Europe has seen a rise in undiagnosed HIV infections — the World Health Organization (WHO) and European Center for Disease Prevention and Control (ECDC) reported that between at least 2018 to 2021, there have been more HIV infections than diagnoses.
The full report showed that testing rates fell during the COVID-19 pandemic and has hindered progress toward eliminating new HIV transmissions by 2030.
“We should all be deeply concerned by the data on HIV testing, treatment and care in Europe and Central Asia,” said Dr. Hans Henri P. Kluge, WHO Regional Director for Europe. “Continuing, widespread stigma around HIV is deterring people from getting tested and is steering us dangerously off course from meeting our 2030 goal of ending AIDS.”
A model used to predict the estimated number of infections and comparing that to testing data from 46 of the 53 countries in the WHO’s European region estimated that one in eight people living with HIV in those regions remain undiagnosed.
A disruption in testing and treatment matter. The longer the time period between infection and diagnosis, the higher the probability of death or severe illness. Additionally, it raises the risk of unknowingly passing on the virus to other partners.
The report further discusses the overstretched resources during the pandemic, which ultimately led to many countries struggling to test and report new infections during the pandemic. Under-diagnosis and under-reporting make late HIV diagnosis a major challenge in the region.
Moving forward, new strategies are required to improve early diagnosis. Expanding diversified and user-friendly approaches to HIV testing is thought to help make more people aware of their infection.
World AIDS Day. For most, it is a global event where we honor, memorialize, and celebrate the lives of those we have lost to HIV and AIDS since the pandemic began in 1981. For me it is so much more.
During those early years of the AIDS pandemic, many of us long-term survivors experienced nothing short of a catastrophic loss of life–losing friend, after lover, after friend, after lover, after friend within a very short period of time. At the height of the AIDS pandemic, there were many of us who were attending an average of four memorials a week, in some cases, six or more.
Psychologists call what we experienced “compounded grief,” something that can occur during and after a mass casualty event such as war or natural disaster. Entire communities were affected, and like other events that result in mass casualties, collective grief manifested. We felt powerless to control the crisis consuming us.
Years later, we feel anticipatory grief. We are scarred by our pasts, seeing the loss around us and the problems not yet fixed as we confront new pandemics (Covid-19, MPX) and crises.
What can we do to heal?
I’ve found comfort in these four steps, and I make sure to incorporate them into every day of commemoration, including World AIDS Day. They are: Acknowledge, Memorialize, Take a Break, and Take Action.
Last year, on December 1, 2022, I took a break from my daily life to focus on the grief that I normally tend to push down. This is normally an act of self-preservation: I push my grief away so that I can function. Most days, if I dwell on my grief, it would overwhelm and consume my very soul. On World AIDS Day, I let my emotions surface.
The day began with Inscribe. Created by George Kelly, in 2016, Inscribe began as a way to teach the students at the Harvey Milk Civil Rights Academy about those early days of the AIDS pandemic. As a community–students, parents, teachers, neighbors, merchants, tourists, and community leaders–we inscribe the names of those we have lost along two full blocks of Castro Street sidewalks using chalk. By the end of the day, the sidewalks along Castro Street are a patchwork of chalk art, reminiscent of The AIDS Memorial Quilt. It is a powerful act of acknowledgement and a way to memorialize those we have lost.
The display–and the collective act of remembrance–brought tears to my eyes.
Later that day, closer to sunset, we held a Vigil1 on the steps of San Francisco City Hall, where we acknowledged the contributions of civic leaders and others, past and present who were essential in the creation the service and safety network that San Francisco sets as the standard of care for those living with and at risk for HIV.
Then we marched. Just like we did those early days we held candles in one hand and protest signs in the other. Reminding people that HIV and AIDS is not over.
By marching from the steps of City Hall to the steps of St. John the Evangelist Church, we reminded people that there are still 16,000 people in San Francisco living with HIV and that over seventy percent of them are over the age of fifty. We were led by Ms. Billie Cooper, who reminded us that even forty years later, there are still disparities among communities including among trans and Black and brown communities. Dr. Monica Gandhi, from Ward 86, called upon us to refocus our efforts on ending the HIV epidemic, marched with us. And afterward…
…we DANCED!
Under a sky of Quilt panels hanging from the ceiling of the church–made up of panels of parishioners lost to AIDS–we celebrated and memorialized all who were lost.
Quilt panels on display at St. John the Evangelist Church, World AIDS Day, 2021. Photo: HIV Advocacy Network/SFAF.
We danced to the music made popular by the Sunday Tea Dances popular in the early years of AIDS. I danced to honor Jerry, my first friend who died. I danced to honor Vincent, the love of my life who I had buried, not even three months earlier on October 14, 2021, a day before his forty-sixth birthday. I danced to honor those who stuck by us and cared for us over the years. I danced to honor those who lost not one, not two, but three partners and yet still continued to fight alongside us. I danced to honor those young people who continue to fight on my behalf so that I may continue to have access to the services that I need.
I laughed. I cried. And I was healed just a little bit more than I had been a day before.
And that’s the thing. Each World AIDS Day, when I am able to join my friends, my colleagues, my peers and so many others of my community and take a break, acknowledge my loss, memorialize those losses and take action by marching or by dancing, I am healed a little bit more.
–
1This event was thanks to the combined efforts of Ande Stone and the other members from the HIV Advocacy Network, Gregg Cassin from the Honoring Our Experience group at Shanti, John Cunningham, Joanie Juster and Michael Bongiorni from the AIDS Memorial & Quilt, the folx at Black Brothers Esteem and TransLife with the help from some good friends at City Hall and the Reverend Kevin Deal and the parishioners at the Episcopal Church of St. John the Evangelist, and Dr. Monica Gandhi, from Ward 86.
Today is an opportunity for people worldwide to unite in the fight against HIV, to show support for people living with HIV, and to commemorate those who have died from an AIDS-related illness. Since 1983 Face to Face has been on the forefront of the AIDS crisis in Sonoma County. As we head into our 40th year we are reminded not only of those that we lost to HIV/AIDS but to all those living with HIV in our community. It is our mission to end new cases of HIV while supporting the health and well-being of those living with HIV/AIDS. Our Prevention program performed 678 HIV tests in 2022 alone while our Harm Reduction program has provided 840,000 Syringes to those in need while reversing 3,200 overdoses by supplying people with Naloxone. Our Care Services team has assisted 180 clients with financial assistance, case management, legal and medical advocacy support with 112 clients receiving housing benefit services. Today we take a moment to remember those lives lost and to all those that our team gets to help each and every day by being on the forefront here in Sonoma. Our work is not finished.
Treating HIV symptoms in “clusters” could help improve a patient’s overall quality of life, according to a study presented at the Association of Nurses in AIDS Care 2022 annual meeting.
The evidence, according to Medscape, showed that the four main symptom clusters for HIV include pain, body psychological, gastrointestinal, and body image. These symptoms were also more common in HIV-positive people older than 45.
Natalie Wilson, PhD, assistant professor of community health systems at the UCSF School of Nursing, and a group of colleagues performed a study that also suggested that the elderly population experienced more distress from their symptoms, with the exception of anxiety.
“The symptom burden is still high in people living with HIV,” said Wilson. “The medications got better but the symptoms remain.”
Higher symptom burdens are also linked to a lower adherence to antiretrovirals. Treating groups of symptoms together could lead to targeted interventions, Wilson said, “instead of treating one symptom at a time and increasing the pill burden for people living with HIV.”
In the full study, previously published in The Journal of Pain and Symptom Management, 2,000 HIV-positive participants completed the 20-item HIV Symptom Index. They then reported their symptoms on their first visit to one of six national HIV Centers of Excellence, rating the presence of the symptom from 1 (doesn’t bother me) to 4 (bothers me a lot.)
The younger population reported more anxiety and were more distressed by it, where the older generation found stressors caused more by muscle aches and joint pain.
While this initial study paves way for further studies over time, the current findings have raised some important questions. One of the more important findings in the study was the accelerating aging process HIV-positive patients experienced.
Cheryl Netherly, an HIV nurse and clinical educator for CAN Community Health, said that people living with HIV and dying from age-related comorbidities is something “we never thought would happen. Unfortunately, now we’re losing them to the different things like kidney issues, heart disease, and diabetes.”
After a successful effort earlier this year to ease longstanding restrictions on service members living with HIV, LGBTQ rights advocates are now pushing for more change. They want to end the U.S. military’s decades-old policy of barring people with HIV from enlisting.
LGBTQ advocacy group Lambda Legal filed a federal lawsuitThursday on behalf of three individuals living with HIV: Isaiah Wilkins, a gay police officer in Georgia; a transgender lesbian woman who left the military in 2013 to transition and a straight woman who had dreams of becoming a parachute rigger. (The women are identified in the lawsuit with pseudonyms because they fear further discrimination, according to Lambda Legal.) Minority Veterans of America, a minority-serving organization for current and former service members, is also named as a plaintiff in the suit, which lists Defense Secretary Lloyd Austin and Army Secretary Christine Wormuth as defendants.
Isaiah Wilkins, 23, tested positive for HIV while trying to join the Army Reserves.Lambda Legal
The lawsuit describes the ban on HIV-positive recruits as “incompatible” with modern medical advancements. The policy, the suit notes, has been in place since 1991 — years before the development of groundbreaking medical innovations that eventually transformedHIV from a death sentence into a mostly nontransmittable, manageable condition, with early detection and the right treatment.
Because of medical breakthroughs over the past decades, a 25-year-old living with HIV who is diagnosed early and receives appropriate treatment has approximately the same life expectancy as a 25-year-old living without HIV, the lawsuit says. A study published in 2014 in the Journal of the International AIDS Society found HIV patients who are successfully treated with antiretroviral therapy have normal life expectancies.
Thursday’s lawsuit, filed in U.S. District Court for the Eastern District of Virginia, follows Lambda Legal’s landmark victory in April, decided by the same court, that requires the Pentagon to now allow HIV-positive service members to be promoted and to deploy overseas.
Before the court ruling, U.S. military policy was to place restrictions on service members if they were diagnosed with HIV after they had successfully enlisted. In a memo to military leadership in early June, Austin eased the restrictions on those currently serving, but he didn’t address the policy that banned HIV-positive recruits.
Kara Ingelhart, a senior attorney at Lambda Legal representing the plaintiffs, called the April ruling “incredibly clear.”
“There should be no barrier for folks like Isaiah who want to serve,” she said, referring to the Georgia police officer.
Discriminating against people based on their HIV status has been illegal in the U.S. for every employer other than the U.S. military since the passage of the Americans with Disabilities Act of 1990.
“I think that there’s still just a ton of stigma around HIV,” Ingelhart said. “The military could really set an example for equity and inclusion.”
Wilkins, 23, served in the Georgia National Guard for more than two years. He tested positive for HIV while trying to join the Army Reserves as part of the application process for the United States Military Academy at West Point and was discharged from the Army Reserves in 2019. He called the discharge traumatic, and he said his long-held goal of becoming an Army pilot was “cut off” solely because of his HIV status.
The policy “really does discriminate against people who not only have the ability but the desire to serve,” he said.
NBC News reported in June that every branch of the U.S. military has experienced major challenges in meeting its recruitment quotas this year, as a record low number of Americans are eligible to serve because of increasing health- and crime-related disqualifications — and an even smaller number of them want to.
A Defense Department spokesperson declined to comment on the ongoing litigation. The United States Army did not immediately respond to a request for comment.
Pennsylvania’s Gov. Tom Wolf (D) just signed a new law that makes it a felony to pass on a communicable disease when they “should have known” that they had it, the HIV Justice Network reported.
Opponents of the law worry it will be used to punish people with HIV or other STDs who unknowingly transmit it to sexual partners. Such HIV criminalization laws have disproportionately been used to target Black men and other men of color.
While the offense, a third-degree felony, has to be “intentional,” one could see an arrestee being charged with it if they accidentally spit onto an officer while talking or bleed onto an officer during a violent arrest.
The law also charges people with a second-degree felony if they knew or “should have known” that they had a communicable disease after transmitting it to someone else. The offense is punishable by up to 10 years in prison and $25,000 in fines.
This not only would apply to anyone who transmits HIV; it could also apply to people who unintentionally transmit hepatitis, influenza, chickenpox, and COVID-19.
The bill has been opposed by the Elizabeth Taylor AIDS Foundation, the Anti-defamation League of Pennsylvania, the American Civil Liberties Union of Pennsylvania, the Pennsylvania HIV Justice Alliance, the Positive Women’s Network-USA, the Sero Project, the AIDS Law Project of Pennsylvania, Advocates for Youth, and many other groups.
“As a person living with HIV who was born and raised in Pennsylvania, the passing of HB 103 serves as a reminder that as we get closer to ending the HIV epidemic, we have a long way to go to end HIV stigma and the criminalization of people living with HIV,” said Louie Ortiz-Fonseca, Director of LGBTQ Health & Rights with Advocates for Youth.
Medical professionals have said that HIV criminalization laws do nothing to stop the spread of the virus and may even encourage people not to get tested for fear that the knowledge could subject them to criminal penalties.
A 2018 Williams Institute study on HIV criminalization in Georgia found that “Black men and Black women were more likely to be arrested for HIV-related offenses than their white counterparts.” While 26 percent of HIV-related arrests were of white males, 46 percent of HIV-related arrests were of Black males. Additionally, 11 percent of those arrested were white females, while 16 percent were Black females.
As of 2022, 35 states have laws that criminalize HIV exposure, according to the Centers for Disease Control and Prevention (CDC). Many of the laws were passed at a time when little was known about HIV and millions were dying from the virus.
“Many of these state laws criminalize actions that cannot transmit HIV – such as biting or spitting – and apply regardless of actual transmission, or intent,” the CDC wrote. “After more than 40 years of HIV research and significant biomedical advancements to treat and prevent HIV transmission, many state laws are now outdated and do not reflect our current understanding of HIV.”
A recent study from the Centers for Disease Control and Prevention (CDC) has found that monkeypox disproportionately affects people with HIV and sexually transmitted infections (STIs).
The study looked at HIV and STI rates among 1,969 people with monkeypox in eight U.S. jurisdictions.
Of that sample, 38 percent of people with monkeypox had also contracted HIV in the last year. About 41 percent of people with monkeypox also had an STI in the preceding year. About 61 percent of the sample had contracted either an STI or HIV in the previous year.
Researchers said this correlation doesn’t necessarily mean that having HIV or an STI means you’re more likely to contract monkeypox.
In fact, the higher number may be due to a “self-referral bias,” meaning that people who visited a medical professional due to monkeypox symptoms may also already have established healthcare for HIV and STIs. Either that, or sexual health providers may be more likely to recognize and test for the monkeypox virus among men who’ve had HIV and STIs over the past year.
“Persons with monkeypox signs and symptoms who are not engaged in routine HIV or sexual health care, or who experience milder signs and symptoms, might be less likely to have their Monkeypox virus infection diagnosed,” researchers wrote.
HIV-positive people in the study sample were also twice as likely to be hospitalized due to monkeypox compared to HIV-negative people with monkeypox, WTTW reported.
This could mean that people with compromised immune systems — the kinds associated with advanced and under-treated forms of HIV — are more likely to exhibit severe monkeypox symptoms. Despite this, people with HIV aren’t more likely to exhibit worse monkeypox symptoms than HIV-negative people in the general population, according to Dr. Aniruddha Hazra, assistant professor of infectious disease and global health at UChicago Medicine.
The study also found HIV was more prevalent among Black and Latino people with monkeypox, with rates of 63 percent and 41 percent, respectively. These rates were higher than the 28 percent of white people and 22 percent of Asian people who have both HIV and monkeypox.
These racial disparities are particularly concerning considering that numerous studies have shown that Black and Latino men are less likely than white men to be vaccinated against monkeypox and to have access to HIV-related medical care.
In response to the study’s findings, the CDC recommended that medical professionals prioritize people with STIs and HIV for monkeypox vaccination. Additionally, the CDC recommended offering STI and HIV screenings for people who are evaluated for monkeypox.
This last week, White House health officials voiced their belief that “we’re going to get very close” to eradicating monkeypox. As of September 23, there were 24,846 total confirmed monkeypox cases in the United States, the CDC reported.
Two new cases presented Wednesday at the International AIDS Conference in Montreal have advanced the field of HIV cure science, demonstrating yet again that ridding the body of all copies of viable virus is indeed possible, and that prompting lasting viral remission also might be attainable.
In one case, scientists reported that a 66-year-old American man with HIV has possibly been cured of the virus through a stem cell transplant to treat blood cancer. The approach — which has demonstrated success or apparent success in four other cases — uses stem cells from a donor with a specific rare genetic abnormality that gives rise to immune cells naturally resistant to the virus.
In another case, Spanish researchers determined that a woman who received an immune-boosting regimen in 2006 is in a state of what they characterize as viral remission, meaning she still harbors viable HIV but her immune system has controlled the virus’s replication for over 15 years.
Experts stress, however, that it is not ethical to attempt to cure HIV through a stem cell transplant — a highly toxic and potentially fatal treatment — in anyone who is not already facing a potentially fatal blood cancer or other health condition that would make them a candidate for such a treatment.
“While a transplant is not an option for most people with HIV, these cases are still interesting, still inspiring and illuminate the search for a cure,” Dr. Sharon Lewin, an infectious disease specialist at the Peter Doherty Institute for Infection and Immunity at the University of Melbourne, told reporters on a call last week ahead of the conference.
There are also no guarantees of success through the stem cell transplant method. Researchers have failed to cure HIV using this approach in a slew of other people with the virus.
Nor is it clear that the immune-enhancing approach used in the Spanish patient will work in additional people with HIV. The scientists involved in that case told NBC News that much more research is needed to understand why the therapy appears to have worked so well in the woman — it failed in all participants in the clinical trial but her — and how to identify others in whom it might have a similar impact. They are trying to determine, for example, if specific facets of her genetics might favor a viral remission from the treatment and whether they could identify such a genetic profile in other people.
The ultimate goal of the HIV cure research field is to develop safe, effective, tolerable and, importantly, scalable therapies that could be made available to wide swaths of the global HIV population of some 38 million people. Experts in the field tend to think in terms of decades rather than years when hoping to achieve such a goal against a foe as complex as this virus.
The new cure case
Diagnosed with HIV in 1988, the man who received the stem cell transplant is both the oldest person to date — 63 years old at the time of the treatment — and the one living with HIV for the longest to achieve an apparent success from a stem cell transplant cure treatment.
The white male — dubbed the “City of Hope patient” after the Los Angeles cancer center where he received his transplant 3½ years ago — has been off of antiretroviral treatment for HIV for 17 months.
“We monitored him very closely, and to date we cannot find any evidence of HIV replicating in his system,” said Dr. Jana Dickter, an associate clinical professor in the Division of Infectious Diseases at City of Hope. Dickter is on the patient’s treatment team and presented his case at this week’s conference.
This means the man has experienced no viral rebound. And even through ultra-sensitive tests, including biopsies of the man’s intestines, researchers couldn’t find any signs of viable virus.
The man was at one time diagnosed with AIDS, meaning his immune system was critically suppressed. After taking some of the early antiretroviral therapies, such as AZT, that were once prescribed as individual agents and failed to treat HIV effectively, the man started a highly effective combination antiretroviral treatment in the 1990s.
In 2018, the man was diagnosed with acute myeloid leukemia, or AML. Even when HIV is well treated, people with the virus are still at greater risk of a host of cancers that are associated with aging, including AML and other blood cancers. Thanks to effective HIV treatment, the population of people living with the virus in the U.S. is steadily aging;themajority of people diagnosed with HIV is now older than 50.
He was treated with chemotherapy to send his leukemia into remission prior to his transplant. Because of his older age, he received a reduced intensity chemotherapy to prepare him for his stem cell transplant — a modified therapy that older people with blood cancers are better able to tolerate and that reduces the potential for transplant-related complications.
Next, the man received the stem cell transplant from the donor with an HIV-resistant genetic abnormality. This abnormality is seen largely among people with northern European ancestry, occurring at a rate of about 1% among those native to the region.
According to Dr. Joseph Alvarnas, a City of Hope hematologist and a co-author of the report, the new immune system from the donor gradually overtook the old one — a typical phenomenon.
Some two years after the stem cell transplant, the man and his physicians decided to interrupt his antiretroviral treatment. He has remained apparently viable-virus free ever since. Nevertheless, the study authors intend to monitor him for longer and to conduct further tests before they are ready to declare that he is definitely cured.
The viral remission case
A second report presented at the Montreal conference detailed the case of a 59-year-old woman in Spain who is considered to be in a state of viral remission.
The woman was enrolled in a clinical trial in Barcelona in 2006 of people receiving standard antiretroviral treatment. She was randomized to also receive 11 months of four therapies meant to prime the immune system to better fight the virus, according to Núria Climent, a biologist at the University of Barcelona Hospital Clinic, who presented the findings.
Then Climent and the research team decided to take the woman off her antiretrovirals, per the study’s planned protocol. She has now maintained a fully suppressed viral load for over 15 years. Unlike the handful of people either cured or possibly cured by stem cell transplants, however, she still harbors virus that is capable of producing viable new copies of itself.
Her body has actually controlled the virus more efficiently with the passing years, according to Dr. Juan Ambrosioni, an HIV physician in the Barcelona clinic.
Ambrosioni, Climent and their collaborators said they waited so long to present this woman’s case because it wasn’t until more recently that technological advances have allowed them to peer deeply into her immune system and determine how it is controlling HIV on its own.
“It’s great to have such a gaze,” Ambrosioni said, noting that “the point is to understand what is going on and to see if this can be replicated in other people.”
In particular, it appears that what are known as her memory-like NK cells and CD8 gamma-delta T cells are leading this effective immunological army.
The research team noted that they do not believe that the woman would have controlled HIV on her own without the immune-boosting treatment, because the mechanisms by which her immune cells appear to control HIV are different from those seen in “elite controllers,” the approximately 1 in 200 people with HIV whose immune systems can greatly suppress the virus without treatment.
Lewin, of Australia’s Peter Doherty Institute, told reporters last week that it is still difficult to judge whether the immune-boosting treatment the woman received actually caused her state of remission. Much more research is needed to answer that question and to determine if others might also benefit from the therapy she received, she said.
Four decades of HIV, a handful of cures
Over four decades, just five people have been cured or possibly cured of HIV.
The virus remains so vexingly difficult to cure because shortly after entering the body it infects types of long-lived immune cells that enter a resting, or latent, state. Because antiretroviral treatment only attacks HIV when infected cells are actively churning out new viral copies, these resting cells, which are known collectively as the viral reservoir and can stay latent for years, remain under the radar of standard treatment. These cells can return to an active state at any time. So if antiretrovirals are interrupted, they can quickly repopulate the body with virus.
The first person cured of HIV was the American Timothy Ray Brown, who, like the City of Hope patient, was diagnosed with AML. His case was announced in 2008 and then published in 2009. Two subsequent cases were announced at a conference in 2019, known as the Düsseldorf and London patients, who had AML and Hodgkin lymphoma, respectively. The London patient, Adam Castillejo, went public in 2020.
Compared with the City of Hope patient, Brown nearly died after the two rounds of full-dose chemotherapy and the full-body radiation he received. Both he and Castillejo had a devastating inflammatory reaction to their treatment called graft-versus-host disease.
Dr. Björn Jensen, of Düsseldorf University Hospital, the author of the German case study — one typically overlooked by HIV cure researchers and in media reports about cure science — said that with 44 months passed since his patient has been viral rebound-free and off of antiretrovirals, the man is “almost definitely” cured.
“We are very confident there will be no rebound of HIV in the future,” said Jensen, who noted that he is in the process of getting the case study published in a peer-reviewed journal.
For the first time, University of Cambridge’s Ravindra Gupta, the author of the London case study stated, in an email to NBC News, that with nearly five years passed since Castillejo has been off of HIV treatment with no viral rebound, he is “definitely” cured.
In February, a research team announced the first case of a woman and the first in a person of mixed race possibly being cured of the virus through a stem cell transplant. The case of this woman, who had leukemia and is known as the New York patient, represented a substantial advance in the HIV cure field because she was treated with a cutting-edge technique that uses an additional transplant of umbilical cord blood prior to providing the transplant of adult stem cells.
The combination of the two transplants, the study authors told NBC News in February, helps compensate for both the adult and infant donors being less of a close genetic match with the recipient. What’s more, the infant donor pool is much easier than the adult pool to scan for the key HIV-resistance genetic abnormality. These factors, the authors of the woman’s case study said, likely expand the potential number of people with HIV who would qualify for this treatment to about 50 per year
Asked about the New York patient’s health status, Dr. Koen van Besien, of the stem cell transplant program at Weill Cornell Medicine and New York-Presbyterian in New York City, said, “She continues to do well without detectable HIV.”
Over the past two years, investigators have announced the cases oftwo women who are elite controllers of HIV and who have vanquished the virus entirely through natural immunity. They are considered likely cured.
Scientists have also reported several cases over the past decade of people who began antiretroviral treatment very soon after contracting HIV and after later discontinuing the medications have remained in a state of viral remission for years without experiencing viral rebound.
Speaking of the reaction of the City of Hope patient, who prefers to remain anonymous, to his new HIV status, Dickter said: “He’s thrilled. He’s really excited to be in that situation where he doesn’t have to take these medications. This has just been life-changing.”
The man has lived through several dramatically different eras of the HIV epidemic, she noted.
“In the early days of HIV, he saw many of his friends and loved ones get sick and ultimately die from the disease,” Dickter said. “He also experienced so much stigma at that time.”
As for her own feelings about the case, Dickter said, “As an infectious disease doctor, I’d always hoped to be able to tell my HIV patients that there’s no evidence of virus remaining in their system.”
The UCLA–Charles R. Drew University of Medicine and Science Center for AIDS Research has received a five-year, $11 million grant from the National Institutes of Health. A priority of the award is to fund research addressing health inequities that have fueled the spread of HIV in marginalized communities.
The Center for AIDS Research will strengthen and amplify the impact of ongoing research at both UCLA and Charles R. Drew University, as well as forming new partnerships with community groups across Los Angeles and in nations that are severely affected by HIV. Its aim is to prevent new HIV infections, reduce deaths among people who are living with HIV and develop strategies for eradicating HIV.
The partnership will be directed by Dr. Judith Currier, chief of the UCLA Division of Infectious Diseases; Dr. LaShonda Spencer, professor of clinical pediatrics and internal medicine at Charles R. Drew; and Jerome Zack, chair of the UCLA Department of Microbiology, Immunology and Molecular Genetics. The Center will support investigators at UCLA’s Westwood campus and affiliated sites including the Lundquist Institute at Harbor–UCLA Medical Center and the VA Greater Los Angeles Healthcare System, as well as Drew CARES, the MLK Oasis Clinic and the PUSH Coalition, a group of organizations involved in HIV services that are located on or near the Charles R. Drew campus.
“We are thrilled to have the opportunity to leverage the resources provided by the Center for AIDS Research to expand the support for HIV/AIDS research across Los Angeles and build new partnerships among investigators at all of the partner sites and communities most impacted by HIV,” Spencer said.
The partnership will support equity in health care in part because Charles R. Drew engages a primarily minority population — 80% of its students and 71% of faculty members are from communities of color — and its scholars are committed to health equity in underserved populations through education, research and clinical service. The partnership also will promote opportunities for early-stage investigators to learn from more experienced HIV researchers, and for senior faculty to learn from younger scholars about community-engaged research, as well as increasing diversity among HIV researchers.
The center’s four primary aims will be:
Provide scientific leadership and institutional infrastructure.
Mobilize and coordinate multidisciplinary, state-of-the-art research.
Develop the next generation of basic, behavioral and clinical scientists in the field of HIV/AIDS, with a focus on promoting diversity in HIV research.
Expand community-based research with populations that are disproportionately affected by HIV in Los Angeles and beyond.
The Defense Department has officially ended a 1980s-era policy that restricted HIV-positive service members from deploying overseas and being promoted into leadership and management positions.
The updated guidance officially took effect Monday, according to a memo addressed to military leadership from the office of Defense Secretary Lloyd Austin. A judge struck down the decades-old policy in early April.
U.S. District Judge Leonie Brinkema of Eastern Virginia found that the Pentagon’s classification of HIV as a chronic condition did not reflect modern scientific understandings of the virus.
In one of two orders, Brinkema banned the Pentagon from “separating or discharging” asymptomatic HIV-positive service members with undetectable viral loads solely because they have HIV.
The two cases involved three men who sued the military for discrimination based on their HIV statuses. One of the plaintiffs, Army National Guard Sgt. Nick Harrison, who was denied a promotion because of his HIV status, called the Pentagon’s reversal a “generally positive move,” but he said it came only after advocates were forced to resort to “kicking and screaming” in the court system.
“I would like to see them go further,” he said. “At this point, the decision is just basically doing what the judge told them to do. So there’s a lot more space for them to do more.”
Kara Ingelhart, a senior attorney at Lambda Legal, which represented the plaintiffs, said the move “makes perfect sense from a science-medical stigma standpoint but also a policy standpoint.”
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“The fact that the military, [which] is the largest employer in the world, not just the country, will no longer be able to treat, categorically, the service members living with HIV differently from others, it’s huge,” she said.
Since the Americans with Disabilities Act of 1990 passed, no employer other than the U.S. military has been legally permitted to discriminate against potential employees because they have HIV. But as noted in the memo Monday, the policy amendment does not change current Pentagon policy denying those with HIV from being able to enlist in the military.
According to the memo, current service members who display “laboratory evidence” of HIV infection will continue to be evaluated on a case-by-case basis, including access to “appropriate treatment” and medical evaluations of “fitness for continued service in the same manner as a Service member with other chronic or progressive illnesses.”
They will not, however, be discharged solely based on their HIV statuses. Military leaders will convene a working group to “develop proposed standards” for case-by-case evaluations, which will consider how long service members must display undetectable viral loads and be symptom-free, the memo says.
The Human Rights Campaign, the country’s largest LGBTQ advocacy group, has long called for the policy reversal, which it listed among 85 recommendations it sent to the incoming Biden administration in November 2020.
“Research has shown for years now that antiretroviral therapy is highly effective in shrinking the risk of HIV transmission to essentially zero,” David Stacy, the campaign’s government affairs director, said in a news release. “To maintain a discriminatory policy against service members living with HIV without the backing of medical evidence was unsustainable, and we’re glad to see our military leaders recognize that.”
Stacy added that the campaign will continue to “push for the same policy to be applied to those who want to enlist.”
“This week’s announcement was a good first step, but as long as some people are still being discriminated against for no good reason, there’s still work to be done,” he said.
