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Interview with Dr. Philippe Chiliade - 2002-07-17


The UN held its International AIDS Conference last week in Barcelona, Spain. Prominent leaders and AIDS activists participated, yet what was accomplished? We invited one of the attendees, Dr. Philippe Chiliade, Medical Director of the Whitman-Walker Clinic here in Washington, D.C. to join us for a conversation about the conference. He shared his thoughts with David Borgida on the VOA-TV program, “NewsLine.”

MR. BORGIDA:
If you've been watching our program, indeed, if you've been following the news lately, you know that an international AIDS conference wrapped up last week in Barcelona, Spain. One of those who attended is our guest. He is Dr. Philippe Chiliade, Medical Director of Washington, D.C.'s Whitman-Walker Clinic. Thanks so much for joining us, Doctor.

You left Barcelona with what kind of feeling, encouraged or discouraged, about the prospects for dealing with AIDS in the next decade or so?

DR. CHILIADE:
I would say mostly overall a positive feeling. I think that over the last two years, since the Durbin Conference, clearly I think people realize that the gap between the developed countries and the developing countries is getting wider. There are things happening. The Global Fund was created. Rich countries pledged to fund that Global Fund. Also the drug companies understood that they had to slash down the cost of their drugs. And they have done that, but it looks like it's surely not enough. And we I think all have to be involved, helping the developing world.

MR. BORGIDA:
You talk about the developed and the developing countries, let's talk about that for a moment. There was quite a bit of criticism of the United States and some other Western countries not doing enough. Are they doing enough, in your view?

DR. CHILIADE:
I think it's clear that everybody now realizes that something has to be done, which I think is already a very positive point. Everybody realizes that probably just prevention is not enough, and we have to help people also to access care.

Kofi Annan, and the WHO, said that probably the Global Health Fund needs at least $10 billion, and probably needs a lot more. And so far, I think the rich countries have pledged a little over $1 billion. So a lot more has to be done.

MR. BORGIDA:
We talk about money and we talk about the commitment of wealthier nations, but the fact remains, isn't it true, Doctor, that if human behavior doesn't change in any way -- that is, if human beings don't act more responsibly -- this is a problem that could continue despite huge amounts of money? Is that the case?

DR. CHILIADE:
In part, it is the case. And HIV is a sexually transmitted disease. And there are parts in Africa now where a third of the population is infected. So I think everybody is at risk. Anybody who is sexually active, even in a responsible manner, is at risk.

Asking for prevention is truly important. Changing behavior is difficult. But also if you offer only prevention, and if you ask people to be tested, and if somebody tests positive the only support that they will have is just being told that they have to protect others and that we are not going to help them to access treatment, and they will be rejected from their families, from the rest of society, really we will have no way to be efficacious on the prevention part. So we really are convinced that we have to attach treatment and prevention, that one will not work without the other one.

MR. BORGIDA:
Doctor, in the Washington, D.C. area, and certainly at your clinic, you see lots of patients with AIDS. And I know the problem in Washington, D.C. is not getting a lot better. Why?

DR. CHILIADE:
In Washington, D.C., when you look at the adult population, 1 person out of 20 is HIV infected. That is 5 percent of the adults over 20.

MR. BORGIDA:
One person out of 20 is infected?

DR. CHILIADE:
In Washington, D.C. Those numbers are very close to the numbers that we see also in Africa. And certainly we see a change in the epidemic. When it began it was mostly limited initially to gay men and the drug-user population and with hemophiliacs. Now we see the epidemic really evolving toward the heterosexual population. When we look at our new patients at the Whitman-Walker Clinic, 50 percent of them are women. Also, the epidemic is moving more and more to minority groups. More than three-quarters of our population are African American.

And surely we know that probably we didn't do a good enough effort in prevention. We are trying to improve that in the clinic. We are actually integrating also this prevention and treatment. But we need to do a bigger effort there. And we know that when we look at our number of syphilis cases, also we know our patients are sexually active and are not having safe sex. And that is truly a major concern for us. So, on a regular basis, we educate our patients. But changing behavior, once again, it is something that is difficult.

MR. BORGIDA:
Changing behavior will be difficult, but at least you come out of the Barcelona Conference a bit encouraged. Thanks so much, Dr. Chiliade, for your views.

Dr. Philippe Chiliade, the Medical Director of Washington's Whitman-Walker Clinic, thanks again.

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