Lord then, too. All right, go ahead. All right, thank you. Okay, go ahead and be seated again. If you brought your Bible tonight. Whoa, whoa, whoa. Tim. Tim. Just sit down. What is this? Are we going to go play volleyball now? No, no, no. In a few minutes. Personally, I'm his boss. I mean, that's the way it goes. Well, turn your Bibles to Romans 1. There we go. Thanks, Ray. Yeah, real quickly, shoot those outlines up. I don't know if I'll be able to really do justice. But I notice people are looking for some paper. Here's some paper to write a few notes on. I'll synthesize what I was going to say and just do it in about 12 or 15 minutes so that we can end with a few more questions and have some prayer. But look at Romans 1. I want to talk about what is God saying in Aids. Can we look at that? It says, verse 18, The wrath of God is being revealed from heaven against all the godlessness and wickedness of men who suppress the truth by their wickedness. Since what may be known about God is plain to them, because God has made it plain to them. For since the creation of the world, God's invisible qualities, His eternal power and divine n