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Letter To The Editor: National Women And Girls HIV/AIDS Awareness Day

AIDS awareness day red ribbon
AIDS Awareness Day red ribbon (public domain image)

[This letter to the editor is from Foster Norman, CEO of Cobb County Community Services Board]

To the editor:

As we recognize National Women and Girls HIV/AIDS Awareness Day on March 10, the United States Department of Health and Human Services recently announced a national strategy to eliminate new HIV infections that is intended to provide resources right here in Cobb County.

During the State of the Union address, President Trump shared this strategy, called “Ending the HIV Epidemic: A Plan for America.” The initiative works by directing new funds to targeted communities affected by HIV in a phased approach. Those of us in the field nation-wide are waiting to hear how this will impact the identified areas, but we know that Cobb County is included on the list. In fact, metro Atlanta has among the highest rates of new infections in the nation; according to the Georgia Department of Public Health, in 2016 Cobb County had 168 known cases of HIV infection.

This is important to our community because the human immunodeficiency virus (HIV) is contagious and can lead to acquired Immunodeficiency (AIDS) if left untreated. Unlike some other viruses, the human body cannot get rid of HIV completely, even with treatment. Once a person has HIV, he or she has it for life.

Education, awareness and treatment are essential to eradicating this disease. Cobb County Community Services Board is part of this effort through its free HIV/Hepatitis C (Hep C) education and prevention, testing, and substance use services. This includes rapid testing (results in sixty seconds for HIV, and 20 minutes for Hep C) and links to care for those who test positive.

Our agency will continue to provide needed services while collaborating with other agencies in the community to educate and bring testing to areas that request it including community centers, universities, churches and health fairs. Those we serve at our substance use treatment centers prove to be some of the most vulnerable populations and are considered high risk. It is important that Cobb County residents are aware of our efforts in the fight against HIV/AIDS education and how the community assists in providing free access to testing and links to treatment.


It is unwise to think we are on the brink of curing HIV

* Any views expressed in this article are those of the author and not of Thomson Reuters Foundation.
News that a second person with HIV has been cured offers hope, but should be viewed with some cautionMatthew Hodson is executive director of NAM aidsmap and the recent winner of Social CEO of the year. NAM aidsmap provides HIV news and treatment information to support people living with HIV, throughout the UK and internationally. @Matthew_Hodson

Any story about an HIV cure is bound to stir excitement. Scientists have just reported a new case study of a previously HIV+ man, referred to as the “London Patient”, who has no remaining detectable HIV a year and a half after undergoing a bone marrow stem cell transplant to treat lymphoma.

The case is the only the second reported example of an adult apparently becoming free of HIV infection. The first, Timothy Ray Brown, known as the “Berlin Patient”, was reported 12 years ago.

It is significant that there have not been any other cases of supposed cure without subsequent rebound in those years. There have been other attempts to discontinue anti-retroviral therapy for HIV+ bone marrow transplant recipients, but in these cases the patient’s virus has returned.

Bone marrow transplant is a high-risk, life-threatening procedure. This treatment would not be appropriate to offer someone who did not have cancer.

The circumstances of this cure do not apply to those of us who have been living with a HIV diagnosis for many years; the risks involved are too great.

However, news that a second person may have been “cured” demonstrates that the Berlin Patient was not an anomaly. It is a proof of concept that may prove valuable.

The circumstances in both cases indicate that people with HIV who have cancer, and who need a stem cell transplant to treat it, may be cure candidates.

In these two cases, doctors selected a donor who had an uncommon mutation that made them virtually immune to HIV infection and this mutation was passed on to the recipient. This indicates that other patients, in the same circumstances, should, where possible, receive transplants from a donor with this same gene mutation. Other, more generally applicable strategies that may, in time, lead to a cure are also being investigated.

Hopes that a cure will be available to all any time soon are misplaced though.

More than 20 years after scientists announced that we had the medical resources to treat HIV effectively, around 40 percent of people living with HIV globally are still unable to access this life-saving treatment.

The treatment that we have means that someone with HIV should have a normal life-expectancy. What is more, when someone is treated effectively they cannot pass the virus on to their sexual partners. This means that when populations are treated effectively we can also stop new infections.

I welcome any reports that further our understanding of HIV and how it can be contained. This case may in time lead to the development of therapies that have less risk and a greater chance of successfully leading to HIV remission.

However, it would be unwise to think that we are on the brink of curing HIV when, after two decades, we have still not been able to provide treatment for all.

Author: Matthew Hodson


Women with HIV may have higher breast cancer mortality

Katrin Sadigh presenting at CROI 2019. Photo by Liz Highleyman.

HIV-positive women with breast cancer appear to have decreased survival compared with HIV-negative women, according to a cohort study from Botswana presented yesterday at the Conference on Retroviruses and Opportunistic Infections (CROI 2019) in Seattle.

Having HIV was associated with a nearly twofold reduction in survival, and this finding held for women on antiretroviral therapy (ART) with suppressed virus and higher CD4 T cell counts, reported Dr Katrin Sadigh of Brigham and Women’s Hospital in Boston.

As people with HIV live longer thanks to effective antiretroviral treatment, AIDS-related mortality has declined dramatically while non-communicable diseases such as cancer and cardiovascular disease account for a growing proportion of deaths. Breast cancer is the leading cause of cancer-related death for women with HIV who have access to effective ART, as it is also for HIV-negative women.

Sadigh’s team performed a prospective analysis to evaluate the impact of HIV on overall survival of women with breast cancer in a resource-constrained setting. While prior research in the US and Africa has found that women with HIV do not have higher breast cancer incidence, or likelihood of developing cancer, some studies with a small number of HIV-positive participants suggested that survival may be reduced.

The current analysis drew from the Thabatse Cancer Cohort, which enrolled nearly 4000 people with cancer at four major oncology centres in Botswana. Participants are evaluated at study entry and followed for five years. Causes of death are obtained from providers, family members and death certificates.

The breast cancer cohort included 510 women who sought cancer care at public or private facilities between October 2010 and September 2018. Of these, 151 were HIV positive and 327 were HIV negative.

The HIV-positive group was younger on average than the HIV-negative women (media 47 vs 56 years, respectively). In both groups, about 5% were diagnosed with stage I early breast cancer, about 25% with stage II, about 40% with stage III and about 15% with stage IV or metastatic cancer. Both groups also had similar proportions of women with oestrogen receptor-positive tumours (about 35%) and triple-negative breast cancer that doesn’t respond to commonly used medications (about 15%); however, more than 40% were not tested for this.

Both HIV and cancer care are provided for free by the government in Botswana, Dr Sadigh said. Before 2016, people with HIV started ART when their CD4 count fell below 350 cells/mm3, but thereafter everyone was treated regardless of CD4 count. Most women (85%) were taking ART at the time of cancer diagnosis, three-quarters had done so for at least two years and 70% had HIV viral load below 1000 copies/ml. The most common regimens were zidovudine/lamivudine/efavirenz and tenofovir DF/emtricitabine/efavirenz, at just over 30% each.

Breast cancer treatment in Botswana typically involves surgery followed by preventive (adjuvant) chemotherapy for early-stage cancer, or pre-surgery (neoadjuvant) chemotherapy followed by surgery or radiation therapy for those with more advanced disease. Both tamoxifen, a type of hormone therapy for oestrogen receptor-positive breast cancer, and trastuzumab (Herceptin), a targeted therapy for HER2-positive tumours, are generally available, according to Dr Sadigh.

Types of treatment did not differ significantly by HIV status, with about 70% of women undergoing mastectomy, about 10% having lumpectomies, about 60% receiving some type of chemotherapy and just under half receiving radiation therapy. Most received multi-modality treatment.

During the course of the study, 70 HIV-positive women (46%) and 101 HIV-negative women (31%) died. In both groups, cancer was by far the most frequent cause of death, accounting for around 90% of cases; around 3% of deaths were attributed to adverse effects of treatment. None of the women with HIV died of directly AIDS-related causes. In a multivariate analysis controlling for other factors, HIV-positive women had an 82% reduction in survival compared with HIV-negative women.

Having HIV was associated with higher mortality in most subgroups. There was little difference among women with stage IV cancer, who had a high death rate regardless of HIV status. HIV appeared to have a greater effect on mortality in women with early-stage breast cancer, hormone receptor-negative tumours and – unexpectedly – higher CD4 counts (above 350 cells/mm3), a finding Dr Sadigh was unable to explain.

“HIV infection was associated with nearly two-fold reduction in breast cancer survival despite good access to ART,” the researchers concluded. “Differences in cancer stage, cancer subtype or access to cancer treatment does not explain the disparity.”

Dr Sadigh emphasised that survival was poor for both HIV-positive and HIV-negative women in this study, and better strategies are needed to speed up diagnosis and improve care.


Author: Liz Highleyman


Doctor: Remove barrier to HIV testing, treatment

When the patients started trickling in during the mid-1980s, I admit that I was afraid. I took every precaution that I could when treating my AIDS patients, but of course, I still treated them — it was my duty as a doctor. The medical community didn’t yet know what caused AIDS, much less how it was transmitted. I could feel my heart beat a little faster and the sweat on my brow when I arrived at work to see that I had an AIDS patient on the schedule for the day.

The fear that I felt, however, paled in comparison to the fear that my patients felt. In the 1980s and early ’90s, an AIDS diagnosis meant certain death. We didn’t have the medicine we needed to treat AIDS effectively, and our patients knew it. Their faces said it all.

Now we know that AIDS is caused by the HIV virus, and we know exactly how it is and how it is not transmitted. We know that when people living with HIV have access to treatment, they can live full, healthy, robust lives. They can have romantic relationships, and even have children with no complications for their partner or offspring. This is all thanks to a single pill that, when taken daily, makes it impossible to transmit HIV to others.

Despite these tremendous medical advances, in Missouri we punish people who know that they are HIV positive, even though knowing your status is the responsible thing to do. It does not matter if a person living with HIV uses a condom, or has successfully suppressed their viral load by taking their once-daily pill — if someone living with HIV cannot prove without a doubt that they have disclosed their HIV status with a sexual partner, they may be subject to Class A felony charges. Even more egregious, we punish people for behaviors that cannot transmit HIV according to decades of scientific research. Transmission need not occur in order to be prosecuted under Missouri state code.

A Class A felony is at the same level as pre-meditated murder. It is at the same level as severe child abuse. Staff at agencies that serve people living with HIV tell us how painful it is to communicate this law to their clients right after they share an HIV-positive diagnosis.

Prosecuting and imprisoning people for living their lives while HIV positive is not effective public health policy. It does not save lives. What saves lives is access to care and effective medical intervention. It is with these tools that we will end HIV/AIDS, not through criminalization.

In memory of my patients who died too soon during the early years of the AIDS epidemic, I am eager to support HB 166 and 167, pre-filed by Reps. Tracy McCreery, Democrat, and Holly Rehder, Republican, respectively. These bills would modernize our outdated, harmful state statutes, removing a barrier to being tested and treated, and moving our state toward an HIV-free future.


Molecular data helps identify HIV networks

Using molecular data to supplement information gained through public health interviews — chiefly, the names of sexual or needle-sharing partners — can help identify HIV transmission networks and prevent new infections in states with low HIV morbidity, researchers reported in a recent MMWR.

“Public health interviews (ie, partner services), during which persons with diagnosed HIV infection name their sexual or needle-sharing partners (named partners) are used to identify HIV transmission networks to guide and prioritize HIV prevention activities,” Katarina M. Grande, MPH, from the Wisconsin Department of Health Services, and colleagues wrote. “HIV sequence data, generated from provider-ordered drug resistance testing, can be used to understand characteristics of molecular clusters, a group of sequences for which each sequence is highly similar (linked) to all other sequences, and assess whether named partners are plausible HIV transmission partners.”


Grande and colleagues noted that although molecular data have been analyzed in states with higher HIV morbidity, few states with lower morbidity — such as Wisconsin — have conducted such analyses. According to their report, in 2016, Wisconsin reported 4.6 HIV diagnoses per 100,000 people aged at least 13 years.

For their study, Grande and colleagues used HIV sequence data from provider-ordered tests to identify molecular clusters and describe demographic and transmission risk characteristics of pairs of people whose sequences were highly genetically similar, they explained. They assessed the overlap between molecular linkages and partner data reported during public health interviews.

According to their findings, “characteristics of molecular clusters in Wisconsin mirrored those from states with more HIV diagnoses, particularly in that most molecular linkages were observed among persons of the same race … the same transmission risk … and the same age group,” the researchers wrote.

There was a moderate overlap of named partner and molecular linkages, with 33.8% of named partners as plausible transmission partners, according to the report.

“Analysis of HIV sequence data is a useful tool for characterizing transmission patterns not immediately apparent using traditional public health interview data, even in a state with lower HIV morbidity,” the researchers wrote.

“Despite relatively low overlap between molecular data and named partner data, the results of public health interviews are still important for identifying persons at high risk for acquiring HIV infections, identifying undiagnosed HIV infection and ensuring that persons with diagnosed HIV infection are engaged in HIV medical care,” they wrote. “The combination of public health interview and molecular sequence data is a powerful new tool for understanding HIV transmission networks and identifying population- or individual-level interventions to reduce HIV transmission and improve health outcomes.” – by Bruce Thiel


Long-acting injectable ARVs are convenient and private, study participants report

HIV-positive people who took injectable cabotegravir + rilpivirine every four or eight weeks as antiretroviral therapy found it more convenient and discreet than daily pills, also feeling that it eliminated a “daily reminder of living with HIV”, Deanna Kerrigan and colleagues report in PLOS One.

Similarly, HIV-negative men who took injectable cabotegravir every 12 weeks as pre-exposure prophylaxis (PrEP) felt that it was probably more convenient and easier to adhere to than daily pills, according to a study from the same research team published in AIDS & Behavior.

Healthcare providers were also supportive, but did point out that the clinical management of long-acting injectable antiretrovirals (ARVs) is more complex. They noted that injectables will not necessarily eliminate the challenge of adherence, with regular attendance at clinic visits more crucial than ever.

Both studies involved in-depth interviews with subsets of people who had taken part in phase II clinical trials, as well as with healthcare providers at trial sites.

The LATTE-2 trial provided cabotegravir + rilpivirine to HIV-positive people who had not previously taken HIV treatment before, in the United States and Spain. Injections occurred every four or eight weeks, depending on which study arm a person was randomised to. For the follow-up qualitative study, 27 study participants and 12 healthcare providers were interviewed.

The ÉCLAIR trial provided cabotegravir to HIV-negative men, as PrEP, in the United States. Participants had injections every 12 weeks, although it has since become clear that an eight-week schedule is more likely to be effective. For the qualitative study, 26 participants and four healthcare providers were interviewed.

In both studies, most but not all of the trial participants interviewed were gay men in their thirties. As people who had volunteered to take part in these studies, they may be more motivated and enthusiastic about injections than other people who need ARVs. Also whereas by definition the HIV-positive participants all needed HIV treatment, most of the HIV-negative participants did not feel that they were at high enough risk to need to take PrEP for themselves.

Most trial participants had had some side-effects from the injections, typically soreness and minor bruising at the injection site for a day or two. A minority had more severe reactions such as fever or impaired mobility. Nonetheless, most felt that the side-effects were “worth it”, as this man taking cabotegravir + rilpivirine for HIV treatment explained:

“One day is nothing… It’s as if you have a day with a headache. You take ibuprofen and that’s it. You put up with it. It’s temporary.”

Injections were felt to be more convenient and easier to adhere to than daily pills by both sets of participants. Especially among those living with HIV, injections were felt to be more private, as other people would not inadvertently see their medication.

“It seems to me that it’s much better because you simply don’t have to worry about anything. If you go on a trip, you don’t have to bring your pills or take anything at all along. You follow your ‘normal life.’ You come once a month. You get the shot and it’s over. You don’t have to be thinking everyday… oh I forgot to take the pill. Or… when did I take it last… You just don’t worry about anything. In reality, taking the pill everyday keeps it [HIV] present… and the shot is just once a month… You remember it when you come in and the rest of the time you can basically forget it.”

Nonetheless, a few participants did express concern about the number of clinic visits required. Friends, family and work colleagues could ask why the person needed to see the doctor so often, potentially leading to unwanted disclosure of HIV status.

Participants agreed that the intramuscular injections (in the buttocks) needed to be provided by a skilled professional, such as a doctor or nurse. A number of possible clinical settings were suggested for providing the injections, but self-injection was not felt to be realistic.

Gay men taking part in the PrEP trial often felt that the injection could give ‘peace of mind’, especially given unanticipated risks.

“I’m thinking why not do injectable PrEP because there could be that one night where you’re not even planning for that, you’re like, oh wait, I have to take pills for a week before I even consider doing this. Because for men who have sex with men, being spontaneous is there. The hookup culture is so prevalent.”

When asked who are the ‘right people’ to use injectables – rather than daily pills – respondents often referred to people who find adherence challenging. Mention was made of people with unstable lives, homeless individuals, substance users and younger people. Potential users must also not have an aversion to needles.

But most of the people living with HIV said that they would recommend injectables to ‘anyone’ living with HIV. Several said that their friends were jealous when they learned of how they were taking their medication.

“90% of the people will prefer this method.”

However, the healthcare providers who were interviewed suggested that injections may not be right for everyone, with the choice of medication best decided on a case by case basis. While people who are less likely to adhere to daily pills might theoretically be good candidates for injectables, they noted that people still need to show up for appointments.

“My concern with injections is this: when you have someone who’s just not compliant. If they’re not compliant and they miss two or three oral doses, it’s not the end of the world. If you’re not compliant with every eight weeks, that could be an issue. So you’ve got to get people who understand the importance of adhering.”

One older man living with HIV noted that as he needed to take several other oral medications in addition to his HIV treatment, he was happy to stick with the pills.

Clinicians also noted that the clinical management of injectables was more complex than with daily pills. Patients need to begin with oral drugs, then switch to injectables, a process which needs to be actively managed. Injectables cannot be discontinued quickly in the event of adverse reaction. Moreover, cabotegravir persists in the body for a long time after discontinuation, potentially creating problems in relation to drug resistance.

To conclude, both injectable HIV treatment and injectable PrEP were highly acceptable and feasible for study participants, with the potential to allow for better adherence.

Author: Roger Pebody


Employers of labour must comply with HIV/AIDS non discrimination Act – Lawyers Alert

A Civil Society Organisation in Nigeria, Lawyers Alert has insisted that employers of labour in the public and private sector must comply with the HIV/AIDS non discrimination Act to protect workers who that are infected with Acquired immunodeficiency syndrome (AIDS), a chronic, potentially life-threatening condition caused by the human immunodeficiency virus (HIV).

The President of Lawyers Alert, Rommy Mom told Daily Trust that the HIV/AIDS non discrimination Act that was passed into law in Nigeria five years ago was not implemented and that his organization has dragged the Minister of Justice and Attorney General of the Federation, Abubakar Malami to court to demand full implementation and total adherence to the law.

He said the HIV/AIDS non discrimination Act mandates the Attorney General of the Federation to ensure that work places have HIV/AIDS policies to protect workers that are HIV positive.

He said the law was passed in 2014 and that it mandates the AGF to ensure that employers of labour in public and private sector in Nigeria have the policy within three months.

Rommy expressed concern that the law was not implemented five years after and that no policy in work places to protect people living with HIV.

He lamented that majority of workers that are HIV positive are facing all forms of discrimination and stigmatization in their places of work.



Ending HIV transmission by 2030

Max Essex

Harvard’s Max Essex, one of the first scientists to hypothesize that a retrovirus was the cause of AIDS, discussed the Trump administration’s plan to end HIV transmission.

Stephanie Mitchell/Harvard Staff Photographer

Harvard professor emeritus Max Essex says it’s possible

After four decades of fighting AIDS and the human immunodeficiency virus that causes it, the U.S. government is pressing forward with a plan to end HIV transmission in the country by 2030.

The plan targets about 48 “hotspots” where transmission is concentrated with enhanced surveillance and tracking, as well as stepped up prevention and treatment efforts. It dovetails with a similar international goal supported by the Joint United Nations Programme on HIV/AIDS (UNAIDS), which also seeks to greatly reduce transmission by 2030.

Max Essex, the Mary Woodard Lasker Professor of Health Sciences Emeritus and chair of the Harvard T.H. Chan School of Public Health AIDS Initiative, has been on the epidemic’s front lines from its start in the early 1980s. He was one of the first scientists to hypothesize that a retrovirus was the cause of AIDS and conducted early work that led to one of the first blood tests for HIV. Through the Botswana-Harvard Partnership, he conducted research on the global pandemic in southern Africa, among the world’s hardest-hit spots.

Essex talked to the Gazette about the Trump administration’s plan to end HIV transmission — announced during last month’s State of the Union address — its chances of succeeding, and what the approach of such a milestone means to those who’ve worked in the field for decades.


Max Essex

GAZETTE: What was your reaction when you heard about the plan?

ESSEX: I was a little bit surprised, but not hugely, because I think it was pushed hard by [Centers for Disease Control and Prevention (CDC) Director Robert] Redfield. Redfield has connections with Christian evangelical groups that he and others worked closely with in ’02 or ’03, during the second Bush administration, to set up the PEPFAR program [the President’s Emergency Plan for AIDS Relief].

I’m sure that constituency, with Tony Fauci [head of the National Institute of Allergy and Infectious Diseases], still exists, although it’s probably somewhat back-burnered by the others who are stronger voices in the Republican Party right now.

GAZETTE: How realistic is the idea that we can end transmission here in the U.S.?

ESSEX: It’s realistic.

Just as background, I’m on the UNAIDS advisory council. That was the group that initially proposed the 90-90-90 guidelines that recommend 90 percent of people who are HIV-positive in a given country should know they’re positive. Of those who are positive, 90 percent should be in treatment. And of those in treatment, 90 percent should be in complete viral suppression, meaning the treatment is working. And if the treatment is working, then they’re not infectious because virus levels in their body, including in reproductive tract fluids and blood, wouldn’t be infectious.

If, by 2020, the world is — or given countries are — in adherence with 90-90-90, then 10 years after that, by 2030, there should be a 90 percent reduction in new infections. That has been interpreted by some as meaning the end of the epidemic, but it’s not really the end.

That’s because the more cases that you successfully treat, the more HIV-positive people you’re keeping on drugs for a long time, maybe a lifetime. So, the total number of people who are infected goes up because they’re not dying.

That plan has worked best in countries that have had the highest rates of infection — in southern Africa: Botswana, Namibia, places like that — where the populations were ready to be tested and get treatment and everything else.

They’ve been doing extremely well and are already at 90-90-90. Probably in Botswana it’s 95-95-95.

GAZETTE: Really?

ESSEX: Yes. We published a paper two or three years ago saying Botswana was almost at 90-90-90. The bottom line is that in places like that, in Namibia for sure and to some degree in South Africa and Swaziland and Zimbabwe, new infections are decreasing very dramatically, much more so than in the U.S.

One of the reasons is probably because they’re generalized epidemics that affect a large fraction of adults. In the U.S., it’s an uneven epidemic that’s concentrated in certain populations and some of the poorest sections of big cities, like Washington, D.C., and Baltimore, where there’s high injection-drug use. It’s also in other communities, not necessarily the biggest cities, characterized by higher rates of hepatitis B and things that are associated with injection transmission, as well as cities that have high rates of gay-men transmission and poverty-related transmission.

It’s logical the CDC would focus in on [those hot spots] because the CDC first gets the information through surveillance. They know which populations are most infected geographically, behaviorally, and otherwise. So, they are the most logical ones to draw up a plan that says we’re going to concentrate our resources for testing and “treatment as prevention” in those places where incidence is highest.

It remains to be determined how universally accepted the interventions will be by those communities.

GAZETTE: Is that the biggest hurdle? Community acceptance?

ESSEX: I think the biggest hurdle is participation by many in the highest-risk groups. That’s especially true in those places and for those subpopulations who’ve been most marginalized and outside of public health programs, like injection drug users who haven’t been exposed to clean needle exchanges and programs like that.

That’s going to be very uneven, according to different state [programs] and local stigma and things like that. It will take a fairly involved analysis and a lot of education of the local political establishment, as well as of the population at risk.

GAZETTE: And do you have a sense that the folks at the CDC and Health and Human Services and whoever else might be involved can pull it off?

ESSEX: Redfield is certainly very knowledgeable, appreciates the magnitude of the problem, and knows what to do. But the extent to which he’ll get cooperation from local and regional politicians in places where there’s still a lot of stigma and discrimination, whether it’s based on sexual orientation or injection-drug use or whatever else, is not as clear to me.

I think that’s a much bigger hurdle for places like the U.S. and other somewhat developed countries of the world as opposed to places like southern Africa, where it was a generalized epidemic early on.

GAZETTE: That’s an interesting distinction you’re making. It sounds like the characteristic of the epidemic in southern Africa that made it such an existential threat — that most of the transmission was heterosexual and it was in the general population — has also made these prevention measures easier and more acceptable to the general population there. Here, antiretrovirals came in right away and the epidemic flirted with crossing into the general population, but we managed to beat it back, and the fear of AIDS has kind of receded. Is that success in some ways working against us in these last phases?

ESSEX: Yes, though I’m not sure a lot of injection-drug users who are at higher risk have quite the same issues.

But for example, younger gay men, some of whom may be fairly sophisticated and recognize that now, going on modern, three-drug regimens with drugs like Dolutegravir — which doesn’t generate drug resistance and is easily tolerated — is not hugely different from going on drugs for hypertension, in the context of taking drugs on a regular basis for the rest of your life, and not having huge side effects from them.

GAZETTE: You’ve been involved with this epidemic from the start. Did you think you’d get to a point where we’d be talking about the end of transmission — clearly a critical milestone — without a vaccine?

Toward an AIDS-free generation

Researchers, ethicists wrestle with how to run a large study that could show effectiveness of ‘treatment as prevention’

ESSEX: It depends on the timeframe in which you’re asking the question. In the 1980s or early 1990s, I would have said our only hope is a vaccine. There’s no chance we’ll get ahead of this with drugs.

If it was in the early 2000s, before 2008 or 2010, I would say drugs are showing an awful lot of promise and the more people who are on them the fewer people who are going to get infected.

But if it was five to 10 years ago, I would say it’s really looking very promising that drugs will be the answer and a vaccine isn’t even needed. Further, I’d probably say that it wouldn’t be possible to do efficacy trials on a vaccine in a conventional way [which would require control subjects to forego known, effective treatment, like PrEP (pre-exposure prophylaxis)].

The change has been a combination of how well treatment-as-prevention is working to decrease transmission, and how well PrEP is working on high-risk groups who aren’t yet infected but are such high risk that drugs might prevent infection.

I think those things, to those of us in the business, were apparent years before they were apparent even to the general health establishment.

GAZETTE: You conducted trials on treatment-as-prevention — which aims to not only keep a person well, but also reduce their viral load to the point they’re not infectious, right?

ESSEX: Beginning by about 2010. We’re getting answers to these questions and they’re clearly affirmative.

It’s apparent to everyone now that you can do tremendous things with drugs. Even more than that, I would say the biggest change — that I wouldn’t have expected — is how well some of the drugs work. They don’t generate drug resistance because they’re well-tolerated, so people have no reason not to take them on a regular basis.

GAZETTE: So, we have good drugs. We have a strategy to slowly strangle the epidemic as opposed to killing it quickly with a vaccine, and here we are?

ESSEX: Yes. There was a timeframe where [many thought] such drug approaches wouldn’t work because the drugs were so expensive. Twenty years ago, some of us were saying, “Yeah, I don’t know how on earth they’ll ever be cheap enough or available enough for widespread use treating people at low-income sites.”

GAZETTE: I remember that narrative. What happened to it? Did the price come down? Or did more money, from PEPFAR, the Clinton Foundation, and other sources, just become available?

ESSEX: It was all of the above. The Clinton Foundation played a big role in that, for sure. And yet, making generics in India and a few other places played a big role in it too. And developing drugs that didn’t generate drug resistance, like Dolutegravir, played a big role. Now Dolutegravir is being used in Africa. For the future, newer slow-release formulations of such drugs will also be very important.

So it was all of the above. Some things more than others, but it’s been quite a ride.



Championing Choice & Safety: A Womxn’s World in Three Parts on IWD

International Women’s Day Event ‘Championing Choice & Safety: A Womxn’s World in Three Parts’. Options for Sexual Health and Battered Women Support Services are pleased to partner in the presentation and world premiere of the series ‘Her Story (In Three Parts), a short film anthology by local writer/director/actor Camille Hollett-French.

Our two organizations have chosen to work together on this project to advance the conversation of the value of choice and safety in the world of all women. These films explore issues of abortion, incarceration and sexual violence through the eyes of three young women in Vancouver, Toronto and Montreal.

Moderated by journalist Charmaine De Silva, the event aims to centre women’s resilience and the role that community supports and services can play in creating safety through choice. Dialogue panels after each film will allow for challenging conversations to be elevated by subject-matter experts and folks with lived experiences.

The evening will be held at the Djavad Mofwfaghian Theatre at the SFU Goldcorp Centre for the Arts in Vancouver. The event runs 7-9 PM, doors open at 6:15 PM. Tickets are a sliding scale of $5 – $15. We invite attendees to pay what they can.

There is also an after party meet-and-greet with cast from 9:30-11:00 PM. (additional purchase)   Please share this with all the feminists you know!

Get your tickets: for general admission, sliding scale ($5 – $15); for after party, a minimum  $25

For more information on the films, please visit


Championing Choice & Safety: A Womxn’s World in Three Parts on IWD

Black women and HIV: Oral history reveals their pain, disenfranchisement and endurance

Sophia Harrison has lived with epilepsy, breast cancer and HIV and is surviving all three, according to the Conversation. (Aamir Khuller)

Some 7,500 women were diagnosed with HIV in 2016 and the majority of them — 61 percent, according to the Centers for Disease Control and Prevention — were black. HIV is just one of the health challenges, including breast cancer, diabetes and heart disease, that affects black women more often than women of other races.

Thurka Sangaramoorthy, an HIV researcher and anthropologist, uses oral histories to learn more about the lives of black women living with HIV. In the past five years, the associate professor of anthropology at the University of Maryland has conducted ethnographic and oral history interviews with 45 women.

A recent article in the Conversation highlights that work and the stories of women such as Marcella Wright, who participated in one of the earliest treatment programs for HIV.

She’s not alone. The women Sangaramoorthy interviews tell stories of stigma and survival. “HIV for African-American women has never been a single issue, separate from histories of addiction, trauma and poverty,” she writes. Today, about 140,000 black women live with HIV.

Like other women living with HIV, the women Sangaramoorthy interviewed contracted the virus from intravenous drug use or sex with HIV-positive partners. Mortality rates among people with HIV have been declining for years, thanks to new medications and a better understanding of HIV/AIDS. But late diagnosis and social and health concerns unique to black women in the United States can make it harder for them to manage the disease.

The stories she collects are each unique — and worth hearing.

By Erin Blakemore