[Please please read the information about HIV below. Also, this post is not as long as the time estimate because the references are included in the word count.]
** The views expressed here are my views and not those of my employer. **
As of last Monday, my job title is Bioinformatician II at the Duke Human Vaccine Institute at Duke University School of Medicine. This is a staff position where I will be supporting the Institute’s efforts to develop vaccines for diseases that are global health burdens. The Institute was founded in the early 1990s to develop a vaccine for HIV, and the work on this challenging problem is ongoing. Now, the Institute is also working to develop vaccines for other diseases. The biology that I am now working on is pretty different from what I have studied in the past. But I am confident that the data analysis skills I learned during my PhD, and my PhD training in the process of science more broadly, combined with some serious on-the-job learning, will enable me to contribute in this role. I am particularly excited about the opportunity to work on the development of an effective vaccine for HIV.
I have a vivid memory of learning about the medical breakthrough of triple combination anti-retroviral therapy (ART) to inhibit replication of the HIV virus in biochemistry class my sophomore year of college. More specifically, I remember a graph showing the dramatic changes (increase and then decrease after ART was available) in the deaths caused by HIV during the 80s and 90s. By contrast, the other leading causes of death hardly changed at all. When my mom picked me up from the airport at the end of the semester, she asked me what I had learned in my classes; I told her about this HIV lecture. I was not “out” to myself as queer then, and I do not remember talking about the epidemiology of the HIV pandemic during biochemistry class. I certainly knew that HIV/AIDS was a global pandemic before that lecture, but I cannot tell you when I learned about the impact of the HIV pandemic on the queer community. Over the past eight years I have put energy into learning about the cultural and scientific/medical history of the HIV/AIDS pandemic in the United States. Engaging with media about the pandemic – reading books, seeing a play, taking an online course – has been an important way to connect with my queer identity.
My confidence in my queerness has been an anchor over the past two years. It has been particularly important in the low moments when I struggled with what being a scientist meant to me. And, the idea that I could potentially find scientific work that would intersect with my queer identity was a version of my future that gave me hope. This is not to say that I concretely imagined having this job before I applied for it, but it is to say that where I am right now makes sense. I am only a week in, and there is so much that I don’t know, but I can say that I haven’t felt this excited about science in a long time. It feels really good.
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Some Information About HIV
HIV is pathogen. HIV (Human Immunodeficiency Virus) is the retrovirus that causes AIDS (Acquired Immunodeficiency Syndrome). However, not everyone who is HIV positive has AIDS. There is currently no cure for HIV, and there is currently no effective vaccine.
Highly effective treatment for HIV exists. Medications exist that inhibit HIV replication. The breakthrough for treatment of HIV came in 1996 when a triple drug anti-retroviral therapy was found to effectively suppress HIV levels long term. Approval of triple drug therapy resulted in a precipitous decline in deaths from AIDS. Since then, many more drugs have been developed and approved, resulting in less complex dosing regiments and fewer side effects from treatment. Many HIV positive people can expect a similar lifespan to HIV negative people [1, 2].
People of all sexes and all genders are HIV positive. Many people think about HIV as a “men’s” disease because of medial portrayal and because in the United States – both historically and currently – more men have died and currently die of HIV [3, 4]. However, current estimates report that worldwide in 2020, more women than men were living with HIV and more women than men acquired HIV [5]. In the United States, transgender women have high HIV infection incidence [6]. [Unfortunately, not all data about HIV includes gender information.]
There are many tools to decrease the number of new HIV infections [7]. Here is a partial list:
1) Condom usage decreases the risk of HIV transmission for both anal and vaginal intercourse.
2) Adherence to anti-retroviral therapy regimes often results in undetectable levels of HIV. It has been established that people who have undetectable levels of HIV are not at risk of transmitting HIV via vaginal or anal intercourse without a condom. This is sometimes referred to as “U = U or Undetectable = Untransmittable [8].” However, treatment with anti-retroviral therapy does not guarantee that viral levels are undetectable; undetectability must be established by testing.
3) Sterile needle exchange programs.
4) Pre-exposure prophylaxis (aka PreP). Patients deemed at risk of acquiring HIV can take antiretrovirals so that any HIV viruses that enter their body will not be able to replicate effectively.
5) Testing! If you don’t know that you are HIV positive, then you don’t know to be on ART therapy. HIV testing kits are available at pharmacies, and HIV testing is considered preventative care by health insurance.
Not everyone has access to the tools for treatment and prevention of HIV. Improving access to medical care and HIV testing is crucial for ending the pandemic [9, 10]. Decreasing HIV stigma and improving general knowledge about HIV is also important [11].
Lean more about HIV biology, prevention, treatment, and current demographics at the CDC and NIH websites.
Thank you to Scott Olesen and Will Betke-Brunswick for input on the HIV information section.
References
[1] National Institutes of Allergy and Infectious Disease. Antiretroviral Drug Discovery and Development. [Internet] [updated 11/26/2018 ; cited 7/8/2022]. Available form: https://www.niaid.nih.gov/diseases-conditions/antiretroviral-drug-development.
[2] National Institutes for Allergy and Infectious Disease. 10 Things to Know about HIV Supression. [Internet] [updated 5/12/2020; cited 7/8/2022]. Available from: https://www.niaid.nih.gov/diseases-conditions/10-things-know-about-hiv-suppression.
[3] Centers for Disease Control and Prevention. HIV Mortality (Through 2009) [Internet] [updated 1/29/2013; cited 7/9/2022]. Available from: https://www.thebodypro.com/article/hiv-mortality-through-2009.
[4] Centers for Disease Control and Protection. HIV in the United States and Dependent Areas. [Internet] [updated 8/9/2021; cited 7/8/2022]. Available from: https://www.cdc.gov/hiv/statistics/overview/ataglance.html.
[5] World Health Organization. The Global Health Observatory: HIV/AIDS. [Internet] [updated 7/2021; cited 7/8/2022]. Available from: https://www.who.int/data/gho/data/themes/hiv-aids#:~:text=Globally%2C%2037.7%20million%20%5B30.2%E2%80%93,considerably%20between%20countries%20and%20regions.
[6] Centers for Disease Control and Prevention. HIV Infection, Risk, Prevention, and Testing Behaviors Among Transgender Women—National HIV Behavioral Surveillance, 7 U.S. Cities, 2019–2020. HIV Surveillance Special Report 27. http://www.cdc.gov/hiv/library/reports/hiv-surveillance.html. Published April 2021. Accessed [7/8/2022].
[7] Center for Disease Control and Prevention. HIV Prevention. [Internet] [updated 6/1/2021; cited 7/16/2022]. Available: https://www.cdc.gov/hiv/basics/prevention.html.
[8] National Institutes for Allergy and Infectious Disease. HIV Undetectable=Untransmittable (U=U), or Treatment as Prevention. [Internet] [updated 05/21/2019; cited 07/08/2022]. Available from: https://www.niaid.nih.gov/diseases-conditions/treatment-prevention.
[9] McKeon, J. SDOH Lead to Care Access Issues and Poor HIV Outcomes. Patient Care Access News [Internet]. 2021 Jul 30 [cited 2022 Jul 17]. Available from: https://patientengagementhit.com/news/sdoh-lead-to-care-access-issues-and-poor-hiv-health-outcomes
[10] Gillot M, Gant Z, Hu X, Satcher Johnson A. Linkage to HIV Medical Care and Social Determinants of Health Among Adults With Diagnosed HIV Infection in 41 States and the District of Columbia, 2017. Public Health Reports. July 2021. doi:10.1177/00333549211029971
[11] Centers for Disease Control and Protection. HIV Stigma. [Internet] [updated 6/8/2022; cited 7/17/2022]. Available from: https://www.cdc.gov/stophivtogether/hiv-stigma/index.html#:~:text=%E2%80%9CInternalized%20stigma%E2%80%9D%20or%20%E2%80%9Cself,disclosure%2C%20isolation%2C%20and%20despair.