Chat transcript: Dr. Jack Killen on World Aids Day

December 1, 1999
Web posted at: 5:09 p.m. EST (2209 GMT)

(CNN) -- Dr. Jack Killen, the Director of the Division of AIDS of the National Institute of Allergy and Infectious Diseases, joined the CNN.com chat room for a discussion about Aids on December 1, 1999, World Aids Day.

Dr. Killen joined the chat via telephone from Washington D.C. The following is an edited transcript of the chat.

Chat Moderator: Welcome Dr. Killen Thank you for joining us today! Welcome Dr. Jack Killen.

Dr. Killen: Good afternoon.

Chat moderator: What advancements in HIV/AIDS have been made in the past year?

Dr. Killen: There is good news and bad. The epidemic is exploding in the developing world. UNAIDS estimates that 33.5 million people are living with HIV/AIDS worldwide. There is good news in this country with a decline in the death rate. But the developing world is not able to take advantage of the treatments which are available here. So new prevention research must be a very high priority

Question from JIMR: What is the good news and the bad news about AIDS treatments these days for the people who can afford them?

Dr. Killen: The good news is that the death rate from HIV/AIDS has declined and people are living longer and better quality lives. Unfortunately, the drug regimens have many side effects and are very complicated. They are also very costly. So new treatments which are simpler and less toxic must be developed and we are also working on treatments to restore the immune system.

Question from cvkline: Don't religious attitudes towards homosexuality have a lot to do with how HIV issues are addressed in public fora? Do they interfere? What can be done?

Dr. Killen: Religious and social attitudes about sexuality and other behaviors which put an individual at risk for HIV infection have a lot to do with misconceptions about risk, and about people seeking help to reduce risk.

Even in this country, peoples' attitudes about homosexuality and drug use prevent many from seeking help or counselling. We must all understand that judgment is not helpful.

It's been a very big year in research. One of the highlights was a study demonstrating the effectiveness of a very simple drug treatment to prevent mother-to-infant transmission of HIV. The study was carried out in Uganda and showed that a treatment which costs only about $4 could reduce the likelihood of a baby becoming infected by 50 percent.

Question from JIMR: How about new funding for research? Are you getting it?

Dr. Killen: Funding for NIH (National Institutes of Health) in general and for HIV/AIDS research in particular is doing very well. We have started a number of new programs to increase the number of vaccines in the development pipeline, for example.

Chat moderator: Where does your funding come from? And how much funding and time do you think it would take to find a "cure" for HIV/AIDS?

Dr. Killen: Funding for HIV research at the NIH totals approximately $1.5 billion per year; NIH is a federal government agency so our appropriation is entirely from tax dollars.

Question from una: Are there any subjective obstacles to AIDS research, like giving priority to some researchers and ignoring others?

Dr. Killen: The NIH uses a peer review process in which all proposals are reviewed by other scientists and rated for their scientific merit. Staff also have flexibility in funding areas of high-priority research, so I honestly do not see a significant favoritism problem.

Question from Joe: How close are we to finding a cure, or at least putting a significant dent into the AIDS virus?

Dr. Killen: A cure may be a long way off, but a huge amount of progress has been made in developing treatments which control the disease. Many scientists believe that it will be possible to think of HIV infection like we think of diabetes or high blood pressure. And we know from studies of perinatal transmission that it is possible to prevent infection with intervention which are quite tolerable and simple.

Question from Allen: Dr. Killen, should the development of an effective vaccine be more important and how is the current progress ?

Dr. Killen: Absolutely, yes. Vaccine research is the highest priority of the NIH AIDS research program. We have dramatically increased funding for it over the last several years. We will be hopefully moving into a large efficacy trial of a preventive vaccine next year and recently began the first vaccine study in Africa.

Question from student: So are we still interested in other types of prevention research, or just vaccine research?

Dr. Killen: Vaccine research is one of several important areas of prevention research. For example, preventing mother-to-infant infection, education and behavioral approaches, topical microbicides, and treatment of other sexually transmitted diseases.

Question from kelliej: Do you think that the vaccine (when perfected) should be given to school children like they are immunized for mumps, measles, etc.?

Dr. Killen: It is a little early, but we would surely want to target people who are at risk from sexual exposure. That is the approach we take with hepatitis B infection - get to them BEFORE they are at risk....but it is too early until we actually have a vaccine for HIV to know for sure.

Chat moderator: Earlier you told us the epidemic is exploding in the developing world. Why do you think that is?

Dr. Killen: The reasons are complex, but we know that poverty, poor health systems, and limited resources for prevention and care all fuel the spread. Also, migrant labor is much more common and sets up situations for sexual transmission. What is the state of HIV/AIDS here at in the US and other richer countries? The epidemic here is levelling off. That's the good news. The bad news is that there are about 40,000 new infections per year. AIDS deaths have dropped with new treatments, but that too is levelling off.

Question from Tototo: In Africa for example, we hear everyday that HIV/AIDS cases are high, do you think African governments, given the current economic situation, can without the help of the international community tackle these problems alone?

Dr. Killen : Africa continues to bear the brunt of the epidemic. I was in South Africa last year and in most of the prenatal clinics I visited, 30 percent of the women had HIV! The African governments definitely need help in dealing with this terrible problem which will become an economic and political disaster for them and us. This is one reason why the search for a vaccine is urgent and of the highest priority.

Question from stu: In your opinion, why is the public awareness of AIDS beginning to lower rather than heightened in the mid 90s?

Dr. Killen: People in this country see less illness around them and hear that people are doing better. Unfortunately, in the developing world, especially southern Africa, India,and Southeast Asia. the opposite is true and the epidemic is exploding. This is not evident!

Chat moderator:Any final comments for us Dr. Killen?

Dr. Killen: Thanks for the interest and I hope you will do whatever you can to keep awareness of the global problem high.

Thanks for joining us everyone . You can read more about aids research at http://www.niaid.nih.gov/