Chasing a Cure: The National and Global Outlook

Bernstein:        Good morning, everyone.  Welcome.  I’m Lenny Bernstein, health and medicine reporter for The Washington Post.  With me today is Ambassador Deborah Birx.  She is the Global AIDS Coordinator and Special Representative for Global Health Diplomacy at the State Department, and Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases.  I appreciate both of you joining us here today.

To the audience and to folks who are watching online, you can tweet us your questions using the hashtag #PostLive, and if I can remember how this works, I will ask them.  But let’s get started.

Dr. Fauci, I am old enough to remember some of the most dire predictions of the early and mid-1980s about what HIV was going to do to U.S. society and to our health care system.  Today, we are managing HIV like another chronic disease.

Fauci:              Right.

Bernstein:        I thought it might be worth briefly just reviewing how we got here, and then perhaps what you think where we might be going in the next five or ten years.

Fauci:              Well, Lenny, the best way to answer that question is just compare where we were back then to where we are right now.  What the good news is, and then the sobering new, and then the challenges we have.

Just a few days ago was World AIDS Day.  That was the thirtieth World AIDS Day, and I can remember very clearly back in 1988 when we commemorated the first World AIDS Day.  We had very few tools in the medical scientific sense to combat this, and treatment or medically-related treatments—a very, very dark time.  What has happened over the years is that we’ve now developed therapeutic capabilities, as well as prevention, and we’ve linked prevention and treatment in a way that if you fast-forward 30 years form ’88 to now, we can say without hyperbole that we have the tools, if implemented the way they could be implemented, to theoretically, essentially end the epidemic as we know it now.

That’s the good news.  That’s the breath-taking scientific news.  The problem is, we have an implementation gap.  We have not yet done that.  And the implementation gap is huge.  It’s huge in this country, and variably huge in other countries that you’ll hear about from Ambassador Birx.

So, the challenges in front of us—it’s kind of, we celebrate what we’ve done, but we have to be actually sobered by what we can do and are not yet doing.

Bernstein:        If we were here 10 years from now and I was asking you the same question, where to you think we would be?

Fauci:              Well, you know, where we would be, or where I hope we would be—I mean, that’s really important.

Bernstein:        Tell us both.

Fauci:              Okay.  Where I hope we would be is that we would have such a successful implementation of identifying the people who are infected, getting them on therapy, getting their viral load to below detectable levels so that they cannot infect anyone else, getting the people at high-risk on pre-exposure prophylaxis, and implementing in an aggressive way.

Also, 10 years from now, I would hope that we would have at least a moderately-effective vaccine, and that’s something we’re working very, very aggressively on right now.  If we do that and combine even a 50% to 60% effective vaccine with the implementation of the scientific tools we have, that could be the nail in the coffin of HIV.  It really could be.  That’s my hope.

Whether it will happen, it depends on the political, economic, financial resources commitment of the entire world to get mobilized and do that.  It’s not going to happen spontaneously.  That’s the problem, because people think we’re doing so well, just stay on course.  With an infectious disease, there’s no such a thing as staying on course.  You either suppress it, or it comes back.

Bernstein:        Dr. Birx, things are not as bright in the less developed world.  Could you give us an overview of where things stand in Africa and Asia, along these same lines?

Birx:                Well, in some areas it is very bright, because we’ve been able to translate the incredible science and tools that you just heard about into effective implementation. But that requires political will from the governments of the countries we work, and really engagement of communities.  So, it’s not just resources; it’s bringing together communities, governments, and resources, and the correct policies, to have a huge impact.

And so, we can see this spectacular progress in a series of countries because we put in absolutely accountability frameworks where we look at data every three months because we agree you have to move quicker and be aware to really stay ahead of the virus.  And then we put surveys in the field to really look at whether we’re having the progress and impact that we expect to have.

And it’s those surveys that have shown us in some countries, like Swaziland and Lesotho, we have made spectacular progress.  One country with less resources than the other country, but both countries with political will; and in other countries we haven’t made the same amount of progress.  And then you have to really start to dissect, because you had the same tools—why aren’t you as effective?  And I think that’s what we ourselves every day.

Bernstein:        Give us, what does spectacular progress look like?

Birx:                Spectacular progress looks like where 85% of adults know their status.  Because we’re talking about a disease—HIV—with initial infection, it’s silent in most people.  So, silently destroying the individual’s immune system quietly, day after day after day, while they feel well.  So, when you try to figure out how do you get the 25-year-old who feels well to interact with a health care delivery system that was never set up for them?  It was set up for children under five and pregnant women, so a 25-year-old who feels healthy doesn’t see themselves in need of health care.

So, we’re having to really change how communities and individuals interact with the health care delivery system in order to be successful.  And I think that’s the real piece.

Bernstein:        Knowing your status and being treated are two very different things in a country like Lesotho where you rightfully say, there’s been tremendous progress.  What does treatment look like?

Birx:                Well, it looks great because of the combination of PEPFAR announced by President Bush in 2003, continued by President Obama and endorsed by President Trump, to really continue that effort, mixed with the Global Fund resources and host country resources.  So, in Swaziland, the government of Swaziland buys a lot of the medication; in Lesotho, PEPFAR and the Global Fund buys a lot of the medication.  And about 60% to 70% of the individuals are on treatment.

But, the other side of it is the 85% who know their status have to be on treatment immediately, even though they feel well, and the other 15% that don’t know their status have to be found.  And all of the zero-negatives need to have effective prevention, and effective prevention knowledge, so they don’t become positive.  Because I really appreciated the opening where they talked about how sobering, yet it’s fallen off the radar screen.

We have millions of people infected every year, and millions of people still dying, and it isn’t in the press.  And it isn’t being discussed.  And it isn’t in the schools.  And so, 16-year-olds are becoming HIV-positive who didn’t even know they were at risk.  And so, we do have a communication gap, and really creating a knowledge gap at the individuals that are the most at risk.

So, we appreciate you doing this today, because we think it’s really going to raise awareness.

Bernstein:        The same question I asked Dr. Fauci.  If we were sitting in these chairs five or ten years from now, what would you expect and/or hope to see?

Birx:                I think two things.  We would love to see—and we think we can get there—a roadmap for success in this series of countries, because, remember, it’s political will with communities.  And so, countries that have that combination, we can make great progress and really show the world what controlling a pandemic looks like, so that we’re ready for the vaccine and the cure.

We should know that historically this has never been done before.  We’ve never controlled a pandemic without a vaccine or a cure unless it decimated the human population, like the black plague, and went away because everybody who was at risk was already infected.  So, this is really an ongoing and constant threat to us that we take very seriously every day to really figure out how we can do better.

Because when Dr. Fauci says we have the tools, we feel that gives us really the moral obligation to translate that generosity of the American taxpayer dollars that Congress has entrusted us with into programs that are going to have the impact that we now they can from the scientific evidence.  And then we’re responsible for making it happen with the countries and communities.

Bernstein:        Okay, so it was about eight minutes before I heard the word vaccine, and I was worried that I was going to have to raise it.  So, Dr. Fauci, please tell us where we stand on a vaccine for HIV.

Fauci:              Where we stand is that we have a very compelling and difficult scientific challenge for the following reason.  If you look at all the successful vaccines that we have made against the big killers and maimers—smallpox, measles, polio—even through there’s a lot of morbidity and mortality, at the end of the day, the body has the capability of removing the virus in question, eradicating it from the body, and leaving you with the immunity to protect you against infection from the same virus.

Unfortunately for HIV, that’s not the case.  The body does not know how to easily make an immune response because no one spontaneously recovers form HIV.  So, when we do the vaccine work, we have to do better than natural infection.  When I was in medical school, we were told by our mentors the best way to make a vaccine is to mimic natural infection without hurting the individual.  Having said that, years of scientific work has now come in that we’ve made some significant progress.

Several years ago in Thailand when we were doing things together back then, we did a trial in collaboration with the Department of Defense, when Debbie was in the Department of Defense, with the Thailand government, and we showed that you can get a modestly effective vaccine—31%.  We were able to show what the correlates of immunity were.  So now, ongoing in southern Africa are two vaccine trials, one that started in March 2017, which is a version of what we did in Thailand, only with some extra added boosts in some adjuvants.

Just literally a couple of days ago, Mbokodo trial, which is also in southern Africa, of another vaccine.  So, we’re really—compare where we were years ago—we have two vaccine trials that are large trials that are going on in a high-risk population.

Now, the thing we have to learn and appreciate about vaccines, Lenny, is that when you think about a vaccine, just say, well you want a 98% effective vaccine.  So, measles is 98% effective; yellow fever is 99% effective.  I don’t think we’re going to get there with HIV because of the nature of the virus.  But, if we can get those vaccines that we’re testing in Africa now to 55%, hopefully 60%–if you take that, together, what Debbie and I have been talking about, about the implementation—that’s where I think we can end the epidemic.

So, vaccine will always be an important part of a durable end.  I say durable because we’ve had situations with infectious diseases—for example—with certain countries and malaria, where you suppress it down to practically nothing, and then you put resources someplace else, and it comes right back.

The only way you put the nail in the coffin of a viral infection is with a vaccine.

Bernstein:        Are we trying to cure HIV?

Birx:                Dr. Fauci’s trying to cure HIV, and I think that’s really important, and I’m glad you brought that up, because rally, the people have been working very hard on that.  And I think when you’re talking about putting a new 15-year-old on treatment for life, to be able to say to them, “There are people working on cure, so that you need to stay on your drugs to keep your immune system healthy, so that when a cure comes you can be cured.  Or when a functional cure comes you can be vibrant and living without your treatment, but still being suppressed with your virus.  But it really requires you staying on your medication so that you have integrity of your immune system when the cure comes.”

So, he’s going to have a cure for us.  A functional cure.

Bernstein:        But that regimen that you are currently trying to put 15-year-olds on, that’s extremely difficult to maintain.  Do people maintain that?

Birx:                That’s why we are so excited about what the innovators are doing in the pharmaceutical industry, because they continue to work on more effective, less toxic, regimens that are available in the United States.  And then they immediately license them to generic companies, so that we can immediately have access in the developing world.  That is extraordinary.

So, when you think about HIV/AIDS has done—it’s brought communities and governments together in a unique partnership.  It’s brought programs and science together in unique partnerships.  And its brought companies together with the generics and the pharmaceuticals together, to ensure that everyone has access quickly.

So, in January, we are going to be able to put a much more effective, and much less toxic regimen in the field, and we’re so excited about that, because that’s really what our 18 and 19 and 20-year-olds need to see.

Bernstein:        So, Lenny, when I was—when all of us were treating HIV-infected individuals back when we had first the final combination of drugs, an average number of pills that my patients were on were like 20.  They had to take it with meals, before meals, after meals, in the middle of the night.

Now, you can have a single pill that contains three of the drugs and taken once a day.  So, when you say cure, you’ve got to divide it into two buckets.  If cure means eradication of the virus so that you never have to be on drug, that’s going to be extremely difficult to do, maybe impossible.  But, if you look at the other thing—can we get people off daily medications—that’s what we’re trying to do.  We’re trying to get better drugs—some that you can give intermittently with an injection once every several months, or passive transfer of antibody, or boost the immune system so that it regains strength to suppress the virus so you could stop taking antiretrovirals.

Bernstein:        You don’t have to worry about missing you pill one or two days.

Fauci:              Exactly.  We have a study that just started now in women in Africa where you give a single injection of a very long-acting antiretroviral that goes for months so that you maybe need to give it only every several months.  That takes away from the stress and the stigma of having to take medicines every day.

Bernstein:        Okay, we have a question no Twitter from Peter, who asks:  President Trump has proposed to cut PEPFAR’s budget by 17%.  How would such a reduction affect the program’s ability to provide much-needed ART—antiretroviral therapy—in developing countries?

Birx:                Well, I think you could see connected with the President’s budget was a very clear evidence space that said, “We will maintain everybody on treatment,” because the United States has that commitment to individuals we have started on treatment.  And at the same time, the Secretary of State, Secretary Tillerson, launched a new, very aggressive strategy that really talked about what Tony just talked about, is, how do we more aggressively do with the resources we have to get to the end of this pandemic, as far as controlling it in a series of countries?

And it’s really challenged us with the new strategy to get to control in 13 countries over the next three years.  So, I think that’s why I made the point very early on about, it’s not just resources; it’s political will and communities being able to support, and the policies that are needed.  If countries don’t go to the ability for immediately testing and starting someone on treatment, it costs us twice as much to find them again later, when their CD4 are lower.

So, every country today has to have that policy that every, single person who’s positive has access to treatment immediately.  These are the things that make our dollars work more effectively and more efficiently.  So, our job is to take our resources that the American people give to us—and when you even say it–$5 billion a year—that is a lot of commitment of the American people and the American Congress to really trust us to use those kinds of resources to really have the impact that we believe we can have.

And, we get up every morning asking ourselves, are we delivering on those dollars that a family in Iowa entrusted with us?  And do we track that dollar all the way down to the site of a client that we’re serving?  And are we serving them with quality and integrity and results?  And that’s our mandate.  And we take that very seriously, and that’s why if you go to, we have all of our data up on our website, down to the district level.  So, you can see the translation of those fundings into a site and the reach that they’re having and the impact that they’re having.

Bernstein:        Dr. Fauci, I wanted to get back to something you mentioned at the beginning about the implementation gap.  So, there are hard-to-reach populations for HIV.

Fauci:              Right.

Bernstein:        Men who have sex with men—particularly African American men who have sex with men.  They are becoming a much larger share of the people who have HIV infections.  What are we doing, and what are we not doing, to reach that population and close the implementation gap?

Fauci:              Well, what we are doing, we’d have to show what the model would be in a different population.  So, just take the city of San Francisco.  They have something that’s called the Rapid Program, and they essentially go out into the community, and people at high-risk—the homeless, gay bars, people who likely would get infected—they test them on the spot; they get the results before they leave the spot.  If it’s positive, they take a bag and give them a month’s worth of antiretroviral, and then they say, “We’re going to ask you to call us at the end, and here’s a prescription to fill it.”

If, in fact, they don’t call, and say, “I don’t have a cell phone,” they give them a cell phone.  That’s a full court press, and they have done this with their infection rate.  That’s what they’ve done.  New York is trying to do the same thing with Governor Cuomo.

But what you’re talking about is a situation in the southern part of the country, where exactly what you say:  African American group, mostly men who have sex with men—and the stigma and the culture associated with how you react to someone who is infected is a very difficult problem to solve.  You’re going to hear a little bit more about it when Mike Saag comes on in another panel, because he lives in Alabama and can tell you about that.

But we know, because we always talk to each other, it’s almost like having a culture change.  And Lenny, one of the things that’s so difficult to change is a deep-seated culture that leads to stigma, and that’s going to be a real problem in accessing those people.  And that’s the reason why they’re kind of like the forgotten group on the bottom that you can’t access, because they don’t want to come out and say, “What do I need to know about my risk?  Should I be on pre-exposure prophylaxis?”  Because then you’re essentially saying you’re in a risk group, which immediately triggers stigma against you.  That’s a big problem.

Bernstein:        Nor can you find people and give them a bagful of medications and cell phone right there.  It’s a much more rural population?

Fauci:              Right.

Bernstein:        So, what do we do?

Fauci:              We have to keep trying to get the people at the community to go out.  You have to get community leaders to do that.  I mean, a white guy in a suit like me going down there and doing that is not going to work.  You’ve got to get the local community people to go in, educate them, and I don’t want to say educate in the demeaning sense, but show them what they can do to help themselves.

But they’re always going to be left with that wall of stigma that is very tough to bring down.

Bernstein:        How about abroad?  Is the stigma problem the same?  Worse?

Birx:                In some places it’s worse.  But, using—we really—what is so exciting is the domestic to global connection, and the fact that we have communication new so much between the programs.  So, we learned from San Francisco and New York, so when we launched the DREAMS Program—Determined, Resilience, Empowered, AIDS-free, Mentored and Save Young Women—that we announce results of it this World AIDS Day.

In just two years, we decreased incidence in young women, the largest-growing group of new infections in sub-Saharan Africa, by 25% to 40%.  That was only possible because we understood what San Francisco and New York was doing, and where the South was, and that you needed to engage communities in the planning, in the implementation, and in ensuring the follow-up in results.  And because the community of young women are leading the program, it’s young women talking about HIV/AIDS to other young women, that decreases the stigma and other groups like Johnson & Johnson and Gilead, indeed, really helped us do market segmentation, because—like Tony said—this is not going to get me credibility with young women in sub-Saharan Africa.

But, Johnson & Johnson and others really taught us how to really develop that kind of community awareness.  That’s going to be important, not only for preventing HIV/AIDS, but also preventing all the noncommunicable diseases.  So, these platforms are going to be utilizable by governments to ensure a healthy society in the future.

Bernstein:        We have a little more than two minutes.  Dr. Fauci, Stacey on Twitter asks:  How are issues like the opioid epidemic, religious freedom laws in Indiana, and opposition to needle exchange contributing to HIV right now?

Fauci:              A lot, shortly.  So, obviously, when you have an opioid epidemic, which is such a serious problem right now in the United States, that would the—as we know from experience—lead to injection drug use with heroin.  Or whatever it is that’s being injected.

Once you get into that, we already have the example in a community in Indiana, where they had the biggest explosion of a localized outbreak of HIV than we’ve seen in decades, but going back to the 1980s—that’s really a critical issue.  Needle exchange and not allowing needle exchange is a problem.  We know that needle exchange works.  During the Clinton administration I was asked by Secretary Shalala, together with David Satcher, who was at the CDC, and others at the time to look at the data and ask a simple question.  If you give needle exchange—A—does it promote drug use, and—B—does it decrease HIV infection?  And we found incontrovertibly that it does not promote drug use and it definitely decreases HIV infection.

And so, if you don’t allow the use of needle exchange, that contributes to the spread in certain populations.  So those are the kinds of things that we’ve got to implement.

Bernstein:        And what about laws like religious freedom laws?  Are those affecting this?

Fauci:              When you say religious freedom, what do you mean?

Bernstein:        I’m—from Twitter here. [LAUGHTER] I think we have religious freedom in this country—yeah.  Okay.

We learned very recently, over a very long time, that if you’re—the virus in undetectable in your bloodstream.  You cannot transmit it sexually to others.  We’ve known that for a little while.  Now, there’s a big campaign to let folks know that.  Is that message getting out to—does the average person know that?

Birx:                I think that’s our job, to make sure that the average person does know that, because that decreases stigma and discrimination.  And it also makes it clear to that person that if they stay on their medication, and they’re what we call virally-suppressed, nondetectable, non-transmittable—if they’re in that place they can live not only a healthy lifestyle themselves, but not ever transmit the virus to others, if they stay on their medications and they’re virally-suppressed.

So, you will see in those surveys that we talked about, we’re measuring viral suppression in the community, and we’re finding unbelievable clients who have 80%, 90% of clients have stayed on their medication, despite the fact that they’ve had to sometimes go weekly to pick up their pills.  So, this is how motivated our clients are.  That’s what motivates us to do a better job, because we are already working with people who have been extraordinarily adherent to their medications, and it’s our job to make sure that everybody has access.

Bernstein:        Got you.  Thank you.  That’s all the time we have for today.  I want to thank Dr. Birx, Dr. Fauci, for spending time with us.  And I’m going to turn this over to my colleague, Eugene Scott.

Crisis Response: Views from the Policy and Advocacy Community

Scott:               Good morning.  I’m Eugene Scott.  I’m a political reporter for The Fix here at The Washington Post and I’d like to introduce our speakers in this next segment.  Jesse Milan is the president and CEO of AIDS United, a nonprofit committed to ending the AIDS epidemic.  Mr. Milan is also a long-time advocate and nationally recognized expert on HIV/AIDS programs.  Congresswoman Eleanor Holmes Norton has represented Washington, D.C. in the House of Representatives since 1991.  She is also a member of the Congressional HIV/AIDS Caucus.  Phill Wilson is the CEO and president of the Black AIDS Institute, a national HIV/AIDS think tank focused on black people.  Mr. Wilson has been a decades long advocate for those living with HIV.

I want to remind our audience in the room and to those watching online that you can tweet your questions to us using the hashtag #PostLive.  I will relay them to our panelists.  Now let’s get started.  So when you think about addressing this epidemic, HIV and AIDS, in this current political climate, what concerns you most?  We will start with the congresswoman.

Norton:            What concerns me most is that we are in a period when we are receiving cuts of every kind.  Those of us, not only in the HIV Caucus, but among many members of Congress, are very concerned when cuts are made where we have achieved some progress.  I should tell you that I know of the current appropriation that there is on the House side what we call “level funding, no increase.”  Would you believe that is considered a win in this Congress because the president indeed put in a budget for almost 20% cut.  On the Senate side, we don’t know yet.

But that means that when the appropriation comes up—and you may know that we are probably going to get a two-week extension.  We’re going to get a number of extensions because it still is controversial—that at least we ought to be able to get no cut, which is a cut because, of course, expenses go up, costs go up.  And when you get no increases you don’t account for inflation and whatever is the targeted and important issue gets hurt.  And that’s what going to happen with HIV, where we’d achieved some progress and may lose that progress.

Scott:               Indeed.  Phill, can you speak about that in relation to black people in the communities that you work with in your nonprofit?

Wilson:            Certainly.  You know, there’s a huge elephant in the room.  Dr. Fauci and Ambassador Birx talked earlier about these new tools we have.  And certainly, we have some tremendous advances over the last few years, and we have new and better tools, better diagnostic tools, better surveillance tools, better treatment tools, better prevention tools.  But here’s the rub, none of it matters if people don’t have access to healthcare.  Full stop.

Ending the AIDS epidemic in our lifetime is over if people don’t have access to healthcare.  So the biggest threat that we have today is making sure that people have access to these tools.  Earlier, they talked about how it’s difficult to reach black, gay, and bisexual men.  Well, you know, quite frankly, I’m tired of that because we’re not difficult to find.  People are not interested in looking for us, so that’s the deal.  And so we need to make sure that the tools are there, but that they’re available to the people and people have access to them.

Scott:               Jesse, when you think about access, are there parts of the country that you see disproportionately not receiving the amount of education and attention that this illness deserves in their communities?

Milan:              Well, the Southern United States is, unfortunately, having an HIV hurricane, literally.  Literally 40% of the people living with HIV are in the South, more than half of new diagnoses, the new infections.  All of those are primarily happening in the South.  So we have to really focus on the community will.  And I loved what Ambassador Birx said earlier.  The political will needs to be at the community level as well as at the national level in order for us to expand access to care.

You know, 40% of people living with HIV access their healthcare through Medicaid, and those states in the South are where Medicaid has not been expanded.  So the pathway to getting to access to care is actually closed for a lot of people, particularly in the South.

Scott:               How do you educate young people about how this epidemic is still very much an issue?  When I talk to high school students, and even millennials, they seem to think there’s a cure.  They think of people like Magic Johnson.  They think of just other issues getting more attention, like the opioid epidemic.  How do you help people realize that this is still very much a concern, congresswoman?

Norton:            We can’t let progress stand in the way of prevention.  So that need falls to us, frankly.  To make every generation know that progress will not be there for them unless they take it a step further.  They don’t need to get HIV.  That’s how it should be laid to them.  You shouldn’t look at people who’ve been cured.  Look at people who’ve been cured of tuberculosis.  You want to get tuberculosis?  If we can keep you from getting it, and there’s a way to do it, then that’s what you do.

Some of the words, when I remember when this epidemic first began, I don’t even hear them anymore, like “safe sex.”  Whatever happened to safe sex?  [LAUGHTER] Why did that disappear from the lexicon?  Why didn’t we say to a new generation at least that old fashioned—that’s what it is now—slogan?  Look, you have to educate every new generation about not getting pregnant.  [LAUGHS] I mean, it’s really the same thing.  Well, we may not have had birth preventatives before we have them now, and so you tell people about birth preventatives.  You don’t just say, “Don’t get pregnant.”

Well, here, we’re not even mentioning HIV/AIDS.  And the role models that may have encouraged them to look closely at the disease they don’t see any longer because people know how to go get treatment themselves.  I think we need some of those role models.  We need to bring some of those role models out so people can see that, yes, even the rich and the famous, at one point, could get this virus and so can you.

Scott:               Indeed.  When you think about communities that aren’t seeing this illness mentioned, one area of attention that people seem to have forgotten about is how global this illness is.  Michael Gerson, a columnist here for The Washington Post, wrote last week about just how less attention Africa is getting in terms of treatment and the education regarding this current administration.  Are you seeing that, Phill, when you look globally at the issue?

Wilson:            Absolutely.  To the question of how we educate young people, we have to go back to trying to do that again.  No, we’re not doing that.  You’re not going to help young people understand the epidemic if you’re making cuts to the CDC.  You’re not going to help young people understand the epidemic if you’re not doing sex education and HIV/AIDS education in the schools.  And that’s true here in the United States, whether we’re talking about the Southeast, or we’re talking about the Midwest, or whether we’re talking about the global epidemic in Sub-Sahara Africa.

Now, a lot of work—we know how to do this.  We’ve made progress.  The challenge we’re having now is that we’re not doing what we know.  We need to make the investments to continue to do the work.  It’s like running a marathon.  You’re at mile 20, you obviously know how to get to the end because you’ve run 20 miles, but you still have to run the remaining race.  And right now, we’re not running the remaining race.

Scott:               Jesse, when you think about maybe one specific issue why we are not doing what we know to be effective, why is that?

Milan:              Well, I think the community will has to be addressed for all of us.  Each of us is part of a community.  We’re also part of a family.  And the stigma of HIV still continues.  And if we’re not willing to literally talk to our own friends and family about HIV, then how can we actually address what Congresswoman Holmes has just talked about?  How will that 13-year-old know that this is a problem and that they can do something about it?

Scott:               Congresswoman, you have been in Congress for quite some time and you have seen how HIV has affected this community, Washington, D.C., in ways that many people around this country just have no idea.  Can you talk about some of the changes and improvements you’ve seen, and what continues to be an issue?

Norton:            Well, if I may indict the body of which I am a part [LAUGHTER], the Congress of the United States, because that is where much of the problem lies.  And I’m not just talking about funding now.  To give you an idea, you talk about the Southern part of the United States, I have seen ideology trump healthcare in my own district.  Why does my own district, the nation’s capital, which by the way is doing very well—it has a surplus unlike many states.  You see cranes all around.  Why is my district a district which is labeled correctly a district with epidemic proportion HIV?

Epidemic means more than 1%.  We are 1.9%; made tremendous progress, but only after I was able to do something that had taken many lives.  Now, when lives are taken because of HIV, because we don’t know what to do, then of course, we wait for and get progress.  But that’s not what happened in the nation’s capital.  What happened here was ignorance and ideology trumped healthcare and knowledge.  The Congress of the United States, which has some jurisdiction over the nation’s capital, it does not over the states, rarely uses that jurisdiction.  When it does, I’m usually able to get it to move away.

For example, we have members who each and every Congress try to wipe out all the district’s gun laws.  Well, I’m able to stop that.  But we had a Republican—forgive me—majority in Congress for a number of years who took the position that the district should not be using needle exchange.  Were it not for years of disallowing needle exchange, the district, we’re like every other big city, we still have more HIV than some other places, as a big city, but it wouldn’t be in epidemic proportions.

Now, let me tell you what this means.  This is worse than what I have to do with Congress very often, which is to say, “Get off our backs,” and finally get something relieved.  This took thousands and thousands of lives needlessly because we could not do needle exchange.  What they do is to say no funds—not no federal funds—no funds of the District of Columbia may be used to engage in a program of needle exchange.  What that meant was that throughout the District of Columbia, at a time when there was more than there is today a drug epidemic, you got simultaneously and epidemic of HIV.  We are just recovering from that.

I’m pleased to say, for example, that we’ve gone now from 147, 10 years ago, people dying because of the needle exchange ban, to only seven.  In other words, 95% of that is gone, but we still are living with the consequences of that.  We wouldn’t have what we have today, which is an epidemic still declared in your nation’s capital, but for the ignorance and ideology of the Congress of the United States, Republicans in the Congress of the United States.

Wilson:            And on that note, you know, while the U.S. Congress was more than comfortable  to allow the people in the District of Columbia to die rather than to effectively use a prevention strategy that we know worked.  No, the community rose up.  The community responded to that neglect.  And that’s actually what we need to do now.  We need to continue to rise up.  These are certainly uncertain times.  They are certainly hostile times in the fight against HIV and AIDS.  And as we have done so many times before, we need to rise to the occasion again.  And that has to be a critical part of what we’re focusing on right now.

Milan:              Absolutely.

Scott:               Jesse, how do you do that?  How do you encourage people to rise up when there are so many things grappling for their attention?

Milan:              We have to understand that we are each part of the political process.  Our congresspersons need to know our message.  During all of the efforts against the Affordable Care Act, literally thousands and thousands of phone calls were made to Congress to tell the story.  And many of those stories were told about people with HIV; how access to care was going to be closed off; how access to their medications might be closed off.  So we have to literally tell those stories because those stories make an enormous difference in this political environment.

Scott:               Congresswoman, since you’re an insider and you can speak to that, we have Alyssa from Twitter, and she said, “What can we do to support advocacy efforts at the policy level if we live in a territory, like D.C., and don’t have a vote in Congress?

Norton:            Well, having a vote in Congress isn’t how I’ve been able to get things done.  Fortunately, [LAUGHS] by the time the vote comes in, the work is done.  I can understand the outrage of people who, by the way, are number one per capita in taxes paid to support the government of the United States, not having that vote in Congress, and having no senators.  The fact is, it hasn’t much hindered me when it comes to the big issues of our time.  As I indicated, we still have our gun control because you do your work before that matter arises on the floor.

And indeed, the district has made tremendous progress.  Once we got that needle exchange gone, our rate has gone 70-some percent for all forms of HIV.  But what you can do is watch the appropriations in Congress.  Do not just write Eleanor.  Eleanor knows what to do.  [LAUGHTER] Write the chairman of the appropriations committee so he knows that people are watching him.  Remember, he’s handling appropriations for the entire country.  He needs to know that people understand it and know it.  It really does matter.

You know, flash, this still is a democracy.  And one way to know that is this: the president’s budget cut everything to smithereens.  I’ve never seen such budget cuts, we’re talking HIV, but they were across the board.  The Congress doesn’t pay any attention to the president, whether Barack Obama or Donald Trump.  The appropriators do their own thing and they never cut or give as much as the president wants.  So what does that mean?  It means keep your eye on the purse strings.  They are in the Congress of the United States, and the appropriators control how much money or whether you’re going to get any money at all.

Scott:               And for those who don’t know, the chairman of the appropriations committee is who?

Norton:            This year—now you’ve caught me off guard.  [LAUGHTER]

Scott:               Just write anybody, everybody on the appropriations committee.  And so, Phill, when you think about issues related to HIV and AIDS that are not getting the attention that they need, that we haven’t mentioned, what comes to mind first?

Wilson:            Well, there are a number of things that come to mind actually.  You know, certainly, we need to understand that HIV doesn’t happen in a vacuum, so we need to pay attention to the social determinants of health.  You know, the issues around housing, the issues around addiction, the issue around food insecurity are all important as well.

But probably at the top of the list, you know, given the advances we’ve made, making sure that people understand the prevention tools that are out there, and that they have access to those prevention tools.  And also that people understand the power of treatment.  I’ve been living with HIV now for over 35 years.  I’m alive today because I have access to treatment.  And we need to make sure that anyone out there at risk for HIV understands that there are treatments that are available to them that can both prevent them from getting infected with HIV, if they’re not infected, and can help them live a long and healthy life if they are infected.

Milan:              I think that’s really important.  The platinum standard that the United States is missing is the number of people who are virally suppressed.  The United States, our glass is literally only half full.  Only half of the 1.1 million people in the United States are achieving viral suppression.  That is criminal when we have countries in Africa, that were in the earlier panel being discussed, have higher viral suppression rates than we do.

And the number of people in this country who understand that PrEP can literally prevent you from ever becoming infected is shocking.  I go around and I talk about a PrEP and people look at me like, “What?  You mean there is a pill?”  So viral suppression, which can prevent you from dying of AIDS or ever developing HIV/AIDS, and also preventing you from transmitting the virus, and PrEP are two of the most important tools in our toolbox, and so many people don’t know how important they are.

Scott:               Awesome.  I have another question from Justin from Twitter.  Current healthcare reform proposals would not oblige insurers, private or public, to cover Truvada for HIV prevention, which is what you were just talking about, PrEP.  At $1,300 a month without insurance, it is inaccessible to most people, especially marginalized communities.  What could cities, states, and civil societies do if this happens?

Wilson:            Well, let’s start by not letting it happen.  [LAUGHTER]

M:                    Right.

Norton:            Well, first of all, I can tell you that my own city, for example, if healthcare gets taken away, they’re going to try to keep people in healthcare.  And I think where you have seen progress, you will see cities step up.  You can’t let Congress get away with that though.  You really can’t let Congress get away with offloading the responsibility to a tax base that is smaller than the tax base of the entire United States.

And that’s why I stress, and it may be hard to believe when you see the division in Congress that you can have any effect on them.  That’s why I point to appropriations, where what the president wants usually isn’t what decides how much money there will be in here.  It’s something that should go straight to him.  And while I can’t think of the heads of all the appropriations committees—

Scott:               It’s Chairman Rodney Frelinghuysen from New Jersey.

Norton:            Frelinghuysen is a very good man from New Jersey.  And the Senate chairman is from Mississippi.  By the way, that Senate chairman has his seat because African Americans, when he was deserted because there was a far-right winner running against him, came to the fore because he had made sure that Mississippi got so much money.  And I will think of his name because I think he would be very open as well.

M:                    Cochran.

Norton:            Senator Cochran, one of the more senior members in the Senate, chairman of the appropriations committee.  Thank you.

Scott:               And so we talk a bit about the impact of the absence of healthcare on individuals with HIV and AIDS, and how expensive it can be.  What can you share with people who do not have HIV and AIDS, and why this epidemic should matter to them, and why they should be concerned about how this illness effects their fellow citizens?

Milan:              Well, I think the most important thing for us to understand is that none of us are safe until all of us are safe.  And that this is an epidemic that impacts all of us.  There’s probably no one in this country that doesn’t know someone who is living with or who has lost someone to HIV.  You may not know it, but were all impacted by this disease.  And the response to it the responsibility of all of us.

Deaths are still happening in the United States.  That’s part of the news.  And in order for deaths not to happen, people need to have access to care.  The story that is important is that those deaths are not being heard by the person who’s turning 13 today, or the person who’s turning 16 today.  My late partner’s death, his anniversary was on Sunday, 30 years ago.  We’re not hearing those stories and so until we have that vaccine, no one is actually safe because it’s still possible to acquire HIV.  And unless you’re taking your medications, it’s possible for you to sill acquire AIDS and become very sick and die.

Norton:            Could I say a word about women, because I think the notion of men having sex with men, and of course that is where most of the issue is, has tended to obliterate how dangerous this is, what the high risks are for women, and what they need to protect themselves.  We also have abysmal ignorance among girls and women about their exposure to the virus.  And there needs to be deep, deep, real deep understanding with girls from the beginning, and with women who are exposed to men with HIV, and may not know what to do, or how to protect themselves, and how safe sex applies to men and women.

Scott:               Congresswoman, how can we get this message targeted towards girls so that they grow up knowing what they can do to protect themselves?

Norton:            The very same people who have done, I say, a credible job in teaching girls how to protect themselves against pregnancy have a job to do with the virus as well.  It seems to me those go hand-in-hand because either one can get you, shall we say, “in trouble.”

Scott:               And what other areas are you seeing, Phill, that perhaps aren’t getting the attention they need?  We’ve seen girls.  We’ve seen women.  We’ve seen people in rural communities.  Are there other populations?

Wilson:            Certainly, one of the populations that does not get enough attention is the impact that HIV and AIDS is having on transwomen, and the violence that’s been enacted against transwomen all over this country.  You know, the transwomen are disproportionately impacted by HIV, particularly transwomen of color.  And that’s inextricably connected to discrimination and stigma.  One of the overlying factors that inhibit our ability to fight HIV is discrimination and stigma, whether we’re talking about men who have sex with men, or whether we’re talking about women, particularly women of color, or whether we’re talking about transwomen, or whether we’re talking about young people.  We have to be aggressive in addressing the issues around stigma.

We need to also make sure that we’re addressing the needs of all of us.  Nobody can be left behind when it comes to this epidemic.

Scott:               Absolutely, nobody.  And did you want the final word here, Jesse?

Milan:              The final word is that we have so much more to do.  We have so much work to do in the South.  We have so much work to do with some very key populations; with women, with the trans community, with youth, especially under 24.  That work is not yet done.  And in this environment, we all can be part of the political will to make a change.

Scott:               Unfortunately, that’s all the time we have for today.  I would like to thank Jesse Milan, Congresswoman Eleanor Holmes Norton, and Phill Wilson for joining us.  Now we will move on to the next portion of the program.

Content from Gilead: Reducing HIV/AIDS-Related Disparities in the Southern United States

M:                    And now please welcome Cornelius Baker of the State Department and Gregg H. Alton of Gilead for our next discussion.

Baker:              Morning, everyone.

M/F:                Good morning.

Baker:              I’m Cornelius Baker.  I serve as the special advisor to Ambassador Debbie Birx, who was here earlier, and also the office of AIDS research, NIH.  Gregg, good morning.

Alton:              Good morning.

Baker:              I’m really pleased to be here with you today to talk about Gilead and the work that you’re doing, and this great partnership with The Washington Post as well.  Last week, we recognized 30 years of the World AIDS Day.  Gilead is also 30 years old.

Alton:              That’s right.

Baker:              And so you were born during the most difficult times of the epidemic.  And so you’ve seen the progress that we’ve made.  And that progress across our country has been uneven.  And especially in the Southern United States, which we want to talk about this morning.  What do you see, as a company, happening in the Southern United States, and what are the tends that you’re most concerned about?

Alton:              Sure.  I think a lot of this was discussed by the prior panelists.  I think there’s been a tremendous amount of progress in the last 30 years.  I’m from San Francisco and we it dramatically in San Francisco, where over the last 10 years we’ve seen the HIV infection rates drop by nearly 60%.  So there’s a lot of progress.  But the trends you’re seeing in the South is that they’re not keeping up; that we’re not seeing the same patterns.

In fact, you can look.  A lot of the statistics of the South have been talked about, where you have the prevalence of HIV in the United States, about 50%.  The incidence is about roughly 50%, and AIDS related deaths are about 50% despite being about a third of the population.  So we’re not seeing the same gains in the South.  In fact, in many cases, the South is seeing trends of HIV that resemble what we saw in the ’80s.  And so one thing that we are really trying to do is ask the question, you know, what are the components of what’s been successful in other areas of the country that we need to be doing in the South, that aren’t happening in the South?  And that has to be tailored to the South, of course.

Baker:              And that’s really important because you talk about what are the other good things, and you talked about the numbers, and we’ve heard the trends, the statistics, this morning.  But we don’t want to just look at the South as a big deficit.  And so what are some of the positive things that you’re seeing, that you think we can build on?

Alton:              Well, clearly, one of the positive things that I’ve seen, and I’ve had the opportunity to spend some time in the South recently, are the organizations in the South.  Currently, they’re doing work.  And these are organizations that are working on building awareness, taking on stigma, working on some of the racial and other inequalities that exist in the South, and providing great care.  These are some organizations that are very good at understanding their community, understanding what the needs are, and whether it’s prevention services, whether it’s HIV treatment services, or whether it’s dealing with the mental health issues of other issues that are suffered by people living with HIV, or at risk of HIV, they’re doing a fantastic job.

So this is not a capability issue.  This is not a lack of expertise.  And I would say I was to draw one contrast between the South and, say, San Francisco, my hometown, or New York, it’s resources.  There are just not as many resources for these really great organizations to capitalize on and really do more of what they’re already doing.  So we just need to make them better,

Baker:              Great.  And so what do you then think Gilead’s role is with those resources then, to be part of the solution.  We heard from Ambassador Birx about the great achievements that are happening in DREAMS, and Gilead is a partner in that.  So what do you see your role within the Southern United States?

Alton:              So, certainly, I think that in terms of what we can be doing, we have to recognize that it must extend beyond access to care.  I think Phill Wilson talked about access to care has to be a critical component of this.  But we need to really look at making sure that we’re more holistic in what we’re doing, and we really identify the entire individual, and so we can deal with the issues of stigma.  And we can deal with the issues of discrimination.  We can deal with the issues of other social and environmental factors.

And the only way we’re going to do that—it’s not going to be Gilead doing this, we simply can’t—it has to be the community-based organizations.  It has to be owned by the communities that are impacted; by the people who live there, who come from there.  And like I said before, they can do this.  I’ve seen this.  And they’re passionate.  They’re capable.  What they are going to need is the support.  They’re going to need some investment.  And it has to be a committed investment.  This has to be supporting these organizations so they can grow, and they can build on what they’ve already been able to do.  And as I said, do more, prevent more infections, treat more people, and provide that comprehensive care to more individuals.

Baker:              I know you have a new initiative, and I know that you’re putting your money where your mouth is.  Can you tell everyone here more about the COMPASS Initiative?

Alton:              Sure.  So the Gilead COMPASS Initiative, which we announced yesterday in New Orleans, it’s a new initiative.  It’s $100 million investment in the South, over 10 years.  We’ve been, over the past several months, planning this out of how we’re going to make the impacts that we’ve been talking about.  And we’re going to focus on three pillars.  The first will be capacity building and information sharing among the organizations that I’ve already mentioned, and continue to say these guys are really good.  They know what they’re doing.

The second component will be around the individual and well-being, mental health, and trauma of people living with HIV or are at risk of HIV.  And then the third component, which we think is going to be critical, the awareness, education, and that key component of stigma reduction in the South.  So those are the areas that we’re going to be focusing on.  Again, working through community-based organizations.

Baker:              Right.  And you’ve talked about the great skills and strengths of community-based organizations in the South, so who are going to be your partners with this?

Alton:              We’re going to start off with three coordinating centers.  And this was through a RFP process that we ran through.  One partner will be Emory University Rollins School of Public Health.  And they will be working on the capacity building and information sharing.  Another organization will be the Southern AIDS Coalition.  They will be working on awareness, education, stigma reduction.  And the third coordinating center will be the University of Houston Graduate School of Social Work.  They will be working on the wellness, the mental health, and the trauma related issues of those living with HIV.

So they will be the coordinating centers.  They will then actually be deploying the funding.  I’ve talked to a lot of people.  We are not going to choose and pick the programs that will be supported.  These coordinating centers will be responsible for doing that in the context of the three pillars that I mentioned.  So they will be out there and identifying who the campions are, and really, again, making them better at what they do, and delivering on what we want to accomplish.

Baker:              That’s great.  And full disclosure, I’m a lecturer at Emory and they’re very excited.  And so we’ve been very, very thrilled to be a part of this.  Earlier, Lenny asked Dr. Fauci and Ambassador Birx what do they see in five years.  Now, you have a 10-year initiative.  How do you hope the world, how do you hope the Southern United States, how do you hope for people in that region?  What’s going to be different for them?

Alton:              Well, we hope that the—I keep repeating this—the first thing that we want to see is these organizations not only be sustained, but grow and build upon what they’ve already done, and be able to provide the care and services for those in the South who may not be aware of where those services are; who may not be aware of the latest in prevention of HIV, and have places to go.  And then over time, it’s very simple, we want to see the South enjoy what other cities have enjoyed, which is really working towards zero new infections, zero AIDS related deaths, and we need to eliminate stigma in the South.

Those are big goals.  I’m a positive person.  I’m actually very confident.  I have a lot of confidence that, not Gilead, but these groups can do this.  So we’re going to invest in them.  And we’re going to commit to them.  That’s what we’d like to see is fewer people with HIV, and fewer people dying of HIV, and we’ve got to get rid of that stigma.

Baker:              We have a minute left.  I guess, you know, we’ve focused on the Southern United States.  Gilead is both a national and global company.  And I guess, you know, reflecting on World AIDS Day and your 30 years—you know, I met your founders when they were starting out at Gilead, and particularly Michael Riordan, thinking about his hopes and dreams—what do you think about Gilead’s hopes and dreams right now?  It’s a company that’s been so invested in HIV.  What would you like to see?

Alton:              In the 20 seconds I have left, so just for everybody here, Cornelius and I, most of the conversations we’ve had around HIV/AIDS have been for Sub-Saharan Africa and Southeast Asia.  But our goals are very simple.  We want to have better medicine for people with HIV.  We want better prevention for people at risk of HIV.  And we want those tools to go out there and make the impact that they need to have.  That means people need to have access to the medicine.  They need to have access to the prevention, and they need to have organizations on the ground that understand how to deliver that to them.

Then we need to get to—the easy answer is we need to have no new infections, everybody needs to be virally suppressed, and we need to, you know, make sure that the HIV community is embraced by the communities they live in.  So we need to get that 90, 90, 90 or more.  And we need to have a cure for HIV.  We need to have a vaccine.  All those things we’d love to see.

Baker:              Great.  Thank you.

Alton:              All right.  Thank you.

HIV in America: The Geography of the Epidemic

Williams:         Good morning, everyone.  I’m Vanessa Williams. I’m a reporter here at The Washington Post, and I’d like to introduce our panel, and get started.  To my left is Greg Millett.  He’s vice president and director for public policy at amfAR, the foundation for AIDS research.  And before joining amfAR, Mr. Millett worked at the highest levels of federal HIV policy development at the White House, and at the CDC.  Mr.  Millett.

Dr. Mike Saag, who is the director of the Center for AIDS Research at the University of Alabama at Birmingham.  He is also founder of the UAB’s 1917 HIV Clinic, which has pioneered treatment programs, and focuses on quality improvement in the area of HIV/AIDS.  Welcome, doctor.

And Linda Villarosa, who runs the journalism program at the City College of New York.  She’s also a contributing writer for The New York Times magazine, and she did this amazing June cover story called “America’s Hidden HIV Epidemic,” which examined the impact of AIDS on people in the south.  So, I want to remind our audience—I’m sorry, welcome, Linda.

And I want to remind our audience in the room, and to those watching online that you can tweet your questions or comments to us, using the hashtag #PostLive, and I will relay them to our panelists.  So, let’s get going, please.  It seems to me that the south provides, if you will, the perfect storm for what is happening now with regards to HIV and AIDS.  You have poverty—a lot of poverty, a healthcare infrastructure that’s either broken in some places, or incomplete in other places, and you have a culturally, socially, and politically conservative sort of climate and mindset, which makes it hard for people to acknowledge that there is a problem that causes people to perhaps attach too much stigma to what’s going on.

So, given those conditions, it is surprising but not surprising, if you will—surprising I say because I think even though I’m a journalist, and I have written about social issues, quite frankly AIDS has sort of gone to the back.  Somehow, I figured it had been sort of managed, or I was aware that for poor people, people of color, people who probably couldn’t afford the expensive drugs, it might be an issue, but I’m really a little bit taken aback to learn about what’s going on in the south.  And what’s continuing to go on in communities of color because this has been the conversation for the past, I’d say, 30 years.  So, I’d like to start with you, Mr. Millett.  Can you give us an overview of what’s happening with regards to rates, and also, I’d like for you to address why the rest of the country could care?  It would be very easy for people to go, well, that’s not problem.  Why should we care what’s going on down there?

Millett:            Well, the reason that we should care, and thank you for the question.  The reason that we should care is that HIV is an infectious disease, and people are not just located in one part of the country, and have absolutely no contact with other people in other parts of the country.  And what’s taking place in the south is something that is very different than what we see in other parts of the United States. So, the south comprises about a third of the US population, about 45% of HIV diagnoses take place in the south.  The 38,000 new infections that take place each year—half of those new infections take place in the south.

When you take a look at AIDS deaths each year, you find that people in some southern states are three times more likely to die from HIV as compared to other states in the United States.  So, in particular, Alabama, Louisiana, as well as Mississippi have rates of HIV death that are three times higher than, say, Maine or Vermont.  And then, when we take a look at other metrics, such as awareness of HIV status, about 87% of Americans who are diagnosed with HIV already know that they’re HIV+.  In the south, you don’t necessarily see that.  About 70% of the worst performing states for HIV diagnoses are in the south.

And then you have other issues.  It’s not just about the HIV epidemic.  You did talk about poverty.  You did talk about race and ethnicity, and we find that 53% of African Americans living with HIV are in the south.  That’s where most of the concentration of African Americans are, living with HIV.  But then we have other issues, as well; we have hepatitis C.  CDC reported that there’s been a threefold increase in hepatitis C between 2010 and 2015.  Most of that is taking place in the south.  Hepatitis C and HIV are diseases that are transmitted through injection drug use, and what we have in the south, as well, primarily in the south, is a huge opioid epidemic that’s concentrated there.

So, it really is the perfect storm, where we have this syndemic; it’s HIV, it’s hepatitis C, as well as opioids, that is producing conditions that are worse in the south than other places in the United States.

Williams:         Okay, Doctor, talk about the healthcare infrastructure that I referenced in the beginning, and how that maybe has hindered getting the community getting its arms around the epidemic, as well as some of the other issues.  And what can be done, particularly in a political climate that doesn’t seem to be in a mood to expand spending for healthcare and other—if you will, the social safety net.

Saag:               If it’s okay, I’ll start with some good news.

Williams:         Okay, that’d be great.  Thanks.

Saag:               So, in the first place, there has been, as Dr. Fauci mentioned earlier, an awful lot of progress, and a lot of that progress has translated all throughout the United States and the world, and that’s great.  And also, we had the Ryan White Care Act, so when we think about poverty, and we think about poor infrastructure for healthcare, one safety net that’s critical for all of our patients is the Ryan White Care Act, and for those of you who aren’t familiar, that provides basically gap services, so if somebody has insurance, but it’s not quite enough, this fills the gap.  If they have no insurance, the medicines and the outpatient care is covered by this program.

So, that anybody who’s diagnosed, regardless of where they come from, if they get into our system, if they get into any one of the seven Ryan White clinics in the state of Alabama, they’re okay, as long as they keep showing up.  That’s the good news.  The bad news is what we’ve sort of already alluded to, and that is people grow up, especially in rural and poor areas of the state, without a culture of healthcare as a routine, as a priority.  There’s a lot of other things on their mind, like food, and getting to where they need to go to work, or getting their kids to school.

Life is overwhelming for people living in poverty.  And so, healthcare is something they do on an emergent, or an urgent basis, but not as a matter of prevention.  It’s not really something people grow up with.  So, you’ve got that, and when somebody is diagnosed with HIV, the concept of coming into routine care, for some people, is not something that they think of as a way to proceed, and then you have the stigma, which is talked about a lot.  So, that’s our challenge, is trying to reach out to where people live, get them into care, and nurture that engagement and care, and we’re doing a pretty good job of that.  The hard part is the people who aren’t diagnosed, and getting them into care.

Williams:         Let me just do a quick follow up.  Even if you could get everybody who needed care to show up, is there enough, again, seven clinics, I’m not sure what that means for people who live around—is that enough to reach everybody?  Are there enough doctors or other care providers?  Are there enough drugs?  Are there enough resources to reach everybody, if everybody showed up tomorrow?

Saag:               I think we’re at a place where we probably could handle everyone.  I’d love to see that problem. I’d love to deal with that.  There’s about 20% of people who have HIV in the state who don’t know their status.  That’s our critical issue, and what I think people tend to get lost in, if you think about epidemiology as snapshots, like how many people between the ages of 14 and 24 are exposed or at risk? Well, that 14-year-old soon becomes a 24-year-old, and then there’s a whole new wave of people who we now have to deal with, and be able to accommodate.

But to answer your question, yes, I think we do have the capacity once they get into care for HIV.  hepatitis C is another story, but because of the Ryan White Care Act, and the continued appropriations of that over the years as a congresswoman talked about, that’s, I think, sufficient.  But what we really need to do is do the outreach and create a culture of ongoing, chronic care.

Williams:         Okay, Ms. Villarosa, your piece was about the impact of the HIV and AIDS in the south, and you went to, I believe, Jackson.  And I want you to talk a little bit about the cultural issues—the stigma, especially.  Also, the gentleman, Mr. Cedric—is it Sturdivant?

Villarosa:         Yes.

Williams:         The gentleman who was doing this really great, on the ground, grassroots work.  And I guess I’d like you to address, is that the solution? And is it possible to sort of clone him, expand those kind of services, and would that do it, or does there need to be something else?

Villarosa:         I think that so much of the problem has to do with the infrastructure, so it’s beyond what one heroic person can do.

Williams:         Absolutely.

Villarosa:         Or even a group of heroic people, because if you don’t have a transportation system that really works, part of the gift of Mr. Ced was that he had a car, and so he was able to travel around. He was able to deliver people’s medication.  He was able to bring them to the clinic for their appointments.  He was often taking people to their jobs, or to job interviews.  And so, if people are having trouble finding work, then they fall—they aren’t doing well, in general.  And if the healthcare system isn’t great, then no matter how many Mr. Cedric’s there are, the problem won’t be solved.

And at the same time, I saw tremendous resilience, and I saw other people like Mr. Cedric, or him training other people.  It was hard, with the stigma, and people were staying away from healthcare facilities, because they felt like they weren’t welcome, they weren’t treated well, or everyone would know them, and everyone would know their business.  And that was a big thing in a lot of people that I talked to. I said, “Well, how did you wait so long before you got into care, or even found out you were HIV+?”  And one guy said, “Well, I didn’t—the hospital in my small town of Mississippi was where I get my care, but everyone knows my grandmother, my aunt, and my mother.  And so, I was afraid of going there, because I didn’t want to be judged.”

Williams:         By the same token, and there’s been a lot of talk about the stigma, and particularly in communities of color, our community and our churches, that people are afraid to speak up.  At the same time, you also had people in your story who had families that were—who were very compassionate and helpful.  There are some community people in the religious community, in the social services community, that do step up.  So, how do you infuse the system, if you will, the overall system with the kind of compassion that would get people to come forward?  That will get them all to show up for treatment, or for help?

Villarosa:         I think a lot of it starts at the top.  HIV/AIDS is an illness; it’s not something to be judged, it’s not something to be ashamed of.  It’s just another illness, so if we treated it like another healthcare issue, then that erodes some of the stigma.  I think I agree with you, and I have seen tremendous progress in the African American community since I first started covering HIV/AIDS where there’s much more acceptance, and there’s much more love, but I think there just needs to be more, and I saw a beautiful panel once, where it was a minister talking to other ministers about being accepting of people—LGBT people as well as people living with HIV/AIDS.

Williams:         And let me just ask you one more follow question, Mr. Millet.  I’m giving you a title.  And that is there’s a lot of discussion about mistakes that were made with regard to outreach and education, back in the beginning, and I believe that most of us probably know and acknowledge that in the very beginning, AIDS was sort of tagged, if you will, as a white gay male disease, so all the focus was there.  All the resources—most of the resources went there.  Why haven’t we caught up?  It was a long time ago that everybody said, “Oops, we messed up.  It’s time for us to get our act together and to get—and to be more broad in how we approach this, and how we do education and outreach.”  What is still—why haven’t we done better?

Millett:            We have and we haven’t.  So, at the very beginning of the epidemic, we had the three Hs.  So, the people who were most affected by HIV/AIDS that you saw in the media were Haitians, people who were heroin addicts, and hemophiliacs.  And then, of course, homosexuals, as well.  And when people talked about the homosexual community, they usually were talking about white gay men, and of course, many African American gay men didn’t think that they were at risk for HIV.

Unfortunately, what happened then is that since a lot of the messages weren’t being directed towards African American gay men, and even to a certain degree, among African Americans, it allowed the virus to really build up in some of these communities.  So, what we have right now, unfortunately, when we take a look at HIV diagnoses, particularly for African American gay men, you find that they are 0.2% of the total US population, but account for a quarter of new infections that take place each year.  They’re 1% of the black population, but half of the infections that take place each year.

And when you take a look at all of the diagnoses for HIV, the nine groups that CDC consistently says have the highest rates of HIV, African Americans are at the top of those nine, so it starts first with black gay men, who are about 10,000 new infections each year; African American women, who are about 5,000 infections each year, and then African American men who are about 2,000 infections each year.  So, there’s a lot of work that we need to do for people to understand that we’re still at risk for HIV.  We talk a lot about what’s taking place in the global context, and that’s incredible.  That’s wonderful work that’s being done, and I’m very happy to see that.  The problem, though, with that conversation, is that people thought that we’re no longer at risk here in the United States.

And you even saw that in certain places, on the cover of Ebony and other places where Magic Johnson, where they said Magic Johnson was cured of HIV.  That sent a message to the black community, and that message was that this is no longer an issue for us.  But unfortunately, we’re still the population at highest risk for HIV.  And the population at highest risk for HIV, particularly in the southern United States.

Williams:         Let’s take a question—thank you—from Twitter.  Carson on Twitter asked, what is the role of technology and data analytics in combatting HIV/AIDS?  And are there efforts to develop and utilize technological innovations, such as the digital pill to help us better understand and improve medical adherence of treatments?

Saag:               Absolutely, and I think this hits at multiple levels.  On a sort of statewide level in our state now, and we’re working longer term with other states in the south, is working very closely with the state health department in tracking new cases.  And then, remember that every case that became—if someone became infected, it was from one other person.  It wasn’t from a mass of people; it was one encounter that led to that.  So, doing what’s called geocoding, you can find hotspots of transmission.  For opioids, we can track actually naloxone use; that’s the antidote to an overdose, from EMS as they go in a location.  You can just track how many times they’ve opened a vial, and you can see the hotspots of overdoses occurring in the state.

And then you can target your messaging, so absolutely technology can be used that way.  The other way technology can be used is in reminders—cell phones—of helping people understand, okay, you’re taking your medicine now.  You’re taking your pills.  That’s another way that we can use technology, and that’s worked in sub-Saharan Africa.  What I like to always remember is that a lot of the efforts we’ve done in sub-Saharan Africa apply back, especially to the south US.

So, a lot of things that we’ve done, for example, in Zambia in our programs, we bring back, and that exchange between Zambia and Alabama, we call Zambama.  That’s our acronym for that.  And so, it’s a way of taking technology and implementing it.

Williams:         Again, though, I’m really curious about where do the resources come from?  Alabama, and indeed a lot of southern states, were not involved in sort of Medicaid expansion, so you can’t say it’s going to—I think somebody maybe in your story, somebody said, like, now everywhere is Alabama, with the erosion of the coverage for people under the Affordable Care Act.  And it just seems that right now, people aren’t of a mind to sort of spend a lot of money. The government isn’t of a mind to sort of spend a lot of money on these type of issues, and frankly, people who do have money, are they of a mind to spend it on these problems?  They were like, look, this is not our problem. Everybody got—we’re in this sort of mindset where people say, “Everybody got to take care of themselves.”  So, is it there?  And Linda, I’d like you to address sort of what can the community itself do to sort of take care of itself?

Saag:               So, just quickly, there’s about 4 million who live in Alabama.  About 1 million live around or beneath the poverty line, so for our state, expanding Medicaid would have brought about 1 million people, or maybe 800,000 into care, that don’t have care otherwise.  And that gets to the point beyond HIV, to many other things like we talked about earlier.  The Ryan White Care Act helps add resources, qualified health center help, but it’s not sufficient to really maintain a really strong health infrastructure for people, not just with HIV, but with all chronic diseases.

Millett:            Can I mention just one other thing, too?

Williams:         Please.

Millett:            We spend about $22 billion a year domestically on HIV.  So, while we do need new resources, another part of the equation is to better target the existing resources that we have.  And something that took place when Douglas Brooks, who’s in the audience, was in the White House, as well as Jeff Crowley, and Grant Colfax, was that we made sure that existing resources, particularly for HIV prevention, were going to those states that need it the most.  So, historically, the formula was to go to states in the west coast, or on the east, where the epidemic was older, but not necessarily the emerging epidemic that we see in the south.

Under the Obama administration, we made sure that we changed that, so that the resources were going to the southern United States, where the epidemic was emerging, and they knew it.  So, sometimes it’s about really just making sure that you take a look at the existing resources, and trying to figure out whether or not we’re spending and allocating it in a way that makes the most sense, in terms of what’s taking place nationally.

Williams:         Okay, and just let me quickly follow up.  Okay, fine, but I guess I would ask you how do you sort of craft the message or the campaign that says to people, this is something really important that we need to do, and we need to send these resources here. Again, like I said, it just—I’m glad we’re optimistic, but it doesn’t seem that—

Millett:            Well, it goes back to also what Mike was saying, is that we really are in a tale of two cities here, with the HIV epidemic nationally.  We’re seeing decreases in HIV across the nation, including in some southern states.  There are no places—there’s no states where we’re seeing increases in HIV.  That’s the great news.  We’re also seeing decreases in HIV over the past ten years for women, for some groups of gay men.  We’re seeing them among African Americans and other populations.  All wonderful news.

The problem, though, is that there are other issues that are taking place.  Those are those hotspots where we’re seeing some lingering problems, and the lingering problems are primarily centered in the southern United States.  If we want to get to the point where we keep saying that we have the tools to end the epidemic, that we can finally end the epidemic, we need to focus on those places where we really need to make the biggest change to end the epidemic.  And right now, that’s the southern United States.  And I think that that’s a message that many people can buy into, saying that we are so close to the end, but to get there, we need to make sure that we focus on those places that would make the biggest difference in getting to the end.

And you see that among a lot of the advocates. The advocates in the national communities, it doesn’t matter if they live in San Francisco, it doesn’t matter if they live in New York City, many of them are on board with making sure that we target our efforts to the southern United States, to make the biggest bang for our buck.

Williams:         Okay, Linda, I have a question here from Justin on Twitter that has to do with the importance of the role of churches and faith base.  And again, I don’t mean to be a cynic or difficult, but given the, let’s say, rise in politics of this sort of conservative, religious voice that basically says, these things are bad and that’s y’all’s problem.  Again, I have to ask, sort of, where do you—how do you do get through? And do you do it in spite of them, or do you go around them?  Just sort of how does it—how do you break through that?

Villarosa:         I think one of the most heartbreaking things that I noticed when I was doing my reporting was that a lot of the organizations had names like My Brother’s Keeper, or Saving Ourselves Symposium, Us Helping Us, or Our People, Our Problem, Our Solution.  Well, this is everyone’s problem.  And you asked the interesting question, why should we care?  We should care because the south is our country.  The south is our birthright.  My grandparents are from Mississippi.  I care about the people, anything that’s happening to them.  So, if the transportations systems are not good, if the educational system is not good, including sexual and reproductive health education, if the job market is not good, we have to care about this large swath of our country, and we can’t let this happen, no matter who is standing in the way, including the church.

Williams:         Absolutely.

Saag:               Our clinic has had outreach into the church community for 25 years and it’s worked very well, but a very, very quick story.  At the 16th Street Baptist church, the one that was bombed in 1963, the 30th commemoration, Mary Fisher, the AIDS activist, came and gave a talk, and afterwards, it was very telling.  She was standing in the middle of this foyer, and people would line up to see her, but at a distance.  And each one would hug and whisper in her ear, “My brother died of AIDS.  My dad died of AIDS.”  And they were all suffering, but they didn’t share their story with each other, but they shared it with this woman who came and spoke.

Williams:         Well, unfortunately, it looks like that’s all the time we have for today.  I’d like to again thank our guests, Greg Millett, Dr. Saag, and Linda Villarosa.  Thank you so much and now, I’m going to hand off to my colleague Jonathan Capehart, and thank you all for listening.

One-on-One with Dionne Warwick

Capehart:         I suppose I should introduce—[LAUGHTER]

Warwick:         Yeah, you should.

Capehart:         Introduce the legend that sits next to me.  Good morning.  I’m Jonathan Capehart.  [APPLAUSE] Opinion writer for The Washington Post and I’m joined on stage by an American icon, a music legend, Grammy Award-winning singer.  How many?  Five Grammys, 14 Grammy nominations, my favorite album.  [LAUGHTER] My homegirl.  She was born in East Orange.  I was born in Newark.  Dionne Warwick.  [APPLAUSE]

Warwick:         Hi.

Capehart:         In 1985, Ms. Warwick participated in the recording of That’s What Friends Are For, which became a number one hit worldwide, raising awareness and major funds for AIDS research.  In 1987, she was appointed US Ambassador for Global Health by President Ronald Reagan.  Throughout her career, she’s been honored by major HIV-AIDS organizations for her advocacy for HIV-AIDS funding, research, and education.  Ms. Warwick, thank you very much for being here.  It is an honor to meet you.  I took a very early plane to make sure that I got back in town to be able to do this and I want to remind the audience into the room and those of you, if I can find a camera—those of you who are watching by a live stream that you can pose questions via Twitter.

You can tweet your questions and comments to us using the #PostLive.  So, Ms. Warwick, it is 10:30 but you’ve been here all morning.

Warwick:         Yes, I have.

Capehart:         For all of the panel so you’ve heard everything and this is the last discussion and I take it that you’re not too happy with what you’ve been hearing or better yet, not too happy about things that you haven’t heard in some of the discussions.  What haven’t you heard that you wish you had?

Warwick:         That’s true.  Well, I have been here since the early morning and I also flew in from Germany.

Capehart:         Okay, you win.  [LAUGHTER]

Warwick:         So we’re on the same wave right at this moment.  Yeah, it was very interesting, the different panels that were featured, speaking of different areas of the HIV-AIDS epidemic and that’s what it’s becoming again, folks, okay?  Let’s not bury our heads in the sand again as we had been for many years.  When I was appointed your Ambassador of Health for the US, it was a self-imposed mandate that I made based on what I was experiencing.  Not personally, but then again, personally.  I lost my valet who worked with me for many years to AIDS, not knowing exactly what it was.  I thought it was cancer like everybody else did from the very beginning of this epidemic thing.  Until Rock Hudson put a face on it and gave it a name, nobody knew what it was and being as curious as I am—as my grandfather used to say.  My mother used to say I was nosy.

[LAUGHTER] And I am.  I want to know.  However, what I felt I needed to know you also needed to know, and I became Dr. Fauci’s nemesis.  [LAUGHS] Tony hated me.  He got to the point, “Dionne, you’re calling me again.  Why are you doing this to me?  Why?”  And I said, “Because I want to know and I need to know and if I’m going to be doing something that’s going to be a help to people, you’re going to have to give me some information.”  And he was.  He was generous enough to do so.  I love that man very, very much.  He has been a part of what I do as a human being and that’s basically all it takes is the quality of being a human being.

My grandfather who was a minister said, “God put us all here on this Earth, regardless of color, race, greed, creed, or religion to be a service to each other.”  And that’s what we have to do, folks, okay?  We’ve got to show up as human beings first.  Now, listening to these folks up here—

Capehart:         [LAUGHTER] She’s got notes.

Warwick:         Yes, I did.  I took notes.  When I started running around the world, and I did.  I physically ran around this entire world at my own expense.  I would not allow President Reagan to do this to me, giving me the opportunity to walk into that Oval Office when I had to and do this to him.  And finally, we got on the same page and that went through his administration, the Bush Administration, and through the Clinton Administration, all of which I didn’t feel ever did enough and they still, as far as I’m concerned, don’t do enough.  Our federal government, it seems like they’re not doing anything and that’s also got to stop.  We have got to rear our heads and let these folks that are sitting in there, making all these laws that none of us want to be of service to us to continue to do that, and there’s a way to do it, folks.

All we’ve got to do is show up.  That’s all we’ve got to do: show up.  Anyway, back to these people talking up here.  [LAUGHTER] They wanted to know how do we reach people.  How do we reach young girls?  How do we reach young boys?  How?  Well, when I first started this advocacy of education and educating people on what it was that we were trying to combat; you have to know what you’re fighting before you can fight it.  At any rate, at that time, the youngsters, we created a comic book and it addressed that it was okay to touch somebody that it’s okay to be in the room with someone; it’s okay to hug someone.  It was okay.  That was not the way this complete disease was contracted.

For the older kids, teenagers, which was our targeted group at that point in time, I kept telling Dr. Woodward, “We need to get their peers—they watch television 24/7—to be a part of advocating how they should be aware of what is going on within their own little small communities of things instead of spending millions of dollars on fliers.”  “We’re going to mail across the country fliers.”  And I said, “Ninety percent of those homes that you’re mailing them to, those people can’t even read.”  And as soon as they get that flier, it goes into the garbage so why are spending millions doing that when we could spend millions doing ads on TV making people aware?

Common sense, folks.  That’s all it takes.  A little bit of common sense.  At any rate, along with these people up here.

Capehart:         Who else?

Warwick:         Well, Phil, who I happen to love very much.  Phil and I were acquainted with each other about 35 years ago in Los Angeles and he was a part of a group called the “Minority AIDS Project”.  Reverend Carl Beam started that project and Phil was very much a part of that and has continued as the National AIDS Foundation in Los Angeles.  He has always advocated not only education, but medication, prevention, and where to go to receive such.  Then I heard, “Oh, we’re doing tests with Dr. Birx.”  Yes, Dr. Birx and Dr. Fauci, “Oh, we’re doing tests that are really giving us wonderful results in South Africa and in Ethiopia and in Thailand and so what happened to the United States?”  Why aren’t we doing those same tests right here in the US of A?  If you’re getting results that are positive, why aren’t we getting results that are positive?  “Because you’re not giving us the opportunity to be a part of these tests.  That’s got to stop too, folks.”  How do we start that?

Rear our heads again; hello?  They’re the phones in every one of these organizations that you can pick up your phone at home and say, “Hey, I just heard.  If it’s true, then when are you going to do something about it?”  That’s all we have to do.  We have to be advocates for ourselves, our neighbors, our neighbors’ children and anybody else that needs our assistance as a human being.  And you’ve got to realize that’s what we are.  We all get up in the morning looking like crazy folks.  [LAUGHS] We do.  We all put our legs in our pants one at a time unless you have some kind of formula that you can jump up and it just happens.  So I am basically saying, “Let’s all get it together, okay?  Let’s put any of this false craziness that we are unfortunately enjoying today within our country.”

People who are acting completely out of their minds and I’ll leave that to your imagination as to who they are.

Capehart:         So I’m looking at your list.  There’s no one left on your list.

Warwick:         No.

Capehart:         So in March, you—

Warwick:         Do I need to put somebody else on it?

Capehart:         No, I was just checking because you were on a reading run there.  [LAUGHTER] So in March with the organization ACRIA, you did a series of PSAs.

Warwick:         Yes, I did.

Capehart:         With the tagline that I thought was genius and I’d love for you to talk about the PSAs and particularly the tagline is “Age is not a condom.”

Warwick:         And that’s true.

Capehart:         And so these PSAs are geared towards older Americans.

Warwick:         Older Americans, especially women.

Capehart:         Especially women.  Why older women?

Warwick:         Well, I shouldn’t say only women.

Capehart:         Okay, older Americans.

Warwick:         I should say older Americans.

Capehart:         But these are geared to women, yeah.

Warwick:         Because once you reach a certain age, I think we all feel we’re infallible.  It’s the same thing with teens.  They feel, “Nothing’s going to happen to me.”  Well, you reach an age of 60, you feel, “Well, I’ve been through it all.  I’m cool.”  And all the people I know, still walking around here healthy, it looks like anyway.  So, “I ain’t got nothing to worry about”—until you have something to worry about.  So we have to pay attention as well.  As we progress in age, we also progress with the same problems that can befall us.

So we have to be well aware.  If you reach a certain age it does not mean you just decide to curl up and die.  [LAUGHTER]

Capehart:         You sound so much like my mom.  It’s incredible and she looks like you, too so this is kind of a surreal situation.  But how is your message received?  You’re talking about people who are 60 years and older who feel like, “I’ve been through it all.  I’ve lived.  I know everything.”  And yet, here come these people telling me that I need to do X, Y, and Z.  How do people react when they’re told, “Uh-uh.  You still need to pay attention.”

Warwick:         Oh, very receptive.  Exceptionally receptive, which is wonderful to hear and to feel.  We’re at an age now where we’re listening to people who have a little bit more knowledge than you do and you’re learning something and that’s what makes the world go around.  The more you learn, the more you know.  The more you know, the better off you are.  And all of those who are well over the age of 25 need to understand that you have something to give to those who are under the age of 25 and those who are well over the age of 50, you have something to give to those who are 25.  Those who are 50 and over, you have something to give to those who are 50.  So it’s about sharing.  You love, you give, you care and you share.  That’s what it’s about.

Capehart:         Now, back in the green room when you were telling me that there were things that weren’t being said and you rattled through the list; one thing that you said back there was, “I’ve been doing this since 1982.  If you had told me that I would be here now still talking about this.”

Warwick:         Yeah.

Capehart:         I know there are some things you said, particularly like testing overseas but why not here.  What are some of your frustrations about the AIDS fight?  Especially since you’ve been in it from the very beginning.

Warwick:         Funding, which is so disproportionate within the communities, within the African-American agencies.  They’re finding it very, very difficult to find funding and the other persuasions are finding it very easy.  Just recently, this young man who said they’ve raised $100 million and over a 10-year period of time, $10 million a year, they’re going to be able to fund their programs within the South, which is very, very needed.  However, if that agency is able to raise $100 million, why can’t we within those folks that look like me?

Capehart:         I was about to ask; who’s we?  Us?

Warwick:         Just another person who looks like me.  Black folks, okay?  If I have to be specific about it at all.  [LAUGHTER] Like you didn’t know already.  Yeah, us.  We find it very difficult to get anybody’s attention, which is so retarded.  That’s what it is.  It’s ridiculous.  And that’s also got to stop.  That’s why I said, “We’ve got to wake up and become those human beings that God made us to be and act like it.”  You have no problem coming to my shows, which I’m thrilled and grateful for.  Thank you very much.  However, you can put on shows of your own as individuals and just be conscious of what you’re doing.  That’s all and just care.  C-A-R-E, just care.  That’s all I want you to do.

Capehart:         So you’ve served as a Goodwill Ambassador for President Reagan and you said it went through President Clinton—

Warwick:         I wasn’t a Goodwill Ambassador.  I was the Ambassador of Health.

Capehart:         The Ambassador of Health and you did work with President Clinton.  So you have no problem serving.  You are bipartisan.  The president of the United States calls, you serve.

Warwick:         Absolutely.

Capehart:         So let’s say—

Warwick:         Oh, I know.  [LAUGHTER] I know what you’re going to say.

Capehart:         Let me get the question out.  Let’s say President Trump were to call and say, “Ms. Warwick, there’s an AIDS epidemic in America that is still raging, particularly in the South.  I need your help.  Please come in and give me your three ideas.”

Warwick:         First of all, it would please me to know that he even has knowledge of this.  That would please me with no end.  [APPLAUSE] If he were to ever ask me to be of assistance, of course, I would.  Yes, absolutely.  I likened this entire mandate of mine—it wasn’t somebody else’s, it was mine.  And it was because I was seeing my industry being decimated.  We were losing people in the hair departments, makeup, dancers, musicians, cameramen.  We were losing people to this disease, so I became involved and wanted to know why.  And I’m saving my folks, people that we are the comrades, we live together with.

It’s a necessary thing for anybody who has a platform and I have many.  I work in theaters and I’ve spoken on behalf of AIDS on many occasions to be able to share what knowledge, what little knowledge I do have.  However, if he were to call me and say, “Hey, girlfriend.”  [LAUGHTER]

Capehart:         Yeah, I’m sure that’s exactly what he would say.

Warwick:         I’m sure it would be those exact words he would say.  I don’t know if he would say, “I need.”  I think he would say, “I’d like for you to”, and proceed from there as a conversation and I would have no problem in responding to him by saying, “Absolutely.  This is something that I’ve been an advocate for and will continue to.”  And from the very beginning of this train ride, I likened it to, “I got in on the beginning of this and I’m going to be on it until we find whatever it is that we can stem it to the point—not necessarily, as it was very, very well put.”  A cure is something that we, of course, all hope for but at least to stem it to the point where it doesn’t keep rearing its ugly head.  AIDS has many different visions, different heads to it.

Once we feel we’ve conquered one, another one just rears its head again.  So, yeah.  I’m on this train ride.  I’ll be on it until we get to that point and if 42 wants to say—yes, that’s what I call him.

Capehart:         Wait, you call him 42?  Forty-five.

Warwick:         Forty-five.

Capehart:         Forty-five, because I was like, “Whoa.”

Warwick:         Yeah, that’s going back too far.

Capehart:         Right, 45.

Warwick:         I’ve got something for 42, too.  But anyway.  [LAUGHTER] But 45, if he did call and ask me to be a part of the solution instead of being continually a part of the problem—yes, I certainly will.

Capehart:         The one thing I get from you—from even talking back there and even here, right now.  There’s no—in the 25 years—if my math is right that you’ve been doing this.  I would understand it if you were visibly angry, frustrated and I don’t get any of that from you.  It seems as though you have this steely resolve to just do whatever it takes to get to that point where if not a cure, something where it doesn’t rear its ugly head ever again.  How do you maintain such—for a lack of a better description, a positive demeanor in all of this?  Given all of the friends that you’ve lost and what this epidemic is still doing in this country?

Warwick:         Well, first of all, I know we have still an awful lot of work to do.  And I have found that over the years, those people have responded.  The old saying you catch more flies with honey than you do with vinegar?  It’s very easy.  This happens to be me and what you see is what you’re always going to get, okay?  [LAUGHS] Most people say, “She does every now and then have a filter, but the majority of the time, Dionne doesn’t.”  Dionne has a way of saying what she feels, and if I feel I’m right and to correct it, I’m going to voice my opinion, and I think I’m supposed to be able to do that.  And I do.  And if it ain’t broke.  [APPLAUSE]

Capehart:         We just have two minutes and—

Warwick:         And nobody wants to ask me no questions.  That’s—

Capehart:         No, well, that’s what this little iPad here is for and I’m sure Vanessa and some of the other moderators had questions come in and I got this message, “Surprisingly no questions from Twitter yet but people are loving it.”  So if anyone is in the two minutes that we have left watching on Twitter, you can tweet us with the #PostLive and you can tweet us @PostLive if my notes are right.  Yes, using the #PostLive.  Okay, so we have to use our voices, get in touch with organizations.  Talk to the president if he calls us.

Warwick:         Yeah, not only the president but everybody in government.  Period, down the line.  Congress, Senate, the health agencies that we all have access to.  All we’ve got to do is take advantage of it.  That’s why we’re citizens.  That’s why we’re all born here.  That’s why we pay taxes.  That’s why we vote.  That’s why we do all of the things we’re supposed to do as citizens of the US of A.  So take advantage of it and really, get busy, okay?

Capehart:         Let me ask you this because you said we pay taxes and you’re urging people to vote.  There are a lot of young people who feel that their vote doesn’t count, that their vote doesn’t matter, their voice doesn’t matter and yet they hear all of these older folks like us saying to them, “No, no, no.  Vote.”  What would you say—

Warwick:         Well, I don’t consider myself—I ain’t older folk, okay?  [LAUGHTER] I am just the folk and I am able to talk to people who are younger than myself.  I have two sons who are younger than myself that I’m able to speak to.  I have seven grandchildren who are much younger than myself that I’m able to speak to.  So for you to say that they feel they don’t have a place, that’s not true.  They know they have a place.  We just have to let them exercise it.  That’s all.  Encourage them to exercise it.  That’s it.

Capehart:         Two sons, seven grandchildren.  What are they going to do for you on your birthday, which is a week from today?

Warwick:         Well, I’ll be in Hawaii with my son and he’s throwing a huge party for me and that’s where I’m going to be and I’m going to enjoy every minute of it.

Capehart:         Where should I be?

Warwick:         December 12th in Hawaii; Honolulu.

Capehart:         Do you want to give me an address where I can go?

Warwick:         No.  [LAUGHTER]

Capehart:         Dionne Warwick, thank you very much for being here.  [APPLAUSE] I forgot to mention that if you would like to watch this program from today, view selected highlights or review past PostLive programs, visit  Thank you very much for being here again and thank you, Ms. Warwick.

Warwick:         Thank you for having me.  It was a pleasure.