Behold POZ’s grandiose plan: how to squelch AIDS by 2014

On New Year’s Eve 1993, 220,000 Americans with AIDS had died, almost 30,000 that year alone. This New Year’s Eve, despite the development of lifesaving drugs, AIDS rages across the planet; here in the U.S. infection rates rise as the poor die on med waiting lists. What will the next 10 years bring? POZ submits its master plan to rescue the future: 10 ways to cripple—perhaps even eradicate—AIDS by New Year’s Eve 2013. Focusing on treatment, prevention, access and activism, our blueprint explains who’s leading the charge, what’s slowing them down and what you can do. Deliverance from HIV lies not with the FDA, the CDC, or the WHO. It lies with us.

1. Be Inhibited

Say what?
We want our entry inhibitors—a new class of drugs to keep HIV from ever penetrating a CD4 cell.


Tell me more...
Approved in 2003, injectable Fuzeon (T-20) may be the most expensive and inconvenient HIV drug ever, but it’s the first of an exciting new crop of entry inhibitors, or EIs. Best-case scenario? You’ll take them combo-style to stop HIV’s dirty work: hijacking—then replicating inside—your CD4 cells. The truly cool part? EIs could avoid the side effects of today’s drugs because they act before the virus cracks your CD4s. (Researchers think woes like lipo may spring from CD4 damage.) New EIs are still in way-early trials—but keep on the lookout for Progenics’ PRO 542 and Tanox’s TNX-355. In preliminary studies, both squashed viral load in HIVers for several weeks with only a single injected dose. Also watch for Schering’s SCH-C and Pfizer’s UK-427,857.


So what’s the holdup?
Dosing. Progenics’ Richard Krawiec, PhD, says of PRO 542 and other EIs, “We have to learn how to use them properly.” The hope is that we could take EIs just weekly or even monthly. Now, that would be freedom.


How can I help?
Follow the progress of EIs in POZ. As they enter large trials, “think about participating, if appropriate,” urges Dan Kuritzkes, MD, a doc at Boston’s Brigham and Women’s Hospital, who’s testing TNX-355. Call 1.800.TRIALS.A or visit www.aidsinfo.nih.gov, click “Clinical Trials” and search studies for the aforementioned EIs.

2. Run Interference

Say what?
RNA interference, a fledgling but promising gene therapy, would “reprogram” our immune cells—using bits of HIV’s own genetic material, called siRNA—and fool the virus into closing down its 24-hour copy shop.


Tell me more...
At a big-deal conference last year, John Rossi, PhD, of California’s City of Hope Medical Center, stirred the crowd by explaining how he had “silenced” HIV in human T cells put into lab mice: He’d infused those T cells with siRNAs. Rossi predicts he’ll start human trials within two years. “We’d reconstitute the immune system with virus-resistant cells,” he says. “At best, we’d eradicate the virus. At worst, you could use this when you’re on a drug holiday.” Harvard’s Judy Lieberman, MD, who’s used siRNAs to prevent hepatitis death in mice, envisions a “drug cocktail of different siRNAs.” No wonder that at Rossi’s presentation last year, half the room was skeptical (such claims have come and gone before) while the other half dared to murmur cure.


So what’s the holdup?
Finding a safe and effective way of slipping siRNA into patients. Rossi proposes transplanting siRNA-infused stem cells, saying he’s tested it safely in humans—sans the mega-drugs that nearly kill stem-cell recipients fighting, say, leukemia. “You might have a one- or two-night stay in a hospital,” Rossi adds. “But you may never need any other therapy again.”


How can I help?
Drop by www.coh.org for updates on Rossi’s research—or write him at jrossi@coh.org to volunteer for human trials.

3. Add Protein

Say what?
Move over Human Genome Project—hello, HIV Protein Project. The latter’s a proposed collaboration of the general-science brain trust to chart the intricate dance between HIV’s many tricky proteins and those of the body’s own cells.


Tell me more...
Tat. Rev. Env. Nef. Vif. They may sound like hobbits, but they’re actually some of the proteins that make up HIV. Today’s HIV meds are based on an understanding of how the virus’ proteins and human immune-cell proteins interact—HIV must first bind to our proteins as part of its invasion. Trouble is, we understand some protein activity better than others. “An HIV Protein Project could focus a lot of individual efforts” and help solve this jigsaw puzzle, says protein wonk Bob Huff, who edits GMHC’s venerable Treatment Issues newsletter. Ideally, the results could yield the “smart bomb” therapies and perhaps the vaccine we’ve been waiting for—and even unspool such side riddles as “why insulin secretion goes up in untreated HIV,” muses Huff.


So what’s the holdup?
No one wants to coordinate all those conference calls. “Who will lead the effort?” wonders research raja David Ho, MD, of the Aaron Diamond AIDS Research Center. “The NIH? A consortium of basic scientists?” At the very least, Huff thinks “someone should or will organize a conference” on the protein scene, which may fuel further efforts, solo or collective.


How can I help?
For an in-depth, idiot-proof lesson on HIV’s wily ways, search for “AIDS” on the home page of www.howstuffworks.com. And urge your congressmembers (find them at www.senate.gov or www.house.gov) to support basic-science HIV research. Tell them lives—voters’ lives—are at stake.

4. Immunize This

Say what?
Let’s turbocharge the effort to immunize the world’s neggies and, possibly, fortify the health of its positives.


Tell me more...
Nothing will stop the spread of HIV faster than a global vaccine. Last year, AIDSVAX, the first HIV shot to survive major trials, flopped big-time. But a handful of different vaccines are approaching their own trials, including a venture between pharma giants Merck and Aventis-Pasteur, and another from the UK’s International AIDS Vaccine Initiative (IAVI). While AIDSVAX aimed to stimulate virus-fighting antibodies, the new models hope to charge up your “killer” CD8 cells (or CTLs). “A combined antibody and CTL approach would be our best shot,” says IAVI founder and president Seth Berkley, MD. “No pun intended.”


So what’s the holdup?
“We need to figure out how to make neutralizing antibodies,” Berkley says. That’s because those antibodies would block the virus from reproducing within healthy CD4 cells. Next, adds the doc, we must tackle “how to make CTL vaccines as broad as possible across clades [global HIV subtypes].” Compared to the challenge of finding funding, the cutting-edge science may be the easy part. “None of the $22 billion the world committed this year to new HIV prevention went to vaccine research,” Berkley says. “We need to create a global movement for an AIDS vaccine. We don’t have to chain ourselves to doors, but we need that sense of urgency.”


How can I help?
Bone up and sign up at www.iavi.org or www.avac.org. And remember: Vaccine breakthroughs may also work therapeutically in HIVers—and shed major light on new HIV treatments.

5. Punish the Pols

Say what?
It’s time to replace Bush’s Christian right administration with politicians who support scientifically proven prevention programs.


Tell me more...
Clinton’s crew wouldn’t deliver essential needle-exchange funds, but compared to Dubya, Slick Willy was President Prevention. Bush’s bunch has tied millions of federal dollars to abstinence-only education, likely pressured the CDC to ax a longstanding endorsement of condoms as HIV blockers from its website, and threatened to pull funds from San Francisco’s Stop AIDS Project and other organizations that address gay sex frankly and positively. “Kids are being told condoms don’t work, so they’re saying ‘Well, I’m not going to use one,’ ” says Tamara Kreinin, who heads the Sexuality Information and Education Council of the U.S. (SIECUS). It supports comprehensive sex ed—that means teaching abstinence and condom use.


So what’s the holdup?
Kreinin blames “a small but vocal and well-funded community who essentially own Bush and many of our congressmembers, and Fox News is their mouthpiece.” Perhaps a bigger hurdle: getting America’s soccer-mom majority—who, when polled, support comprehensive sex ed—to break their silence. Thankfully, it’s already happening in California and Maine, which now require comprehensive classes. The school board in the primarily poor, African-American District of Columbia is on board as well. Says Kreinin, “One member told me, ‘Our kids are dying.’”


How can I help?Start by educating yourself at www.nonewmoney.org, www.advocatesforyouth.org and www.siecus.org, where “you can find out what’s happening in your state,” says Kreinin—and whom not to vote for in 2004. “Then contact SIECUS to connect you to people doing things locally.” Needle-exchange boosters should shoot for www.nasen.org and www.harmreduction.org.

6. You Go, Girls

Say what?
Women now account for more than half of new infections worldwide. From Detroit to Delhi, we need HIV prevention that puts the ladies in control.


Tell me more...
The female condom may not have caught on (did the name Femidom help?), but researchers haven’t stopped pushing for equal prevention rights. They’re developing HIV-killing antimicrobial gels that women could plant in their own secret gardens (or their backdoors, as men could too.) “Microbicides are a lot less sophisticated than a vaccine, more like hitting the virus with a hammer,” says Anna Forbes of the Global Campaign for Microbicides. “But if they stop the virus, they stop the virus.” Forbes says at least one of the 11 in human trials right now could be available within five years—and a handful, like Savvy and Carraguard, will soon begin final trials in Africa. From there, the possibilities run to “vaginal rings”—which would release microbicide for weeks at a time—to a rectal lube or suppository.


So what’s the holdup?
Microbicides need major backing from pharmaceuticals. All 11 trial candidates are funded solely by government or charity, but Forbes says that “once there’s proof of concept,” only Big Pharma can make them a market reality. Another complication: “Nobody knows what a microbicide is,” laments Forbes. “Research shows the more prevention options you can offer, the more likely people will prevent themselves. We’ve been locked into the condom code.”


How can I help?
Master microbicides at www.global-campaign.org—and discover how to help pass the Microbicide Development Act.

7. Break Out

Say what?
We need prison reforms that will reduce HIV deaths and slow its spread behind bars.


Tell me more...
According to the American Journal of Public Health, between 22 and 31 percent of HIVers spend time in prison. Most deaths result, unnecessarily, from hepatitis C. Activist Judy Greenspan of California Prison Focus insists we “change the drug laws” by rehabbing, not imprisoning, people with petty charges. “You’d empty the prisons of people with HIV and hep C,” Greenspan says, adding that prisons should provide condoms and dental dams (only two states and a handful of city systems do). Prisoners’ rights advocate Rachel Maddow wants every penal system to follow CDC guidelines for testing and treating hep C. The ACLU’s Jackie Walker says that correctional HIV care must modernize to match “outside” standards. Her priority is conditions in Alabama prisons, which she calls the “absolute bottom.” The state segregates HIVers, excluding them from early-release programs.


So what’s the holdup?
Greenspan points to the “real lock-’em-up, law-and-order” mentality that has prevailed since 9/11. Maddow cites the “wall” that hides prisoners from public view and makes concerned outsiders feel unable to help.


How can I help?
Demand that Alabama prison commissioner Donal Campbell (1400 Lloyd St., Montgomery, Alabama 36107) stop segregating HIVers. Visit www.hcvinprison.org, www.prisonactivist.org or write Rachel Maddow at maddow@rcn.com to join her listserv. Urge your local ASO to accept collect calls from prisoners needing post-release services. And push your state lawmakers and prison heads to boot bad policy.

8. Accessorize!

Say what?
Nearly a decade after lifesaving treatment emerged, most of the world’s HIVers—including some in this richest of nations—can’t access it. That’s not just absurd: It’s immoral.


Tell me more...
From Bush to Bono, the Clinton Foundation to the World Health Organization, the world’s biggest players care about drug access. Problem is, their efforts just ain’t enough. The revised WTO agreement on cheap generics contains lots of fine print, so the market for them won’t be truly competitive. What’s more, “rich countries are still failing to contribute to the UN Global Fund to Fight AIDS,” says Nathan Geffen of South Africa’s Treatment Action Coalition. (The U.S.’s celebrated $15 billion would be dwarfed by a truly globally funded Global Fund.) Here at home, seven low-income HIVers have recently died on med wait lists because Republicans unilaterally refuse to fund ADAP. “I guess they’re hoping more people are going to die off,” says Lei Chou, of the Access Project advocacy group.


So what’s the holdup?
“We’re the only industrialized nation that doesn’t have any drug-pricing controls,’’ Chou says, “and the industry is obviously not self-policing.”


How can I help?
Try www.stopglobalaids.org, which links you to access heavies like the Global AIDS Alliance and Health GAP Coalition. Act up for ADAP in your state via www.atacusa.org/adap.html or by calling the Access Project at 1.800.734.7104. Southern states really need to hoot and holler—infections are up in Dixie and ADAP wait lists are lengthening. And come November, evict any congressmember who wouldn’t pass a hangnail’s worth of the Iraq budget to save your life. (For more on that travesty, turn back to No. 5, “Punish the Pols.”)

9. Shoot for the Stars

Say what?
It’s time for a new generation of celebrities and a new wave of pop culture to make fighting HIV—and injustice against HIVers—glamorous again.


Tell me more...
Ten years ago, the red ribbon, Philadelphia, The Real World’s HIV heartthrob Pedro Zamora and the grand dame of AIDS advocacy, Elizabeth Taylor, sparked an explosion of American HIV awareness. Today, rewarming this country’s AIDS empathy isn’t about putting a human face just on gay men—but on the world’s poorest. How about an “AIDS Ambassadorship 101,” where Liz, Magic, Elton (and latter-day saint Bono) groom a new strain of stars to talk up safe sex and global activism. “We need J.Lo redoing ‘Love Don’t Cost a Thing’ as ‘Love Can Cost a Lot,’ and [2003 New York City marathoner] P. Diddy joining the 2004 GMHC AIDS Walk,” says Village Voice celeb-ologist Michael Musto.


So what’s the holdup?
“Celebs don’t necessarily feel that refueling AIDS awareness will keep them popular,” says Musto. Props to TV, though: Media giant Viacom launched the distinctly young ’n’ urban KNOW HIV/AIDS campaign, including HIV storylines on TV hits Girlfriends and The District. MTV has broadcast the pull-no-punches documentary Stayin’ Alive (hosted by R&B diva and POZ cover girl Mary J. Blige) and star-crammed World AIDS Day concerts. But can Diddy, Eminem, 50 Cent and the rest of hip-hop’s top dawgs dis the industry homophobia and misogyny that undercut the message?


How can I learn more and help?
“Appeal to your favorite celebs and urge them to take a stand,” says Musto (you can contact most via their websites). And check out www.knowhivaids.org while you’re at it.

10. Color Coordinate

Say what?
We have to create AIDS activism that adapts ACT UP’s confrontational street style to the new face of HIV: people of color and the poor.


Tell me more...
A longtime member of ACT UP/Philadelphia’s crew of multiracial hell-raisers, activist Julie Davids says a massive “scale-up” in new activists is needed. Many founding ruckus-makers, she says, have their hands full “running and defending the safety net” they fought for. So now she’s focusing her efforts on a new project, Community HIV/AIDS Mobilization for Power (CHAMP), which aims to cultivate activist cells in four East Coast cities; they’ll use ACT UP-style demos to link AIDS to “issues like immigration, housing and prisoners, that don’t fit under an AIDS-services category.” Meanwhile, in AIDS-beleaguered Miami, a group called Empower U. is teaching Black PWAs to “work within the system, sit at the table and have real parity,” its HIVer cofounder Vanessa Mills says. Gay black HIVer and ACT UP veteran Keith Cylar of the New York AIDS group Housing Works sees homegrown solutions nationwide: “I know a Baptist minister in Tennessee who runs an illegal needle exchange. Does it look or smell like ACT UP? No. Is it getting stuff done? Yes.”


So what’s the holdup?
Cylar worries that ACT UP Philly will be hard to replicate: “I’m not sure that doing mass demos is the way to galvanize communities of color.” Mills agrees but adds she “wouldn’t oppose it. And I’d be there. Oh, yes.”


How can I help?
Be a CHAMP—and join its nonpartisan coalition to press the 2004 presidential candidates on AIDS (www.treatmentactiongroup.org/). Also hook into www.blackaids.org and www.latinoaids.org.