It's World AIDS Day
We Have the Science, It's About Access and Priorities Now
It’s World AIDS Day. For the 33rd consecutive year, governments and advocates around the world will be using this day to reflect on where we are and where we’re going in our efforts to end this epidemic. There is actually a lot of good news when it comes to the HIV/AIDS epidemic, especially here in the United States. What was once a death sentence is now a chronic health condition that can be effectively managed with medication. Moreover, we now have biomedical prevention methods that are 99% effective in blocking sexual transmission of HIV and have all but eliminated mother-to-child transmission in this country. Science truly came through and a lot of what was learned in HIV/AIDS research has been important as we deal with the current Covid-19 pandemic. That said, HIV began as an issue in marginalized communities in our country. While the scientific discoveries seem impressive and fast, the political and social will to end the epidemic was slow and hard fought. The HIV epidemic has always been (and continues to be) a story of stigma and disparities. We have the science, now it’s about access and priorities. Unfortunately, if our newest pandemic has shown us anything, it’s that our priorities are pretty f**ked up.
Powerful T-Cells May Have Helped Two Women Clear HIV Without Treatment
An Argentine woman may have become the second person whose immune system managed to rid their body of HIV without the help of treatment. A new study, published last month in the Annals of Internal Medicine, says that scans of over one billion cells in this woman’s body found no viable virus though they did find fragments which proves that she had at one point been infected with HIV and that the virus had replicated.
The patient, who is now 30, was diagnosed with HIV in March 2013. She did not take antiretroviral medications until 2019 when she was pregnant. She stopped taking them after giving birth last year (her baby was HIV-negative). She had her viral load tested at least 10 times over the course of the eight years since she was diagnosed and each time the virus was undetectable in her blood.
Researchers say they can’t prove that she is cured but believe that her immune system has successfully rid her body of the virus on its own. They are calling her the Esperanza Patient based on the Spanish word for hope.
In 2020, a different group of researchers reported on a woman in California with similar results. Loreen Willenberg, now in her mid-sixties, was diagnosed with HIV in 1992 but other than one test many years ago, researchers have never been able to find HIV in her blood or tissues. For last year’s study, they looked at 1.5 billion of Willenberg’s blood cells as well as cells from her gut, rectum, and intestines, and found no trace of the virus.
Some experts believe that the Esperanza Patient and Willenberg could be considered functionally cured. They follow in the footsteps of Timothy Brown and Adam Castillejo, both of whom underwent bone marrow transplants for cancer using cells from donors known to have a genetic resistance to HIV and were found to be free of HIV afterward. Bone marrow transplants are not a solution for those living with HIV, however, as they require potentially life threatening chemotherapy or radiation ahead of time and immunosuppressant drugs afterward. This is why researchers are so interested in the two women who received the same results without the intensive medical interventions.
This was not Willenberg’s first research study. She has been known to researchers as an “elite controller”—part of the 1% or so of those living with HIV who can suppress the virus without the help of drug therapies. In fact, there were 63 other people in the 2020 study who might also be considered functionally cured because HIV was “blocked and locked”—banished to cells where it cannot reproduce. Still, sophisticated tests were able to find the virus in these other people.
Researchers are still not sure how Willenberg and now the Esperanza Patient were able to defeat the virus other than to say that they clearly have very powerful T-cells. More importantly, they still don’t know whether the mechanism could be replicable for others who are not blessed with Wonder Woman-Worthy immune cells. As one expert said of Willenberg’s results: “I think that is a novel, an important discovery. The real challenge, of course, is how you can intervene to make this relevant to the 37 million people living with H.I.V.”
Study Suggests More Cisgender Men Would Benefit from PrEP
Pre-exposure prophylaxis (PrEP) has changed the landscape of HIV-prevention tremendously since it was introduced in 2012. PrEP is a prevention strategy for people who currently do not have HIV but are considered at high risk of contracting the virus. It involves taking antiretroviral medications to prevent infection. PrEP is highly effective. As I mentioned earlier, if taken as prescribed, it can reduce the risk of getting HIV from sex by 99%.
Uptake, however, has not been as extensive as hoped. In 2016, an estimated 1.1 million people in the U.S. were eligible for PrEP based on their risk factors, but only 78,360 people filled prescriptions. And now, research out of the UK suggests that the eligibility requirements may be missing some at-risk people.
The PrEP Impact Study followed cisgender men who have sex with men (MSM) who received treatment from the National Health Services sexual health clinics. To be included in the study men had to be HIV-negative at enrollment and report having had anal sex without a condom in the previous three months. Men were considered high risk and offered PrEP if they had taken two or more HIV tests, had ever had a rectal bacterial sexually transmitted infection (STI), or had sexual contact with someone with HIV or syphilis. Health care providers could also add people to the PrEP group at their own discretion based on other information that came up in discussions. In all, 17,770 MSM were included in the PrEP group. For the purposes of analysis, their health outcomes were compared to a control group of over 97,000 MSM who did not use PrEP.
Researchers followed both groups from October 2017 through February 2020. During that time 24 people in the PrEP group were diagnosed as HIV positive compared to 640 in the control group. It is important to note that these results do not tell anything new about the efficacy of PrEP as we don’t know whether the people in the PrEP group who became infected were adhering to their regimens. Instead, the researchers are focusing on the number of infections in the control group and the fact that 71% of which were among participants who were not considered high risk. The researchers see this as proof that too many MSM are being missed by current risk screening processes.
Eligibility for PrEP is based on self-reported behaviors which means health care providers can only know what a patient is willing to tell them, but Ann Sullivan, who presented the findings from this study at the European AIDS Society Conference (EACS 2021), is more concerned about PrEP gatekeepers who turn patients away: “If people are coming forward for PrEP, they have self-identified that they need PrEP, we should be allowing them to take PrEP. We just need to trust patients. People know their risk and we just have to accept that they know what they need best."
Right Wing Radio Host Rewrites History to Compare Anti-Vaxxers to Those with AIDS in the 80s
In an apparent effort to gain sympathy for those choosing not to get the Covid-19 vaccine, right wing blowhard Dennis Prager compared anti-vaxxers to those who contracted HIV early in the epidemic. In a November interview with Newsmax, Prager said: “During the AIDS crisis, can you imagine if gay men and intravenous drug users...had they been pariahs the way the non-vaccinated are? But it would've been inconceivable."
No, Dennis, that’s not how it f**king worked. It wasn’t inconceivable; it was a daily reality.
Early in the epidemic, gay men and IV drug users were treated as pariahs whether they had HIV or not. The evidence for this is so overwhelming it’s almost impossible to comprehend how Prager (who was a full-fledged adult in the early 80s) could pretend otherwise. Here are just a few examples that illustrate the attitudes toward HIV, gay men, and other at-risk populations:
HIV/AIDS was repeatedly referred to as the “gay plague” by the media and others.
In response to a question from a reporter about HIV/AIDS in 1982, the White House Press Secretary joked “I don’t have it, do you?” Two years later, when 4,200 people had died of AIDS, he continued to joke about it with the press pool and insist that he and President Reagan had never discussed the epidemic. It wasn’t until 1987—by which time over 20,000 Americans had died of AIDS—that Reagan himself gave a major address on the epidemic.
In 1983, Lambda Legal took on its first case of HIV/AIDS discrimination when a Manhattan co-op board attempted to evict a doctor from his office because he was one of the few physicians in the city treating those with HIV.
NYC counted 351 hate crimes aimed at gay people (ranging from verbal attacks to homicides) in the first nine months of 1986 as the HIV/AIDS epidemic was garnering more attention. This was more than double the number of incidents from the same period of time in the previous year. And, 25% of the incidents specifically included comments about AIDS.
A 1987 New York Times article noted that so few dentists in Chicago were willing to treat people living with HIV that the Chicago Dental Society considered setting up a special clinic.
A 1987 Pew poll found 43% of Americans agreed with the statement “AIDS might be God’s punishment for immoral sexual behavior” compared to 47% who disagreed.
Ryan White, a teenager in Indiana, was not allowed to return to school after his 1984 diagnosis because the school feared that he was a risk to other students. White was a hemophiliac and was infected with HIV through blood clotting medication before the blood supply was tested. His mother described the opposition to him attending school as vicious: “People were really cruel, people said that he had to be gay, that he had to have done something bad or wrong, or he wouldn't have had it. It was God's punishment, we heard the God's punishment a lot. That somehow, some way he had done something he shouldn't have done or he wouldn't have gotten AIDS.”
Of course, my favorite example comes from the 1990 New Jersey Model Congress which brought high school seniors from around the state together for two days to pretend we were legislators. I was assigned to the Health and Human Services subcommittee and authored a completely non-controversial bill to increase funding for Head Start (thanks, Mom). But someone from another school introduced a bill that proposed sending all “AIDS Patients” to Alaska as a means of controlling the epidemic.
I begged my chair (who was an I.P.L.E. classmate) to give me the floor, and I was pretty sure that Representative Kempner (D-East Brunswick) eviscerated the bill’s underlying premise (that those living with HIV were a public health threat) while pointing out its obvious constitutional flaws. Still, I don’t think I got through to its author. He promptly offered up an amendment to change the location of the banishment. To be clear, it was not the snow or subzero temperatures that I was objecting to.
In addition to representing a complete rewrite of history, Prager’s analogy simply doesn’t work. Contracting AIDS—especially in the early years when science had yet to figure out what it was or what caused it—was not a deliberate decision. Avoiding vaccines is.