Daniel Zulaika: “Society has changed mentality on AIDS”
Daniel Zulaika: “Society has changed the AIDS mentality”
Data show that in Euskal Herria the incidence of AIDS is decreasing. Is it no longer a disease that should be scared?
I think the reality of AIDS is quite complex. It is 20 years since the first cases of AIDS appeared, and at that time AIDS has changed the world. Here, today, the most important issue around AIDS is prevention, because if done well, the spread of the AIDS virus is avoided. This will be very important until we get an effective vaccine, if we ever get it. Therefore, as far as prevention is concerned, I believe that throughout that time there have been positive and negative aspects, as in other areas.
If we look at the advantages…
If we look at the current ones, those of recent times, we should talk about prisons. The Nanclares syringe exchange programme was launched at this time, which was launched in Basauri in 1997 and has been developed in Martutene. The first to implement such programs has been the Autonomous Community of the Basque Country, but they have also been others such as the distribution of contraceptives or methadone programs. AIDS itself has revolutionized prisons. There is still much to be done, I am not triumphalist, because on this subject it cannot be.
Another important change has been to prevent the birth of children infected with the AIDS virus. In 1984, one in five hiv-positive children were born infected, many died, and those who remained orphans were not too few. Currently the probability of the baby being born infected by the virus is 0.1%. For me that has been huge, seeing how we managed to end one of the HIV transmission routes.
Is all this due to treatment?
On the one hand, for the TR treatment – retrovirals – that is given to pregnant women and on the other, for the realization of cesarean deliveries. In fact, we already know that the AIDS virus enters the fetus most often at the time of delivery, since it is infected in the birth canal, but the caesarean section opens the gut and takes the child without risk of infection. For me it has been a great symbolic advance in the fight against AIDS, and the exchange of syringes in prisons. The Xiring program is conducted only here and in the Spanish state. In the rest of the world the prison situation is catastrophic.
And how important is syringe exchange?
Yes, but I think we have arrived a little late, so we had to start before. But the implementation of syringe exchange programs also in the street has given us enough work, it has not been easy. Non-governmental organizations began in 1987 with such programs, with the first being in Bilbao. Subsequently, an evolution of society as a whole was necessary for the implementation of programmes in medicines. Now we consider it normal, but when we started and our own colleagues, doctors and nurses, said that they did not want to give methadone to drug addicts, that they could not be luxury traffickers… we had to listen to it, and society itself said that “they wanted…”; the mentality has changed little by little.
He talks about prisons, drug addicts… is AIDS still marginal?
And the gay collective is also there. AIDS was initially marginal, but then it affected the whole of society; already in schools there is talk of sex education, of affectivity… AIDS has normalized sex education. When AIDS started, talking about sex and birth control was taboo. In the 1980s there was very little talk about sexuality and AIDS got into the education system.
How do the sick in Euskal Herria live today?
I would tell you that regardless of the problems they may have with the drug, such as trials, the need to be in jail, the need to take methadone, the life of the rest of the patients is good. I would say that the introduction of antiretrovirals in the history of medicine is only comparable to the invention of penicillin. AIDS died every year to thousands of people and suddenly find something similar to the miraculous medicine that doctors of years ago were looking for. I think it can only be compared to the invention of Fleming antibiotics. In the history of medicine there have been no other kind of events that have caused the resurrection of the people who suffered. Patients say it clearly: “I was wrong, I had to enter six times a year… I started with retroviral treatment and I live well, I want to live, I want to have children…”. Currently, the main HIV positive demands, like many others, are housing and work.
And is it still marginal to society?
On the issue of marginalization I think we have improved a lot. In 1987 we schooled the first hiv-positive child in a school. The teacher was shaking, did not sleep, stressed, had to put it in treatment... nowadays it does not happen. Much progress has been made on the issue of marginalization, but there is more progress.
The AIDS prevention and control plan was launched fourteen years ago. What would you say for a brief assessment?
That we have come a long way, that there are many positive things, but that we cannot be triumphalist, that if we lower the piston there is nothing to do. When AIDS has ceased to be deadly, people have come back into dangerous situations. This is happening with new addicts and also with young homosexuals. These people don't see their friends die from AIDS, so they take fewer preventive measures. I think today we have new challenges, like the internet itself. We need to make good information available to young generations so that they are informed. And the issue of immigration, especially in Bizkaia, is an open door issue, such as those who start prostituting themselves. If we transform immigrants into marginal collectives, as happened 20 years ago with other collectives, we will be making the same mistake.
When to vaccinate against AIDS?
In 1990 Montagnier said that in ten years we would have an AIDS vaccine. This year, at a seminar held in March, journalists asked him the same question and said that within ten years it could be a vaccine. The problem is not for when. It's about whether the vaccine is effective or not. We change the flu vaccine every year; the AIDS virus has more mutations than the flu virus. We can find a vaccine that protects 10% of grafts, but that is useless; we can also find one that protects 20%… It is not worth it. Society demands a vaccine that ensures 100%. Do you assure me that if I have sex with a hiv-positive I do not get infected? Being such a social requirement, one cannot speak of vaccines until obtaining an effective vaccine of 100%.
Therefore, the answer to the question is that we currently have vaccination, prevention. The key is prevention, we have to learn to live with AIDS.
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