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[Narrator] Behind every heartbeat is a story we can learn from. As we have for over 80 years, Blue Cross and Blue Shield Companies are working to use the knowledge we gain from our members to better the health of not just those we insure, but all Americans. Some call it responsibility. We call it a privilege. "Second Opinion" is funded by Blue Cross Blue Shield.


[Announcer] "Second Opinion" is produced in conjunction with UR Medicine, part of University of Rochester Medical Center, Rochester, New York.


[ Applause ]


[Dr. Peter Salgo] Welcome to "Second Opinion." In the world I faced when I began practicing medicine, in the late '70s and early '80s, a new and terrible disease was sweeping the country. It killed as it went. The deaths were terrible to behold. I saw them. This was AIDS. We didn't know what caused it. We didn't know how it spread. We didn't even have a name for it. Any hope of stopping it seemed unlikely. I reported on AIDS during that era, too. But today's show is not about despair and disaster and death. It is about hope and life. I'm your host, Dr. Peter Salgo. I want to thank all of you for being here today. Our experts today are infectious-disease specialist Dr. Nicholas Van Sickels from CrescentCare in New Orleans and primary-care physician Dr. Lou Papa from the University of Rochester Medical Center. And now I'd like you to meet our special guest -- someone you've probably known for years -- Olympic gold medalist Greg Louganis, who is here to share his personal story.


[Greg] My name is Greg Louganis, and I started in acrobatics and dance when I was a year and a half, and I started performing onstage when I was 3 years old. I sang and I tapped and – and then I got a partner. And then my partner went into gymnastics. I followed her into gymnastics, and I fell in love with gymnastics. And that was my dream, was to make the Olympic team in gymnastics. And so then, when I was between 7 and 8, we had a pool built in our backyard. And I started trying some of my gymnastic stunts off the diving board at home, and my mother didn't want me to kill myself, so she got me dive lessons that summer. And so, the first day out to dive lessons, the coach asked me to join the club team. And then, when I was 12, I was diagnosed with Osgood-Schlatter. And so then my doctor told me that I had to give up everything except diving. So all of that energy was focused onto one sport. And in a year, I became world champion for my age group. And then, three years after that, I was on my first Olympic team.


[Dr. Peter Salgo] Greg, thank you so much for being here. It's an honor to have you on our broadcast.


[Greg] Oh, thank you.


[Dr. Peter Salgo] Tell us a little bit about your Olympic history. Some of our audience is old enough to remember it.


[Greg] [ Laughs ] "Some."


[Dr. Peter Salgo] Some are out there too young to remember.


[Greg] Some are a little too young. Yeah, my first Olympics was in 1976. I was 16. I got the silver medal there. Nadia Comaneci and I were the two youngest at that Olympics Games. I qualified for the 1980 Olympic team. Unfortunately, we didn't go, because it was in Moscow, and Russians' invasion of Afghanistan at that time. Jimmy Carter decided not to send the team.


[Dr. Peter Salgo] Politics.


[Greg] Yeah, politics. And then continued on to '84, and got two golds in '84. And then went on to Seoul, Korea, in '88 and won two golds there.


[Dr. Peter Salgo] Before we go any further, that's an accomplishment.


[ Applause ]


I think, even people who don't know much about the Olympics, they know about '88.


[Greg] Yeah.


[Dr. Peter Salgo] You went off the board and hit your head?


[Greg] Yeah, fortunately, it was in prelims.


[Dr. Peter Salgo] Uh-huh.


[Greg] And, yeah, I went up in the air. I was doing my reverse 2 1/2 pike. I knew I was gonna be close. And so you're always worried about hitting your hand or maybe your arm or something. And then I heard this big, hollow thud, and I go crashing in the water, and I was thinking, "What was that?"


[Dr. Peter Salgo] [ Chuckles ]


[Greg] And I realized that was my head.


[Dr. Peter Salgo] Wow.


[Greg] And so my first emotion was I was embarrassed, I mean, because I was supposed to be a pretty good diver. This is the Olympic Games. And I mean, pretty good divers don't do that kind of thing. And so I was trying to figure out how to get out of the pool without anybody seeing me, but the entire world is watching. So there's no way of that. And -- And then I got angry with myself. And I -- And I also became scared because, six months prior to that Olympic Games, I was diagnosed being HIV-positive. So, on the ninth dive, I hit my head on the board. I had about between 20 and 25 minutes to get my head sewn up and get back on the board. And so, actually, it was my coach, Ron O'Brien. We made the decision. He said, "You know, you can walk away right now and look back. You have all these records and have an incredible career to look back on. You don't have to get back up there." And knee-jerk reaction as an athlete -- I turned to him and said, "We worked too long and hard to get here, and I don't want to give up without a fight."


[Dr. Peter Salgo] After all of that, how many golds did you win in Seoul?


[Greg] Two. In diving, we only had two events at the time.


[Dr. Peter Salgo] And you won both?


[Greg] I won both, yeah.


[Dr. Peter Salgo] Not a bad Olympic.


[Greg] No, not bad.


[Dr. Peter Salgo] Now... [ Laughs ] [ Applause ] So, that was the world the viewers saw. You found out you were HIV-positive.


[Greg] Mm-hmm.


[Dr. Peter Salgo] What was that like – that moment?


[Greg] Being diagnosed HIV-positive six months prior to the Olympic Games, my thought, before my diagnosis came back, was, if I was HIV-positive, I was gonna pack my bags. I was training in Florida

at the time. And I was going to pack my bags, go back to California, lock myself in my house, and wait to die, because that's how we thought of HIV – that it was a death sentence. And so my doctor convinced me that the healthiest thing for me -- because we had no idea how long I'd been exposed to the virus and how long I'd been HIV-positive -- so he said, "The healthiest thing for you is to continue training," and he'll look after the medical side and let my coach do his job and get me in the physical condition that I needed to be in to be successful.


[Dr. Peter Salgo] I remember, in New York City in that era, people were dying left and right.


[Greg] Yeah.


[Dr. Peter Salgo] Your friends -- some of them must have been sick, some of them must have died.


[Greg] Yeah.


[Dr. Peter Salgo] Did that go through your mind?


[Greg] It did. I didn't go to all of the memorials, because, I mean, my friends in New York, I mean, you could go to two, three, four in a weekend, because so many of our friends and people that we loved dearly were just dying off. I didn't think I'd ever see 30. I -- For -- Sometimes for -- because of the HIV thing, I also dealt with clinical depression, as well. So that was also kind of in the mix there of that thought of never seeing 30.


[Dr. Peter Salgo] Let's turn to some of the biology here. We're talking about a virus. We now know a lot about this virus. We didn't know much back then. There's a distinction between HIV-positive and AIDS. What is HIV? What is AIDS? Are they the same thing?


[Dr. Sickels] HIV is a virus. We get it through many ways. Most commonly, worldwide, it's through sexual transmission. It can be spread through sharing needles, other things, through blood, through fluids we transmit during sex. It is a virus that attacks our immune system, and over time, it weakens the immune system to the point where the immune system can't fight a lot of infections that our body is normally kind of fending off on its own. When it reaches a certain point -- and we have certain thresholds that were defined by the CDC -- we call it AIDS. And all AIDS means is that your body is more at risk for infections. And a lot of times, we will give medicines to prevent you from getting infections.


[Dr. Peter Salgo] Back in 1988, did we know that HIV was the causative agent, that that's what caused AIDS?


[Dr. Sickels] No, I mean, there wasn't a lot of knowledge about it, about the science, about what goes on, about the medications, certainly -- the first medication AZT, that came out in '85.


[Dr. Peter Salgo] Lou, do you remember any of this?


[Dr. Lou Papa] I do. I graduated from medical school in 1989. And it was actually... My wife and I got married around that time. I had a cousin who was diagnosed with AIDS. When I was a resident, there was a large number of patients that I was taking care of that had AIDS, and you just felt like you were, you know, plugging holes in a dam. There was so little you could do.


[Dr. Peter Salgo] All right, I want to fast-forward to today. Is there still a stigma? Back in the early '80s, the stigma to admitting that you were HIV-positive or had AIDS was overwhelming. People lost their jobs, people couldn't have apartments. Is that stigma still there?


[Dr. Sickels] 100%, yes. 100%, the stigma is still there and is one of the things that we have to combat to end HIV in our country, in our world.


[Dr. Peter Salgo] And does a negative HIV test mean you're not infected with HIV?


[Dr. Sickels] No, it doesn't, in and of itself. We've come a long way in HIV testing. You know, back in the '80s and '90s, the blood tests you had to get took weeks to come back. Sometimes people would get their test and they would either never come back or they would, you know, be terrified for two weeks about what their results might be. The tests we have now can tell you in one minute if you're living with HIV or if you're not. The problem is, there's always a window, 'cause our tests are looking at the body's response to HIV -- the antibody response. In one test case, they actually do look at a small part of the inside of the HIV virus. But even then, there's still a window of about 17 to 20 days, at best-case scenario, during which time, if you'd had sex or been exposed to it, we don't catch it with the normal tests we do.


[Dr. Peter Salgo] But it's a vast improvement over where we were.


[Dr. Sickels] So much better, and it's so much faster. I mean, and when I see somebody now, I can either rule them in or rule them out for HIV within 20 minutes. If I rule them in, we link them immediately to care. We bring them in. It's almost -- It's a behavioral intervention as well as a medical intervention. We bring them in, we hug them, we get them right away. If they're HIV-negative, we link them to services to prevent HIV. We have medicines to prevent it.


[Dr. Peter Salgo] You know, as the testing has improved, so has treatment. And that's what -- In fact, if you're gonna ask me my most surprising aspect of this, it's that -- that we actually have... When you were starting your career, did you have any treatment for any viral disease at all that worked?


[Dr. Lou Papa] No, I mean, viruses were one of those things that you just had to kind of "let it run its course." And this was terrifying because the course was deadly.


[Dr. Peter Salgo] Often.


[Dr. Lou Papa] We had very little. When they came out with AZT, it was like, "Wow."


[Dr. Peter Salgo] Yeah, but AZT -- tell me what it's like being on AZT. AZT is a drug you take every four hours.


[Greg] Yeah, it's very toxic.


[Dr. Peter Salgo] Tell me about that.


[Greg] I -- Fortunately, I didn't read the side effects on the bottle.


[Dr. Peter Salgo] Probably a good thing.


[Greg] And also, I wasn't in touch with a lot of other friends who may have been on AZT. But when -- when I was working on my book, "Breaking the Surface," with my co-author, I told him that they put me on -- he asked me what my treatment was. And I said, "Well, they wanted to treat me very aggressively, so they put me on AZT right away." And he started sobbing, 'cause he was from New York and he lived through that – that nightmare of losing all of his friends and seeing his friends who are on AZT that didn't tolerate it well, if they tolerated it at all.


[Dr. Peter Salgo] That was AZT. That was -- That was HIV back in '93. Something changed.


[Dr. Sickels] Yes.



[Dr. Peter Salgo] What happened?


[Dr. Sickels] Well, science happened. We have so many medications that came out, and in the mid-, late-90s, we figured out, through science and scientific research, that really three drugs, which actually is possibly changing now, but three drugs were the key to kind of beating down the HIV virus and keeping it at bay and letting the body recover and its immune system recover and for people to stay living. And a lot of people who were fortunate enough, like you, to survive during that period, good and bad, were able to make it to the next drug, to the next drug, to the next drug and finally get on a cocktail, as we called it back then, to work and keep it at bay for a long period of time.


[Dr. Peter Salgo] This was research no one expected to work -- nobody. I didn't. Did you, Lou?


[Dr. Lou Papa] No, I mean, I think all you heard was doom and gloom all the time about how the virus just changed and how it was able to work its way around everything that we did. Any thoughts of a vaccine were dashed. It was really hopeless.


[Dr. Peter Salgo] Today, as opposed to the AZT era, what's it like? What's the medication regimen like for someone with HIV positivity?


[Dr. Sickels] It's much simpler. The side effects are very minimal. It's one or two pills. We start them often within 24 hours of diagnosis. It puts people to where we don't see the virus in the blood anymore, on average, within 30 days.


[Dr. Peter Salgo] Just stop. I want our viewers to just hear that. You don't see the virus in the blood anymore.


[Dr. Sickels] Correct. That means they can't transmit it.


[Dr. Peter Salgo] Important.


[Dr. Sickels] Yes, it's very important.


[Dr. Peter Salgo] I heard someone say that it is conceivable, going forward, if we get enough people on the new drugs, that we can stop AIDS. If we stop the transmission, it's over.


[Dr. Sickels] That's correct. We have everything in our tool chest now to end HIV in our world -- we do -- without a cure and a vaccine, which would, obviously, be ideal, to eliminate the disease.


[Dr. Peter Salgo] We might be able to stop AIDS, eliminate it. Is that what you said?


[Dr. Sickels] Yes.


[Dr. Lou Papa] I mean, it's another example of, you know, the success of public health, right? You know, you work on science for individual health, and then you apply it to public health, and that's where the heavy lifting really happens.


[Dr. Sickels] I'm glad you brought that up. I think it's science, and I agree this approach to ending HIV is different than what we've had for other disease states, where we do have a vaccine or a cure. It is a public-health approach. It is everybody getting tested, everybody knowing their status. I don't care who you are or what you think your risk factor is, know your status so your neighbor will get tested, too, getting them into care. People who are not living with HIV, getting them on medicines to prevent HIV. People who are living with HIV, get them treated early. And then it burns out. But it's a lot of work.


[Dr. Peter Salgo] A couple -- Well, yeah, but look at the payoff for that work.


[Dr. Sickels] It's huge.


[Dr. Peter Salgo] A couple of very quick questions. People with HIV, on the new medications, life expectancy?


[Dr. Sickels] Normal.


[Dr. Peter Salgo] Normal?


[Dr. Sickels] Yes. Yeah, normal.


[Dr. Peter Sickels] The diseases you worry about are the diseases of aging.


[Dr. Sickels] Correct. That is the problem that there's a lot of talk in the infectious-disease and HIV community about how a lot of us are now looking to you to help us with primary care.


[Dr. Lou Papa] And actually it's interesting, because patients of mine that are HIV-positive, you know, I've got to talk to them about colonoscopies and, you know, cholesterol and, you know, "Lose the middle."

And they're like, "Great!" You know, "I'm gonna get a colonoscopy! That's wonderful!"


[Dr. Peter Salgo] I'm sorry to tell you, you're listening to your future.


[Greg] I know. I've already had my two, okay?


[Dr. Peter Salgo] I hope so.


[Greg] You know, I had it at 50, 55. I'm in there.


[Dr. Lou Papa] So, you thought you were gonna be gone at 30? You're how old now?


[Greg] I'm 58. My 33rd birthday, I thought I was saying goodbye to everybody. And I thought I should let my mom in on knowing that why I thought it was my last. And shared my HIV status with her then. And her initial reaction was, she started crying. She said, "Well, you know, mothers aren't supposed to outlive their sons." And so she was really upset. And then she looked at me, and she goes, "You know, Greg, you've beaten so many odds. It's, like, I probably have nothing to worry about."


[Dr. Lou Papa] Hmm.


[Greg] And so, yeah, I'm – you know, I'm here today.


[Dr. Peter Salgo] You are here.


[ Applause ]


Tell me what it's like now, living with the medications. What's your life like?


[Greg] I did get on a cocktail, so I am taking three meds -- HIV meds. But I also have an acupuncturist and Chinese herbalist who also is looking at my vitamin levels and that sort of thing. So I try to take a more, you know, not only Western approach to my HIV but also an Eastern approach.


[Dr. Peter Salgo] What are most people surprised to learn about HIV, AIDS in today's era?


[Dr. Sickels] The biggest thing that I have had -- and the CDC finally endorsed this in December of 2017 -- is the "undetectable is untransmittable" message. I think that is a game-changer for people living with HIV who, I will tell you, hands down, their biggest fear always is transmitting it to somebody else, because – especially somebody they care about. But even then, doesn't matter. People don't generally want to hurt each other.


[Dr. Peter Salgo] Tell me about PrEP. What is PrEP?


[Dr. Sickels] So, PrEP is HIV pre-exposure prophylaxis. And currently, it's limited to one medicine. It's a pill you take every day. And if taken correctly every day, it's about over 90% effective in preventing HIV. And we encourage other forms of sexual wellness to prevent symptoms of an infection. and HIV acquisition. If you take it correctly, it's over 90% effective. So, not 100% but you're much less likely to get HIV.


[Greg] Yeah, and the thing is -- the key is that you have to take it as it's prescribed.


[Dr. Sickels] Mm-hmm.


[Greg] Unfortunately, I mean, with a lot of our young people -- 'cause I do a lot of mentoring and I do a lot of speaking on college campuses and that sort of thing -- is that, "Oh, I'm gonna go out tonight. I plan to have a good time." And they'll take their PrEP, you know? And it's not prescribed that way. You have to have that built up into your system.


[Dr. Sickels] And that is one of the downfalls, because you're seeing lots of people who are younger, who are not used to taking medicines, you know, and you're saying, "You've got to take this pill every day." And it's a larger pill. It's not small.


[Greg] All right.


[Dr. Sickels] But you really enforce the education, "This is important."


[Dr. Peter Salgo] Okay, we're gonna take a brief break. You know, every day, we hear about medical innovations that make an impact and hold promise for improving our healthcare. Take a look at this.


[Man] Even in the United States, HIV remains a really big public-health problem. And if we really want to end the HIV epidemic, the most important thing we can do is come up with an effective HIV vaccine.


[Woman] Our mission is HIV prevention and treatment and vaccine research and finding that ultimate goal. That's really where we work very

closely together.


[Stephen] HIV is still an urgent problem. We often get this notion that now that we have really very effective antiretroviral drug therapy, that somehow the disease is cured or not a problem, and that's just not true.


[Catherine] There's still people around the world that don't have access to medication, and actually medications do cause side effects. So, having a vaccine would be the way to end HIV.


[Stephen] There's several kinds of immune responses that could be protective. Among those, what's called the adaptive immune response is really the area that mostly the vaccines focus on. So that's our B-cell response that makes antibodies, and our "T" cells that provide a protective cellular immunity. So, in the antibodies, what we want is what are called neutralizing antibodies that block virus infection and really disable the virus' ability to get into a new cell and infect it. And on the T-cell side, what we're looking for is essentially an army of cells that survey the body and look for a cell that has signs of being infected by HIV. And when they find that cell, they kill it.


[Catherine] The science has actually become more robust because of some of the findings we've had about five years ago, which sounds like a really long time ago. But when you get a somewhat small breakthrough, then you just move forward and take it in all the directions you possibly can, to find the next breakthrough. So it's a really big international effort. We can be doing a study here, and individuals in South Africa are doing the exact same study.


[Stephen] If you look at vaccines in general, they're the most cost-effective way we have of preventing disease. If you think about smallpox, for example, that disease is eradicated from the planet, and that's because of vaccines. So they have an extraordinary effectiveness and an extraordinary level of safety. The very encouraging thing is that we had the first positive signal in a vaccine trial a couple of years ago. It was about 30% effective. That vaccine trial shows that we can make a vaccine that works, but it's not good enough. 30% is not good enough to give that to the -- you know, ideally, to the planet. So we need a better vaccine than this first signal that we've gotten. And at that point, we scale it up and we go global with the vaccine, because that's what we need to do.



[Dr. Peter Salgo] Nick, right now in America, or the world, who's at risk --

highest risk -- for new infection?


[Dr. Sickels] Right now, the recommendation is to test everybody. Everybody is, potentially, at risk. But when you look at it and see who is affected by HIV, it's disproportionate, based on demographics. And the CDC published a really jaw-dropping paper of who's at risk. So you can look at it by state, and you can see, in the South, the rates are higher. In certain areas of the country -- like D.C., for example -- the rates are higher. If you look at population, African-American, Latinos are disproportionately affected. In the South, women are disproportionately affected. Youth are disproportionately affected. And if you look at men who have sex with men -- and that's a term the CDC uses instead of "gay" or "bi" because not everyone identifies that way – overwhelmingly disproportionately affected. The most scary statistic that the CDC came out with, if you are an African-American man who has sex with men, your risk of acquiring HIV in your lifetime -- that's what CDC estimated -- is one in two. It is a terrifying statistic, and it's something that we have to acknowledge and we have to get into communities and teach kids and adults and everyone about HIV -- about prevention, and about treatment -- so we can eliminate it from not just the disproportionately affected communities but all of the community.


[Dr. Sickels] So, we've got the science.


[Dr. Sickels] Yes.


[Dr. Peter Salgo] Now it's time for the public health.


[Dr. Sickels] Correct.


[Dr. Peter Salgo] Letting people know it's there, there's hope.


[Dr. Sickels] There's a reason I keep saying "living with HIV." You live with HIV, just like you live with diabetes, you live with high blood pressure. You live with it.


[Dr. Peter Salgo] What's your advice now to someone who has just been recently diagnosed with HIV?


[Greg] Immediate treatment and care, and also each drug regimen is different. So, with the new regimens that are out there, work with your doctor. You know, be up-front if you need somebody. There are many young people who have called, who have contacted me and said, "Well, we're talking about potential treatments." And I've been through just about all of them -- you know, from the protease inhibitors to, you know, all of those tests and all of that stuff -- so I know a lot of the side effects. And so I'm able to go with them and support them and give them an idea. But have somebody there, because it's a lot information to take in all at once and around this issue, which also, you know, becomes -- you get very emotional.


[Dr. Peter Salgo] What about screening? There are people who are afraid to be screened.


[Greg] Mm-hmm.


[Dr. Peter Salgo] They're afraid to hear any news.


[Greg] Yeah.


[Dr. Peter Salgo] What's your message for them?


[Greg] You know, I worked with -- with a group, and they said that everybody has an HIV status.


[Dr. Peter Salgo] Mm-hmm.


[Greg] Everybody has an HIV status. You know, if you're sexually active, get tested. You know, and learn if you're HIV-positive or negative.


[Dr. Peter Salgo] Greg, I just want to thank you so much for being here. It's an honor to meet you.


[Greg] Thank you.


[Dr. Peter Salgo] It was terrific. And, guys, I'm glad you were here, too. I want to thank our studio audience for being here. Great having you here today. And of course, thank you at home for watching, as well. Remember, you can get more second opinions and patient stories on our website at You can continue the conversation on Facebook, Twitter, and Instagram, where we're live every day with health information. I'm Dr. Peter Salgo. I'll see you next week for another "Second Opinion."


[ Applause ]


[Narrator] Behind every heartbeat is a story we can learn from. As we have for over 80 years, Blue Cross and Blue Shield Companies are working to use the knowledge we gain from our members to better the health of not just those we insure, but all Americans. Some call it responsibility. We call it a privilege. "Second Opinion" is funded by Blue Cross Blue Shield.


[Announcer] "Second Opinion" is produced in conjunction with UR Medicine, part of University of Rochester Medical Center, Rochester, New York.