Video: Texas human trafficking epidemic among worst in nation

Video: Texas human trafficking epidemic among worst in nation


 >>Mark: WELCOME BACK.  JUST ABOUT 9:23 MONDAY MORNING.  JANUARY IS NATIONAL SLAVERY AND  HUMAN TRAFFICKING PREVENTION  MONTH AND FEDERAL LAW  ENFORCEMENT ARE USING DIFFERENT  CAMPAIGNS TO RAISE AWARENESS.  >>Leslie: ACCORDING TO THE  HOTLINE.  IN 2016 THERE WERE MORE THAN  7600 REPORTED CASES OF HUMAN  TRAFFICKING AND 650 OF THOME  WERE IN TEXAS ALONE.  >>Mark: LAST YEAR THOUSANDS OF  PEOPLE CONTINUED TO BE VICTIMS.  TIFFANY WARE HAS LOOKS AT HOW  TWO AGENCIES ARE NOW  APPROACHING THAT ISSUE.  >>I DRINK, I DO WHATEVER DRUGS  HE HAD JUST TO LIKE CLEAR MY  MIND SO I WOULDN’T THINK ABOUT  IT.  BECAUSE AT THE TIME, I FELT  LIKE HE WAS PERFECT TO ME.  >>Reporter: THIS WOMA RECALLS  HOW SHE BECAME A VICTIM OF  HUMAN TRAFFICKING.  >>HE WOULD TELL ME HEY, YOUR  MOM DOESN’T LOVE YOU, NO ONE  LOVES YOU BECAUSE THEY ARE NOT  LOOKING FOR YOU.  >>Reporter: SHE SAID SHE SPENT  NIGHT AFTER NIGHT IN DIFFERENT  HOTEL ROOMS WITH DIFFERENT MEN  HELD AGAINST HER WILL AND  BEATEN.  THIS IS JUST ONE EXAMPLE OF HOW  THOUSANDS OF PEOPLE HAVE FALLEN  VICTIM TO HUMAN TRAFFICKING.  >>HSI LOOKS AT THIS  INVESTIGATIVE DISCIPLINE MORE  FROM A VICTIM CENTRIC  PERSPECTIVE.  WE HAVE DOZENS UPON DOZENS OF  VICTIM ASSISTANCE SPECIALISTS.  >>Reporter: SPECIAL AGENT IN  CHARGE SHANE FOLDEN SAID THEIR  BLUE CAMPAIGN IS A DRIVING  FORCE IN FIGHTING HUMAN  TRAFFICKING.  EDUCATING THE PUBLIC IS PART OF  THAT CAMPAIGN, INCLUDING WHAT  TO LOOK OUT FOR AS WARNING  SIGNS.  >>A RESTRICTION OF MOVEMENT OF  INDIVIDUALS OR INDIVIDUAL  DEFERS TO SPEAK OR AN  INDIVIDUAL HAS VERY, VERY FEW  POSSESSIONS.  >>Reporter: OVER AT THE FBI,  THERE ARE CRIMES AGAINST  CHILDREN FOCUSES UPON CASES  INVOLVING MINOR, PARTICULARLY  RUN AWAYS.  >>ONE OUT OF EVERY FOUR RUN  AWAYS WILL ACTUALLY BE  APPROACHED BY SOMEONE TO  TRAFFIC THEM WITHIN THE FIRST  48 HOURS.  >>Reporter: EACH YEAR, THE  FBI’S CROSS COUNTRY OPERATION  FOCUSES ON RECOVERING UNDERAGE  VICTIMS OF PROSTITUTION AND  GETTING THE PUBLIC’S ATTENTION  TO THE EPIDEMIC OF SEX  TRAFFICKING.  WHILE TECHNOLOGY AND SOCIAL  MEDIA CONTINUE TO PLAY A BIG  ROLE IN THIS ISSUE.  AGENCIES HOME THEIR MESSAGE AND  ACTION CONTINUE TO REACH AS  MANY PEOPLE AS POSSIBLE IN  ORDER TO SAVE LIVES.  >>VERY TROUBLING STATISTICS  THAT STATE THAT WITHIN FIVE  YEARS OF BEING TRAFFICKED, A  MINOR WILL START EXPERIENCING

Epidemic Trailer


The pill you talk about gets rid of all pain. Physical, or emotional… but what is the price? These pills… they’re supposed to keep the eternal pain away… TO LIVE but…I think the fact that we can’t feel the pain… IS TO kills us inside… SUFFER. That’s what’s going be what ends us.

Fentanyl In Hull: Deadlier Than Heroin | Drugs Map Of Britain

Fentanyl In Hull: Deadlier Than Heroin | Drugs Map Of Britain


It is just like,
just like heroin, yeah. But ten times stronger.
Yeah, it’s really strong. In the last six months, I must have lost a good
12-14 friends on fentanyl. It’s too dangerous. Everybody
seems to be going over on it. I overdosed. I said, “Look,
I’m never doing that again”. The next day, I was,
I was bang right back at it, do you know what I mean? Fentanyl is taking the opioid
epidemic to a new level of urgency. America is in the midst of declaring
a state of national emergency in response to their
current opioid crisis. One of the key drivers of this
is a powerful synthetic painkiller called fentanyl. The substance has now been linked to a recent spike
in overdoses on UK soil. The majority of these cases
have been found in Yorkshire and the Humber. We travelled to Hull to meet those
affected by this lethal drug. Say on a scale of one to ten, heroin’s a 2
and fentanyl’s like an 11. It’s like… It’s like going
from being slapped with a pillow to hit by a train,
do you know what I mean? I reckon… I reckon we’re just a small… ..percentage of what… what it actually is. It will be here, there
and everywhere. It won’t just be a small amount
here and now, and then it’s gone. My dad passed away.
My mam passed away. My nan and grandad, like,
they left me. They moved to Scarborough, so… I’ve been on my own since. Why do you think they left? I don’t know, to be honest.
I was only a kid. They didn’t really do much wrong. When you’re a kid and you’ve
got no rules, a lot of things what you shouldn’t
do or shouldn’t have done, you start doing,
do you know what I mean? And… I don’t know.
It just gets worse from there. The National Crime Agency says that
60 people have died in the UK in the past eight months after taking the
painkilling drug fentanyl. It’s 50 times more potent
than heroin and is the drug that was linked to
the death of the rock star Prince. About six months ago, right,
I actually come across it, not looking for it and not
realising, but I tried it, and it-it blew my
head off, to be fair. Like I said, it’s just
so strong, honestly. It’s really, really strong. Quite recently, a lot of people
think it’s gone for good and think they
can’t find it but it’s, like… I know where it’s coming from.
I know where it is. I know how to get it.
Not everyone does any more. But, yeah, yeah, it’s still there. Is it still out on the street? Yeah, definitely.
It’s still on the street. It’s definitely out there, yeah.
Definitely still out there. Yeah, definitely. 100%. I’ve lost a lot of good mates
to it this year. Yeah, it’s not, it’s not good.
It’s dangerous. Seven or eight of my friends
are dead already. It’s dangerous. And so were people
worried when it first came in? And what were you excited about? Do you think the dealers worry
about killing people? Back in February, I became aware
of what I felt were an increased numbers of
potential drug-related deaths. It was probably the end of March, we started getting some of the
toxicology results coming back in, where these drugs,
which were new to me, were getting named
in the toxicology reports. Now, we’re probably looking at
about a third, very crudely, about a third from those reported have come back with fentanyl,
carfentanyl. Yeah. Yeah. It’s only Luke. Can I meet you for one of each? Does it look the same as heroin? Yeah, but slightly… Like, a different colour brown and it’s got a slight red tint
to it when you cook it up. That’s fentanyl on this foil. I used to smoke it, like him. Once you try it the other way,
then it don’t compare. It’s not the same. Smoking, it’s more… It creeps up on you more, I suppose. Like, it takes time to get your,
your buzz, whereas injecting, it’s instant, straightaway, so… It’s not that I’ve stopped caring,
but… I’ve given up…given up a bit. And I think to myself,
at the end of the day, like… if I weren’t here, if I did die,
then, I don’t know, just… I wouldn’t have to worry
about anything any more. Like, I am ashamed of what I do,
but, at the same time, I feel like I can’t stop. I won’t need any more for… ..say, 6-12 hours. So I won’t rattle, I’ll feel fine. Like, the main buzz,
I’d say, lasts about… 20 minutes, if you’re proper smashed
and you’re on, like, a big hit, to a couple of hours. Feeling…itchy, though. Just really itchy. Fentanyl is a CNS depressant. Essentially what happens is that you
get the respiratory depression, you get the sedation,
you get the drowsiness… and the next thing you know,
their colour will begin to change. They turn blue. The blood pressure
will begin to drop. The pulse will begin to drop. And they have difficulty
breathing on their own and managing their own
cardiovascular system. You get the people who, because
of their length of use, they’ve been using drugs
for so long, and have developed high tolerance
to whatever it is that they’re using regularly, they want that additional buzz
of something else. I still feel it, don’t get me wrong. But if that was heroin,
I would have got, like, a tiny amount of that feeling
and then, like, that would have been it,
do you know what I mean? So… I was an heroin addict and I went
to score a bag off somebody. They never told us
that fentanyl was in it. We took it. I walked round the corner
and I collapsed and my face hit the pavement. I nearly died. There is a cohort of vulnerable drug
users out there who, on a daily basis,
will find funds from somewhere, go and buy drugs, take drugs. And as we found recently,
people are literally dying, taking what they’ve been taking. Excuse me? Couldn’t ask you
a favour, could I? Erm, like, I’m homeless
on the street, yeah? I’m literally just trying to get
some change together for some food. I don’t suppose you could help me,
could you, please? Thank you. It’s been a bit rough this year. Erm, I’ve been staying
in a few doorways, but I’ve got myself
a sleeping bag now, so… I’m laughing. I just need to get
a couple of quid together so I can go get some fenny and that. Couldn’t ask you a favour, could I? I don’t… I’m homeless
on the street, yeah? I’m literally just trying to get
some change for something to eat. I don’t suppose…?
I ain’t got any money on me. Now we’re aware of what’s out there,
we are asking more questions and we are trying to work
with our intelligence team or to ask who’s bringing
these drugs in. When you look at routes
into any system now, when you look at, say,
the World Wide Web, when you look at where Hull is
placed, on the end of the A63, M62, it’s easy to come to. People have been going to areas of
Hull where they felt they will get, in their view,
the better quality drugs, referred to as “the strong stuff”
or “the better gear”. After a swift response
from the National Crime Agency that resulted in a number
of operations across the UK, the availability of fentanyl in Hull seemed to have dropped off
considerably. Yo! Yes, Stan.
Yes, Mac. In spite of this, Luke was still able to find a dealer
that could sell him the drug. You all right? I don’t know the original source,
no, but like we’ve said, there’s three main people, three
main people in Hull who are… who are doing it,
who are getting it. It’s like there’s a, it’s like
there’s a secret underworld going on, do you know what I mean?
People don’t, people don’t see it. Who I’m going to ring, they didn’t have it,
whereas they’ve got it now. Yo, easy, Johnny, Ryan,
can I meet you for one of each? Yeah, man, same place, yeah? Yeah, all right, I’ll be there
in two minutes. Cheers, my man. Boom! Sorted. Let’s have a look, then. How far along are you now?
Three months. Yeah? So you don’t know if
it’s a boy or a girl yet, do you? No. No. What do you want? Girl. Girl. I had a little girl. Did you? Yeah, yeah.
She’s cute, innit? Yeah? Yeah, man. Do you know what,
honestly, though, I’m proud of you and that. So next time you have the next scan
photo and it’s a boy, you’ll have to show me, won’t you?
Yeah, I will. Yeah, man. Here, give us a squeeze.
Anyway, I’m going to chip you. All right, see you later.
Look after yourself. My little girl ain’t
going to want to… want to have a dad who’s on gear and fentanyl and crack. It’s fucking, it’s not-not a life
for her, do you know what I mean? How can I set an example? How can I set a standard? How can I…
How can I be right for her? I can’t, you know what I mean?
I just… I just can’t be. What you saying, darling,
you all right? Yeah, you all right? Not too bad.
How are you? I’m not bad. I’ve just won the lottery, you know. Have you? Yeah.
Get some nice gear then? Get some nice gear.
You know it, girl. I’m at the track now. MAN ON PHONE: All right.
All right, safe, brother. Nice one. Get my shit now. Give me two minutes.
I’ll pop around this corner. I know quite a few addicts, yeah,
what inject and that, and really, every time
they’re injecting, really, they’re just wanting to die,
hoping that they go over. But don’t. So they’re out for
the next day, doing the same again. It just comatoses you,
throws you to the floor. And it could be six to eight hours,
if you are all right, to come back round. It’s ridiculous. £20. £20 for that. How long is that going to last? Well, it’s going to fuck me up
instantly, but… What are you doing there? Putting it under my tongue,
because obviously class As, if coppers stop me
and it’s under my tongue, I can swallow it straight away. So it’s gone. It’s a regular occurrence these
days, yeah. They seem to be bashing
the heroin with it, selling that a lot better
than what it has been selling. So, yeah, dangerous stuff. Some people don’t like it, like. Since it disappeared,
everyone was, like, “Oh, fucking… I don’t want it,
I don’t want it”, because they seen what it
was doing to people, but, like, I can’t lie. I love the shit. And I mean love it. This is one of
my good friends, Terry. We’d been aware of fentanyl, largely
because of what was happening in parts of Europe
and in North America. We first probably became
aware of that in this country in around late March. Towards the end of April this year, we issued our alert to make
the health care system aware of the situation,
and also drug treatment services. Yeah, I am fucking young, like. Do you know what I mean? I’m fucking, because there’s
not many people fucking… Well, people call me a bairn. There’s not many bairns who do it. Why do you think there aren’t many
bairns that do it? It’s one of them,
through fear I suppose. How long have you known Luke for,
then, Terry? And have you seen him change much? Yeah. Fucking hell. Bad sleep last night. Thank you for that, Terry. You’re all right mate,
get on with it. Do you feel better?
Yeah, much better, mate, thank you. Sit and have a smoke now. I’ll see you later on. Another day living the dream. Just off to the hostel, going to see
if I can get my room sorted. It’s like, running a bit late
and that, but… That’s what I mean, my priority
should be one thing, but your priorities go
out the window, do you know what I mean? I know there’s a lot of people
that are addicted to it now, where they would only buy
that with fentanyl in. And I look at them and I say,
“Well, I wouldn’t”. So basically they’ve got actually
addicted to the fentanyl. They’re not addicted to the heroin.
They are addicted to the fentanyl. There’s a good 10-12 people I know
that just want the fentanyl now. I don’t think I’ve heard about it
for over six weeks now. It seems to have dried up. That’s my experience. I don’t know whether they are
using and not telling us, or is it just that it’s longer
available for now. How come you’re late for the hostel? Because my habit’s got in the way. Are you worried about
it coming back? Obviously. That would be the trend. You get periods
when the batch comes in, people use them
and then it dries up. And then it comes back again. Don’t say it again. You needed to have been here earlier
to do the paperwork and everything. It’s only my…
I have to be here, though, because it’s like my thingy address,
my bail address. I have to be here. My name’s Luke, my name’s Luke. After six o’clock,
we don’t move people in. One of the concerns is also, like, how long your offending
history actually is. Because from what I can gather, your probation, like, is included
in on a fair amount of it. You need to come back tomorrow
any time after ten, speak to the manager, and then
we can go from there, all right? All right. What’s the verdict, Luke? Not so good. I’m banned from most of the hostels
because I have rent arrears, a lot of fighting, etc. It feels like I’m always
waiting for something. It’s like a full-time job,
having a habit. Because, like, you’ve got to get
the money for it, or you feel shit. Then you spend half your time
running around, trying to ring up. Then you spend half your time
running around to get it. Then the rest of your time you spend
trying to find somewhere to do it, especially when you’re homeless. After spending two weeks in Hull, it became clear that the current
batch of fentanyl had run out… ..but there were still fears
from the authorities and the people we talked to
on the street that the problem could
resurface at any time. I think we always need
to remain vigilant, and if it’s not fentanyl,
it could be something else. So we need to make sure
that treatment services, that the harm reduction
messages are right, and that we are ready to respond
if it comes back on a larger scale. Does it ever get easier doing this,
Luke? No. It doesn’t, ever. It’s just fucking… It’s just the same shit, different
day, you know what I mean?

Epidemic “Rainy Dayz” Feat. LMS (Produced by Jesse James)

Epidemic “Rainy Dayz” Feat. LMS (Produced by Jesse James)


Epidemic “Rainy Dayz”
Monochrome Skies Produced by Jesse James “What they have said is that I have no ambition
at all. I feel myself sincerely, I don’t [have] ambition [for] power, money,
nothing, only to serve…” Yo Sometimes, you just feel like you got no
ambition left Rainy days, we give ’em too much credit sometimes,
know what I mean? Gotta get up Verse 1 (Hex One) Yo I’m getting sick of just star gazing
I’ll start paving the way to chase what my heart’s craving
While others covet money and start changing Some of us just love the bizarre painting
of struggling and hard straining The troubles trying to make it through God’s
training Under the sun we just play the part of a small
raisin The thought of leaving your mark’s tainted
when it starts raining It’s product is living with scars ain’t it?
So if life’s a battle then that’ll be what is leaving your jaws caved in
So are we on a mission? Listen, who knows They say that death’s the intermission through
souls So while you’re sitting there convinced
That your condition got you living too cold Just think, there’s probably many different
loopholes That conviction you chose, made you sink and
got you thinking you froze But yo, just know from that affliction you
rose kid, and made it through See that’s what happens, you evade what’s
true (When?) When overestimating what the rain can do,
this shit is crazy Chorus (Tek-nition)
Raindrops hit my window pain, it ain’t the same
But I search, just hoping for change Leaving a stain in the night skies
But something gotta keep me sane in this lifetime, yeah Raindrops hit my window pain, it ain’t the
same But I search, just hoping for change
Leaving a stain in the night skies But something gotta keep me sane in this lifetime,
uh Bridge (Tek-nition)
First the rain drops, then the night falls Wonder will the pain stop from watching the
light crawl Right up in the same spot, that’s when life
stalls Then the sun sets, we gon’ be alright y’all Verse 2 (Tek-nition)
I had dreams of being the richest poet (I did)
Dripping oceans out of my pen because my gift is golden
But I admit it feels so different, don’t it? (It does)
Travel throughout these ups and downs and these mixed emotions
Different strokes, my life’s a bitch, to find a niche is just a bonus (For real)
Knowing I got to borrow, and I’m sick of owing (Sick of that shit)
I’m inches from homeless, feel intense while holding this eviction notice (Another one?)
Shatter the glass of serenity with my last step
While trying to take a jab at divinity as I gasp breath
Breathe, huzza, you can just get a new job, ’cause 11 dollars an hour is too hard
Dealt a hand with a few cards, when an obstacles easy, that’s when it’s too odd
‘Cause my life wasn’t always jazzy as Utah Shit but hey, well that’s me just trying to
find the perfect rhyme to coil With reality ’cause no one else can search
inside it for you Will pain stop a person? Time will show you
Til my veins rot, I know the rain drops can only fertilize the soil Chorus “You know, it all depends on when the battle
is done, Who’s the last man standing” Verse 3 (LMS)
It feels like I’m living the beginning and the end of it
Life through a kaleidoscope without a slight of hope
Nevertheless I’m not resenting it Because my life is in my hands and I’m the
one that’s penning it So before you say it’s inspired you, I’ll
say don’t mention it How many times has it been I’ve shown and
proved and defended it I rep my city regardless if anyone’s remembered
it ‘Cause when the time is on, that’s my moment,
I own it, nigga And you know who else will remember it? My
opponent, nigga These rainy days in Dade County, man they
stay around me Even the thoroughest niggas within my hood
see I keep faith around me I said faith around me, if you ain’t notice,
g That’s exactly why Chico niggas clutch and
rock a rosary On my block it’s supposed to be, the only
cop that’s close to me Is the one putting on my handcuffs, I stand
tough and know it’s me Against the world, between me and you, man
the difference is I just don’t care enough about you to notice
the differences All I notice is the sea level rising
‘Cause in this world, man, no man could possibly be an island
The rain is a symphony, the shit’s haunting it rearranges
I’m just glad that in my city the weather constantly changes, feel me? What you have just witnessed, is the strength
of street knowledge. These rainy days are an epidemic, and I am
the one and only LMS. Hex One, Tek we out. Its real out here ya
heard? Lets go! Special thanks to Youtube user Abstractded

The Early AIDS Epidemic in the United States: Views from Atlanta and Hollywood

The Early AIDS Epidemic in the United States: Views from Atlanta and Hollywood


Booker Daniels: Good afternoon, everyone. How are you today? Outstanding. I’m Booker Daniels. I’m a member of the staff at the Division of HIV/AIDS Prevention at CDC. It’s my esteemed privilege to be somewhat moderating or just introducing these incredible individuals for this panel session today. The title of our session today is The Early AIDS Epidemic in United States Views from Atlanta and Hollywood. And throughout the course of the conference there will be many sessions where people say there are two individuals that don’t require any introduction. These two individuals certainly do not. But I will introduce them, nonetheless. Seated to my right immediately is Dr. Harold Jaffe, Associate Director for Science at CDC. And prior to this role he served 27 years as most notably as a medical epidemiologist and part of the initial AIDS investigation team and a former director of NCHHSTP. We’re also joined by Dr. Jim Curran, who is currently the dean of the Rollins School of Public Health at Emory, Rollins University, Rollins School of Public Health at Emory University. Prior to this role, he had a career at CDC for 24 years and he was the initial director of the Regional AIDS Task Force on the initial outbreak of the epidemic. With that, I’ll turn it over to the panelists and we’ll get underway. [Applause] Harold Jaffe: I wanted to thank Booker for the kind introduction. I thought he was going to say: If there are two people who shouldn’t be introduced, it would be Jim and me. But it’s a pleasure to be here, and it’s a pleasure to be on this session with Jim who played such a key role in the investigations of the early history of the AIDS epidemic. I guess the first question is why should you care? What difference does it make what went on 30 years ago? And I guess I can think of a few reasons. First of all, judging by the looks of at least some of you, you were too young to have remembered this epidemic and may not have been born. So this is a bit of a history lesson. Secondly, for those of you who are physicians but only have cared for AIDS patients after the mid-1990s, this is a reminder of what a terrible disease this was in the pre-treatment era. And, thirdly, I think this is an important illustration of the power of epidemiology and the epidemiological method to understand a new disease, to understand how it’s transmitted and even prevent it without even knowing what the cause is. So we’re going to try to do this both through a lecture, which I hope is going to be more or less factual, and also clips from this film “And The Band Played On.” It’s less factual but I think it’s helpful in understanding the main events of the time. The film was released by HBO in 1993. And it was based on the book of the same name published in 1987 by Randy Schultz, who was an openly gay reporter for the San Francisco Chronicle, and very sadly died of the disease himself. The film uses actors, I think some of whom you’ll recognize, playing the parts of real people. And Jim Curran is one of the real people, and I’m going to be periodically asking him to make comments as we go along. So here I’ve listed some of the main characters you’re going to see in the film. Obviously many, many more people were really involved, and the movie, I guess, picked people for dramatic effect. The roles of some of the people, particularly Jim Curran and Don Francis, are quite distorted. Again, I think for dramatic purposes. The film starts with a scene from the intensive care unit at UCLA Hospital in the fall of 1980. This scene was of special interest to me because I trained in medicine at UCLA and had left just six years before and had spent many nights in that intensive care unit. So let me show you that first clip. [Video] >> Thank you. Thank you very much. Thank you. Thanks very much. Thank you. >> Doctor? >> Here we are. [Crowd cheering] >> No T. cell count. I’ve got to tell you, Dr. Gotlieb, this is weird, man, he doesn’t have any. >> How can he not have any T cells? >> His immune system’s gone. [Typing. Phone ringing] >> Good morning. Good morning, Dr. Gotlieb. [Knocking on door] >> Can I talk to you for a minute? I just got this in the mail from our man in LA, Dr. Shandera, got it from a Dr. Gotlieb, I think you ought to look at it right away. >> Jim, looks like there’s a very weird epidemic breaking out among gay men in Los Angeles. There have been five cases of pneumocystis with no contributing disease within the past few months and already two fatalities. Plus I made calls to New York San Francisco and it seems they’ve had similar cases. I think this ought to go into the weekly newsletter as soon as possible. What did you do that for? >> I don’t decide what goes into the newsletter. I can only recommend. But, Mary, we’ve got a new administration; you want to see this published so people can read it, or do you want to see it killed? Harold Jaffe: Well, the article was in fact published, but it didn’t even make the cover of the MMWR on June 5th, 1981. As mentioned in the film, the article described five young previously healthy homosexual men who were treated for biopsy-proven pneumocystis pneumonia at three hospitals in Los Angeles. Two of them had already died. These cases seemed very unusual in several respects. First, virtually all previous reported cases of pneumocystis in the United States, at least in adults, were in persons with an obvious cause of immune deficiency such as an organ transplant recipient or someone receiving cancer chemotherapy. But these men did not have those risk factors. Secondly, it was a mystery as to why they were all homosexual men and, third, why were they coming from Los Angeles and possibly San Francisco and New York. So let me first ask Jim for his thoughts when this article was published. Did you cross out the title? Jim Curran: Well, as cute as the guy is, I’m not him. The context, Ronald Reagan was elected President over Jimmy Carter, and it was very high inflation and unemployment. And there was an immediate domestic hiring freeze and a travel freeze on CDC staff. We were fortunate to have a mentality at CDC where everybody wanted to work on the new problem. And this was a new problem. So there was a lot of enthusiasm among the staff. But very little money and inability to hire new people. So the context was a very dire economic environment in which to study a new problem. But the CDC was a fertile place to do it. It’s always painful to watch movies. The real history behind the MMWR was that there was a clerk named Sandra Ford who was handling requests for pentamidine-isethionate, which is a second line drug to treat pneumocystis. She noted some requests which had almost always been in people with cancer, underline immune deficiency, coming from requests for people with no underlying disease in New York and California. Called attention to her supervisors in the Parasitic Disease Division, and they couldn’t get any information out of New York. They were trying to hold the information back, and Dr. Gotlieb, Dr. Wayne Shandera, the EIS officer and others, accumulated the information and sent it into CDC to the Parasitic Disease Division. The title and stuff had already been decided actually by the head of the MMWR at the time, Mike Gregg, before Harold and I saw it. It was kind of delivered to us and we were asked because we had been studying hepatitis B and hepatitis B vaccine in gay men in the STD division, to talk to our contacts in the gay community. So, in fact, we actually at the time would be maybe the only part of CDC other than parts of the hepatitis division that had any programmatic context and contact with the gay community. And it should have been left in homosexual men. Harold Jaffe: Just a month later, the mystery became even more mysterious. Let me show you the next clip which depicts a CDC staff meeting. >> Okay. What we’ve got in Los Angeles, San Francisco and New York is a number of gay men who have been hit with a variety of opportunistic infections and really that’s all we know. I’ve asked Don to join us because for the last three years he’s been tracking hepatitis B virus in gay men and before that worked on the ebola fever epidemic in Africa. >> Thanks for joining us. >> What we’ve got to do is hit the phones, spread out and contact all the departments in all major metropolitan areas as usual so they can do a hospital-to-hospital search for cases. >> Make sure of the epidemiology. >> Talk to the patients, talk to doctors who may have treated those patients, friends, relatives. No question too stupid or too personal. >> Sexual relationships, too. >> Household chemical cleaning, diet. >> Could be a bad batch of street drugs. >> Pets. >> Maybe they all got the same kitty litter. >> John, I’m going to go to New York this afternoon, take a look at this disease. Can you come with me? >> Sure. >> If I knew these blotches would turn purple, I would have brought some bags to match. Here. Look at my book. When I was still human. I was the best in the business. Ask anybody. Leave it to me to get some disease nobody ever heard of. Kaposi’s sarcoma. Even my doctor had to look it up. Nothing to worry about, he said. Usually happens to Italian men in their 60s who continue to live a normal life until they die of something else. Do I look like an Italian man in my 60s? Now I do. 160. Why do they make things like this that nobody can ever solve? Harold Jaffe: So just a month later, July 1981, we started to hear about young men with malignancy Kaposi’s sarcoma. Some had also developed pneumocystis pneumonia and others had other forms of opportunistic infections, things like cerebral toxoplasmosis or cryptococcal meningitis. Now up until this time Kaposi’s sarcoma was a very rare disease in the United States. It had been described about 100 years earlier by the dermatologists Morris Kaposi, and the disease he described was one that had a male predominance. And typically occurred in men age 70 or older. Based on cancer registry data, it was estimated that in the mid-70s there were only three or 400 cases occurring each year in the United States. When it did occur, it was most often in men from southern Europe, Italy, Greece and those of Ashkenazi Jewish ancestry. The disease that Kaposi described, which is called classical Kaposi sarcoma, looks just like this. It’s a typically kind of raised plaque lesion, most often on the lower extremity and progresses very slowly. So if you read the textbooks at the time, they would say that an elderly man is more likely to die with this disease than from this disease. What was being seen, though, in these young gay men, even though pathologically or histologically — thank you very much — nice to have a moment of levity during this. Pathologically, you couldn’t tell the difference, the two forms of the disease looked the same, but clinically they’re quite different. The form that was being seen in these young gay men was much more aggressive. So here’s a man with these multiple skin lesions. If you saw them in clinic one week he might have two or three. A few weeks later he might have ten or 12. And a few weeks later he might look like this. And the disease was not limited to the skin. So here’s an example of a patient who has an oral lesion. These same lesions could be seen farther down in the gastrointestinal tract. They were seen in the lung and they were vascular. They could bleed. So some patients were actually bleeding out into their lungs or into their intestine and dying of the disease, which was extremely rare before the AIDS epidemic. Now there was a clue in the literature. If you look at the cancers that occur in people following organ transplant, particularly renal transplants, Kaposi’s sarcoma occurs at increased frequency. In contrast to what we were seeing with these young gay men, there’s no male predominance. And the most interesting feature is that there are case reports where it was possible to either taper the level of immune suppression or actually stop the drug or the disease would go into remission or sometimes even disappear. So there was clearly some very tight link between the immune system and this malignancy, although at the time we really didn’t know that was. Early in the summer of 1981 we were getting case reports simply by physicians calling us and saying: I think I saw one of those cases that you’re interested in. And we would very dutifully write down all the information we could by hand and stick it in a file. That was our system. And at that point we said, well, that’s not really very good, is it? We really need a national surveillance system. And to do that you need a case definition. So we made one up. Notice that the disease was not called AIDS at the time. It actually had no name. We were using KSOI for Kaposi’s Sarcoma Opportunistic Infection. The case definition that we made up said that we wanted to know about individuals who had proven Kaposi’s sarcoma or one of about a dozen severe opportunistic infections. We weren’t interested in this form of Kaposi’s sarcoma in the elderly. So we said patients less than 60. And, of course, we excluded anyone who had a known form of immunosuppression. So we made this definition available to major teaching hospitals, oncologists, infectious disease specialists and health departments. We said if you see a case like this please report it to your health department who will in turn report it to CDC. So let me ask Jim at this point what your thoughts were kind of in the middle of the summer of ’81. Jim Curran: I think in retrospect, one of the most important things that was done was the development of this case definition, which was highly, highly, highly specific. We knew it was insensitive. And we made a bunch of iceberg slides and sent them around saying that this was only the tip of the iceberg. But these conditions were so uncommon and they required, in the case of pneumocystis, open lung biopsy at the time to make a diagnosis. It required a pathologic diagnosis for both Kaposi’s sarcoma and the infections. And they were so rare in the developed countries that you could be sure that this was going to be part of this new epidemic. And that allowed us to determine whether a new case was part of it or not part of it, whether it was occurring only in gay men, was it occurring only in New York and California, and ultimately led to the definition — I mean, the determination of the epidemiologic patterns which led to prevention recommendations and convinced virologists and others that this was caused by a blood-borne and sexually transmitted virus. Harold Jaffe: Let’s move ahead to a little bit later in the summer of 1981. [Video] >> Do you have many gay friends? >> Not too many, no. Two doctors I know in medical school, I still stay in touch with them. >> Are they a couple? >> Yes, actually. 15 years. >> Kiko — Kiko is my lover — we have a wide circle of friends and most of them are in relationships, or want to be in relationships. >> So what are you saying? >> Lots of men go to these bathhouses, but there are tens of thousands of gay men in this city, maybe a couple hundred thousand, cops, and waiters, and teachers and lawyers and ditch diggers and athletes. >> Don’t talk loud, so they can’t hear you down the block. >> I’m sorry. I don’t mean to lecture. I just don’t want you to come away from your tour of the bathhouses thinking that’s how all gay men live. >> Last night we lost another one. In three weeks this handsome young, guy turns into the elephant man. We found out it was caused by some rare parasite that only sheep get. So I called a vet to ask what they do when sheep get it. They shoot them. >> Good luck. Thank you. >> Hi, Bill. Madrid Department of Public Health. >> Let me see if I can find the boss. [Music] >> Those two guys there, are they strangers? >> Maybe. Probably. >> They just met and now they’re going to go in — >> Right. >> It’s interesting. >> Listen to me. Imagine yourself in a place like this. It’s only filled with women, I mean, really beautiful women. Imagine one of those Penthouse women, she wants to go into that little room with you, nothing between you but a little towel, are you going to tell me you wouldn’t go into that little, consider dropping that towel? Yeah, I know men would give up food for it. >> How are you? >> Good. >> [Inaudible] from the Centers for Disease Control. >> So what’s the problem? >> There may be some kind of an epidemic spreading in the gay community, and I’d like to just come in and have a look around. >> I’m sorry, that’s impossible. We have to protect the confidentiality of our clients. >> I know, but, Eddie, you know I speak on behalf of the Gay Liberation Committee, the city council, the state assembly, I can tell you without fear of contradiction you are regarded second only to Abe Lincoln as a citizen that would fight to the death to protect civil liberties. So let’s cut the crap, it’s 10:00 in the morning for God’s sake. Let us in. >> Thelma, only for you. >> Thank you. Thanks, Eddie. >> How many men come here a night? >> Hundreds, every night of the week. Some bathhouses more than a thousand. >> What’s this? >> Poppers. They’re a quick, cheap high. Harold Jaffe: You probably recognize some of the actors there, Serena McKellen and Lily Tomlin and Phil Collins. The actor who played me is a person named Charles Martin Smith, whose previous big role was Terry the Toad in American Graffiti. So that probably tells you everything you need to know. This is based on a visit that Bill Darrow, our research sociologist, who you will see later in the film, and I made to a bathhouse in Atlanta, the club baths. The reason we went was we had learned from talking to some of the early cases that many had visited bathhouses and many of them had used nitrate inhalants and we wanted to learn more about it. We got permission from the owner. We turned up one night. We were fairly obvious because we were the only ones wearing clothes. We were sitting there in our government blue blazers at a table and saying, excuse me, I wonder if I could talk to you. Quite amazingly, almost all these men were perfectly happy to sit down and talk to us. And, as I said, we were particularly interested in learning about the use of these inhalants. You can see some of these in some of these labeled bottles. Locker room is a good name, because they smell like sweat socks. You could buy these in the bathhouse. In fact, it was popper night when we went. You could get them for a discount. We also discovered, though, that you could buy them in bars and bookstores in these much more mysterious looking unlabeled brown bottles. And we wondered: What’s in this stuff? In theory, it should be amyl butyl or isobutyl nitrite used to enhance gay sex, but we really didn’t know. So we bought some of these and brought them back to Atlanta, had them tested chemically to look for a contaminant. We didn’t find any. We even had them used in animal experiments where they were aerosolized to see whether they would suppress the immune system of, I think, rats. I’m not sure. And they didn’t. So it didn’t entirely exclude the possibility that these played a role. But I think it made it a little less likely. I think maybe we were thinking gosh, this is it, we’ll get rid of this stuff. End of epidemic, we’ll all be heroes. But it unfortunately didn’t turn out to be quite that easy. Let me ask Jim, at this point in time, did you think it was likely there was an environmental cause of the disease, or did you think it was more likely it was infectious? Jim Curran: I had been coming from the STD world and we had been working on hepatitis B vaccine trials. And from the beginning this suspiciously looked a little like hepatitis B, a lot like hepatitis B. So that always, I think, was for most of us was most likely that it was due to a sexually transmitted agent. Whether it was some sort of mutant cytomegaly virus or some kind of concatenate of agents. I think most of us believed that was the most likely cause. It would have been a thrill and a wonderful thing for the world if something as simple as poppers could have been it and we could have turned into Carrie Nation and gone through and broken all the bottles in the country and saved 30 million lives. But it wasn’t to be. Harold Jaffe: Let’s move on now to a CDC in the early autumn of 1981. [Typing] >> What do we think, what do we know, what can we prove. >> Zip. >> Only gays. >> Think but can’t prove. >> Only males. >> Think but can’t prove. >> Semen depositors. It’s in the semen, unless there’s something specifically unusual about this disease, it shouldn’t make a difference where the semen is deposited, whether in the anus or in the vagina, which could mean that women will be getting it also. >> Good point. Focus on that. >> All we know so far is that the immune system stops functioning completely, all cases. >> No but can’t prove. >> What we have here looks more like a sexually transmitted disease than syphilis does. >> Think or prove? >> I can’t prove that the sun isn’t going to turn into a bran muffin next Tuesday. After 20 years of doing this I know what I know. >> That’s not what I’m talking about. >> It’s pure supposition, but it’s more than strong enough to justify a definitive study. >> I agree with Phil. >> Single infectious agent with high probability of sexual transmission. >> Viral or bacterial? >> Just think and prove it’s viral, but it’s only a guess. >> Guess. >> Let’s assume it is a virus. Now, the question is, is it one that we already know that has become lethal, or is this some kind of brand new virus we haven’t seen before? >> Here’s a stat to chew on. In seven months the number of cases jump from five to 152 in 15 states. >> Seven months. >> But the spooky part is that so far the mortality rate has been 40 percent. >> 40 percent? >> According to the doctors taking care of these patients the mortality rate could ultimately turn out to be 100 percent. >> 100 percent. >> My God. >> Let’s set up a case control study based on the premise it’s sexually transmitted. Harold Jaffe: Having worked for Jim Curran for many years I can say with great confidence he never said think or prove even once, did you? I don’t think so. But anyway we did the case control study. Selecting the cases was pretty straightforward. We decided that we would try to interview every living reported case in one of four cities in person that had to be homosexual men with either pneumocystis or Kaposi’s sarcoma or both. But it wasn’t so obvious how to select the controls. Did we want men and women? Just men? Heterosexual men? Homosexual men? Both? We finally decided that we would recruit apparently healthy homosexual men who were within five years of the age of the case that they were matched with. They had to be of the same race and live in the same city. But then how do you do that? So we spent a long time thinking about the best way to do it. And I’m not sure we ever came up with a good solution. First we thought okay we’ll ask the cases, the names of their friends who are not their sex partners. And less than half of them could do that, which was probably a hint right there. So then we decided we would go a different route and we would go, first of all, to the private practices of physicians who saw mainly gay male patients in their cities and ask them to recruit for us. And secondly we would go to public STD clinics that primarily served gay men. Now, we knew there was an obvious bias in this, because by definition a man going to an STD clinic must be pretty sexually active. We figured we know that. We’ll have to take it into account. But it was a relatively easy way to get controls relatively quickly. As Jim indicated in the film that was set up with the idea that we were probably looking for sexually transmitted disease, and obviously the fact that it was occurring in a number of highly sexually active gay men was consistent. But because these men frequently were using drugs, not just the nitrite inhalants but a variety of street drugs we couldn’t rule that out. As I mentioned, we interviewed cases and controls in person as is shown in the next clip. [Video] >> Stick around here. Coming right back. [Bell] >> Dr. Mary Guinan, please. >> I’m a friend of Dr. Konig’s. >> Your name? >> You can tell him. He has no idea who you are and we’ll pretend we never heard of you. >> You guys ahead of me? >> You can go ahead. We got nothing to do except go to a Halloween party, during rehearsal. >> I know. >> [Inaudible], but I happen to think you’re a genius. >> Double genius as a director and choreographer. >>You? >> Robbie Campbell. Self-appointed KS poster boy. You look surprised. >> No. Curious, maybe. >> If the gay community doesn’t start raising hell, do you think Reagan’s going to do a damn thing? >> I wish I had your courage. >> Courage. No. I’m scared to death. I just have this absurd determination to live, don’t you? [Knocking on door] >> It’s open. >> Dr. Guinan? >> Yes. >> I expected the neighborhood, the hotel, this room even, but I think it would take Filini to cast such a beautiful, young woman in a sweat suit as the doctor I’m supposed to reveal my most intimate sexual eccentricities to. >> I’m Mary Guinan. The reason for the sweat suit is somebody stole every piece of clothing I brought with me from the laundromat this morning. Would you mind signing these two consent forms? One is for the questionnaire and one is for the specimens I need to collect. >> What specimens? >> Blood, urine, a swab from the inside of your mouth and another from your rectum. In this study, some had the disease and some like you have no symptoms. >> I really don’t mind if you know all this about me. I’m just not too sure I want to know. Is there a name yet for this disease? >> The gay press calls it gay pneumonia or gay cancer and the straight press doesn’t mention it at all. >> I was hung up in traffic coming over here. Gay Halloween parade was on. Have you seen it? >> I didn’t know they had one. >> Yeah, they do. It’s really pretty amazing. [Music] >> Party’s over. Harold Jaffe: Well, I want to know why Richard Gere didn’t play me. [Laughter] [Applause] That sounds like a vote of support, or at least I’ll take it that way. Well, we didn’t interview Richard Gere and Mary Guinan only had her underwear stolen, not all of her clothes. But the rest of this is pretty realistic. We did interview these men in our government rate hotel rooms, which were not very luxurious. We did get 25 bucks in San Francisco. We did get funny looks from the desk clerks about why these young men were coming up to see the CDC doctors. But it was remarkable that these men, once we started talking, really were quite open and willing to talk about what had been going on in their lives. Think about it. What if I came to you now and said you know I don’t mean to bother you but I’m from the federal government and I’m going to ask you everything I can think of about your sex life, drug use and anything else, I’m not sure you’d be that happy to talk to me. But here, these men were really scared, appropriately so. Many of them had friends who had died or were sick, and they wanted to know what was going on. They wanted to know if they were at risk, maybe what they could do to help themselves. So they were remarkably open in talking to us about what they had been doing. So these next few slides come from the original case control study. First of all, to show you where the patients came from, the four cities I mentioned. The majority of cases, three-quarters, were white, which fit the demographic profile at the time. And let me go back here. Here’s some of the variables comparing the patients seen on the left with the two control groups. Remember the clinic control group comes from an STD clinic and the others come from a private medical practice. So in terms of history of sexually transmitted diseases, the cases were more likely to have gonorrhea or syphilis than either of the control groups. They also used more different street drugs and the use of poppers the nitrite inhalants, was essentially universal in both groups. Looking in more detail at some of the sexual activity differences, here we see the median number of sex partners for the cases was more than twice as many for either control group. Again, one of those control groups comes from a public STD clinic. The cases had a higher proportion of partners from bathhouses and they were more likely to start having sex at a younger age. In a mltivariate analysis, which I’m not showing you here, these same sexual variables seem to be the most important. But when we published the study we were fairly cautious. We said we thought the occurrence of Kaposi’s sarcoma and pneumocystis pneumonia in these homosexual men is associated with certain aspects of their lifestyle. We went on to say that sexual activity seemed to be the biggest difference. But because drug use was so highly correlated, so related to sexual activity, we really could not rule out a possible role for those drugs. Now, the next clip doesn’t come from the film, it actually comes from a national broadcast, NBC news. I wanted to show it to you because it shows you how the case control study was presented in the press and it also shows you the real Bobbie Campbell and the young or younger Jim Curran, who looks almost the same as Jim Curran today. [Video] >> Scientists at the National Centers for Disease Control in Atlanta today released the results of a study which shows that the lifestyle of some male homosexuals has triggered an epidemic of a rare form of cancer. Robert Bazell now in Atlanta. >> Bobbie Campbell of San Francisco and Billy Walker of New York both suffer from a mysterious newly discovered disease which affects mostly homosexual men but has also been found in heterosexual men and women. The condition severely weakens the body’s ability to fight disease. Many victims get a rare form of cancer called Kaposi’s sarcoma, others get an infection known as pneumocystis pneumonia. Researchers know of 413 people who have contracted the condition in the past year. One-third have died and none have been cured. >> Death didn’t scare me. It was living with this for a long time. That’s more frightening than death. >> Investigators have examined the habits of homosexuals for clues. >> I was in the fast lane at one time in terms of the way I live my life. And now I’m not. >> The best guess is that some infectious agent is causing it. Today, researchers here at the National Centers for Disease Control say they have found several cases where people who had been sex partners both had the condition. Scientists say this probably means they are dealing with some new deadly sexually transmitted disease. The investigators see this as a serious public health problem. >> From an epidemic point of view there have been more deaths from Kaposi’s sarcoma and pneumocystis pneumonia than have occurred with all the cases of toxic shock syndrome and the Philadelphia outbreak of Legionnaire’s disease combined. >> Researchers are now studying blood and other samples from the victims trying to learn what is causing the disease. So far they have had no luck. Robert Bazell, NBC News, Atlanta. Harold Jaffe: Jim, other than any comments about your youthful appearance, is there anything else you’d like to say about what you thought was going on at the end of the case controlled study? Jim Curran: Well, first of all, Harold Jaffee and Martha Rogers, Kelon Troy, many people were the leaders in the case control study and put together a rather complex study design and implemented it to include 75 or 80 percent of living gay men in the United States and published it rapidly. So that was quite a feat. I want to just give you a couple other contexts. One is we knew that the controls were matched. And by matched, we meant that they were matched for certain characteristics. They were matched by sexual orientation. They were matched by age, within three years. They were matched by the city where they lived at the onset of the case’s symptoms, and they were matched by race. All of the cases — all of the controls were interviewed by the same person that the case was interviewed by to try to minimize to some extent interview bias. And we thought that we would be overmatching by picking people who were symptomatic with STD symptoms and that would minimize the chance of finding a sexually transmitted variable. In retrospect, of course, many of the controls were almost certainly infected with HIV themselves leading to a lot more overmatching. So that made it even more remarkable that sexual variables were the most important ones. But in retrospect, that’s not remarkable at all, because when any new, rare epidemic occurs, and this was rare at one time in gay men, then the ones most likely to catch it are going to be the ones with the extraordinary number of exposures. And that’s how it was in the gay community in the mid-’70s, if you caught HIV. You were most likely from San Francisco and New York, most likely going to bathhouses. By the time the virus was discovered, however, half a million gay men were already infected, and the disease became endemic in the gay community and exposure became much, much more frequent and likely. The last thing I’d like to say is that people didn’t believe in this epidemic then. I mean, gay men who didn’t live in New York and California didn’t believe in the epidemic. Even gay men who did live in New York and California thought it occurred to other people, because it was relatively infrequent. At the time of the case controlled study, maybe the cases were occurring in 15 states. That left something like 35 states where they weren’t occurring. The Reagan Administration knew about this, of course. I interviewed only one case — Harold sent me to New York. So I was coordinating the New York work with EIS officers there. But there was one case that wanted to be interviewed by the head of the task force. That was the managing director of the Joffrey Ballet. A very busy man. He was so busy because the next week — he had pneumocystis pneumonia once. He was going to be hosting Nancy Reagan for the opening of the Joffrey Ballet in which her son, Michael, was a ballet dancer. Harold Jaffe: Ron. Jim Curran: Ron — Michael. Sorry. Wrong son, the right wing one. Ron was the ballet dancer. He did that and then the next, couple days later he was back in Bellevue Hospital with his final fatal case of pneumocystis. We know at least Nancy Reagan had some exposure to this five or six years before the president spoke about it openly. Harold Jaffe: The last bit of the newscast, it was mentioned that some of the cases were thought to perhaps be sexual partners. This information came to us from Dr. David Auerbach, who was a CDC medical officer assigned to Los Angeles County. Through his contacts in the gay community in Los Angeles he had learned that this was the case. And he wanted to interview these men to verify this. But he had never actually done this kind of work before and wanted some help. So we were able to send out Bill Darrow, our research sociologist, who had been previously a syphilis public health investigator, had done a lot of this, to help David out with the interviews. So the answer to the question about sexual relationships came just a few days later, as shown here. [Video] >> Jim, I got a call from LA. >> Wait, I am on the phone. >> I got a call from LA. This could be the first real lead to prove this thing is sexually transmitted. My plane leaves in 40 minutes. >> We don’t have the budget. >> Don’t sweat it, I’ll front the money. You’ll pay me back. >> If you think you have definitive proof it was brought in by a UFO, please send it in to us. Thank you. >> You don’t know a man from New York with a French Canadian accent, very handsome, sheik? >> I don’t think so. I very seldom — wait a minute. This might help somebody else, right? >> Right. >> Of course I know him, from the bathhouses. I never had sex with him. But almost everybody I know has or wants to. >> Fine. Then he gave me hepatitis, so it’s quite possible he gave me this, too. >> The moment I first spied him at the tubs, I was so crazy about him. He was so gorgeous. >> Can you just give me his phone number, address or any way I can get ahold of him? >> All I know, he’s French Canadian. He’s an airline steward based in New York. I don’t even know which airline. >> That’s okay. If you can just give me his name. >> I called him Dougie, nickname. >> And his full name? [Phone ringing] >> Hi, Mary. >> Hi. You back in town. >> Just for the night. I’m probably nuts, but I’m on my way to New York to try to find a very sexually active French Canadian airline steward. >> Gatan Dugas. Bill Darrow. >> Hello. >> Nice to meet you. >> Nice to meet you. >> Sit down. Take all the time you need. >> Thank you. >> Thank you. >> Thanks very much for coming in. >> Well, I’m very flattered to be asked. Although I have no idea what I’m here to discuss. Would it disturb you if I smoke? >> If you need to, go ahead. Mr. Dugas, did you have sex with any of these people? >> Is that what I’m here for, to talk about my beautiful lovers? Now I am flattered. If you don’t mind my saying, I can’t possibly imagine why you would be interested. >> We’ve been finding substantial evidence to suggest that one of the ways this disease may be transmitted is sexually. >> Wait a minute. All I have is skin cancer which is not contagious. And you know it. >> No one is accusing you of anything. We just need to know as much as we can. >> You know, I adore doctors, but I must say if this is an epidemic, this gay plague thing, it’s your fault for not stopping it. It’s not mine. >> That’s exactly what we’re trying to do. And we need everybody’s help. So if you could give me the names and addresses of all your lovers and start with the people on this list, please. >> My friend, we’re talking about thousands of men all over the world, whose faces I cannot even remember and you want names. >> As many as you can remember would help. >> My book’s in my apartment. Call me. >> What’s the number? >> I’ll call you. >> Listen: Help me, don’t help me, that’s up to you. But don’t fuck with me. I’m not playing games here. >> Not before six, and not after 6:30. >> Thank you. >> And remember something: Whatever it is, if I got it, someone gave it to me. >> All right. This is how it breaks down. This is Patient 0, an airline steward from New York and the starting point of this particular group. Now, these are the eight with whom he had direct sexual contact, these four in New York. These four in LA. This is LA 3. He had sex with LA 2. This man from Florida who in turn had sex with this Florida man. Two from Georgia, one from Texas and so on. In all, 40 cases in 10 cities are verifiably linked to Patient 0 which strongly suggests this is a sexually transmitted disease. >> That’s great. Absolutely terrific work. >> Bill, that is the first sign of real proof. >> Good job. Harold Jaffe: I recently came across an interview that Bill Darrow gave about this investigation. And he said, well, these three men, they never met, they never had sex, yet they named the same guy in New York. I actually dropped my pen. Auerbach’s mouth was just hanging open. He practically fell off of his chair. So these are the slides that Bill Darrow showed us in Atlanta. You can see that Gatan Dugas the out-of-California KS case, is linking together these two clusters of cases in Southern California. And here he’s linking together cases from Los Angeles to New York City and then the slide that you saw in the film where he’s in the center of this cluster of 40 cases, sexually linked between 10 North American cities. Now when we published this in a journal, we had a legend on it. And Gatan Dugas was indicated as 0 and there was one, two, three, four, five, and so on. When the American press saw this, they said Patient 0, he’s the guy who started it, he’s the guy who brought this disease, whatever it was, to North America, which, of course, was never our intent, and we have no proof that that was true. On the other hand, knowing what we know now that this is a sexually transmitted disease, it wouldn’t take that many people like Gatan Dugas, people who were very sexually active, very mobile, going to bathhouses all over North America, somebody like that actually could have spread a lot of infection relatively quickly. And I believe that two other members of the cluster were also flight attendants. So, Jim, I wonder at the conclusion of the presentation by Bill Darrow what you were thinking. Jim Curran: Well, you know, this was very convincing to us who didn’t much need convincing when it was published in the American Journal of Medicine and the MMWR, they did an analysis of what if five to 10 percent of men in the United States were gay and they had — how many had — what is the likelihood that these — this was like 40 percent of the cases that had been diagnosed in the United States that were alive in gay men. So what is the chance they would be linked in a cluster? And I think one of our statisticians said the chance was one times 10 to the minus 12th. But there’s still an awful lot of people that didn’t want to believe that this was related to sexual transmission. Because the implications of it or the fact that it could be caused by a virus was probably too great for people to deal with. But it was a very important investigation for that reason. Now, I’ve looked back on these things, and I’d like to think what we know about the pathogenesis of HIV and the transmission of HIV, and I think of this cluster and I also think of the cluster that we saw in the dentist, Kimberly Bergalis case, and the fact that we didn’t see things in other healthcare professionals. And it makes me think we had to have with this cluster and what we had to have in particular with the dentist case is a lot of highly pathogenic, high viral load early cases with short periods of time between infection and disease in order to do this. If the average case here went from 10 years after transmission, it would be extremely unlikely that you could link something like this up. So you had to have probably, in retrospect, high viral loads and high pathogenic titers. Harold Jaffe: I think as all of you who have ever worked at CDC, people at CDC walk around with these little green lab notebooks. I actually have no idea why. For those of you who will see the film “Contagion” that comes out in a few weeks, I think one of the key lead characters Kate Winslet, who plays the epidemiologist, has one. So I had one, even before Kate Winslet. So I took this photo of a page from my notebook. I think the date is November 1982. And it’s a phone call that I received from Dr. Art Ammann, who is a well-known pediatric immunologist at UC San Francisco, who wrote the book, literally, on congenital immunodeficiency. And what he told me over the phone was that there was a child born there in March of 1981 who had RH disease, incompatibility of blood type between the mother and the child, causing a severe anemia in the newborn requiring six exchange transfusions. The child left the hospital but then began developing a whole series of complications, recurrent infections, fat malabsorption and immunologic abnormalities, opportunistic infection with microbacterium and avium. So Dr. Ammann did a very extensive immunologic workup on this child and said: This does not fit with any known form of congenital immunodeficiency. It looks like AIDS, except no one’s ever described AIDS in children, how could that be. He also learned that all the blood from this child had been received from Irwin Memorial Blood Bank. This next clip will show you that investigation. This clip I think is the least accurate of the ones I’ve shown you. Art Ammann is morphed into a woman played by Angelica Houston. You’re going to hear a number of speeches that were never made. You’ll hear the term “GRID”, which stood for Gay Related Immune Deficiency which was the term we never used at CDC. [Video] [Baby crying] >> Harold Jaffe, CDC. [Baby crying] >> Hi. >> How do you do? >> Harold Jaffe. >> So it’s true? >> He was born here 20 months ago. >> An RH baby. >> Within a week his entire blood volume had been replaced six times. Now he has Zostera, practically zero T cell count, more opportunistic disease than we know what to do with. >> And he had 13 donors? >> All from Irwin Memorial. That’s all I could find out. They keep a lid on the place so tight it’s like the Pentagon. So forget about getting a list of donors from them. >> The first irrefutable case caused by transfusions and these people are stonewalling us. I know what we need. Somebody just to scare the hell out of them. >> Only Attila the Hun could. >> Selma Dritz. [Laughing] >> I got it. But there’s one problem, two problems. I’m freezing, that’s one problem. Let’s get some coffee. One of the donors died from the disease two months ago. >> We can’t prove that. >> What do you mean we can’t prove it? How can we not prove it? >> He was one of the richest, most socially prominent families in town. He swore to his dying breath he wasn’t gay. >> What’s the difference what he said? If somebody dies from it you can’t mistake it for whooping cough. >> According to his doctor he died from encephalitis. It’s on his death certificate. >> Talk to the doctor. >> Get him to say what, he lied? >> Somewhere in this town there’s got to be somebody that — a gay man he had sex with or what about his family, do they know? >> My brother wasn’t gay. And I can assure you no matter how hard you search you’re not going to find one shred of evidence to suggest the contrary. He was on the board of several corporations. He was the chairman of the fundraising community for Saint Patrick’s. He was meticulous. He was meticulous in concealing his other life, even from me. >> Excuse me. I would like to remind everyone — I’d like to remind everyone that these are not regulations. These are not regulations from the CDC. This is a workshop where every agency connected to the blood industry can evaluate the information that the CDC has found and together we are hoping to be able to arrive at some course of action. >> One option is to establish guidelines to keep people who are at high risk from donating blood to begin with. >> Banning homosexuals from giving blood won’t protect the blood supply. What it will do is stigmatize them. Reminds me of blood banks rejecting donations from blacks for fear of syphilis. >> Have you any idea of the civil rights implications — >> Civil rights, my ass. My son is a hemophiliac. And if homosexuals are infecting the blood supply, why not keep them from becoming donors? >> What do mean the entire gay community? Then what, separate drinking fountains, one for gays and one for humans. >> Don’t start that gay rights crap with me. There’s 20,000 hemophiliacs in this country and GRID has become the second leading cause of death amongst them. We have rights, too, and one of them is the right to stay alive. >> I know that we’re dealing with a very complex and highly emotional issue, but it would help for all — >> How can you expect us to be unemotional, when at least one person is dying every day from a disease that doesn’t even have a name. Now, if the CDC can’t bother to come up with a name, at least it should stop the media from calling it GRID. We have enough people hating gays without having the entire stigma of this disease placed on us. Especially since it has been shown that this disease is no longer merely gay-related. Now, I make a motion to officially call this disease Acquired Immune Deficiency Syndrome, or AIDS. >> Questions or discussions on this issue, please? >> I second it. >> All right. All in favor of Dr. Valor’s motion? Motion’s carried. >> The FDA Advisory Panel to the Blood Banks feels that the evidence for nearly all of this is inferential. The CD’s evidence of blood transmission cannot be warranted until the CDC shows definitively that an infectious agent causes this disease. Nothing about it even exists in the peer reviewed medical literature. Not one case. Evidence of such blood transmission is lacking. >> May I point out that the blood industry is under the jurisdiction of the FDA and the FDA, according to Dr. Bovey, does not acknowledge that there’s an epidemic because there’s no evidence that it’s a blood-borne disease. >> Suppose, for example, the small amount of blood by some unlikely chance is contaminated, with no tests to find out which blood is safe and which isn’t, what do you suggest we do? Destroy the entire blood supply in America, because some of it may or may not be contaminated? >> No, no. Well, in fact, testing — testing is the second option that we should discuss. Now, we at the CDC have found, we’ve found that the hepatitis B test is 88 percent effective in identifying patients with this disease. >> Is the CDC seriously suggesting that the blood industry spend $100 million a year to use a test for the wrong disease because we’ve had a handful of a transfusion fatalities and eight dead hemophiliacs. >> How many dead hemophiliacs do you need? How many people have to die to make it cost efficient for you people to do something about it? 100? A thousand? Give us a number so we won’t annoy you again until the amount of money you begin spending on lawsuits makes it more profitable for you to save people than to kill them! >> The disease called AIDS, Acquired Immune Deficiency Syndrome, sounds less deadly, more like a diet pill. >> Medical researchers are warning… the risk of contracting the disease AIDS. >> Henry Penia, who has AIDS, got into a minor traffic accident. So police called the hazardous materials team. >> The impact on blood banks could be disastrous. Harold Jaffe: As I mentioned, this scene isn’t very factually correct. For those who might have known her, Selma Dritz was a very nice lady nothing like portrayed in the movie. AIDS was not named at this meeting. And Don Francis, for those who knew him, recall that he made many passionate speeches during his career, but he didn’t make that particular one. Jim, you looked very nervous at the end of that meeting. Maybe you can tell us why. Jim Curran: The events, as I remember them, is the very careful investigation, we had a few cases of what looked like transfusion-associated AIDS. And indeed the blood banks were hiding behind confidentiality issues in New York and California in investigating them. The only one really that was investigated very thoroughly initially was the one that Harold was involved with in San Francisco with the baby. When the three cases occurred in patients with hemophilia, young men who had received essentially untreated factor concentrates pulled from tens of thousands of blood donors each year, it was a canary in the coal mine type of experience in the sense that if anybody was going to get a new virus, these men were likely to get it. And that really convinced most people that this was new. Now, there were two meetings. There was a meeting, a broad meeting of the blood banking community, and there were smaller — it was a smaller meeting in HHS. And the blood banking community, it is really true that the blood banking industry and the blood banking leaders were quite resistant to any change or any screening or any questioning, and Dr. Bovee, it was not his most proud moment. And he had, unfortunately, worse moments on behalf of the American Association of Blood Banks going forward. But there was really very little reaction from the gay community. We had pretty good contacts with many people in the gay community. And I think they were more or less convinced that this was really true and were not standing up in public and screaming civil rights and things like this at this blood banking meeting. The other thing about the name AIDS itself, is a lot of people had been looking for a name. And a lot of us had talked to several people. There was a guy named — several doctors in New York and a lot of us at CDC thought Acquired Immune Deficiency Syndrome was accurate and also had an acronym which might live a while and would be something that could be used. So there was a meeting in Washington of blood banking officials. It was kind of a semi public meeting that Jeff Copeland chaired. And we arranged for Don Armstrong, who was the head of ID at Memorial Sloan Kettering, to make a suggestion to the PHS that the term AIDS be used. So there was a guy, it wasn’t this guy, it wasn’t at that meeting, and it was kind of prearranged by CDC to use the term AIDS. What else can I say about this meeting? That’s about it. I think what we were nervous about mostly is there wasn’t any consensus at this meeting. And it was a highly public meeting quoted in the press and everywhere else. And it was quite clear that the blood banks and the CDC were at odds. The National Heart and Lung Blood Institute was also at odds and basically what do a bunch of infectious disease epidemiologists know about blood banking anyway. Harold Jaffe: Well, fortunately, discussions that were held more in private over the next few months were more productive. And just three months later, in March of 1983, the U.S. Public Health Service issued the first guidelines for prevention of the disease that was known as AIDS at that time. But, first of all, the guidelines said that persons at increased risk of the disease those were signs and symptoms, their sex partners, sexually active gay and bisexual men with multiple partners, Haitian entrance into the U.S. which was contentious at the time, all we knew was that Haitians living in Miami and New York City were getting the disease. We knew that the disease was occurring in Haiti itself. We actually did a case controlled study trying to figure out what the risk factors were and we didn’t come up with anything. So we said for public health purpose we’re going to say that Haitians should not donate blood. Now, this clearly led to a lot of discrimination in the Haitian American community, which was undoubtedly not what we wanted. But at the time we didn’t really have a choice, or at least I didn’t think we did. Intravenous drug users were getting the disease, patients with hemophilia. And then the recommendations went on to say to avoid getting the disease, avoid sexual contact with persons known or suspected to have it. But having multiple partners increases the risk. In here it says it’s a temporary measure, but many of you know it’s still a requirement in the United States that blood bankers not accept donations from homosexual men. So despite the denial that went on at that meeting, these guidelines came out, which I think even in retrospect were essentially correct. Jim, can you tell us anything what went on between that meeting and the formulation of the guidelines? Jim Curran: There was increasing consensus that this was likely to be caused by infectious agent. And increasing concern that it was present in the blood supply. So that drove the consensus recommendations, and we were able to have these recommendations come from all public health service agencies, but also be endorsed simultaneously by the American Association of Blood Banks, American Red Cross, National Gay Task Force and many — American Association of Physicians for Human Rights. So we had AMA, lots of groups like this. So I think there was in general quite a proud moment for CDC that these recommendations could be promulgated well before the cause of the syndrome was discovered. Harold Jaffe: In fact, the first publication describing what we now know as HIV was made in May of 1983 by Luc Montagnier and his colleagues in Paris, that was recognized by the 2008 Nobel Prize in medicine. And it was another year before Robert Gallo and his colleagues at the NCI really established that the virus was the cause of AIDS. And as I mentioned, I think this is rally an important illustration of the power of the epidemiologic method to understand a new disease. Now, I’d like to say that the story of AIDS ended in 1983, but if it had, you wouldn’t be here. So let me just give you a snapshot of the next few years. So here’s May of 1985, the first 10,000 cases mainly in New York, San Francisco, Los Angeles, Miami. 1989, here’s the first 100,000 cases, large numbers in places like Puerto Rico, Houston, Dallas, Seattle, Chicago, Atlanta. And then by the end of 1995, the first half million cases. So at this point really every major metropolitan area in the United States was reporting cases. And finally, our most recent data, from June of 2010, with more than a million reported cases and more than half a million deaths. These numbers are important. But I don’t think they give you maybe the most important part which is the human face of the epidemic. To do this I’m going to show you the very last clip of the film, which includes a number of people who had the disease or were advocates for the cause. I know who a lot of them are but not all of them. But I’ll say the ones I know anyway. [Video] Yesterday you came to lift me up as light as straw and brittle as a bird. Today I weigh less than a shadow on the wall, just one more whisper of a voice unheard. Tomorrow leave the windows open as fear grows please hold me in your arms. Won’t you help me if you can to shake this anger. I need your gentle hands to keep me calm, ’cause I never thought I’d lose. I only thought I’d win. And never dreamed I’d feel this fire beneath my skin. I can’t believe you love me. I never thought you’d come. I guess I misjudged love between a father and his son. Things we never said come together. The hidden truth no longer haunting me. Tonight we touched on the things that were never spoken. That kind of understanding sets me free. Because I never thought I’d lose. Only thought I’d win. I never dreamed I’d feel this fire beneath my skin. I can’t believe you love me. I never thought you’d come. I guess I misjudged love between a father and his son. Things we never said come together. The hidden truth no longer haunting me. Tonight we touched on things that were never spoken. That kind of understanding sets me free. ‘Cause I never thought I’d lose. Only thought I’d win. I never dreamed I’d feel this fire beneath my skin. I can’t believe you love me. Never thought it would come. I guess I misjudged love between a father and his son. Harold Jaffe: Thank you. [Applause] Booker Daniels: I’ll try to keep my composure. We have ten minutes for questions for the panelists. If you would, form a line in the center of the aisle and we’ll direct some questions. Member from the Audience: Since the theme of this involves a little bit of Hollywood, if you could write the end of the script, what would it look like? Jim Curran: As a result of a safe and effective vaccine and curative therapy, in the year 2000 and blank, HIV was eliminated from 90 percent of the countries on earth with the promise of eradication not too far behind. [Applause] Member from the Audience: Thank you for the presentation. I actually was one of those people who — I’m not that young. But I do — I was young enough not to pay that much attention in the early ’80s. You mentioned a little bit about once or twice about the movie “Contagion” that is coming out. We know that Hollywood dramatizes things for effect as we saw in this presentation. How can we as public health workers, not just in respect to HIV, but in respect to any type of infectious disease, how can we then communicate with communities who are going to be going to see this motion picture to help them understand what it is that we do and what they can do? Harold Jaffe: I haven’t seen the film myself. Although, several people from our office have. And I think it’s some horrible disease that kills just about everybody. I think the message from public health is that’s why we’re here. I mean, there is no such disease. Thank goodness. But if there ever were, that’s why we’re here. So I think that’s the message that CDC would want to get across. Jim Curran: It’s hard — the problem with this movie for Harold and I and other people who are at CDC we’re actually real people. And we have real names and then we see ourselves and we see all the changes and all this sort of thing. And so it’s hard for us and our friends and family to look at this and get beyond the personal part of it. But if you step back from this, if you look at And The Band Played On as a movie, in general I think you see in CDC and parts of the country reacting quite positively and doing the best we could under the circumstances to combat the epidemic. And this was occurring in somewhat of a sea of denial and there was some neglect. Probably wasn’t quite as blatant as Randy Schultz in the movie portrayed it. But it certainly was there. There was a lot of denial and neglect on the part of many, many people. I think in general, names aside and who did what aside, the CDC, staff and faculty and people we worked with and the people we worked with in the gay community, and the people we worked with who are HIV positive, were extremely courageous and worked very well together to get to the bottom of the problem. So if the public sees this and all they see is CDC working hard with the gay community about a disease which was a really, really horrible disease, with an unknown cause, people getting needle sticks when they were investigating cases, not knowing what it meant, not knowing what their future was, but still having the courage to go do it, I think in a sense it’s public health at its best. They could have used somebody more handsome, though. Member from the Audience: Just one question. You remarked about perhaps being more a pathogenic virus early on. Couldn’t it also be the phenomenon of a lot of acute infection going around where the guys were very recently infected and still very sexually active in those houses as opposed to it being more pathogenic? Jim Curran: I think the fact that you could link up a number of cases to somebody who had sexual contact, all of whom had sexual contact with somebody reasonably recently. In a lot of these cases that had contact with Gatan Dugas, just like the dentist case, people were getting sick and getting AIDS within a couple of years, within three years. So you had to have a cluster of people with a rapid infection. That’s one of the things that I think stopped a lot of the demonstration of healthcare workers associated cases because most of them would be in isolation and also would be long, long incubation periods. So I think it’s probably potentially a combination of both. But I think there had to be — in order to have the detection with people with end stage disease linked to individuals who were still alive, you had to have some kind of epidemic situation. If I were the movie character I would say: Think, can’t prove. [Laughter] Although I never said that until now. Member from the Audience: Took us, what, about four years before we actually had a test for HLB 3 LAV and 1985 we introduced that test. Yet it wasn’t universally accepted. Can you kind of talk a little bit about that? Some of the issues that we dealt with back then. Jim Curran: I have a cartoon I showed. One of the things that our laboratories did when the virus was isolated, we got a lot of reagent from the National Cancer Institute. Our jobs, John Ward, Charlie Schaible, Paul Feorino, Tom Peterman, a lot of people worked with the American Red Cross to demonstrate the sensitivity and specificity of the blood test and blood banking situation because it was about to be rolled out in blood banks nationwide. Unfortunately, the study that Harold did, he had several thousand gay men who were tested from a San Francisco hepatitis cohort, and demonstrated that the longer people were infected, not only were they infected a long time earlier, but the longer they infected, if they had positive antibody, the longer they were infected, the more sick they were to be. And Dr. Feorino tested specimens we had from blood donors and found out that essentially having a positive antibody was equivalent to being infected unlike a lot of other viruses. So it was a dangerous virus and having the antibody meant you had the virus and there was no treatment. So what came from a real need and urgency to get the infection led to a lot of distrust, particularly in the gay community about what would happen to the test results, who would know, who would tell whom, what would happen to my insurance status, what would happen to my identity? Because, after all, if you were a man with a positive antibody test, you were probably gay, at least that’s what people thought. And to this day, when we see somebody with HIV, our own brains always say to us I wonder how she got it or I wonder how he got it. So that was the thing that led to the concern. There was essentially nothing that could be done for these people. But we were promoting the test and people were not always happy about that. Harold. Harold Jaffe: I think the other thing to say is the test really was first rolled out for the blood banks, because there were at that point hundreds of transfusion cases, and we had no way to prevent them other than voluntary disclosure of a man being homosexual or injection drug user. So really the point of the test initially was to screen donated blood because of a concern that people would go to blood banks to get the test because there was no other place to go led to CDC setting up a series of alternative test sites where people could go if they wanted to be tested but not be blood donors. Member from the Audience: First, thank you for the session. Thank you both for your service. Two simple questions: First, how do you think the AIDS epidemic has changed the thinking and practice of public health today? And the second is what do you think, the second simple question, what do you think is the perception in the general population in the U.S., I’ll keep it to the U.S., the current thinking about AIDS and in that regard what is our biggest challenge going forward in that regard? Harold Jaffe: I’ll do the first one because I think it’s easier. It was interesting. Gary Nobel is sitting in the audience. I think he would confirm this. The thinking at the CDC in the early ’90s was that the year of infectious diseases was over. We had vaccines. Small pox had been eliminated eradicated. We had antibiotics. And CDC’s mission was changing. So we started growing in areas of chronic disease and environmental health. And there was really no expectation that suddenly we would have to sort of say, wait a minute, there’s more out there than we knew about. But there was. And HIV became the prototype of the emerging infection, and now we’re aware of dozens, if not more than that, of infections that we had no idea would infect humans that we thought were only in animals or didn’t know about it at all that suddenly popped up. So I think it told us that we weren’t as smart as we thought we were, and infectious disease era was far from over. Jim Curran: I’d rather answer that one again, so I’ll try. Couple things in CDC that were going on. Harold and I worked in STD research before AIDS came along, and people used to say to us, when they thought there ought to be more contact tracing, how come you don’t treat AIDS like any other STD? And my comment usually was: What do you mean, just ignore it? Because that’s really what people did with STDs. They essentially ignored them as public health problems, for the most part. What made AIDS different was of course that it was fatal. And the fatality and the activists who were dying people themselves called attention to something that was so important that it deserved more attention. But there was no magic bullet. And so Bill Darrow was either the only doctorally trained behavioral scientist or one of two or three at the CDC in 1981. Now there are hundreds and hundreds and hundreds. And so I think that changed. I think the recognition and respect of behavioral and social scientists and social determinants of health occurred in parallel with the beginning of the AIDS epidemic. I’m not saying it wouldn’t have occurred anyway. But it was certainly stimulated by AIDS and a lot of behavioral scientists at CDC kind of cut their teeth on AIDS. And it was okay to talk about sexual behavior. The other thing that happened was a new relationship with nongovernmental organizations occurred with direct funding and partnership with state and local health departments, because of the general horrible distrust of government at all levels by many people in the communities. And that’s something which I think is renewed public health. I forgot your last question, Paul, but it was something about — Member from the Audience: Perception. Jim Curran: I think people think it’s pretty much over and not paying too much attention to it, largely because it hasn’t been in the press very much. It’s not publicized very much, because not as many people are dying. And you know every year four million plus people have sex for the first time in the United States. So since HARK, there’s been 60 million new Americans having sex for the first time in an era where there hasn’t been as much publicity. That’s sort of the way I would summarize it. It’s not over. And more people are infected than ever and they’re going to be really crunched by the economic crush in the United States and the impossibility of healthcare reform. I think we’re going to see more and more people lined up to get treatment in the future. Booker Daniels: With that, we’ll have to conclude our panel session. Our time is up. Let’s give a round of applause to our panelists one more time. [Applause]

The Nearsightedness Epidemic

The Nearsightedness Epidemic


When you hear about epidemics, it usually
has to do with some frightening virus like HIV or Ebola. So when scientists in the know start talking
about an epidemic of nearsightedness, it probably sounds … strange. I mean, how can something that isn’t infectious
or contagious become an epidemic? And yet: The prevalence of nearsightedness
in the US is pushing 40 to 50% among young people. And that’s nothing compared to parts of
East Asia — particularly Singapore, China, Japan, and Korea — where nearsightedness
among high-school-age children is at 80% or more. Is it because kids these days have too much
homework? Or is technology to blame? Are iPads ruining our children?! New research suggests the cause of nearsightedness
might not be peering too closely at your homework … but neither is it all up to genetics. And that might be a good thing, because there’s
a potential prevention out there that’s universal, and free. The antidote to nearsightedness might be good
old-fashioned sunlight. Nearsightedness, or myopia, is a condition
in which your eyeball is elongated. When light enters an eyeball that’s too
long, the lens focuses light in front of the retina instead of right on its surface. This creates an image that’s blurry if you’re
looking at anything farther away than your outstretched arm. Myopia is easily corrected with glasses, contacts,
or surgery. But in extreme cases, what eye doctors call high myopia, it carries a risk
of severe eye problems, like glaucoma, retinal detachment, and cataracts. Nearsightedness has always been around to
some extent. Astronomer Johannes Kepler blamed his near-sightedness
on all of the writing and calculations he did up close, and for centuries that’s been
the conventional wisdom. For a long time, peering too closely at written
material, termed near work, has been blamed as the cause of nearsightedness. Near work typically includes things like reading
and writing. Watching TV doesn’t count, because it’s far enough away, and even using
a computer isn’t as hard on your eyes. Things like smartphones and tablets are new
enough that it’s hard to say whether they should be included in the definition, but
nearsightedness has been on the rise since before they became mainstream, so they’re
probably not at fault either way. But while extensive studies have had a hard
time ruling out near work entirely, they also have a hard time establishing a firm link. So, most scientists no longer think near work
is directly responsible for nearsightedness. But In the 20th century, we learned that there’s
a certain amount of genetic influence on nearsightedness. If your parents are nearsighted, you might
be, too. But that genetic influence isn’t really
straightforward. It involves a few dozen genes, each of which only contributes a fraction
of the overall story. Plus, a study of an Inuit community in Alaska
back in 1969 showed that nearsightedness can spread way too fast for genetics to explain. At one point, only 2 out of 131 people in
that community were nearsighted — that’s one and a half percent. But the prevalence rose to nearly fifty percent
in their children and grandchildren! Genetics couldn’t possibly be responsible
for such a rapid spread. This led scientists to conclude that, while genes have some influence,
the main cause of nearsightedness must be something in our environments. And it must be something that’s dramatically
increased in recent times. While near work itself doesn’t seem to be
the culprit, there does seem to be a link between nearsightedness and education. One study, published in October 2015 by researchers
from Cardiff University in Wales, found that firstborns are more likely to be nearsighted
than later children. About 10% more likely, to be specific, which
certainly doesn’t account for the skyrocketing prevalence, but it might provide a clue. When the researchers adjusted the data to
account for how much education the participants had had, the effect diminished, which means
that it was the education of the subjects that made the difference. The scientists suggested it was a result of
so-called “parental investment.” First-time parents who make their oldest kid hit the
books might be a little more relaxed by the third one. As a result, firstborns who spent
more time studying ended up being more likely to be nearsighted. Another study, by researchers from Sun Yat-sen
University in China, compared the rates of nearsightedness in two neighboring Chinese
provinces. They looked at schoolchildren in Shaanxi,
a middle-income province, and comparatively poor Gansu province. The prevalence of myopia among kids from the
wealthy province was roughly twice that of the poor province. The researchers couldn’t
fully explain this difference, but higher math scores were associated with higher rates
of nearsightedness. So it certainly looks like education correlates
with nearsightedness, but how is this happening? And if it’s so easy to correct, why worry? Well the fact is, about 20% of people with
nearsightedness end up having high myopia. For example, more than 90% of 19-year-old
men in Seoul, South Korea have myopia. So that means nearly 20% of that population is
at risk for those serious complications we mentioned, which can lead to blindness. Having this many people at risk of serious
eye problems is a major public health concern. And eyeglasses will certainly help, so getting
glasses to kids who need them is a big priority — or, at least, should be — in these countries. But still that’s not going to address the
underlying problem. Why are so many people throughout the industrialized world nearsighted,
when our ancestors didn’t have this problem? And why is the situation especially dire in
Asia? The best guess anyone has is that it’s related
to the particular emphasis placed on education by many East Asian cultures. China has a do-or-die college entrance exam
that makes the SAT look like a walk in the park. Kids as young as 10 spend hours every
day doing homework. If education is a factor in nearsightedness,
that’s where it’s going to show up. To tease out the effect of cultural environment,
Australian researchers from the University of Sydney looked at 6 and 7 year old ethnic
Chinese children living in Sydney and Singapore. The kids’ parents had similar rates of nearsightedness–around
70%–in both study groups. But in the kids themselves, the difference
was stark. Only 3.3% of kids in the Australian group were nearsighted, compared to 29.1%
in Singapore. And the children in Sydney actually did more
near-work activities, like reading and homework, than the kids in Singapore, so that couldn’t
possibly be the cause. The only difference between the two groups
of children that could account for the difference in myopia was how much time they spent outside. The kids in Sydney spent more than 13 hours
a week outside, the kids in Singapore only 3. This seems almost hard to believe. Can sunlight
really prevent you from becoming nearsighted? Scientists and public health officials would
really like to know. But, nothing in epidemiology is ever simple. In order to figure out if natural light can
treat myopia, we need two things: Rigorous evidence that sunlight really works, and a
scientific reason–a mechanism–for it to have that effect. Fortunately, within the last few years, researchers
have made progress toward both. Experiments in animals, including chicks and
rhesus monkeys, have shown that light can protect against myopia. Researchers in Germany first tried to induce
myopia in a set of chicks using special goggles, so that all the other variables could be controlled.
Then they exposed two groups to different lighting conditions, with one group being
raised under bright light that was meant to simulate sunlight, and others under normal
laboratory lighting. Turns out, the onset of myopia was slowed
in the group raised under bright lights, by around 60%. Then the researchers focused their attention
on a substance produced by your own brain that’s known to influence proper eye development:
the neurotransmitter dopamine. In another experiment, the researchers injected
the chicks with a chemical that blocked dopamine. Without the dopamine, the protective effect
of sunlight disappeared. So it’s believed that dopamine is released
into your eyes as a result of bright light. This chemical is at least partly related to
your body’s day/night rhythm — it’s involved in the switch body undergoes from from low-light
nighttime vision to daytime vision. And it’s what lets bright, natural light signal to
your body that it’s daytime. So, researchers now think that this dopamine
cycle is needed for healthy eye development throughout childhood. If it’s disrupted, like by spending all
your time indoors in dim light, your eyeball starts to become elongated, and myopia results. This light-dopamine hypothesis is currently
the best theory for how sunlight can help your eyes develop. Best part is, sunlight is free, and it’s
an easy thing to try to see if it keeps kids from becoming nearsighted. A few studies have even looked into using
sunlight as preventive medicine. One of the biggest studies looked at primary
school children at 12 schools in Guangzhou, China. They were divided into two groups of
six schools each, with about 950 children in each bunch. The control schools didn’t change their
daily routine, but the other schools added a 40-minute outdoor activity period. Then
the researchers tracked the kids for three years. By the end of the trial, the incidence rate
of myopia in the group that spent more time outside was 30%, compared to 39.5% in the
control group. The reduction was actually less than what
the researchers expected. But still, preventing myopia in young kids is worthwhile, they say,
because the longer it progresses, the worse it gets. The most difficult thing about using sunlight
as medicine might just be convincing parents to send their kids outside more. In the Chinese study, the schools sent the
kids outside for an extra 40 minutes, but parents were also asked to send their kids
outside even more on their own time. But as far as the researchers could tell,
the parents kind of…didn’t do that. And they think more than 40 minutes is needed
to achieve the most beneficial effect. So, it seems like a victory for sunlight.
I mean, it isn’t established for sure — many studies have shown that vision quality benefits
simply from going outside, rather than bright light per se. So it could be that the effect comes from,
say, playing more sports rather than sunlight. But researchers are calling for more studies
to better establish the link, and the data so far look promising. In the meantime, fresh air and sunlight as
a clinical intervention is a pretty appealing idea. In the end, it doesn’t seem like video games
or smartphones are to blame for the nearsightedness epidemic. But neither are books and homework.
And, thankfully, it’s not a terrifying virus that’s causing the epidemic of nearsightedness. Rather, it might be an overwhelming cultural
tendency to stay indoors. So if you want to keep your kids from becoming
nearsighted, maybe sign them up for soccer. Sports: they’re good for you. Who knew? Thanks for watching this episode of SciShow,
which was brought to you by our patrons on Patreon, like Carsten Steckel and Glen Knowles!
Thank you both! If you want to help us make more content like this, just go to patreon.com/scishow.
And don’t forget to go to youtube.com/scishow and subscribe!

Hidden Casualties: Consequences of Opioid Epidemic on Spread of Infectious Diseases Pt. 3

Hidden Casualties: Consequences of Opioid Epidemic on Spread of Infectious Diseases Pt. 3


>>THANK YOU SO MUCH,
DR. MERMIN, FOR HIGHLIGHTING
KIND OF AN OVERVIEW OF WHERE WE ARE, WHERE THE TRENDS ARE WITH
THE OPIOID EPIDEMIC AND INFECTIOUS DISEASES. WE RECOGNIZE THAT THE PRIMARY
PURPOSE FOR THE DEVELOPMENT OF SOME OF THE MORE EFFECTIVE,
LONGER LASTING OPIOID MEDICATIONS, MANY OF WHICH HAVE
PLAYED A PART IN THE OPIOID EPIDEMIC, WAS INITIALLY TO
ADDRESS PEOPLE’S PAIN SYMPTOMS. SO THE TREATMENT OF PAIN IS ONE
OF THE ISSUES THAT MUST BE CONSIDERED IN OUR RESPONSE TO
THE OPIOID EPIDEMIC. EVIDENCE SUGGESTS THAT MANY
PRESCRIPTIONS MEANT TO CONTROL A PATIENT’S PAIN END UP BEING
MISUSED, EITHER BY THE PATIENT THEMSELVES, A FRIEND OR A FAMILY
MEMBER. TO HELP TACKLE THIS ISSUE, I’M
PLEASED TO INTRODUCE DR. VANILA
SINGH. DR. SINGH IS CHIEF MEDICAL
OFFICER FOR THE OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH
HERE AT THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES. AS CHIEF MEDICAL OFFICER, SHE
SERVES AS THE PRIMARY MEDICAL ADVISER FOR THE ASSISTANT
SECRETARY OF HEALTH ON THE DEVELOPMENT AND IMPLEMENTATION
OF HHS-WIDE PUBLIC HEALTH POLICY RECOMMENDATIONS. DR. SINGH HAS BEEN ACTIVE IN
NATIONAL MEDICAL ORGANIZATIONS AND PRIOR TO JOINING HHS, SHE
WAS A CLINICAL ASSOCIATE PROFESSOR OF ANESTHESIOLOGY AT
STANFORD UNIVERSITY SCHOOL OF MEDICINE, SPECIALIZING IN
TREATING PATIENTS WITH COMPLEX CHRONIC PAIN ISSUES. IF WE COULD PLEASE PLAY THE
VIDEO MESSAGE FROM DR. SINGH.>>Good morning, Welcome to all of you who are participating
in this important symposium. My name is Dr. Vanila Singh and I serve as
the Chief Medical Officer at the Office of the Assistant Secretary for Health, at the
U.S. Department of Health and Human Services. The opioid crisis is among the top priorities
that HHS is addressing, and taking steps to reduce the misuse of prescription drugs is
a key part of a multi-pronged approach. Recent data from the National Survey on Drug
Use and Health indicate that approximately 11.8 million individuals misused opioids in
2016—and the vast majority of those, 11.5 million, were misusing prescription pain
relievers. This figure is down by one million from 2015,
however, opiate overdose and deaths remains a major issue and one that requires a much
broader understanding of a complicated problem. As part of the HHS 5-point strategy to combat
the opioid epidemic, HHS, along with the Department of Veterans Affairs and the Department of
Defense is leading a Congressionally-mandated task force through
CARA, the Comprehensive Addiction Recovery Act of 2016) to develop best practices for
prescribing pain medication and for managing chronic and acute pain. The Task Force will include federal and non-federal
representatives with expertise in the field as well as other stakeholders. The Task Force will be charged with identifying
gaps or inconsistencies that exist in pain management best practices among federal agencies
and with proposing recommendations for addressing them. We are also partnering with the National Institutes
of Health to implement the National Pain Strategy, which is the federal government’s first
coordinated plan for reducing the burden of chronic pain that affects millions of Americans. The National Pain Strategy is a roadmap toward
achieving a system of care in which all people receive appropriate, high quality and evidence-based
care for pain. These activities, along with other efforts,
aim to improve the way opioids are prescribed, so patients have access to safer, more effective
chronic pain treatment while reducing the number of people who misuse, abuse, or overdose
from these drugs. As a pain physician and anesthesiologist who
has helped patients manage acute and chronic pain my entire career, I recognize that it’s
important to balance the need to end the devastating effects of opioid misuse that we are seeing
across the nation, while ensuring that pain patients can work with their doctors to develop
an integrative pain treatment plan that optimizes function, quality of life, and productivity. The nation’s opioid epidemic is a multi-faceted
issue that requires novel strategies with newer partnerships and relationships that
help to enhance the well-being of all Americans. I’m pleased that we are focusing today’s
discussion on communities at risk for infectious diseases so that we can address the needs
of this vulnerable population, with the hope of increasing awareness. Thank you for participating in the discussion
of this important topic today.>>DR. SINGH REALLY WANTED TO BE
HERE TODAY BUT UNFORTUNATELY SHE HAD A PRESENTATION SHE ALREADY
AGREED TO AT NIH.

Epidemics and Pandemics

Epidemics and Pandemics


With the constant media coverage of diseases
like the zika virus, ebola, H1N1 and the yearly flu, we keep hearing about the threat of epidemics
and pandemics, but what do these really mean when it comes to disease emergence and spread? The baseline or endemic level of a disease,
is the amount that is usually present in a given community. An epidemic is a drastic increase in the number
of people infected with that disease, in that same community. A pandemic refers to an epidemic that has
spread to several countries or continents, affecting a large number of people. So what can cause an epidemic? Epidemics can be caused by a couple different
factors including: • An increase in the amount of a disease
or its virulence • Its appearance in a new location
• An enhanced mode of transmission • A change in the susceptibility of the
host to being infected and
• Increased host exposure or a new method of host infection 3 common ways epidemics can be spread are:
• From a common-source, where a group of people are all exposed to an infectious agent
or toxin from the same source • By propagated outbreak, with transmission
from one person to another Or
• Using a vector or carrier (like mosquitoes) that interact with humans and transmits the
disease To classify the spread of disease as a pandemic,
there need to be community level outbreak epidemics in at least one other country in
a different world health organization defined region, which means the disease is starting
to spread around the world. By this time the respective governments of
outbreak-stricken countries should have taken action to halt disease progression and implement
national health strategies. So next time you hear about epidemics and
pandemics on the news, you don’t need to prepare to flee to Antarctica. Take some time
to learn more about the disease, how it’s spread and where it is prevalent, to keep
yourself safe. For more information please visit the WHO’s
website at www.who.int

Ending AIDS? These three places show the epidemic is far from over


Several places are still far far away from ending their epidemics and in fact are seeing their epidemics increase and that’s what I’m focusing on. Asking the question why and who’s there on the ground trying to fix things. My name is John Cohen. I’m a staff writer with Science magazine. the Pulitzer Center funded travel for this project which also involved a collaboration with the PBS Newshour. I’ve been covering the epidemic around the world now for nearly 30 years. When I began doing this I’d go on trips to other countries and see warehouses full of people dying. I don’t see that now but I do see places that are struggling to use the very powerful tools that exist both to help keep people alive and to stop them from spreading the virus to other people. About one out of four mother to child transmissions in the world happen in Nigeria. And Nigeria has had billions of dollars of foreign aid poured into the country to help solve the problem. So what’s wrong? The big problem is so many pregnant women never intersect with healthcare. They either give birth at home or they have a traditional birth attendant but she’s not necessarily a trained health care professional who’s gonna do HIV testing. So one of the creative things that Nigeria has going right now is a project working with traditional birth attendants. I met with a traditional birth attendant Mama Metta and they have trained Mama Metta to encourage women to come to her clinic on a day when an HIV testing group shows up and she also knows that if a woman does test positive that she should transfer her to a hospital or a regular clinic for care. So that’s one of the progressive things that’s happening in Nigeria to try to really isolate a problem. About 90% of Nigerians go to services on the weekends whether they’re Christian or Muslim and the country’s about 50/50 so a project has begun called baby shower where they go to the churches and they have the priests say all pregnant women And their partners come to the front for a special blessing. And then the priest says after the service we’re gonna have health testing here we’re gonna check you for sickle-cell anemia and we’re gonna check you for hepatitis B and we’re gonna check you for HIV. HIV is just wrapped up into this because there’s so much stigma and discrimination people might not come for an HIV test but for a health test with all these things they’ll show up. And they get a gift for their baby and for their birthing and then if a woman tests positive there—they link the woman to care and they make sure that she gets on antiretroviral drugs, her baby receives the treatment to stop transmission. It’s a full package to try to address the problem. With baby shower it’s producing some amazing results. It’s spray is like perfume. You can spray it here and somebody else somewhere hmm so what is that and comes looking for what it is. Once they get into the village you see all that running and coming oh the baby shower, I saw you today, this, that, dah, dah. The perfume is spreading, the fragrance is going everywhere. Russia accounts for 80% of all the new infections over the past five years in Eastern Europe and Central Asia. And it has about 10% new infections a year. Something’s really wrong. Well what? What’s broken? Well, Russia only has antiretroviral drugs reaching about one third of the infected people. That’s a big problem. They do not promote needle exchange programs. They barely allow them. So the Russian epidemic has just been growing at a time when it’s dropping everywhere else in Europe. In that harsh political environment, HIV infected people and advocates have created a pharmacy—sort of an underground pharmacy to supply infected people with drugs when the government runs out of drugs. So they collect these antiretroviral drugs and redistribute them to people in need. This is for free. Just help each other. When I did a just a completely unbiased look at the data, what’s happening in the United States— Miami has more new infections than any
city in the country. That shocked me and then when I looked at the top 10 cities in the country—four of
them were in Florida for the new infection rate. Florida has basically every driver of the epidemic that we know of in the United States. High rate of infection in men who have sex with men, it has people who inject drugs, public transportation isn’t really what it should be, and then our rural areas are even more challenged. Homelessness, mental health, ethnic disparities all get in the way of us dealing with the epidemic here. it’s a challenge under the best of circumstances to get appropriate messaging to get people into care. The Haitian community for example, a lot of people don’t speak English—they speak Creole. So, to reach the Haitian community a radio program has a health section that just goes after that Creole population. A way to specifically get them HIV tested. Here’s a clinic in Little Haiti. It has people speaking Creole. They’ll pick you up at your home and take you back and forth. We know if you are treated with antiretroviral drugs and you drive your virus in your body down to levels that are undetectable your odds of transmitting that virus to someone else are exceedingly low. Myself, I take my meds all the time so I have become undetectable. That’s at the heart of all these efforts is get everyone tested get everyone who’s positive on treatment and getting everyone who’s at high risk to lower their risk. To do something like needle and syringe exchange programs or pre-exposure prophylaxis which is a pill usually used to treat HIV that can prevent HIV. That’s what’s needed to really break the back of the epidemic. And there’s a whole lot we can today.