25 Years of AIDS

OPERATOR: Good afternoon and welcome to today's teleconference. At the request of today's conference host, this call is being recorded. Should you have any objections, you may disconnect. Following the presentation, you will be given an opportunity to ask questions. But until then, all lines will remain in a listen only fashion.

At this time, I will turn the call over to today's conference host, Gabrielle Price. Ma'am, you may begin.

MODERATOR: Good afternoon, everyone. Thank you for joining us today to commemorate 25 years of AIDS with our speaker, Dr. Anthony Fauci, the Director of the National Institute of Allergy and Infectious Disease at the National Institute of Health.

This also marks the first time in recent memory that the Foreign Press Center has used a conference call to bring the press together with a newsmaker. We hope to make better use of this technology in the near future. So we hope that you will informally share your feedback and your impressions of this event with Foreign Press Center program officers.

As I mentioned, our speaker today is Dr. Anthony Fauci, and he has been at the National Institutes of Health since 1968. And in 1984, he became the Director of NIAID. He has made many contributions to basic and clinical research on the treatment and of immune mediated diseases, including understanding how the AIDS virus destroys the body's defenses, leading to its susceptibility to deadly infection.

Dr. Fauci serves as one of the key advisors to the White House and the Department of Health and Human Services on global AIDS issues and on initiatives to bolster medical and public preparedness against emerging infectious disease threats.

Dr. Fauci will begin with a few opening remarks before taking your questions.

DR. FAUCI: Hello, everyone. It's a pleasure to be here with you this afternoon. I'm just going to make a few minutes of comment about HIV/AIDS in general, and then I'll be delighted to open up for discussion, comments or questions.

As I'm sure all of you know that this coming June 8th, literally just a few days from now, is the 25th anniversary of a really historical report that appeared in the Morbidity and Mortality weekly report, which is the weekly health letter of the Centers for Disease Control and Prevention, that described five young and previously healthy gay men from Los Angeles who had an unusual disease called pneumocystis carinii pneumonia. And a month later, in a second report on MMWR it described additional men, again from New York, Los Angeles and San Francisco with not only pneumocystis pneumonia but Kaposi's sarcoma in San Francisco, New York and L.A.

We did not realize it at the time, it was a curiosity, but this turned out, as you all know now, to be probably one of the most important, if not the most important, beginnings of a pandemic in the history of our civilization. For 25 years later, now as we know from the most recent numbers, from the UNAIDS that this virus has infected more than 60 million people and has killed more than 25 million.

There are so many aspects of HIV/AIDS that need reflection and discussion on this the 25th commemoration. The first is the enormous amount of death and suffering that this disease has caused first appearing in the developed world as an oddity among gay men who, at that time, were really the tip of the iceberg of what was going on throughout the world particularly in sub-Saharan Africa and the nations of sub-Saharan Africa where a virus that has now been clearly traced molecularly to a chimpanzee group originating in sub-Saharan Africa and southern and southeastern Cameroon with the first recorded case now retrospectively in 1959 in which was then the former Congo. Now if you fast forward so many years, you've seen what has happened both in the developed and developing world.

There were many misconceptions about HIV in the beginning about how it was transmitted, about the risk groups. In the United States there was -- in which the first cases were reported but in which certainly were not the first cases that actually existed was the association with certain risk groups like gay men, injection drug users and even Haitians, which were probably the beginnings of the heterosexual transmissibility in the Western Hemisphere as well as hemophiliacs, who got it from blood transfusions.

The first two or three years were very discouraging. I myself was personally involved from literally the first day in seeing HIV-infected individuals, which we did not know was HIV at the time here at our facility at the National Institutes of Health. And virtually over the next few years, we saw patients who were in the advanced stages of disease, which was not really reflective of what was actually going on because we didn't have a test that would give us an idea of the scope of the infection. We only saw people who were very sick.

Some major successful landmarks occurred in 1983. The French identified, by an electromicrograph, the first indication that this was a virus. The following year the Gallo Group in Bethesda was able to show the connection between HIV and AIDS. And so that's the reason why you hear about the co-discovery of the AIDS virus.

The next major breakthrough was in '85 when a test was developed not only to identify people knowing now what the iceberg component of the tip of the iceberg was, but also to protect the blood supply. The first drug AZT gave some hope in the mid '80s but soon became aware that one drug was not good enough because very rapidly even those people who improved transiently on AZT very rapidly started to deteriorate because of what we did not know then but we know now is the development of resistance to this drug. It was only until a rather aggressive drug development and testing program over the subsequent decade until the mid 1990s when the triple and quadruple combinations of drugs were made available was there a dramatic turnaround in the clinical course of HIV-infected individuals. And for those who had availability of the drug, there was almost a breathtaking difference in the life capabilities and life span of people.

Again, there were some challenges that remained there: (a) the drug had toxicities and it took a few years to get them in a much more patient-friendly form with less pills and less toxicities, although we still have toxicity. The results in the developed world were absolutely astounding. A recent report came out last week to say that in the United States alone, since the onset of the use of these effective drugs, there have been 3 million life years saved among people who were infected.

The next challenge was to how do we get these capabilities to the developing world. And just a few years ago, people essentially felt that this was not doable, well, because of the price of the drugs and what was perceived incorrectly as the lack of a capability or infrastructure to deliver drugs. This was soon shone to be obstacles that could be overcome. And in early 2000 -- well actually the watershed meeting was in 2000 in Durban in South Africa when the activism of the South Africans and others of the countries in the European continent felt that this was completely unfair, as it was, that they could not have access to drugs and programs such as the President's Emergency Plan for AIDS relief. The Global Fund and other bilateral organizations and NGO are now revolutionizing the situation in the developing world with a long way to go because it isn't nearly where we need it to be, but just a few years ago only tens of thousands of people were on treatment in the developing world and now over 1.4 million people are on therapy.

We have a long way to go with regard to the stigma. Still that is something that is a big problem, particularly to face the women's face of HIV/AIDS in developing nations, particularly Africa, the now concentration of the disease in the United States in minority populations in inner city, prevention, particularly the development of a topical microbicide is a very important goal. And then finally, the last of the Holy Grail of scientific accomplishments, a vaccine has been very elusive because of the fundamental nature of this virus which has an uncanny ability to elude the immune system under natural circumstances, which has made it very, very difficult in fact to develop a vaccine. So we really must rely on prevention measures in what is now truly a global pandemic with enormous implications.

So for 25 years, in summary, the suffering has been great, but the scientific and public health advances have been substantial. However, the next 25 years is really going to be that upon which we are judged because now we have some of the tools that we need to get care and treatment and prevention to people. And it is how well we use that and how much we invest in that for which we will be judged to see if over the next 25 years we'll be able to put an end to this epidemic.

So I'll stop there and be happy to answer any questions.

MODERATOR: To our guests, if you do have any questions, the operator will now give instructions.

OPERATOR: Yes, ma'am. If you would like to ask a question, simply press *1 on your touchtone phone. Once again, that is *1 to ask a question.

MODERATOR: Do we have any questions from our guests today?

OPERATOR: Once again, if you would like to ask a question, simply press *1 on your touchtone phone. If you're using speaker equipment, you will find it necessary to lift the handset prior to entering *1. One moment while the questions register. Please stand by. The mike is open, you may ask your question.

QUESTION: Yes, Dr. Fauci, this is Phillip Tazi of The Cameroon Herald. I know I've met you in quite a few places, the White House, the Foreign Press Center. I am from Cameroon and I wanted to ask you this question.

Now that -- what is the implication of the fact that this -- the origin of this virus has been identified, I mean has been traced back to Cameroon?

DR. FAUCI: Well, there really are only implications of historic interest. It's important to point out that this has nothing to do with any nation or region being at fault for anything.

About 70 percent of the new and emerging diseases that the human civilization experiences are diseases that we call zoonotic, which means they originated in an animal species and infected humans.

Sometimes those are dead-end infections and they won't really amount to much. Occasionally they adapt themselves well to humans and, in fact, it becomes a real serious problem. HIV/AIDS is a classic example of the latter.

Early on, there were viruses that were isolated from monkeys but then later on from chimpanzees, particularly the pan troglodytes, troglodytes species of chimpanzees. But they were really mostly shown to be chimps that were in captivity and rarely in the wild.

A recent study in Cameroon and neighboring nations showed that if you look at the fecal specimens that are collected, because you certainly cannot approach the chimps and do anything to harm them to get blood from them, that if you do molecular analysis of the fecal species, you see that the virus that is in a substantial proportion of some of the roaming chimp tribes in Cameroon is virtually identical in many respects, in many molecular respects to the virus that jumps species probably decades and decades ago but did not really take effect in a widespread pandemic likely because they dead-ended with a person who might have infected his wife.

What happens is that somewhere down there, likely because of the disruption of some of the societies when colonialism ended and there was the fertile ground for the spread of an infection among humans with commercial sex work and the disillusion of some of the family units, it was clear that somewhere and the first identified case was in Kinshasha in the former Congo in 1959, it is likely that by accident someone cut themselves as they were butchering a chimp for bush meat and actually got infected, and the infection adapted well, and then that person passed it on to others. So really it is of historic interest to be able to ultimately show that the source was this particular animal species in that particular region.

Whenever you're trying to trace the evolution of a virus to see where it's going molecularly, is it evolving, is it getting more virulent, less virulent or what have you, it's always extremely helpful to get as far back as the original source as you can to help you do what we call a phylogenetic tree, which is to trace how the virus evolved. So it's of some scientific interest but mostly of historic interest.

QUESTION: Thank you very much.

OPERATOR: Thank you. Our next question comes from Adrian Kreye.

QUESTION: Hello. This is Adrian Kreye from the German newspaper Suddeutsche Zeitung. I want to know since this is a global pandemic, how much did the international community learn from this pandemic and how many new international bodies of health came out of this crisis?

DR. FAUCI: Well, the international community learned a lot. It learned that we are vulnerable and susceptible to a new and emerging disease. One of the real problems that is very complicated about this is that it is fundamentally a sexually transmitted disease and it is fundamentally sexually transmitted through heterosexual sex, particularly in the developing nations. And it is very difficult when there are fixed patterns of behavior in societies to get people to realize the risk of unprotected sex with a partner in whom you do not know what the HIV status is. So it has really put a great demand on leadership in individual countries to get the public to first not deny that there is a problem and (b) to be able to remove the stigma that is associated with HIV, of which there should be none but yet there is.

And particularly in developing nations, sub-Saharan Africa has several and in the Caribbean and some Asian countries, to make sure that women can be empowered to protect themselves against infection because often in a situation in which there is denial, women are not allowed to be able to protect themselves because they don't have the kinds of individual empowerment rights that others do.

So we've learned, as Jonathan Mann, who used to be the head of the UNAID group several years ago before his untimely death would often say, that HIV/AIDS is as much a disease of human rights as it is a disease that's a virus. So we've learned that we've got to be open, transparent and tolerant or we'll never get the message of prevention across.

With regard to the question of how many international organizations, well, the UNAID is responsible as the umbrella organization but there have been many, many local NGOs that have been established throughout the world in very different countries that have now been focusing very intensively on HIV/AIDS.

QUESTION: Thank you very much.

OPERATOR: One moment please. The next question will come from Olga Bakova.

QUESTION: Hi, Dr. Fauci.

DR. FAUCI: Hello.

QUESTION: Good afternoon. This is Olga Bakova from Slovak Radio. I have like two, three questions because I don't want to complicate the situation. First of all, I would like to ask you what we still don't know about this virus. And then you said that this might be some kind of turning point, the 25 years. Where do you see us, everybody, in the next 20 years in connection with AIDS? And then maybe last question, why are women so affected with this disease that, you know, the number of women is still growing?

DR. FAUCI: Well, let me just take them one at a time and try to answer them as directly and as succinctly as possible.

First of all, what we do not know is an important scientific issue. We do not understand why the immune system is so incapable of dealing with HIV despite the fact that it has shown us over the centuries of civilization that even though there are serious diseases like smallpox and measles and polio, the majority of people who get these infections, even though many die and many get very sick, the majority of people, their immune system ultimately conquers the virus and is able to eradicate the virus from the body. This is absolutely not the case with HIV. Even though it takes years to get people sick with HIV, it is relentless in its destruction of the body's immune system. And we just don't know why and we call that the correlates of immunity. Why the human immune system does such a poor job of containing HIV.

When we figure that out -- that's the last of the real major scientific obstacles -- then we will be much further towards developing a vaccine. It's that lack of understanding and it's a very difficult problem that has really been one of the major stumbling blocks on the road to a vaccine.

Now, in my opening remarks when I made the statement about the next 25 years, what I'm saying is that we already have the tools: We have good drugs, we know how to prevent this infection. We don't have a vaccine for sure, but you can prevent HIV by getting a good preventive measure, education and behavioral modification, distribution of condoms, safe sex, enlightening people, getting people to be monogamous, getting people to be abstinent where appropriate and where it's feasible, and when it's not to practice safe sex with a condom. We need to get drugs to people who need them. We live in a global society now. The world is all one. And the resource-rich nations must work with the resource-poor nations to make sure that not only prevention messages and methodologies get to the developing nations but that we get the resources to be able to get the drugs to treat those people who need it.

On the other hand, the leaders of developing nations must not stand in the way of the progress in HIV by being close-minded or not removing the stigma or not appreciating the seriousness of the problem or not even investing important resources in helping their country.

The third question about women: In every sexually transmitted disease known, women are more vulnerable by the very nature of their anatomy and physiology. When you get an infection that is sexually transmitted and lies for a period of time in the vaginal vault after sexual intercourse, that that is much more susceptible to a woman than a man, although men are really quite susceptible.

The other is that in many societies women do not know that their partner is infected so they innocently -- even in a marriage -- will be totally monogamous and yet, because their male sexual partner either does not know or does not tell their partner that they're infected, they find themselves being vulnerable because of a lack of knowledge that they are at risk. So those are things that we need to correct in the next 25 years.

OPERATOR: Thank you. Our next question comes from Moctar Balode.

QUESTION: Good afternoon, Doctor.

DR. FAUCI: Good afternoon.

QUESTION: And good afternoon to everyone. Okay, I'm calling from Los Angeles and I'm from Guinea and here is my question. In 2002 during his speech on the State of the Union, President Bush asked Congress for an envelope of $15 million to fight AIDS around the world. And what we see now is I think they're not -- the Congress has been slowing down to release the money. And can I get your opinion on this? That is my first question.

DR. FAUCI: Sure, absolutely. In fact, that is absolutely incorrect that the Congress has slowed down. They are exactly on target to spend $15 billion over a five-year period from 2004, '5, '6, '7 and '8. In the first year of the PEPFAR program they spent 2.3 billion. In the second year in '05 they spent 2.7 billion. They didn't spend the average of 3 billion a year because they needed to start up and the capacity to absorb wasn't there yet. In the third year, which is last year, they did 3.3 billion, that last year being 2006, which is now, and next year the Congress will be giving 4.0 billion.

So the amount of money that's being allocated for the President's Emergency Plan for AIDS Relief, or what we call PEPFAR, is exactly on target to reach $15 billion by 2008. So there's a misperception that they have been slow. They have not been slow at all. The figures speak for themselves. They started off with a lower amount because they knew as you got more people involved and the program expanded, that in the middle to later years of the five-year program you would need more than 3 billion a year. And in fact, last year they did that this year. They gave 3.3 billion and next year we're going to get 4.0 billion. So we're right on target.

QUESTION: Okay. Here's my other question. Okay. In order to make the drugs affordable for (inaudible) people, you know, who cannot afford it in Africa, in (inaudible) or (inaudible), what do you think about (inaudible) countries which are (inaudible) from African countries to make the drugs themselves and to put it on the market at a lower price?

DR. FAUCI: Yes. In fact, the PEPFAR money is over the last year and a half or more allowing generic drugs to be purchased and they have expedited the review of that by the USFDA, who have been very quick in giving approval. In fact, there are several generic drugs that are made in the countries involved that are being paid for by PEPFAR money. So I think it's quite a reasonable idea. There has to be some quality control so there has to be some assurance that this isn't a fake drug, that it's a drug that actually will work. And people, even though they were skeptical in the beginning, are starting to see now that the expedited approval through the U.S. regulatory agency to be able to free up the funds to buy those generic drugs has been very, very rapid. So generic drugs are definitely an important part of the solution and are encouraged if they're good drugs.

QUESTION: Thank you.

OPERATOR: Thank you. Our next question comes from Rita Siza.

QUESTION: Hello. Earlier today the UN Secretary General was highly critical of countries that didn't meet the targets of the 2001 declaration and called for bigger commitments to providing universal access to treatment of people in 2010. Do you still believe that this is possible or what do you think that policy-wise are the biggest challenges until 2010?

DR. FAUCI: Well, I think, I mean, that's a very good point. You know, President Bush made a breakthrough decision a few years ago when he decided that he would put $15 billion over five years, and at that time we also called, as well as the UN Secretary General, for other countries to increase their commitment because it has been estimated that you need anywhere from 15 to now, by next year, up to -- excuse me, 15 to, by next year, up to $20 billion a year. The amount that's spent internationally this year is somewhere around 8 to 10 billion so the nations of the world, both developed -- especially developed -- and developing, have fallen short of what we would hope would have been a totality of global contributions.

So I agree that we should strive for universal access to drugs by 2010. Whether we reach that goal is going to depend upon whether the countries come through with their pledges and/or whether they pledge as much as they should given the degree of resources that they have. So we all are hoping that in the next few years we will reach that goal of universal access.

OPERATOR: Thank you. Our next question comes from Charlene Porter.

QUESTION: Yes, Dr. Fauci, thank you so much for doing this. Following up a bit on the question about lessons learned, one of the breakthrough moments in the United States coping with this was the report issued, I guess it was by the National Security Council in around 2000, recognizing that the epidemic was really a national security concern, that the health of the people in a given nation was critical to ongoing economic and indeed military stability.

How widely do you think that lesson has been embraced and indeed what actions flow from it when that notion is embraced?

DR. FAUCI: Well, it's been spotty. There are some nations that get it; namely, they realize the importance of addressing the HIV/AIDS problems. Other nations still practice varying degrees of denial. There's no question that a country in which a substantial proportion of the people are sick and dying from a potentially fatal disease, that that has both economic, sociologic and political consequences; namely, consequences of instability. And whenever you have instability in a nation, the issue of national security and even regional security comes up. So this is something that should be taken very, very seriously. Fortunately, some countries are and, unfortunately, others are a bit spotty in their realization of either the actual enormity of the problem or the potential enormity of the problem.

The one thing that we don't need for the future of HIV/AIDS over the next one, two, three, five, twenty years is denial. There needs to be a realization of the seriousness of the problem and the seriousness does extend to national and global security.

QUESTION: Can you say -- if I may follow up, can you name countries where you've seen a significant turnaround in the grasp of this concept and how it's affected actions?

DR. FAUCI: Well, you know, Uganda has always been given as the example. A good example of leadership from above, of realization of the problem and of really going after it. I'm somewhat disappointed, as many are, at the pace of the response. It's somewhat better now, but at the pace of the response of South Africa, who clearly are doing much better than they were, but the idea of getting bogged down in denialism was, I think, a setback for that nation.

QUESTION: Thank you so much, Dr. Fauci.

OPERATOR: Thank you. Our next question comes from Enrique Rubio for the EFE newswire.

QUESTION: Good afternoon, Mr. Fauci. Thank you. I think I know this is a very hard question, but how do you think -- how many years and how much money are we still away from finding a vaccine?

DR. FAUCI: You know, you're absolutely right, it is not only difficult to answer that problem, that question; it is impossible. If it were a material logistic obstacle like building a large bridge or a big tunnel across the English Channel or something, we could say, well, I can't tell you exactly when but it's likely going to be in X number of years. The issue is a scientific obstacle and science is discovery and you can never really predict when we will come to that knowledge to be able to say now we understand how we can do an immune response in the body that would actually protect against HIV. Unfortunately, because of the extraordinary complexity of this virus, we don't know the answer to that question. So it would be folly for me to give you a number when a number can only be based on something predictable, and science is very unpredictable in this regard.

QUESTION: Thank you very much.

DR. FAUCI: You're welcome.

OPERATOR: Thank you. Our next question comes from Akemi Yoshimoto of Kyodo News.

QUESTION: Hello, this is Akemi Yoshimoto. Thank you very much, Dr. Fauci, for giving us this opportunity.

DR. FAUCI: You're welcome.

QUESTION: My question is a kind of scientific one and after 25 years from the first documented case, do scientists see any change or evolutionary sign in the virus itself? I am keeping in my mind that there was a report last year on a possible more virulent strain of HIV in New York state.

DR. FAUCI: Now, that was incorrect.

QUESTION: Okay.

DR. FAUCI: And I was one of the ones who warned that that was just an oddity that never panned out to be more virulent. And in fact, we occasionally see an individual in whom a virus just does not respond very well at all and the person does poorly because of resistance of the virus to the drug. We have not seen any further indication that this has become a more universal problem. So the answer to your question is there really is no good scientific data that the virus has evolved in either a more virulent way or in any other way.

QUESTION: Okay, thank you so much for the clear answer.

OPERATOR: Thank you. Our next question comes from Phil Nomel of the Ivory Coast.

QUESTION: Yes, good afternoon, everybody. My name is Phil and I am new in the program. My question is concerned about the widespread of AIDS in Africa. This has been 25 years since the disease has been discovered. How much work, how much the international community has been doing concerning education, because the problem of Africa is to educate people. How much emphasis is international community putting on education for African people to learn about the danger of AIDS?

DR. FAUCI: Well, the international community is helping in a number of different ways with regard to a three-pronged approach. There's treatment, there's prevention and care. And inherent in the issue of prevention is education and behavioral modification. So programs have multiple different proportions of what they put in with regard to resources when you're talking about the international community. But we in the United States when we were faced with the peak of the epidemic in the early '80s when it struck mostly our gay community, found out that education and behavioral modification is best administered at the relatively local level and at the community level.

So although there are significant resources such as, for example, 20 percent of the -- President Bush's program, the PEPFAR, 20 percent of that is on prevention that each of the individual nations need the leadership of their own nation to be very much involved in a culturally sensitive way to get the prevention message out because it's difficult for a developed nation that does not fully understand the culture of a developing nation to start giving prevention messages.

The prevention messages have to be first from the top of the leadership of the country and must get translated down to the community level where the people who would benefit from the prevention and behavioral modification message can relate very well to those people who are speaking to them. So it's really something that must be translated at the local level and not necessarily come from above.

OPERATOR: Thank you very much. Our next question comes from Phillip Tazi of The Cameroon Herald.

QUESTION: Dr. Fauci, it's Philip Tazi again.

DR. FAUCI: Yes.

QUESTION: I know that when the Bush Administration came into what's -- came in 2000 that there was a major emphasis on the Ugandan ABC approach to the prevention of AIDS -- of HIV/AIDS. But at some point, I think about two or three years into the Bush Administration's government to the fight against HIV/AIDS infections, it became obvious that a lot more attention was being paid to abstinence as opposed to the use of condoms. I just wanted to -- now that you've worked with the Administration for quite awhile, do you think it was the wrong policy to adopt at that time and what modifications have been made since these criticisms became, you know, became evident?

DR. FAUCI: Well, you know, I very strongly believe that abstinence can work under certain circumstances but in other circumstances it's not feasible and that condom use is a very important part of the preventive strategy together with monogamous being faithful in relationships that are, hopefully, monogamous relationships. There has been some misperception about the emphasis that's placed on abstinence alone. There are some local people who put a lot of emphasis on that.

I don't necessarily agree that abstinence at all would work under certain circumstances. So you have to be open minded and realize that there are situations in which abstinence would be the message that should be put out to the particular group and there are other situations where condoms clearly are the situation. And there are, for example, certain stipulations that a certain percentage should be spent on abstinence or of the 20 percent of the money that goes into prevention, a third of that goes to abstinence which means two-thirds of it goes to condoms and the idea of education to be faithful. But the broad policy of the administration absolutely includes the use of condoms. I certainly feel strongly that way. Thank you.

OPERATOR: Once again, that is *1 one to ask questions. If you're using speaker equipment, please use the handset. Once again, to ask a question, simply press *1 one on your touch-tone phone to ask a question. One moment, while the questions register.
The next question comes from Andrian Kreye.

QUESTION: Yes, hello. This is Andrian Kreye from the German paper Suddeutsche Zeitung. I had a question how big a problem is counter complacency in the developed world where some people think there is now fewer almost and some behavior modifications from previous generations, kind of revert back, especially in like the homosexual communities?

DR. FAUCI: Well, I think it's a serious issue. We're seeing it in a disturbing way here in the United States. And for the others on the call, what the caller is referring to is that in the developed world in which there's widely available drugs and in which there are people, particularly gay men, who are very young and have not lived through the early '80s, when such a large proportion of their friends and colleagues and lovers they saw before their own eyes suffer and die. They haven't seen that because AIDS, now with the treatments that are available, is not perceived as a particularly serious problem, even though it is as serious as it always has been.

And what we're seeing is that there is an increase in risky behavior particularly among young gay men, which is really a great tragedy because we know now how you can prevent HIV early on the epidemic in the hubs in the United States like San Francisco and New York people were getting infected because they had no idea there was a virus out there. Now that we know so much about HIV, it's a terrible shame that because of the perception that since drugs are available, it may not be such a bad thing to be infected, we are in a disturbing way seeing a small but, nonetheless bothersome populations of people percentages that are increasing in their infection among the gay community. And we're also seeing the increase in other sexually transmitted diseases, which is a surefire indicator or surrogate of rather permissive sexual behavior and not taking as much care as we'd like people to do.

QUESTION: From a medical standpoint -- (inaudible).

DR. FAUCI: Yes.

QUESTION: From a medical standpoint, did you -- is there something like a classification of pandemic or of a disease, whether something like code orange, red or blue? And did classification of HIV/AIDS ever change from whatever, terminal to fatal or?

DR. FAUCI: No. No, no. No, that has not been the case. Without therapy it's in a vast majority of people a relentless disease that ultimately ends in death. So people treat it early and well. You know, the lifespan now we still don't know what it is because it continues to get more and more. But there's never been any fundamental change in the coding of the seriousness of the disease.

QUESTION: Thank you very much.

DR. FAUCI: You're welcome.

OPERATOR: Thank you. Our next questions from Jessica Berman of the Voice of America.

QUESTION: Dr. Fauci, hi.

DR. FAUCI: Hi.

QUESTION: This is Jessica Berman. Maybe you can go into a little bit of detail not too technical. I understand there was a study last week tying the virus more closely to Simeon virus in Africa. What was that about and what's the importance of terms of research?

DR. FAUCI: You probably didn't hear it, but I'll answer briefly the question because someone asked that question, but I'll give you real --

QUESTION: Oh, I apologize. I came kind of late here.

DR. FAUCI: Don't worry. I'll be able to give you a real quick one. There was identification of a Simeon immunodeficiency virus in chimpanzees mostly in captivity several years ago. Molecularly it was as close a match as you possibly could get to the human immunodeficiency virus, particularly the MNM groups. The recent discovery in the wild by examining, of all things, fecal specimens where researchers went out into the Bush in Cameroon, in South and Southeaster Cameroon, and it was able to identify in a substantial proportion of the specimens the fact that this virus is there which means these chimps are infected and they're adapted. Evolutionarily they've adapted which means that the hypothesis which seems almost certain now, that decades ago and maybe even for a long time there was jumping of species so that when you butcher a chimp for food to eat, that you may have accidentally cut yourself and got infected and either stayed infected yourself or infected your wife and usually a dead end.

Somewhere way back in the first recorded case is in 1959. It adapted well enough to a human to start the beginning of what we now know as the HIV/AIDS epidemic. So it's of historic interest putting very serious proof now on what was formerly a hypothesis, that it is a zoonotic infection or an infection predominantly that has adapted in animals but then jumped species and began to adapt itself very well to humans. So it's a historical interest from a molecular standpoint.

QUESTION: That's what I was going to say is it sounds that way, but is there any sort of practical --

DR. FAUCI: Well, actually, no. I mean, it's always important to know what the point source of a viral infection is. Of course, over the years, decades or more as it evolves if you want to trace its evolution, knowing what the point source is it's always very helpful, when you build what's called a phylogenetic tree, which is a tree of the evolution of the virus.

QUESTION: Would it give you any -- I'm sorry to hog this, but would it give you any sense of how the virus changes or mutates or anything like that?

DR. FAUCI: Yeah because as it -- that's what I said, when I say "evolve" I mean mutate. As the virus mutates along, you can tell the rate and the capability of the mutations by what it started off from the beginning. So if you knew what it looks like from the time it jumped species from a chimp to a human that would give you a good reference point to be able to calculate the rate of mutation and the importance of mutations.

QUESTION: OK. Thank you very much.

OPERATOR: Our next question comes from Olga Bakova.

QUESTION: Hi, sir. Again, Olga Bakova. I would like to ask you two more questions. We are discussing how governments cooperate and do not cooperate. How do you evaluate EU approach -- United -- European Union approach? And then if you would put, you know, something like a (inaudible) talks, viruses diseases which affect human -- mankind, where would you put AIDS? On the top or somewhere in the middle? Can you give us a perspective?

DR. FAUCI: Sure. I mean, I don't want to be passing judgment on the European Union in any way positively or negatively. They've done some very good things. But as Kofi Annan has said today or yesterday that we have fallen short of the goal of where we wanted to be in the amount of money and resources we've put into this. So I would refer that to the statement of Kofi Annan. I think we all need to do better and that's including the European Union.

Now with regard to the question of the importance of HIV in history, I think the numbers speak for themselves. There have been 60 million people who've been infected 25 million of whom have already died and there's no real end in sight. So among the diseases that have afflicted mankind historically over the centuries, I would put HIV/AIDS very high at the top of a very small number, including the Bubonic plague and including the influenza pandemic.

They -- the plague was more drawn out. The pandemic flu of 1918 happened all in one and half years. A large number of people have died worldwide, about 50 million, but it ended. Right now we've had 20-plus million people of HIV/AIDS die, but there's no real end in sight. So there are different kinds of diseases, but if you were going to list the top few of the historic devastating pandemics, AIDS would be in that top few and every time.

OPERATOR: Thank you. And at this time, I show no further questions, ma'am.

DR. FAUCI: Okay.