By CBS News

21 January 2001

Lesley Stahl: Four years ago, in late 1996, it looked as if we had finally found the answer to AIDS. New combinations of drugs, known as "cocktails," so powerful that they stopped the virus in its tracks; so successful that doctors couldn't find any virus in the patients' blood. People on the verge of death got out of bed and went back to work. In a few years, the theory went, people would be able to go off the drugs, cured - or at least AIDS would become a manageable illness.

Jeff Getty: People thought it was all going to go away. They thought it was over. But it's not. Not only is it not over, but it's back, and it's getting worse.

Stahl: Jeff Getty has been an AIDS patient and activist for 15 years. He says things have not turned out the way that they were supposed to. [To Getty:] You had doctors telling us that if you hit this early, and hit this hard, this was manageable. This is what the - everybody thought.

Getty: They were wrong. They thought that if they gave the virus enough drugs early on, that they could keep it running in circles and keep it contained. But the virus was smarter than they thought.

Stahl: It turns out the drugs suppress the virus, but don't kill it off completely. It's always hiding somewhere, waiting to come bounding back. So the drugs that have saved Jeff Getty's life have become his life. He must take them every morning, and every night, forever. [To Getty:] You take how many pills a day? Did you ever count them up?

Getty: Well, no, you lose count. I use a combination of two nucleosides, and then I combine it with another drug which is called an NNRTI [non-nucleoside reverse transcriptase inhibitor], called Viramune, and then I take this drug to keep me from getting PCP pneumonia.

Stahl [fingering a hypodermic needle]: This is an injection? This is what you take by injection?

Getty: Right. These are injectables that I use for keeping my weight on.

Stahl: But even with all these drugs, that cost $14,000 a year, Jeff's health is slowly failing. That's because of another problem. Over time, the virus becomes resistant to the drugs, so patients must switch to different drugs. And pretty soon, they run out of options.

Getty: My virus is resistant to all known drugs. Seventeen drugs. Fifteen approved, and two experimentals.

Stahl: And you are resistant to all of them?

Getty: Right. Then you get into the very end stage of the disease, where I live now: the most-likely-to-die club. People with my numbers have a one-in-four chance of dying in the next year. This disease is still a terminal illness. It is not a chronically managed disease.

Stahl: No one knows that better than AIDS doctors, like Mike Saag at the University of Alabama in Birmingham. He says that, while some of his patients are doing fine several years into the use of these drugs, more than half are showing troubling side effects. Everything from constant nausea to diabetes, liver failure, and lipodystrophy, a condition where fat drains from a person's face and limbs, and settles in the belly and upper back.

Dr. Michael Saag: You're on somewhere between 12 and 13 different medicines?

Harry Wingfield: Right.

Stahl: Dr. Saag has treated Harry Wingfield for 10 years. [To Wingfield:] Harry, I see two indentations on your cheeks. Is that because of the medications?

Wingfield: Right. The fat has drained out of my face. I used to have nice round, rosy cheeks. And now they're kind of depleted.

Stahl: Harry suffers from a more dangerous side effect: cholesterol and blood pressure levels so high, he's at risk of heart attack or stroke.

Wingfield: It comes down to, am I going to die from the HIV? Am I going to die from the HIV drugs? Am I going to die from the blood pressure?

Dr. Saag: What we're finding now are longer-term toxicities that we really didn't anticipate.

Stahl: Well, these people are, in a way, living on chemo for their whole lives. So you would expect, wouldn't you, that there is some degree of poisoning?

Dr. Saag: It is chemotherapy, and when you put it in the terms of shouldn't we expect complications, when you put it that way, yeah, we should. I think that maybe what happened four years ago is that that was such a monumental time. We were able to knock the virus down to levels that were unimaginable two years previously. And then the thought of cure, that we sort of blocked out the concept that this was chemotherapy and it might have side effects.

Stahl: So now patients face a devastating catch-22: they have to stay on the drugs for life, but the severity of the side effects, coupled with resistance, makes a lifetime on the drugs impossible. Doctors say that after years of decline, death rates among AIDS patients have begun inching up. And there's more bad news: researchers in San Francisco have begun to see a rise in the rate of new HIV infections among the city's Gay men. Tom Coates is director of the AIDS Research Institute at the University of California at San Francisco. He helped compile the new statistics.

Tom Coates: The rate of new HIV infections has increased by about 60 percent -

Stahl [sounding shocked]: Sixty percent?

Coates: - among Gay men.

Stahl: Why? Why has there been an increase?

Coates: People - Gay men in San Francisco and in other communities have been living with this disease for 20 years. They have been told, "Use condoms. Be careful." Then the drugs come along, and words like "cure" are thrown around, and everybody says, "Oh, we can let up our guard. It's not as bad. It's O.K." And people just get careless.

Stahl: How soon after the new drugs came out, which was 1996, did you begin to see this turnaround in unsafe sex?

Coates: Almost immediately.

Stahl: Almost immediately?

Coates: Almost immediately.

Stahl: Why is that?

Coates: Well, all of a sudden HIV is not this dreaded disease it once was. And people aren't afraid of it.

Female Prevention Volunteer [clip from a San Francisco street outreach program]: Did you always use a condom?

Man on Street 1: Yes.

Stahl: We're on the streets of San Francisco with a local AIDS prevention group that's taking a survey of sexual behavior in Gay neighborhoods.

Female Prevention Volunteer: Do you intend to continue using condoms?

Man on Street 1: Yeah, I don't want to die.

Stahl: Most of the people they meet use protection. But they are seeing increasing numbers of men who are willing to chance it.

Male Prevention Volunteer: And did you always use a condom?

Man on Street 2: No.

Stahl: And men who think, if they got the disease, they could manage it. [To Man on Street 2:] Do you think the medications that they have now would allow you to live a pretty good life, or not?

Man on Street 2: I'm not on it, but if it ever happened, I think it would be fine.

Stahl: And occasionally they meet someone like this man, 39 years old, who is HIV-positive.

Male Prevention Volunteer: How many sex partners did you have anal sex with in the last six months?

Man on Street 3: I would say 15.

Male Prevention Volunteer: And of those 15, how many were unprotected.

Man on Street 3: Every one of them.

Stahl: He says he tells his partners that he's HIV-positive. But occasionally he's had anonymous sex where there's no discussion at all.

Getty: I used to think it was really simple, to say that people were just being irresponsible. But there's a lot of variables coming into play. It's the idea that the virus isn't so big a problem anymore. It's the idea that if I'm undetectable, maybe I won't spread it. It's the message that even if people get the virus, they're going to be fine.

Stahl: A message, he says, that the companies who make the AIDS drugs reinforce with their ads.

Getty: People see these ads and they go, "Oh, well, if I get HIV I can go mountain-climbing."

Stahl: They really think that?

Getty: "If I get HIV, I can go sailing," because look, here are the pictures. And not only that, but the people in the ads look just like them. They're young, they're attractive, they're sexy. This disease is not sexy. You don't go mountain-climbing, Lesley, unless there's a toilet halfway up the mountain and another one at the top for your diarrhea.

Stahl: And add to the mix the discredited notion that HIV isn't the cause of AIDS. Remember the criticism South African President Thabo Mbeki got last summer for suggesting such a thing? Well, incredibly, there are people in this country still making that argument. This small band of activists in San Francisco, a fringe chapter of the AIDS group ACT UP, are what's known as "AIDS denialists." They claim HIV is all a lie and a conspiracy. They urge people not to get tested for HIV .

Man on Street 4: Don't get tested?

Ronnie Burk [ACT UP San Francisco street outreach worker]: Don't get tested at all.

Man on Street 4: Why not?

Stahl: . not to take AIDS drugs; and, they say, AIDS is over. Michael Bellefountaine and Dave Pasquarelli, both HIV-positive, are the leaders of the group. [To Pasquarelli:] David, how long have you been HIV-positive?

David Pasquarelli: I've been HIV-positive for five years.

Stahl: And Michael?

Michael Bellefountaine: I've been positive for about six years. I was diagnosed with AIDS about five years ago.

Stahl: But you don't think that HIV gave you AIDS?

Bellefountaine: No, I don't.

Stahl [to Pasquarelli]: Do you think HIV gave him AIDS?

Pasquarelli: I don't think HIV gave him AIDS, or gave me any sicknesses, or AIDS to anybody else.

Stahl: They claim that all the so-called "AIDS deaths" were caused by pneumonia, recreational drug use, or AIDS medicines like AZT, not the HIV virus, which they argue is harmless. Scientists call their claims "specious," and "a dangerous, deadly form of denial." [To Coates:] Are they part of the reason you're seeing an increase?

Coates: They are part of the reason we're seeing an increase.

Stahl: People believe them?

Coates: People get confused by them. They're confused. They muddle the message. They confuse the facts. They distort those facts. They are a destructive force.

Getty: That's amazing, Lesley. I go out and I do college lectures at times, and at the end of the lecture there is inevitably a group of people that gathers around me, that wants to argue with me, that HIV and AIDS doesn't even exist. And every year that group of kids is getting larger and larger and larger.

Stahl: This whole thing is really catching on?

Getty: And it's really frightening. And if you think that AIDS is all a lie and a myth and a conspiracy, come live in my body for a week, and put up with what I have to deal with to stay alive.

Stahl [to Pasquarelli and Bellefountaine]: You're telling people not to get tested. You're telling them that this is a hoax, a conspiracy.

Pasquarelli: We're telling people that a mistake has been made: that a premature conclusion that HIV causes AIDS was made by the American government.

Larry Kramer: I think they are crazy. I think that most people recognize them as crazy.

Stahl: Playwright Larry Kramer, who created the original ACT UP back in 1987, dismisses the San Francisco group. He's launching a new campaign, this time against the drug companies. He accuses them of failing to deal with the long list of devastating side effects. [To Kramer:] You were one of the original founders of ACT UP?

Kramer: Right.

Stahl: And pushed the drug companies?

Kramer: Right.

Stahl: Not only to come up with drugs, but to get them to people very, very quickly. And they did that.

Kramer: Right.

Stahl: Now you're turning around and you're attacking the drug companies.

Kramer: No, I'm saying that they didn't go far enough. They didn't make - continue making better ones. They didn't refine the ones they have.

Stahl [to Dr. Saag]: You have said, in terms of AIDS, that it's the best of times and it's the worst of times. What did you mean by that?

Dr. Saag: It's the best of times in the sense that we absolutely can prolong survival. But it's the worst of times in the sense that patients who we had helped get better, those patients are now starting to get sick and die.

Stahl: And the worst of the worst is that the numbers are beginning to go back up, of new infections.

Dr. Saag: Absolutely.

Stahl: And lest you think you're safe if you're straight and live outside San Francisco, think again. Experts say San Francisco has been the canary in the coal mine throughout the AIDS epidemic: that it's the first to see the rise in new infections, but it isn't going to be the last