Horizon, Host: Ted Simons

May 29, 2006


Host: Michael Grant

AIDS in Arizona


  • Part one of three Join this first of a three-part examination of the HIV and AIDS problem in Arizona. Bruce Porter, chief of the HIV and AIDS office for the Arizona Department of Health Services is our guest.
Guests:
  • Bruce Porter - chief, office of HIV AIDS, Arizona Department of Health Services


View Transcript
Michael Grant:
Tonight on Horizon, the first of a three-part series on the impact of AIDS in Arizona. Tonight, who is at risk, how the trends have shifted over the years. Also it could be another deadly summer for illegal border crossers.

Announcer:
Horizon is made possibly by contributions from the friends of eight, members of your Arizona PBS station. Thank you.

Michael Grant:
Good evening, and thanks for joining us tonight on Horizon. I'm Michael Grant. Tomorrow night PBS will begin a special Frontline production, "The Age of AIDS." It has been 25 years since the first diagnosed cases of AIDS. Scientists have confirmed that the HIV virus originated in chimpanzees in Africa. Someone contracted the disease by being bitten by a chimp or by butchering one. Frontline will look at the history of this still devastating pandemic. To coincide with that program, Horizon will look at the impact of the disease in Arizona. Organizations such as body positive that are helping AIDS victims cope, and the research being done in our state to find a cure for aids. Around the world approximately 25 million people have died of AIDS. About 40 million have been infected. 1981 was the first year HIV AIDS was reported in our state. Since then, there have been more than 19,000 confirmed cases of HIV infection. More than half of confirmed cases of AIDS in the state have resulted in death. The number of deaths from AIDS decreased dramatically in the late 90's because of multi-drug treatment. Arizona currently has nearly 11,000 people living with HIV or AIDS. One of those people is Keith Thompson. Thompson is executive director of the Phoenix Shanti group, a nonprofit organization that provides services to AIDS victims and family. Larry Lemmons tells us his story.

Donald Fisk:
Hey Keith, how's it going?

Keith Thompson:
Pretty good. How's this HUD system stuff coming along?

Larry Lemmons:
Keith Thompson is a fortunate man. Perhaps it's unusual to say that about someone who's HIV positive, but he's survived the disease for more than 20 years.

Keith Thompson:
I tested in '85. I'd been with a partner. We met in '81 and moved in together in '82 and in those first couple years we'd been hearing about this disease that had come up amongst gay men in some big cities, New York and San Francisco primarily. But I just went for a routine doctor's visit in 1985 and my doctor knew that I had a male partner and so he suggested that I might want to consider getting this new test. And I did and then the results were positive. And I was stunned. I remember my first reaction was the same reaction that others of us had back in those years, which was my life is probably over and I need to prepare to die.

Anonymous:
So this is all filled out, too.

Keith Thompson:
Thank you. Good.

Larry Lemmons:
Today Keith Thompson is the executive director of the Phoenix Shanti group. He's talking with the organization's director of operations Donald Fisk. The Phoenix Shanti group provides health and housing services, education and client services to people infected by AIDS and their loved ones. Thompson's partner died of AIDS.

Keith Thompson:
'91 was a very difficult year. That's when my partner died. For about a year before that he had started getting really sick. Lost sight in his one eye. And I remember that Christmas, he died in September, but that Christmas we were at my mom's and we-- I never had spoken with her about he or I's diagnosis. And she had never said anything to us either. But he was very visibly ill then. And I remember just us being out in the patio, she and I, and all she said to me was, if I could take what's happened to David on myself, I would do that. Because he's too young, just too young to die. And I-- it reminded me of how remarkable my mother was and that's all we needed to say. Because I knew then that she loved him as much as she loved me. For her to say that.

Larry Lemmons:
The reason Keith Thompson's HIV has not ultimately become fatal is fairly simple. In the mid 90's, about the time his health was seriously deteriorating, drugs were developed.

Keith Thompson:
1996 was a turning point, and when some of these new medications were being developed and my doctor was sure to get me on them, I think that I don't know why I responded to those and again there's been others for whom those medications have not been effective.

Larry Lemmons:
Twice a day, every day, Thompson takes Viramune and Combivir. These have helped those suffering from HIV. The pills are not a cure and must be taken without fail.

Keith Thompson:
That's one big issue for us positive people with these drugs, is that we can't miss doses, because what might happen, this is a tricky virus and it can mutate readily and we call it in the HIV field resistance, but we know in some of the folks that are even taking these meds, they're developing resistance to the drugs. Which means the drugs won't be effective for them anymore. And it's a big concern for all of us in the HIV field that resistance not develop, because the drugs are what's keeping us alive.

Keith Thompson:
Okay, I'll be over at the store. And I should be back about 1:00.

Larry Lemmons:
Occasionally Thompson will travel to Shanti's 2nd Chances, a resale furniture store that provides funds for the organization.

Keith Thompson:
It's a store and it's supported by hundreds and hundreds of people from throughout the community who call and have us come and pick up their used furniture that's in, as you can see, in really great shape in most cases and we're also supported wonderfully for many years by corporate and business people like Metropolitan Mattress, La-Z-Boy Gallery, Terri's Consign & Design, have been wonderful business and community supporters as well for us.

Larry Lemmons:
Keith Thompson has had a surprisingly long journey, considering his expectations 20 years ago. Because of his health and the years spent helping others with the problems associated with AIDS, he's had time to think about what potential victims of the disease should know.

Keith Thompson:
If it happens to you, it really is different than happening to someone else. That it's-- it will change your life. Maybe it will also change it in better ways. If you're using drugs and if there's other behaviors in your life that are contributing to your talking risks that maybe you'll look at your own life differently, value it even more, and make some other changes in your life, so that you can really live. Not only with HIV but live better altogether. But education is a piece of it. Getting over the obstacles, whatever they are, that are leading to your risky behavior, again, whether it's substance abuse, whether it's you're not valuing yourself, whether you have your own internal homophobia, if you should be a gay man, that you don't care enough about your own life, whether you're depressed. We know depression is a major cofactor for people taking risky behavior. Seek out help for those things and find a community of support so you're not putting your own life at risk.

Michael Grant:
With us now to talk about the impact of AIDS in our state, the chief of the office of HIV AIDS at the Arizona Department of Health Services, Bruce Porter, who I might add has returned recently from Africa, where he saw the AIDS problem up close on that continent. Bruce, it's good to see you.

Bruce Porter:
Good to be here.

Michael Grant:
Remind us again of the difference between being HIV positive and having AIDS.

Bruce Porter:
Well, as with every other disease, infectious disease this is this whole sequence of events that can occur. The first thing that has to occur is becoming infected with the virus. Typically people with HIV become infected, asymptomatically, and will be in a state of actually not knowing they have anything going on. They don't know that they have HIV and may over the years eventually develop symptoms and other diseases, opportunistic infections that crop up. So the difference really is having the virus and no symptoms, no diseases that would warn you that perhaps you needed to look at this as something that might be going on, and then later developing AIDS. Which typically is still in the neighborhood of about ten years on average.

Michael Grant:
If you have the HIV virus, is it inevitable that you are going to have AIDS?
Bruce Porter: I don't know that that's true. I don't-- one of the things that I like to remind myself of, I've been doing this work for over 20 years, and the reality is that in this country we've only known about the virus for 25-- or about the disease and the virus for about 25 years. I don't think we know yet the whole natural history of HIV. I am believing that there will be a fair number of people who remain asymptomatically infected with HIV for many, many, many years and may never develop defining characteristics of aids. But I don't know that to be a fact. All I know is we haven't had 50 years; we've only had 25 years to look at it.

Michael Grant:
However, would this be accurate: for most, it's going to turn into it?

Bruce Porter:
I'm thinking that that's probably true, certainly been what we've seen.

Michael Grant:
I see. Let's focus on Arizona, get some numbers, get some feel. What are the numbers for HIV AIDS in Arizona right now?

Bruce Porter:
We're currently estimating probably between 11 and 12,000 people are living with HIV infection at this moment. One of the things that's interesting is that over time we've started to sort of drop our distinction between HIV and AIDS, basically just starting to think of it as a whole disease process and refer to it more as HIV infection, HIV disease, rather than making the distinction. But around 11,000 to 12,000. I think what's interesting for Arizona that might be different from the rest of the country is that this epidemic in its beginnings 25 years ago was largely confined to men who had sex with men. And that has not changed. Appreciably, over time. That if in the early days it was 70\%, it's still over 60\%. As we speak now. So it's largely a disease of men who have sex with men. What is interesting also is that we're seeing fewer cases attributable to needle sharing among injection drug users. That's actually on the decrease, and I would suggest that some of that is because of some good interventions that have been done.

Michael Grant:
Okay. So the group in Arizona most at risk remains gay men.

Bruce Porter:
It's still MSM. That's right.

Michael Grant:
But if I understood you correctly, nationwide it may not be-- that may not be as statistically significant now.

Bruce Porter:
Now. What we've seen on the coasts, basically, or mostly on the east coast, is an increase in the number of cases that are attributed to heterosexual contact. Clearly we've seen an increase in heterosexual transmission in Arizona; it just hasn't reached the proportions as in other parts of the country. So in general in terms of risk behavior, still mostly MSM, heterosexual is increasing and injection drug use is decreasing.

Michael Grant:
Demographic risk, racial group risk?

Bruce Porter:
Yeah, it's certainly interesting. We did a process this year of trying to estimate prevalence rates, rates of infection among different populations. Racial or ethnic populations are easy to count. These are numbers that are available. When you want to know how many gay men are there in Arizona, it's a whole different question, or how many injection drug users. We spent some time estimating those. And one of the things I think is really important to say and was actually quite shocking to me personally and to our office and to the community, was that for men who have sex with men between the ages of 40 and 49, in Arizona, 25\% are currently infected with HIV. One in four. Men 40 to 49 who have sex with other men. That's a shocking kind of number. 25\% is a huge number.

Michael Grant:
Right.

Bruce Porter:
But we were only able to find that number when we started doing some estimates of population size and started to see really what an impact it's been. 25 years ago there were none. 25 years later, a quarter of a population of that particular age group. So I think that's one of the statistics that's important to remember. There's another one, but looks like you have a question.

Michael Grant:
Well, no. I was going to say in that 25-year span, how would some of the trends and statistics and those kinds of things that we've been talking about additionally have changed?

Bruce Porter:
Well, one of the big changes we've seen is among African-Americans. As you may know, African-Americans comprise around 3\% of the total population of the state of Arizona but when you look at HIV AIDS it's not that at all. Overall 12\% of the prevalent cases of the living cases of AIDS in Arizona are African-American. That's four times higher than what you would expect to see in the population. Clearly there's something that's remarkable there.

Michael Grant:
Yeah. How do we explain that or can we explain that?

Bruce Porter:
I don't know that we can explain it. When we look at risk for comparing populations, Blacks versus Whites, we don't really see any appreciable differences. It's just something that we need to keep paying more and more attention to. It's even more alarming, if I can use that word, when we separate by gender, that even though the rates are still very high among African-American men, when we start looking at African-American women, they are much higher. 15 times higher among African-American women than White women in this state. For new cases. Nine times higher in terms of cases that have the sort of cumulative number of people that are living here. So it's a problem we need to look at.

Michael Grant:
We have become increasingly aware of all the problems associated with meth. One that I was not aware of though is the role it's also playing in HIV AIDS infection.

Bruce Porter:
Yeah, there's certainly been a lot of attention about the possible role of meth in promoting transmission of HIV AIDS and of course logically it makes sense. There we're dealing with debilitating drug, a drug that alters people's ability to make rational decisions about their activities. It also might promote people exchanging sex for drugs, engaging in risky behavior in order to acquire money or to acquire the drugs. Certainly they're going to be biological, physical effects on people who are meth users that might render them more likely to be infected given exposure. We haven't been able to quantify the impact of meth use in Arizona on our case rates. We know that it's there, it just has not been something we haven't been able to do the study yet that tells us what proportion of cases might be related somehow to meth use.

Michael Grant:
Bruce, the tape package we saw talked about the cocktails that became available in the mid-1990's and obviously those have been somewhat successful. They're not a cure though. Are we close to a cure or not?

Bruce Porter:
Now that's-- the whole cure idea is an elusive concept. And there have been years and years and years of conferences where people would attend the conference waiting, thinking this was the year the big announcement's going to be made, the breakthrough viralogic antiviral agent that would be what we've been waiting for. We haven't seen it yet and I think as more time goes by we are still exploring, investigating, testing, we're still looking for that. But I think we come to understand that this behaves a lot like a chronic condition that's going to need to have consistent attention applied to it through a variety of antivirals we've come to call the cocktail. They have been remarkably effective in prolonging people's lives. Keith is an example of someone who's lived for over 20 years with HIV infection and he's not unusual in that regard. Long-term survivors are really quite common these days. There are things that are associated with having to take those pills, you know, some long-term ill effects that occur from that. But I think on balance there is no question they've had a dramatic impact on reducing death rates.

Michael Grant:
You just recently got back from Botswana. Is the African content the most impacted by AIDS?

Bruce Porter:
Absolutely. No question about it. Sub-Saharan Africa, if you leave out Sudan and northern regions of the state. The sub-Saharan part of the country-- the continent, rates of up to 35 to 40\% of countries who are currently infected, Botswana, their calculated rate for the country is 36\% of the population is infected. That is a completely different situation than we have in America. We don't have anything like that here. So when you go to a country like Botswana, you're in a different world. Your approaches are different. Your thinking is different. You have to-- it's a generalized epidemic and the targeting and the focusing and the EPI that I might have just talked about doesn't matter there. It's a problem for the whole country and it's recognized actually as a problem for the whole country.

Michael Grant:
When something though is that widespread you would think a society would react.

Bruce Porter:
Yes.

Michael Grant:
Okay. But 36\%, I mean, obviously something is still going very wrong there.

Bruce Porter:
Well, there are communities actually, one community in the northern part of the country, that's 75\% of folks in that region are known to be infected with HIV. Something went terribly wrong and continues to go terribly wrong in that kind of a situation. The government has now done amazing campaigns. Over half of the federal budget of the country of Botswana is devoted to HIV. There are resources all over the place. But you know, there are issues that are existent there that keep driving the epidemic that we haven't been able to get a handle on.

Michael Grant:
All right, Bruce Porter, good information, Arizona Department of Health Services, thank you very much.

Bruce Porter:
Indeed.

Michael Grant:
Tomorrow night on our part three look at the AIDS problem in Arizona, we'll take you to a Body Positive, an organization for people infected and affected by HIV. Triple digit temperatures have arrived in our state. That means the danger increases for those who cross the border illegally. Tony Paniagua reports on attempts to dissuade those thinking of crossing the treacherous Sonoran desert.

Tony Paniagua:
Triple digit temperatures are part of a seasonal experience in much of Arizona. Something you put up with a few months out of the year. But while most of us can get relief in our air conditioned houses or vehicles, thousands of others have no such luck.

Geoffrey Boyce:
It's remarkable. As soon as the temperature hits 100 degrees, we start seeing a lot more people in real crisis out there.

Tony Paniagua:
Geoffrey Boyce works for No More Deaths, an activist organization trying to prevent additional fatalities in the desert. The group is joining others in trying to get the message out about the dangerous environment. They'll be working in Arizona and Mexico, hoping to dissuade potential crossers from risking their lives.

Geoffrey Boyce:
Letting people know the danger that they're in and encouraging them to get out of the desert, which for most people means, you know, turning themselves in to the border patrol and going back to Mexico. We're going to be working with migrant shelters in Mexico so that they have a place to go once they're back there. And you know, and when people are in medical emergencies it will also mean getting them to a medical facility for treatment.

Tony Paniagua:
The Mexican consulate in Tucson is also beginning a new awareness campaign. It will include television and radio spots as well as information in newspapers and flyers. This one was part of the effort in 2005.

Alejandro Ramos Cardoso:
And here it says yes, it's true, the desert is dangerous. Do not try it. And finally, it says do not allow your loved ones to cross the desert during summertime. Do it for them. Our aim is to send it everywhere possible, not only in the states but also in Mexico. We're going to do this through the different offices, office of foreign affairs in Mexico. We have about 35 offices throughout the whole country and we're going to ask them to distribute this material in the local media.

Tony Paniagua:
But many people continue to do it, in part because of lack of education or misinformation. Many Mexican migrants live in the central or southern part of that country. Tropical areas with plenty of trees for shade or water in the countryside. They are not aware of our extreme conditions and they try to travel with just a few quarts of water.

Geoffrey Boyce:
When the temperature hits 110 degrees it's physically impossible to carry sufficient water with you. There's not water available in the desert. If you were to start out with all the water that you needed you'd be carrying 50 one-gallon containers of water. I mean, you need to replenish your body with about a quart of water an hour in the heat of the summer, when you're exercising heavily.

Tony Paniagua:
The heat and lack of water are some of the major problems the immigrants will encounter as they try to make their trek across the desert. Some may find wild animals like rattlesnakes while others will be raped, robbed, or even abandoned by the very people that are supposed to be guiding them.

Alejandro Ramos Cardoso:
They tend to tell people they're going to walk for about six to eight hours, whereas we know that from the border, they have to walk for about three days to get into Tucson, for example.

Tony Paniagua:
But even though hundreds have died in recent years, many more people are continuing to take a chance. In fact, the Tucson consulate has become the busiest in the United States when it comes to death and dying in the desert. Mexico has 46 consulates in this country.

Alejandro Ramos Cardoso:
We are unfortunately the consulate that has more deaths of Mexican nationals crossing the border.

Geoffrey Boyce:
We're expecting that this year we'll again break the record for the number of people who die out here, not only on the border in general, but particularly here in the Tucson sector. So we are in the midst of a humanitarian-- of a human tragedy and humanitarian crisis here and so until there is a comprehensive immigration reform that does provide people legal path to come to this country, legal, safe, and secure, we're going to continue seeing this human crisis.

Tony Paniagua:
But even as the U.S. passes a comprehensive immigration bill that allows more people to come and work here legally, Boyce believes it will take months to implement. In the meantime many more migrants will probably lose their lives, exposing themselves to the elements in a dangerous journey.

Merry Lucero:
An Arizona organization is having a positive impact on the global fight against HIV AIDS. Body Positive has done clinical trials on 23 of the 26 drugs now prescribed to fight AIDS. Now they're doing a study on a vaccine that could help prevent the infection, part two of our series AIDS in Arizona Tuesday on Horizon.

Michael Grant:
And Wednesday we will wrap up the examination of AIDS in our state with a look at research being done here to cure the disease. Thank you very much for joining us this evening. I'm Michael Grant. Hope you have a great one. Good night.

Discouraging desert deaths


  • Find out what's being done to discourage illegal immigrants from attempting to cross the Sonoran desert in the deadly summer heat.
Guests:
  • Bruce Porter - chief, office of HIV AIDS, Arizona Department of Health Services


View Transcript
Michael Grant:
Tonight on Horizon, the first of a three-part series on the impact of AIDS in Arizona. Tonight, who is at risk, how the trends have shifted over the years. Also it could be another deadly summer for illegal border crossers.

Announcer:
Horizon is made possibly by contributions from the friends of eight, members of your Arizona PBS station. Thank you.

Michael Grant:
Good evening, and thanks for joining us tonight on Horizon. I'm Michael Grant. Tomorrow night PBS will begin a special Frontline production, "The Age of AIDS." It has been 25 years since the first diagnosed cases of AIDS. Scientists have confirmed that the HIV virus originated in chimpanzees in Africa. Someone contracted the disease by being bitten by a chimp or by butchering one. Frontline will look at the history of this still devastating pandemic. To coincide with that program, Horizon will look at the impact of the disease in Arizona. Organizations such as body positive that are helping AIDS victims cope, and the research being done in our state to find a cure for aids. Around the world approximately 25 million people have died of AIDS. About 40 million have been infected. 1981 was the first year HIV AIDS was reported in our state. Since then, there have been more than 19,000 confirmed cases of HIV infection. More than half of confirmed cases of AIDS in the state have resulted in death. The number of deaths from AIDS decreased dramatically in the late 90's because of multi-drug treatment. Arizona currently has nearly 11,000 people living with HIV or AIDS. One of those people is Keith Thompson. Thompson is executive director of the Phoenix Shanti group, a nonprofit organization that provides services to AIDS victims and family. Larry Lemmons tells us his story.

Donald Fisk:
Hey Keith, how's it going?

Keith Thompson:
Pretty good. How's this HUD system stuff coming along?

Larry Lemmons:
Keith Thompson is a fortunate man. Perhaps it's unusual to say that about someone who's HIV positive, but he's survived the disease for more than 20 years.

Keith Thompson:
I tested in '85. I'd been with a partner. We met in '81 and moved in together in '82 and in those first couple years we'd been hearing about this disease that had come up amongst gay men in some big cities, New York and San Francisco primarily. But I just went for a routine doctor's visit in 1985 and my doctor knew that I had a male partner and so he suggested that I might want to consider getting this new test. And I did and then the results were positive. And I was stunned. I remember my first reaction was the same reaction that others of us had back in those years, which was my life is probably over and I need to prepare to die.

Anonymous:
So this is all filled out, too.

Keith Thompson:
Thank you. Good.

Larry Lemmons:
Today Keith Thompson is the executive director of the Phoenix Shanti group. He's talking with the organization's director of operations Donald Fisk. The Phoenix Shanti group provides health and housing services, education and client services to people infected by AIDS and their loved ones. Thompson's partner died of AIDS.

Keith Thompson:
'91 was a very difficult year. That's when my partner died. For about a year before that he had started getting really sick. Lost sight in his one eye. And I remember that Christmas, he died in September, but that Christmas we were at my mom's and we-- I never had spoken with her about he or I's diagnosis. And she had never said anything to us either. But he was very visibly ill then. And I remember just us being out in the patio, she and I, and all she said to me was, if I could take what's happened to David on myself, I would do that. Because he's too young, just too young to die. And I-- it reminded me of how remarkable my mother was and that's all we needed to say. Because I knew then that she loved him as much as she loved me. For her to say that.

Larry Lemmons:
The reason Keith Thompson's HIV has not ultimately become fatal is fairly simple. In the mid 90's, about the time his health was seriously deteriorating, drugs were developed.

Keith Thompson:
1996 was a turning point, and when some of these new medications were being developed and my doctor was sure to get me on them, I think that I don't know why I responded to those and again there's been others for whom those medications have not been effective.

Larry Lemmons:
Twice a day, every day, Thompson takes Viramune and Combivir. These have helped those suffering from HIV. The pills are not a cure and must be taken without fail.

Keith Thompson:
That's one big issue for us positive people with these drugs, is that we can't miss doses, because what might happen, this is a tricky virus and it can mutate readily and we call it in the HIV field resistance, but we know in some of the folks that are even taking these meds, they're developing resistance to the drugs. Which means the drugs won't be effective for them anymore. And it's a big concern for all of us in the HIV field that resistance not develop, because the drugs are what's keeping us alive.

Keith Thompson:
Okay, I'll be over at the store. And I should be back about 1:00.

Larry Lemmons:
Occasionally Thompson will travel to Shanti's 2nd Chances, a resale furniture store that provides funds for the organization.

Keith Thompson:
It's a store and it's supported by hundreds and hundreds of people from throughout the community who call and have us come and pick up their used furniture that's in, as you can see, in really great shape in most cases and we're also supported wonderfully for many years by corporate and business people like Metropolitan Mattress, La-Z-Boy Gallery, Terri's Consign & Design, have been wonderful business and community supporters as well for us.

Larry Lemmons:
Keith Thompson has had a surprisingly long journey, considering his expectations 20 years ago. Because of his health and the years spent helping others with the problems associated with AIDS, he's had time to think about what potential victims of the disease should know.

Keith Thompson:
If it happens to you, it really is different than happening to someone else. That it's-- it will change your life. Maybe it will also change it in better ways. If you're using drugs and if there's other behaviors in your life that are contributing to your talking risks that maybe you'll look at your own life differently, value it even more, and make some other changes in your life, so that you can really live. Not only with HIV but live better altogether. But education is a piece of it. Getting over the obstacles, whatever they are, that are leading to your risky behavior, again, whether it's substance abuse, whether it's you're not valuing yourself, whether you have your own internal homophobia, if you should be a gay man, that you don't care enough about your own life, whether you're depressed. We know depression is a major cofactor for people taking risky behavior. Seek out help for those things and find a community of support so you're not putting your own life at risk.

Michael Grant:
With us now to talk about the impact of AIDS in our state, the chief of the office of HIV AIDS at the Arizona Department of Health Services, Bruce Porter, who I might add has returned recently from Africa, where he saw the AIDS problem up close on that continent. Bruce, it's good to see you.

Bruce Porter:
Good to be here.

Michael Grant:
Remind us again of the difference between being HIV positive and having AIDS.

Bruce Porter:
Well, as with every other disease, infectious disease this is this whole sequence of events that can occur. The first thing that has to occur is becoming infected with the virus. Typically people with HIV become infected, asymptomatically, and will be in a state of actually not knowing they have anything going on. They don't know that they have HIV and may over the years eventually develop symptoms and other diseases, opportunistic infections that crop up. So the difference really is having the virus and no symptoms, no diseases that would warn you that perhaps you needed to look at this as something that might be going on, and then later developing AIDS. Which typically is still in the neighborhood of about ten years on average.

Michael Grant:
If you have the HIV virus, is it inevitable that you are going to have AIDS?
Bruce Porter: I don't know that that's true. I don't-- one of the things that I like to remind myself of, I've been doing this work for over 20 years, and the reality is that in this country we've only known about the virus for 25-- or about the disease and the virus for about 25 years. I don't think we know yet the whole natural history of HIV. I am believing that there will be a fair number of people who remain asymptomatically infected with HIV for many, many, many years and may never develop defining characteristics of aids. But I don't know that to be a fact. All I know is we haven't had 50 years; we've only had 25 years to look at it.

Michael Grant:
However, would this be accurate: for most, it's going to turn into it?

Bruce Porter:
I'm thinking that that's probably true, certainly been what we've seen.

Michael Grant:
I see. Let's focus on Arizona, get some numbers, get some feel. What are the numbers for HIV AIDS in Arizona right now?

Bruce Porter:
We're currently estimating probably between 11 and 12,000 people are living with HIV infection at this moment. One of the things that's interesting is that over time we've started to sort of drop our distinction between HIV and AIDS, basically just starting to think of it as a whole disease process and refer to it more as HIV infection, HIV disease, rather than making the distinction. But around 11,000 to 12,000. I think what's interesting for Arizona that might be different from the rest of the country is that this epidemic in its beginnings 25 years ago was largely confined to men who had sex with men. And that has not changed. Appreciably, over time. That if in the early days it was 70\%, it's still over 60\%. As we speak now. So it's largely a disease of men who have sex with men. What is interesting also is that we're seeing fewer cases attributable to needle sharing among injection drug users. That's actually on the decrease, and I would suggest that some of that is because of some good interventions that have been done.

Michael Grant:
Okay. So the group in Arizona most at risk remains gay men.

Bruce Porter:
It's still MSM. That's right.

Michael Grant:
But if I understood you correctly, nationwide it may not be-- that may not be as statistically significant now.

Bruce Porter:
Now. What we've seen on the coasts, basically, or mostly on the east coast, is an increase in the number of cases that are attributed to heterosexual contact. Clearly we've seen an increase in heterosexual transmission in Arizona; it just hasn't reached the proportions as in other parts of the country. So in general in terms of risk behavior, still mostly MSM, heterosexual is increasing and injection drug use is decreasing.

Michael Grant:
Demographic risk, racial group risk?

Bruce Porter:
Yeah, it's certainly interesting. We did a process this year of trying to estimate prevalence rates, rates of infection among different populations. Racial or ethnic populations are easy to count. These are numbers that are available. When you want to know how many gay men are there in Arizona, it's a whole different question, or how many injection drug users. We spent some time estimating those. And one of the things I think is really important to say and was actually quite shocking to me personally and to our office and to the community, was that for men who have sex with men between the ages of 40 and 49, in Arizona, 25\% are currently infected with HIV. One in four. Men 40 to 49 who have sex with other men. That's a shocking kind of number. 25\% is a huge number.

Michael Grant:
Right.

Bruce Porter:
But we were only able to find that number when we started doing some estimates of population size and started to see really what an impact it's been. 25 years ago there were none. 25 years later, a quarter of a population of that particular age group. So I think that's one of the statistics that's important to remember. There's another one, but looks like you have a question.

Michael Grant:
Well, no. I was going to say in that 25-year span, how would some of the trends and statistics and those kinds of things that we've been talking about additionally have changed?

Bruce Porter:
Well, one of the big changes we've seen is among African-Americans. As you may know, African-Americans comprise around 3\% of the total population of the state of Arizona but when you look at HIV AIDS it's not that at all. Overall 12\% of the prevalent cases of the living cases of AIDS in Arizona are African-American. That's four times higher than what you would expect to see in the population. Clearly there's something that's remarkable there.

Michael Grant:
Yeah. How do we explain that or can we explain that?

Bruce Porter:
I don't know that we can explain it. When we look at risk for comparing populations, Blacks versus Whites, we don't really see any appreciable differences. It's just something that we need to keep paying more and more attention to. It's even more alarming, if I can use that word, when we separate by gender, that even though the rates are still very high among African-American men, when we start looking at African-American women, they are much higher. 15 times higher among African-American women than White women in this state. For new cases. Nine times higher in terms of cases that have the sort of cumulative number of people that are living here. So it's a problem we need to look at.

Michael Grant:
We have become increasingly aware of all the problems associated with meth. One that I was not aware of though is the role it's also playing in HIV AIDS infection.

Bruce Porter:
Yeah, there's certainly been a lot of attention about the possible role of meth in promoting transmission of HIV AIDS and of course logically it makes sense. There we're dealing with debilitating drug, a drug that alters people's ability to make rational decisions about their activities. It also might promote people exchanging sex for drugs, engaging in risky behavior in order to acquire money or to acquire the drugs. Certainly they're going to be biological, physical effects on people who are meth users that might render them more likely to be infected given exposure. We haven't been able to quantify the impact of meth use in Arizona on our case rates. We know that it's there, it just has not been something we haven't been able to do the study yet that tells us what proportion of cases might be related somehow to meth use.

Michael Grant:
Bruce, the tape package we saw talked about the cocktails that became available in the mid-1990's and obviously those have been somewhat successful. They're not a cure though. Are we close to a cure or not?

Bruce Porter:
Now that's-- the whole cure idea is an elusive concept. And there have been years and years and years of conferences where people would attend the conference waiting, thinking this was the year the big announcement's going to be made, the breakthrough viralogic antiviral agent that would be what we've been waiting for. We haven't seen it yet and I think as more time goes by we are still exploring, investigating, testing, we're still looking for that. But I think we come to understand that this behaves a lot like a chronic condition that's going to need to have consistent attention applied to it through a variety of antivirals we've come to call the cocktail. They have been remarkably effective in prolonging people's lives. Keith is an example of someone who's lived for over 20 years with HIV infection and he's not unusual in that regard. Long-term survivors are really quite common these days. There are things that are associated with having to take those pills, you know, some long-term ill effects that occur from that. But I think on balance there is no question they've had a dramatic impact on reducing death rates.

Michael Grant:
You just recently got back from Botswana. Is the African content the most impacted by AIDS?

Bruce Porter:
Absolutely. No question about it. Sub-Saharan Africa, if you leave out Sudan and northern regions of the state. The sub-Saharan part of the country-- the continent, rates of up to 35 to 40\% of countries who are currently infected, Botswana, their calculated rate for the country is 36\% of the population is infected. That is a completely different situation than we have in America. We don't have anything like that here. So when you go to a country like Botswana, you're in a different world. Your approaches are different. Your thinking is different. You have to-- it's a generalized epidemic and the targeting and the focusing and the EPI that I might have just talked about doesn't matter there. It's a problem for the whole country and it's recognized actually as a problem for the whole country.

Michael Grant:
When something though is that widespread you would think a society would react.

Bruce Porter:
Yes.

Michael Grant:
Okay. But 36\%, I mean, obviously something is still going very wrong there.

Bruce Porter:
Well, there are communities actually, one community in the northern part of the country, that's 75\% of folks in that region are known to be infected with HIV. Something went terribly wrong and continues to go terribly wrong in that kind of a situation. The government has now done amazing campaigns. Over half of the federal budget of the country of Botswana is devoted to HIV. There are resources all over the place. But you know, there are issues that are existent there that keep driving the epidemic that we haven't been able to get a handle on.

Michael Grant:
All right, Bruce Porter, good information, Arizona Department of Health Services, thank you very much.

Bruce Porter:
Indeed.

Michael Grant:
Tomorrow night on our part three look at the AIDS problem in Arizona, we'll take you to a Body Positive, an organization for people infected and affected by HIV. Triple digit temperatures have arrived in our state. That means the danger increases for those who cross the border illegally. Tony Paniagua reports on attempts to dissuade those thinking of crossing the treacherous Sonoran desert.

Tony Paniagua:
Triple digit temperatures are part of a seasonal experience in much of Arizona. Something you put up with a few months out of the year. But while most of us can get relief in our air conditioned houses or vehicles, thousands of others have no such luck.

Geoffrey Boyce:
It's remarkable. As soon as the temperature hits 100 degrees, we start seeing a lot more people in real crisis out there.

Tony Paniagua:
Geoffrey Boyce works for No More Deaths, an activist organization trying to prevent additional fatalities in the desert. The group is joining others in trying to get the message out about the dangerous environment. They'll be working in Arizona and Mexico, hoping to dissuade potential crossers from risking their lives.

Geoffrey Boyce:
Letting people know the danger that they're in and encouraging them to get out of the desert, which for most people means, you know, turning themselves in to the border patrol and going back to Mexico. We're going to be working with migrant shelters in Mexico so that they have a place to go once they're back there. And you know, and when people are in medical emergencies it will also mean getting them to a medical facility for treatment.

Tony Paniagua:
The Mexican consulate in Tucson is also beginning a new awareness campaign. It will include television and radio spots as well as information in newspapers and flyers. This one was part of the effort in 2005.

Alejandro Ramos Cardoso:
And here it says yes, it's true, the desert is dangerous. Do not try it. And finally, it says do not allow your loved ones to cross the desert during summertime. Do it for them. Our aim is to send it everywhere possible, not only in the states but also in Mexico. We're going to do this through the different offices, office of foreign affairs in Mexico. We have about 35 offices throughout the whole country and we're going to ask them to distribute this material in the local media.

Tony Paniagua:
But many people continue to do it, in part because of lack of education or misinformation. Many Mexican migrants live in the central or southern part of that country. Tropical areas with plenty of trees for shade or water in the countryside. They are not aware of our extreme conditions and they try to travel with just a few quarts of water.

Geoffrey Boyce:
When the temperature hits 110 degrees it's physically impossible to carry sufficient water with you. There's not water available in the desert. If you were to start out with all the water that you needed you'd be carrying 50 one-gallon containers of water. I mean, you need to replenish your body with about a quart of water an hour in the heat of the summer, when you're exercising heavily.

Tony Paniagua:
The heat and lack of water are some of the major problems the immigrants will encounter as they try to make their trek across the desert. Some may find wild animals like rattlesnakes while others will be raped, robbed, or even abandoned by the very people that are supposed to be guiding them.

Alejandro Ramos Cardoso:
They tend to tell people they're going to walk for about six to eight hours, whereas we know that from the border, they have to walk for about three days to get into Tucson, for example.

Tony Paniagua:
But even though hundreds have died in recent years, many more people are continuing to take a chance. In fact, the Tucson consulate has become the busiest in the United States when it comes to death and dying in the desert. Mexico has 46 consulates in this country.

Alejandro Ramos Cardoso:
We are unfortunately the consulate that has more deaths of Mexican nationals crossing the border.

Geoffrey Boyce:
We're expecting that this year we'll again break the record for the number of people who die out here, not only on the border in general, but particularly here in the Tucson sector. So we are in the midst of a humanitarian-- of a human tragedy and humanitarian crisis here and so until there is a comprehensive immigration reform that does provide people legal path to come to this country, legal, safe, and secure, we're going to continue seeing this human crisis.

Tony Paniagua:
But even as the U.S. passes a comprehensive immigration bill that allows more people to come and work here legally, Boyce believes it will take months to implement. In the meantime many more migrants will probably lose their lives, exposing themselves to the elements in a dangerous journey.

Merry Lucero:
An Arizona organization is having a positive impact on the global fight against HIV AIDS. Body Positive has done clinical trials on 23 of the 26 drugs now prescribed to fight AIDS. Now they're doing a study on a vaccine that could help prevent the infection, part two of our series AIDS in Arizona Tuesday on Horizon.

Michael Grant:
And Wednesday we will wrap up the examination of AIDS in our state with a look at research being done here to cure the disease. Thank you very much for joining us this evening. I'm Michael Grant. Hope you have a great one. Good night.

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