Adam Bink

How you can help end the HIV epidemic

Filed By Adam Bink | May 18, 2010 8:00 PM | comments

Filed in: Living
Tags: HIV infection rate, HIV vaccine, HIV Vaccine Awareness Day, HIV vaccine research, HIV/AIDS

And no, this doesn't have to do with condoms or getting tested.

Today is HIV Vaccine Awareness Day, so I have to take a moment to get personal on you.

I'm in the middle of reading And The Band Played On by Randy Shilts, one of the first major books on the HIV/AIDS epidemic. It's about the system failure of institutions and communities - the government, the medical community, the gay community - to respond to a rising epidemic. It is set in the early 1980s when the infection was spreading like wildfire. Since then, treatment has become available and we've made great strides in treating individuals living with HIV/AIDS.

And yet we are losing. Today, for every person that begins treatment for HIV infection, 2-3 more people become newly infected. History has shown us that no major epidemic has ever been successfully controlled without a vaccine. Which brings me to today.

Many of us take vaccines for granted. We've just achieved a cervical cancer vaccine. Every winter, everyone flocks to get a flu vaccine to the degree that there's always a shortage. Every child gets an MMR vaccine. Hepatitis B. Polio. On and on and on. People know how critical vaccines are. What seems to be be unknown is that these vaccines do not come out of thin air. They come from people volunteering to help develop them so that the rest of our country, and the world, can live longer.

And that's where you come in.

Nearly three years ago I participated in an HIV vaccine trial through the National Institutes of Health. It wasn't difficult - when I had a visit (I had a total of about a dozen), I hopped on the DC Metro a couple of stops to the NIH campus on the Red Line. I did a few visits of background medical counseling and routine blood tests, the same you would get at a yearly check-up with your physician. The vaccine was given in separate doses- all with careful monitoring of symptoms. The extremely courteous, friendly, professional medical staff called regularly to check up and make sure I was okay. I was given a chart to monitor any reaction I had, which was none. The follow-up visits consisted of simple blood tests and inquiries on any symptoms. It was a simple series of medical visits, and I was generously compensated for my time. In fact, I found the experience so rewarding I'm back participating in an avian flu vaccine trial right now.

And I've been tested multiple times since then and am still HIV-negative, as the trial vaccine cannot cause HIV infection. From the NIH website set up for volunteer intake (emphasis theirs):

Q: Can a study vaccine cause HIV infection?

It is impossible to get HIV infection or develop AIDS from experimental vaccines. They are not made from live HIV, killed HIV, weakened HIV, or HIV-infected cells. The investigational vaccines in this trial cannot cause HIV infection.

Now, I'll be the first to say I'm no expert on epidemics, and I know items like getting tested, combating stigma in the African-American community, and condom use are important. But finding a vaccine is also critical. Late last year, with the participation of more than 16,000 volunteers, Thai researchers made a breakthrough in finding that volunteers who received a combination HIV vaccine were 31% less likely to become infected. It's modest progress, but it's a start, and it made headlines around the world for a reason. I've checked back on progress at the National Institutes of Health, where I volunteered, and the products they are working on have also made headway. We are closer than ever.

But the vaccines you've received don't make themselves, and an HIV vaccine won't either. That's where you come in.

If you are a man who has sex with men, between the ages of 18-45 and HIV negative (along with some additional requirements), please consider volunteering. You can call 1-866-411-1010, e-mail vaccines@nih.gov or go to www.HopeTakesAction.org. Ongoing trials are enrolling right now. There is no risk of infection from the vaccine and you will be (generously, in my view) compensated for your time. And there are trial clinics all over the country.

If you aren't, you can still help by passing along the information to family, friends and colleagues who are. Think of people you know who might be interested. You can also post it on social networking websites. Please take a minute.

No matter if you're eligible to volunteer or not, there's something you can do to help end the HIV epidemic. We will never get eradicate these diseases if we don't and step up individually. Lots of people volunteered to make what are now routine vaccines to keep us healthy, and you can help do the same. Please, mark HIV Vaccine Awareness Day by taking a giant step forward towards a cure.

Cross-posted at my home blog, OpenLeft.com, where I write and organize on LGBT issues.


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A. J. Lopp | May 19, 2010 12:43 AM

First, Adam, let me state emphatically that I join you in your encouragement of people to participate in HIV vaccine studies.

You make it clear that the vaccine cannot result in HIV infection. Good. But another question also needs to be covered: Is it possible that the vaccine might cause you to test falsely positive on any of several common HIV antibody tests? Since vaccines cause the body to produce related antibodies, this might seem like a reasonable question to anyone who isn't an expert immunologist.

My understanding of the science is that the antibody that is targeted in HIV-antibody tests is a non-protective antibody, so if a vaccine happened to activate that antibody, there would still be no immunological protection --- thus, there is no reason for the scientists to want a vaccine to produce that particular antibody. At most, the vaccine might cause the body to produce a test-targeted antibody only as a secondary consequence to the vaccine causing one or more other antibodies to be produced --- hopefully at least one of which will confer the actual protection against HIV that is the purpose of the vaccine in the first place.

That's my take on it --- but no one should make such important decisions based on armchair scientific speculation such as mine above --- and the question can really be answered only by the scientists designing any particular candidate vaccine.

So what's the answer to that question? Or can the answer vary from one candidate vaccine to another?

That's a good question. Yes, it is possible for a vaccine to elicit a false-positive result- although that does not happen to everyone, and further tests would demonstrate a negative result. From the Seattle clinic FAQ's:

The most common test for HIV is an antibody test. Antibodies are proteins in the blood, made by your body to try to defend itself against infection. If you receive an HIV vaccine, you could develop antibodies to the vaccine, so your HIV test could turn up antibody positive even though you are not infected. This is called a “false positive test.” The false positive test does NOT happen to everyone who receives a vaccine. It also does not mean you are infected. There are other tests for HIV that can prove that you do not have HIV and we would do these tests in our clinic to help you avoid any problems or misunderstandings from testing false positive. There is no possible way that anyone can contract HIV or AIDS from the vaccine.

Question:

How do they know if the vaccine is working if they don't infect you with HIV? I mean, how do they know it's effective?

Another good question. There are several "Phases" in a trial. Phase 1- the one I was in for a particular type of vaccine- was a safety study. They are closely monitoring reactions. Phase 2 is an efficacy study- is the vaccine effective? So trial volunteers may be grouped into one of several phases. And some volunteers receive placebos, not a vaccine.

To get to the thrust of your question, the study vaccines test the immune system to find which vaccine is most likely to help the body fight HIV. I don't completely understand the chemistry behind it, but it's essentially poking the immune system with a product similar to HIV to see how the immune system responds.

There's some more details here on what one of the DC trial vaccine contains, chemistry-wise.

A. J. Lopp | May 19, 2010 10:39 AM

Thanks, Adam, for both responses.

@Bil: Of course it would be unethical to deliberately expose people to HIV. However, I gather that when the scientists have a candidate vaccine that gives every preliminary sign like it is working or may work, eventually it would be given to a very large number of sexually active volunteers. Even in a population that tries to practice safe sex, there is a known conversion rate --- unfortunately, people do occasionally slip up, sometimes they take risks they shouldn't ... gay men know this story all too well.

Somewhere in this process, if the vaccine is having a worthwhile effect, a difference in infection rates will emerge between people receiving the vaccine and the "natural" infection rate of the general public --- and it is only then that the scientists will know for sure that they have an effective vaccine.

(Adam, feel free to correct me if I have any of this wrong.)

I can't actually speak to a lot of that science, I would just have a note of caution on it. Science may be advanced beyond what we think it may be from our "armchairs" as you put it!

The best thing to do with such a question would be to reach out to vaccine researchers themselves at hopetakesaction.org or e-mail vaccines@nih.gov.

That's basically what the Thai study did, although they had a control group that got a saline solution. In the group getting the vaccine, something like 54 people seroconverted (if I remember the data correctly), and in the control group it was something like 75. Which, for the size of their sample, had a p-value just under .05. I should look this up to make sure my numbers are ok....

http://www.nature.com/news/2009/091021/full/news.2009.1035.html

The teams analysed infection rates in three ways. One, denoted 'intention-to-treat' (ITT), included the full cohort of 16,402 people. This analysis found that 56 of those in the vaccine group became infected, which was 20 people — or 26% — fewer than in the control group. That difference was not statistically significant.

Another analysis, called 'per protocol', excluded 3,860 people who failed to strictly adhere to the trial protocols, such as the calendar of vaccinations. This also showed a difference of 26%, again not statistically significant.

A third analysis — the only one to be presented on 24 September before publication of the full data — used a 'modified ITT' data crunch, which excluded seven participants who contracted HIV between the time they enrolled in the trial and their first vaccination. This lowered the number of people who became infected in the vaccine group from 56 to 51, and the number in the control group from 76 to 74, yielding a 31% difference between the groups. This just scraped into statistical significance, with a p-value of 0.04.

Either way it looks like there's still some work to be done here.

A. J. Lopp | May 20, 2010 11:27 AM

Thanks for the interesting info, Alex.

Although scientists are in love with doing double-blind studies because their peers will criticize them if they don't, I personally think that giving someone a saline solution and suggesting "This might be an effective vaccine" carries ethical questions of its own. Some might use that notion to justify sexual risks they might not take otherwise.

But I don't have a PhD so who cares what I think?