He said it was a virus that annihilated the human immune system. Tuberculosis was a global epidemic that killed 1.6 million people in the year 2017 emphasis on the word was as a YouTuber exert one a proposed. Imagine if in the future all of these were true sound quite promising for us. I'm born and in this episode of The Dog Whisperer is I'll be talking to dr. Edmund on a Malaysian infective disease specialist who has been working for quite a number of time in the UK back. Then people who were affected by HIV were known as HIV sufferers, but nowadays they are HIV survivors and as mainly thanks to a special therapy called heart. Haart how very own guest dr. Edmund Ang has been directly involved in the development of heart. He has been a part of the building blocks of understanding HIV ever since it was first discovered 36 years ago. Now, dr. Edmund tongue is a full-time lecturer in Newcastle University and is currently in a three-year secondment period in the Malaysian Campus of the University aiming to part his deep deep wisdom about medicine aside from that I guess is really been putting his foot out there in terms of infective Medicine. He's had research that has gone and is still going on in Myanmar about infective diseases and low resource settings. He's also been involved with medicines son Frontier, which most of us would know as Doctors Without Borders during the Ebola outbreak. Now this is a lengthy episode. But I hope you'll be as taking a back as I was when I was diving into the life of dr. Edmund on especially in the bus that means section where common myths around HIV including homosexuality arises and a word of advice from our guests since we're talking about HIV and infective diseases. We must be mindful to put aside whatever stigma that we might have and approach the topic with an open mind and an open heart. Are you doctor? Thank you. I'm very well and takes a pleasure to be actually interview on this podcast. Okay, and that they've been looking very much forward to this event and to share some of my views and ideas about the great outer aspects of medicine. Alright, so as they start like to just kick up this situation here, I'll talk a little bit about your experience with the medicine Sans. And also the Ebola outbreak, can you find it? Okay. Yeah, I'm infectious. This is a physician and I went into infectious diseases essentially at the beginning with a very naive view that a lot of the patients with infections and I see are going to be potentially curable people will get better by simple intervention now in that context Lobby. Whole is that know when I started my career and training? It's really not the case. Okay that for example, as you can see ebola is a very deadly diseases actually the West Africa outbreak that started in 2013 and progresses on no into nearly 2015-2016 was one of the worst deadly outbreaks of an infection that actually I had a very high mortality rate. People that gets the infection died very quickly very very sad indeed okay in their contacts and that it took a medicine some Frontier. Okay, who is a history NGO The Doctors Without Borders? Yes, right. Yeah. So Doctors Without Frontiers, okay to highlight the urgency and the issues surrounding this particular outbreak and I suspect it's because it was affecting a part of the world where property is. Is so prevalent and that a lot of other countries was not aware of this particular issue and okay. Now you can say as much as you like, but we'll have organization. Yeah, I think it's been quite clearly shown as well that will have organization did actually meet it to a number of mistakes of not highlighting this particular outbreak and contacts. So it's an msf international was formed. On the ground. Okay way if you look at how the epidemic for started from Guinea spreading on to die Liberia and then subsequently to civilian. Okay. I am fortunate in such contexts that I supported them smsf International for quite a number of years with a lot of other work in that context. What did you do in the it essentially? Okay. We provided the training on the ground. Okay, and the wonders of of Technology. Okay, we have actually had very secured telemedicine connection, but that I could be sitting in Newcastle. Okay, we've worker in the front line using a high-definition head cam camera right in the field Hospital talking to me directly and me being able to advise. Okay. What about your dad precisely one hundred percent? Okay, it just shows the Advances in technology. Okay, telemedicine has got a huge role. Okay in such a setting okay, in terms of training and even okay in terms of made making diagnosis and management in that respect. I can tell you a very good story. Okay in the context of an incident that actually happen way a natural fact are very well qualified any consultant who is a volunteer in a field hospital. It was asking me says Ed. I'm not quite sure. Sure, what's wrong with the 16 year old kid, you know he had Ebola and he we treated him the service Associated him with fluids and he on his latest measurement of his PCR which is the measurement of the viral load is undetectable, but he is not waking up. He's still comatose. Okay. Can you just come in with me? Okay, I'm gonna go in and I'm going to go on out and we're going to see the patient and you can actually see the patient with me. Okay? Okay, so he went in and I Good, no, rather shameful lie. I must say sitting in the comfort of my office in Newcastle could see what he's doing. Okay, and he was examining a patient with the nurses. Okay was turning around the patient and he says Ah, he signs has happened. What changed? Okay, his neck is very very steep. But he would open his eyes and said, okay just roll him over says her so he did roll him or her and indeed he's got such a stiff neck and I said to my colleagues as he has got God and CNS, in fact yet. Okay. He needs a lumbar puncture. Okay, then and as you know in a field Hospital, you're not going to have cityscape talking about of facilities. Okay, so it's okay. Let's do that. Okay. So if the nursery actually turn around the patient and their actual fact the very little anesthetic in did a lumbar puncture as soon as his needle when in the CSF short out or we high-sided so high pressure and I said to him agitated says this is CNS infection called cryptococcus meningitis are you don't actually have to look into the microscope. This is the pressure also hi-yah and why does this keep the needle in there? So he kept a needle in there. And then as soon as the pressure is relief this young 16 year old kid start to go start a wake up. Literally. Okay at the end of his lumbar puncture needle poke in that context. So I said right you got a diagnosis he needs treatment. This happens to be one of the comb abilities in a country like Syria and Iran for that people are at risk of having another infection just doctor support so it just shows okay in the context that telemedicine has such an important role in actually assisting and providing Health Care intervention in really limited results setting. Yeah. Okay, and that's what msf is very good at It's amazing. So you work with msf before right? So but before that you were also is it before or is it after that you were involved in the research facility in Myanmar? Yeah. It was actually after okay. It's actually my interest in South Africa and koalas Rule and in 2006. That's when you may have be a way of the outbreak of xdr-tb, which is highly resistant drug-resistant TB. Where number Of co-infected with HIV individuals actually died from this particular resistant tuberculosis very very quickly and unfortunately during that period of time okay about three healthcare worker also acquired infection. So what's actually true that experience in Kuala zululand that I developed an interest is really from into drug-resistant TB, although I had we had an interest in TB and HIV is as far back as during my registrar training days. Okay, Byron start training days was around in Period of 1987. 1988. Okay way I actually had my first memorable patient which presented with a very active faculty be of the neck. Okay and round about that period of time was the start of the HIV epidemic in the United Kingdom and I heard all about HIV before Ki gauge waited in III HIV started to actually make the headlines around about 1981. You may recall that night let you want the center of Disease Control through a publication called more ability and mortality weekly report in June describe five cases of people presenting with pneumocystis. Carinii pneumonia. Okay to be given they really don't know what this okay do to okay. It's very new at the time and date. Time, okay. It was a year later when they discovered that this five individuals have got such a shattered immune system. Okay that the immune system really they don't have any secular dating functional CD4 cells is actually known precisely that's how they actually coined the term acquired immunodeficiency syndrome. There was even before they identify the value in 1983. If you I wasn't even born then. Okay, so when I heard about this is a fried. Okay, and it was quite devastating at that time. No HIV was more or less a deadly disease with the death sentence. So did that perturb me on hindered me into going to the specialty? No, I said to myself really I think you know, this is a new disease entity. There's no cure for it at this moment in time. They will be quite exciting to be involved in looking through the hole from the start to perhaps know. What we eventually will come up with a cure. Okay that contacts so that's how my interest in TB in association with HIV came along. Okay the in the during the years of my registrar training and my time in Kuala Zulan, okay in the context and subsequently in 2014 around the same time of the Ebola outbreak. I actually getting good opportunity through the Royal College of Physicians. Go out to maila to actually undertake postgraduate teaching. Okay in let's okay. So when I went out there there was my first time when I started to actually get involved okay in looking to see what countries like and quite quite surprisingly to me. Okay lived in the inner cities, you get all the usual wealth and so forth. Soon as to travel out five six miles of the city. It is clear this birdie very property. It's about the fourth poorest country in the world. Okay, so I got involved with teaching training and subsequently. I also got involved with health charity, which is called medical action Lila. Okay that particular charity is a hundred percent funded externally. The government is so poor. That is no funding to run of any basic Healthcare at this moment in time. There is no universal healthcare. So I even though you are back where you need medical interventions, whether you go to any of the government hospitals, you have to pay the sum of money medical action environment provide. Point of K free edges K is privately funded. Yeah, okay and funding a from either Grand living bodies or Charities. Okay that context so at this moment in time, there are 10 clinics scattered throughout the whole purpose. So while I was there, okay, they got 200 Medics that runs this this this network of clinics and I trended at the the Medics. Okay, and the nurses at the same. I'm have undertaken a number of research projects to try to see whether is there anything that one can do? Okay, in terms of simple intervention that can make very very significant outcome in that sort of local sector, right? So that's what makes me tick. Okay get to be able to see and go okay with efficiently to be efficient and obviously the things that we do here in well resource country and I will say Malaysia is relatively. Well, right. All right, it's all right. Yeah, but UK zones obviously will result in parts of the world like things really are quite different in that context. So that's what makes me Sparkle. Okay, and that's what makes me think and in that context and yes, we have undertaken a number of drug-resistant TB projects out there particularly more to what we called Intervention implementational sign. Research by EU actually applied for a grant that will involve some sort of treatment intervention so that you're not doing what we call Blue Skies research where you just look for new and things we like yeah. Okay. So I the things that I mean like to get involved with is things that I hope at the end of the project will make a difference and record a hundred percent. Is it same as translational research? 100% and it has to be applied and relevant to that part of the world as you can do as much as you like, but if at the end of the day if it costs tens of thousands of ringlets or Pounds to make the intervention, it's not worth today. That is what I call Blue Sky. Okay. So you are funded by Newcastle for the research live. Do you have the number of external agencies already? I'm going to pick up Grant from the global fund. Okay? Could be a grunt from some of the charitable organization United Kingdom. Okay, particularly for the HIV work undertaken. So there's a lot of a lot of external agencies. Okay, we have to beat for it. Okay Astro and and furthermore this this organization would also want to look at the sea. Is this blue sky research or is this something at the end of the day they can go to make a difference to the people. All right. Okay, so let's rewind a little bit. Okay talk a little bit about you. And how did you come to be a an effective medicine specialist? Yeah, right. Okay. I actually got my MRCP my membership of the Royal College of Physicians that are relatively young stage of my training. Okay, do US during the second year of my senior house officer later training and I actually didn't know what I was going to do and and have a got an interest in. Okay. What's the right towards the tail end of my second year and I then went to to have a chat with my supervising consultant and it says right why don't you take time out perhaps to do some sort of a research or secrecy whether you can can can come up with any interest that you may come along and actually fact research post came up advertised at the London School of tropical medicine write and research work was on malaria. Okay, and can I tell you at that stage of my career? Sir, I don't know. I didn't know anything about malaria. Don't worry. It's very rare over there. So I went down to talk to this supervisor who is actually the proof of belly. Mellaril gok he is an expert in the he does nothing else but for malaria and everything and they said okay and he said to me, right? Okay, the job is yours if you want it. Okay make about it means that you have a week. Midget to educational spending some time in the lab. Okay, which we can give you the training and so forth, but there will be a bit of clinical work or to go out to the field and Soulful. So when back as a can I it was a Friday because I scan I think about it. Okay, I so I went back home over the weekend talking with my family and so forth. So on the Monday as a right. Okay, I think let's have a go. Okay is relocating myself. Okay from the north right down to London is got her done. Yes a big step. And London professionally is a great place but not quite sure about leaving the stepping stone to go into training in infectious diseases. So I went to Manchester at mon-sol hospital, which is one of the Because I D unit in the country. So I spent two years. There is a registrar in two years as a senior registrar and was a chair towards the tail end of my senior registrar years. Okay. That's where my interest in HIV and TB came along right? Okay in that context and I have never ever look back. Okay, I've been fortunate in many aspects. Okay because of my interest in HIV and TB that I've seen the start of the epidemic of HIV right through the last 36 years. To its present-day, okay, which which which I think I'm being really really considered to be privileged to have gone through and see all the various bits of it. Okay, I participated in clinical trials. Okay, making sure that effective highly active antiretroviral therapy what they call Hot therapy comes to being. Okay before 1995 1994 HIV It was untreatable. Untreatable people die from it very quickly, but when hot therapy comes along, okay, I'm a quite fortunate that I was part of the network of investigators that actually did the clinical trials with it's okay. Okay, and that my prisoners everyone start to smile. Okay, and we're fortunate the unit that I work. I got appointed as a consultant back in your Castle in 1991. Okay, so he can see 1991-1994. That's why we did on the clinical trials. Or the three for years people were starting to smell. Okay, if to say in the clinic, okay, no longer are we asking patients who are newly diagnosed to actually think about retirement preparing for the inevitable. And so for now we tell them that firstly do not give up your job and you're going to lead a normal life number one and you're going to lead as normal a quality of life as The normal person walking down and I use the word down in Northumberland Street, which the men stood. Yeah. Yeah team was smiling. Okay, the contacts the whole emphasis of educator of HIV was not towards death and dying anymore. It was actually making sure that people get back to work and lead a normal life is very functional. Yeah. 100% 100% okay in the context, so I honestly hope that this is going to be translated. Hopefully two countries that has got low resources and that's where I'm going to concentrate whatever professional life span that I've got. Okay like that bit to actually bring this two countries. Okay, then contacts and we are partly. They're not fully there as well. We're getting late. I think we will I have a feeling that if there is Will and if there is political will as well politics is quite important in this recipe. Okay? This can be a chief. Okay in the context. I'm sure you heard about 19 1990 Target of the United Nation. It's 19 9 90 90 90, and I'm not sure why not don't worry. Okay, don't worry. Okay, the 1999 T Target rates of unaids. Instead if you want to interrupt transmission of HIV by 2030, which is very optimistic 30 not too far from now. Yeah, you need to actually test 90% of the population at risk for HIV to give that test. So 90% of the people that were tested subsequently positive 90 percent of that group of individuals have to go on Treatment and 90% of that individuals if they go on treatment ninety percent of them have to achieve undetectable viral load for undetectable viral load simply means you cannot transmit HIV infection. Yeah. So that's the nineteen ninety. Ninety United Nation targets for 2030. Do you think we're getting a number of countries achieving it? Okay, but some countries are not so I think we have got a bit of time. Here you go. Eleven years and a lot of the countries that have gotten not that sort of resources to actually implement this needs to open up and says, please come in. Okay, and let's do this as a team. Okay in the contest. Let's talk more about the low resource countries. But before that I would just like to ask so recap. So you did MRCP. Yes, and then was there any special special and the exam writing? I'm one of the four very fortunate one that after my ma the mCP is a stepping stone to any training program in any bits of internal medicine. Okay be infectious diseases respiratory Cardiology gastroenterology. You need to have your emails. P to enter into training program mmm. I was one of the inverted comma all school training program. Okay. We're also get an ample amount of CPU compete for a registrar training posts, which usually it's two years and after the registrar training posts after three years. It was compete for a senior registrar pause, right? But now in UK it is what we call you got two years as a foundation. Dr. F 1 f 2 they got two years in Co medical training CMT 1cm T2. So after your CL 81 CMT to you should have got your membership to be eligible to apply to what we call a specialist training program. That's when you get appointed as st3 level. Yeah, so like for example infectious diseases, there are quite a number of training programs. Okay, you can be trained in infectious diseases or General Internal Medicine. You can be trained for infectious diseases with virology. Okay, you can be trained with infectious diseases with microbiology. Okay? Okay. So those are the three Main most popular drinkers of IT training combination. Okay, you can be trained solid Tree in infectious disease alone, but very few people do that. Okay, that's like more like a jack of all trades, right? Okay in that context Malaysia slightly different. Okay, because now I do train a number of the doctors from Malaysia because I've been quite fortunate and begin Malaysian myself. I've taken a number of doctors from Malaysia and other parts of the world to come to my unit for training. I recently just had add specialist that can just spend his last year of this Fellowship in infectious diseases from Malaysia in Malaysia. You have to become a specialist in Internal Medicine first. All right after the MRCP before you enter into a tree year fellowship program in infectious diseases provided by the public universities pop provided actually provided by either the Ministry of Health. Okay all one of the university, all right. The university stipulates if you're going to use one of the stimulus University program is what it called a master's in medicine and met okay mnb bracket infectious diseases. Okay, so that is acceptable. Okay in the context, but the fellowship in infectious diseases is a possum our CP three-year training program. The first two years is really going through all the various aspects. The core elements of what ID specialist should know the third year is At times the the trainee can decide whether they're going to spend that final year abroad to get some training right number of people going Australia. Okay number of people go to UK. Okay. So this particular individual who is now in structure in the hospital for like actually decided to come over to you know, Castle. Okay, and it just finish in October. So now he is fully what we call trained in that context. So the next For him would be a consultant pulse. Then he is now in Malaysia. I normally yeah, so that's the training aspects of being an infectious diseases. Okay physician, okay, and in that context, so yes, it's doing the the great thing about infectious diseases as a specialty particularly in the United Kingdom. It's very popular highly competitive. So that's that's that's that's the that's the that's that's what at times could be a hindrance to a lot of other people. Okay, because it's so popular to a lot of people want to go into the training program. So I'm at times. I'm very fortunate. Okay before I got sick on that here in you met I had eight trainees. Well, okay and there are just about the best group of trainees. I can wish for because these are the cream, okay. Go into the training program. Okay, and a number of them will have MRCP and none of them would have finished your PhD as well. Okay, so they all this other people that score points on the application and subsequently country related doctor. Yeah, but it's very interesting exciting as well. And these are the people that it does not just people that have got a focus in just simply blue skies research. Yeah. Okay, so I'm quite pleased that within my department there. There is this culture of thinking. Yeah. Okay, we can do the amount of these things here in the United Kingdom. We need to think about how applicable it is to outside outside. Let the video on it to go into the low resource countries. What is the main challenges it diagnosing or is it treating or is it stigma stigma is definitely one of them okay stigma and getting access to access to health care is Actually challenging is it knowledge and access or is it like awareness awareness? Because they are for people don't see themselves to be at risk for HIV. I'm not seeing themselves to be at risk for tuberculosis. So they don't seek medical help and partly because of the structure of the Healthcare System. Okay, a lot of people because you go to the Hospital or clinic you have to pay. So a lot of people then go and sick alternative medicine first because it's dead Jeep. Okay is a fraction of what they pay. So they will go to all the alternative no outlets and so forth and it was actually then when they're actually not getting better after them after duration period of time there is a better go to the hospital or finally go to the hospital. Okay, so that's the mean precisely so that's the Swapped do the patient sort of a access to treatment the other aspects of treatment is that some of our clinics that are support some of the individuals sometimes have to take up to two to three days to travel to that particular clinic. So that's really the challenge is again problem type so you may get a patient. So we have been actually utilizing a lot of what go point-of-care testing point of K intervention. Point of care treatment. So therefore we actually do the diagnosis make sure of everything treat them on that day and then making sure that where they are got likely going to be so we have got a lot of work Community Health worker. Okay, then we'll be able to track and go and see this patient if they don't turn up all the community health worker go and express supervisor treatment because of no treatment for tuberculosis straightforward is at least Months and are very challenging and have 2.3 cisely and people have to take the medication. Yeah 100% So therefore no we're going to make sure that the patient finishes of the treatment hmm. Human beings are human beings, right? Okay. I'm particularly in poor resource countries. Okay, some of this individuals who say ah, I take my TB treatment two months into it. I feel so much better than your wife or I need to take another four months of it, right? Right. So the default treatment, they don't come back you need to go and hunt and station to make sure that listen you need to finish our trip. Okay, because in actual fact we have got the funding to give TB treatment for free. Okay, people don't have to pay for it. Okay in that context, okay in our setting yeah, so that's where the challenge is going to be. Okay in the context of understanding of their disease entity and therefore the importance. Of actually adhering to the treatment and completing the treatment in so this is really in poor resource settings. Okay in that context because at this moment in time now practically a lot of the HIV medication provided free of charge okay to O Lord to put the pulley results country. Okay the contacts so it's education education education access access okay in that Next and last bit of question on that which one would you think would be better for governments and policies to be set up so that you have more facilities spread out or to have more health care workers stationed out. Yeah. I think I think in geographically challenging environment. Okay one needs to think about innovative ways to actually gain access and patience to be easily accessible. Able to the treatment centers. Okay. I think it's well and good to have a bright and shiny. Okay, tertiary referral centers and Soulful, but at this moment in time, I think basic Universal Health Care coverage is very important. Okay the context mean if you ever raise any building, but nobody can go there last night was a binary. Yeah. Okay hundred percent. Yes, right. So thank you for that now since he HIV E + TB always comes together almost always right frequently. At least we're going to move on to the next section of our podcast which is called us. We were taking questions and that common misconception QR code exam and we'll just ask your opinion about it. Okay. So for one HIV was acquired by humans in the eating monkey brains that now I'm gonna no no. No, I'm off that. Myth. Okay. All right in the context the first isolate as far back of the IV HIV isolation that spec as far back as 1959. Okay, it's okay. So it's actually yes. The origin of hiv-1 is still relatively contagious. Okay in the context that we don't know exactly but the group of opinion that is actually Like mentally from the primates that this is come from okay as I've uh, yeah in that context. So I think I'm belong to that group of individuals that think that it's actually from the primates hiv-1 and hiv-2 is a bit more straightforward HIV to we know it comes from the sooty. Mangabey Apes. Okay? Okay, it should be to hiv-1 how it probably is from the primates. Okay in the contacts and that If you sequence that particular sample from 1959, you can see that a lot of the kerbin viral sequencing of the viruses belongs to the same family tree. Okay, so that's where it comes from. Okay, there's no doubt. However that HIV transmission is actually through bodily fluids. Yeah. Okay the context okay, but obviously know if you think about it that if you have got An infected material and you've got lesions in them in your mouth. Okay, eat infective material and lesions in the mouth that could potentially transmitted infection but there's no doubt. No HIV infection is through bodily fluids. Okay, and then was during the initial years of the description of the epidemic before they even identify the virus then they could work out. How was HIV transfer student. Okay was true bodily fluids. Okay blood. No bodily fluids milk. Okay in that sort of context. Okay, but you need to have that virus in those material to transmit it. But somehow the primate version of the virus has converted into a human version. Yes, somehow somehow your true true true evolution of the virus. Yes, and they quite rapidly evolved. They are very beautiful. All right. So with our next question with current new treatments at this day and age. Can you cure HIV right? I think there has been three cases of Q okay for HIV, but it's true a very complicated and hazardous procedure is true bone marrow transplantation. Okay, but there are only three cases so far reported in the literature okay in that context and new way. We actually make this as they attend the treatment of HIV we can however use combination of antiretroviral therapy to treat HIV to a level that it becomes what we call undetectable to the extend that it became then none transmissible. Okay. So the IE if your viral load is less than 50, okay you Have got practically zero risk of transmitting your virus. And if you suppress your bowel up to that Salon level, it gives your immune system the opportunity to recompensate and regenerate itself to build up your immune system to a level that you can have a normal immune system. And when that happens you are in a position to lead a normal life. Okay, bye normal here. I'm assuming like Example the common understanding is that if you have HIV would have to always go with protected sex so note if you are undetectable, so okay that the but you don't have to yeah, undetectable viral load equals on transmissible. Okay in the context isn't that amazing? There is a very amazing amazing. Okay, then which means that if you on regular follow-up and your own treatment, and if you undetectable you do not need to actually take A caution as far as transmissibility of your HIV and is treatment is a lifelong treatment lifelong change at this moment in time. Okay in the in that in that context. Okay. So like for example in United Kingdom or in well resourced countries. Okay, if you are HIV infected on regular medication and regular medical follow-up, you can have a life insurance. Okay with no problem. Okay, you can apply for Baggage with no problem at all. I can tell you a bit of a story okay of discordant couple. Okay IE the husband is positive. Unfortunately true blood transfusion to wife is negative. But the husband is under my K on good treatment undetectable viral load good CD4 count the wife. Unfortunately. It's got diabetes and Insulin dependent diabetes. So they were both planning for a holiday in the United States. Okay, so the both applied for travel insurance, okay, and have a guess the husband's travel insurance because it's got undetectable viral load under good follow-up is practically a tenth of what his wife travel insurance has because the wife is insulin dependent diabetes. Okay diabetic and they were so upset. They came to see me sir. Why am I is it my wife travel insurance is 10 times premium more than me. This is insurance companies have got this and I understood the whole thing. Okay that having HIV under good medical treatment and treatment. You lead a normal life. Yeah diabetes has got a much more issue with long term complication. So it just shows how the whole thing has turned round. Okay in that context, that's pretty cool. Yeah, but can you still do need blood for know at this moment? In time I you are not in at this moment in time because that there is still this is to get there. The guidance is still there. Okay, but I think it's highly likely going to be changed in the future in the familiar and undetectable hiv-positive. Yes fish in cash. Let's go. Yeah and furthermore. They are accepting people who are undetectable viral load for organ donation. Oh, oh, yeah. Yeah. Yeah. Yeah, that's pretty good their contacts. Yeah. To the next myth TB is easily spread in public transport. What do you think about that? No, no. No, let's let's let's bust that myth. All right, let's to transmit TB. You need to be next to a person fairly close who is coughing. Okay and has got present someone called acid-fast bacilli in his sputum. And the category of someone that is at risk of acquiring TB from infected individual with an open cavity rule lung disease is that that individual have to spend at least 8 hours per day with that individual and that is how we use that criteria for contact tracing. Okay. So IE if you happen to be in a household that someone has been diagnosed with open typical. That means coughing with SVC. Like if you've been in that household and a policeman in hours per day, if that individual constantly, then you are at risk of acquiring TV. There's no like if you just for 15 minutes is not going to happen. Right? No not happen Okay, because that context yeah. Yeah. I can I can categorically you know this myth that myth. Okay, that's nice. So the two questions that we have here, why are the African Americans the ethnic group with the highest risk for HIV right? If you look at what actually has happened with HIV epidemic? Okay the context it's a bit sad. Okay the context that the actual fact you can the 1959 sample was actually an African. Region throughout okay that the epidemic was not recognized early on. Okay, if you look back to the old medical literature, okay, there were a lot of description of a disease entity called slim disease SL. I am sleeping disease because people don't actually know what was wrong with the patient, but it was actually essentially a term for requesting disease people become very wasted a very simple. Hmm, and it took A group of Pathologists. Okay, thinking back true after the HIV epidemic was described and realized I didn't own the HIV epidemic was actually the Americal America setting that was recognized and sold out. Okay, and then they went back to see and what actually happens at they've got some of the samples of this people that have died from sleep disease and went back to look back to all the specimens. Okay, and practically Over 80% of the specimens are hiv-positive for people have not recognize it so until for unknowingly has been transmitting the disease in that period of time and to focus unfortunately wasn't there frico. Okay in that context, there is also a story to this. Okay, the strain in Africa is quite different from the American strength, okay. That context so they don't fall. You may want to ask me so despite 36 years of what we have learned and natural history. Okay into treatment at all the advances why is there not an effective vaccine and why that is the case is because the virus is quite clever. Hmm, the African isolates. The variant is quite different from the American isolates. They change regular cisely they change regularly so I either If you device and innovate and the vaccine for American population will not work at all in Africa. Yeah, see that's where the challenges so they are still challenges even though they've been major advances. There are still challenges Steph. Okay, so to our last question then in need so we all know that. This is a bit of a controversial topic. But we all know that in meal with male sexual relations. It hosts about 20 times the risk of Contracting HIV. And in in that behavior in that activity that is a receiver and then there is exhibit. Yes. So in the question is in MSM male sex with males. The receiver is at higher risk of Contracting HIV then the giver accessible Percent, okay. So if you want to use another term, okay. I like your terms. I think I think it's a very good generic term for the general public to to understand. Okay, but if you put it in the medical context is called receptive intercourse, or are you practice insert of intercourse? Okay. Okay. So someone that is actually practicing receptive intercourse are more at higher risk of acquiring. Uh, I bet someone practicing insensitive. Okay boss. So if you think about it, okay in particularly, if you're talking in the context of men who have sex with men your insert if the person that inserts are can practice in certificate sexual intercourse is going to be the person that ejaculate right? So is the ejaculate of the fluid that contains the concentrated virus? Okay, there are so therefore there is the guided practice. Sensitive intercourse is going to be the one that is higher in contact with in context. So it's fairly similar if you think about. Men heterosexual setting hmm. Why is a women at high risk of acquiring HIV and it's the same principle. The man is the guy who is infected. It's going to be one that will be ejaculating with the measure viral infected fluid into the female. And the female is the one that has more second highest risk of acquiring HIV. Essentially, it's just previously. Yeah, so I'll show ya I mean very good Christian. Okay in the context offer assisting risk. Okay, and that's why I times when you're working in such a setting do not be afraid to us about sexual practices. Okay, because it gives you a bit of idea in terms of the risk of that particular individual assessment of their acquisition of HIV, okay? Right. So that's a very comprehensive and very very nice session. So to end this are there any advice for medical students or the general public that you would like to put it? No. No, I think I've been really delighted. It's been an incredible past three months that I've been here for really enjoyed my time and I must say okay that the the students population. I've met just about one of the best I've come across. Really super kidding. Okay, such an enjoyable aspect of the I've got my patient in teaching apart for my research. Okay. I enjoyed teaching. Okay, and it's such a great defying aspects of experience when I teach with enthusiastic patient students who wants to know more and more and more and I think it holds really promising future for the Next Generation you guys Guys are going to be the one that is making the difference. Okay, you guys I got good to be wondering I'm only here to pass on my experience and help you and cultivate you about you guys are going to be the one that makes the greatest impact in what's going to happen in this new Malaysia. Well, that's nice. Well, we don't know what the future so it is quite exciting to see thank you very much for that. And that is the end of the deadly Duo and episode from the dark Whispers. If you liked this episode, please leave your reviews throughout iTunes or 3s at dot underscore Whispers. See you next time. Bye.
Is there a cure to HIV? How do I become an infectious disease physician? Can tuberculosis be spread via public transport? We have Professor Edmund Ong on this episode, he is a consultant infectious disease physician with special interests in HIV and tropical medicine. This man was directly involved in the creation of HAART for the treatment of HIV. He has worked with Doctors without Borders, contributed to numerous textbooks on infectious diseases, and the list goes on. Basically, listen to be inspired by Prof Ed's passion for his job as he shares his limitless wisdom to us students. 