The feeling was unshakable. For two weeks Lee Fischer,
then 60, suffered chills and weakness, and watched his rangy
frame whittle itself down from 185 pounds to 165. He visited
his doctor in Wilmington, Delaware, where he worked as a
chemist, and confirmed his suspicion: He was HIV-positive.
Fischer knew all about AIDS—he had delivered meals to
people with HIV in the 1990s. Back then he was in a committed gay relationship, and he and his partner got tested
regularly, though they used protection. But shortly before his
diagnosis in 1997, the now-single Fischer had indulged in a
fling while on vacation in Seattle. That one time was enough.
Epidemiologists have long known that sharing needles can
transmit HIV. But they have also found that people who use
any sort of drug—even, like Fischer, a few too many drinks
on vacation—are more likely to take risks that could lead to
infection. And infected people don’t always protect others. In
a study of older HIV-positive people in New York City, one
in three sexually active subjects had recently had risky sex.
Gay men remain the highest risk group for HIV overall,
says Ronald Johnson of AIDS Action, an advocacy group
in Washington, D.C. Men over 50 who were cautious when
younger have reported “condom fatigue”—they tire of the
decrease in sensation that condoms cause, Johnson adds.
Now 74 and living in Baltimore, Fischer is in good health,
thanks to HAART and a regimen that includes yoga, meditation, gym visits, and dog walks. He drinks no alcohol. Mi-cromanaging health can keep people with HIV alive longer.
“Taking care of yourself is a 24-hour job,” Fischer says.
strides on therapy
and continue to
hunt for a cure
in six countries last year.
But Truvada is licensed as
only a treatment, not a
prophylaxis. That means
many insurance plans
might not pay for HIV-negative people to buy it.
The virus that causes AIDS
mutates endlessly, and the
federal government invests
$3 billion each year in research designed to get
ahead of those mutations—and maybe even
head off the virus entirely.
Right now, researchers are
doing the following:
3 Making gels that kill the virus
A recent study of 900
women in South Africa
showed that a vaginal gel
made from the active
drugs in Truvada reduced
the odds of acquiring HIV
by 39 percent, a boon to
women whose partners
refuse to wear condoms.
Research continues into
microbicides that are
inexpensive enough to be
used regularly by women
in the developing world.
La Wanda Gresham
In the 1990s La Wanda Gresham thought she was living life to
its fullest. By day she served food in Los Angeles school cafeterias. By night she lived for the streets, partying even though
it alienated her from her daughter and granddaughter. “I call
it ‘the age of darkness’ now,” says Gresham, 58.
In 1996, when her husband, Grover—an IV-drug user—got
shingles, he was encouraged to get an HIV test. Gresham got
one too, and both results were positive. As a black woman,
Gresham reflects a grim reality: AIDS is a serious danger to
the African American community. Black women are nearly
20 times more likely to get HIV than white women, and black
people make up half of U.S. AIDS deaths each year, though
they represent only 14 percent of the population.
Three years after Gresham’s diagnosis, her husband died
Fortunately, a clinic doctor knew which button to push
from AIDS and she went into an emotional tailspin. “It was
all falling down around me,” she recalls now. “I was having
reactions to the medicine. I basically said to hell with it.”
Depression is a common symptom of the disease. Older
people with HIV/AIDS suffer depression at five times the
rate of their uninfected peers. And depression keeps people
from taking care of themselves. Gresham was too stoned or
despondent to take her medications for about a decade.
to get her treatment on track. “He told me that if I wouldn’t
take the drugs he prescribed, he’d give them to someone who
1 Developing vaccines A preventive inoculation
was tested in Thailand in
2009; those who received
it were 31 percent less likely
to contract HIV than a
placebo group was. The
study, financed mainly by
the National Institutes of
Health, gives researchers
hope that a stronger vaccine could be developed in
the next few years. “It gives
us something to build from,”
says Carl Dieffenbach,
Ph. D., director of the Division of AIDS at NIH.
The government supports early-stage research
into so-called therapeutic
would prevent people
with HIV from developing
4 Encouraging male circumcision
Studies have shown that
men in Africa who have
had their foreskin removed
are 60 percent less likely to
get HIV, perhaps due to the
thinness of the foreskin’s
protective keratin layer and
the presence of vulnerable
immune cells there. Public
health scientists are trying
to find ways to reach more
men and encourage them
to undergo the procedure.
2 Using HIV drugs as preventatives
HIV-negative, sexually active gay men who took a
daily dose of the HIV drug
cocktail Truvada (Tenofovir
and emtricitabine) reduced their odds of contracting HIV by 44 percent,
in clinical trials performed
5 Improving success- ful treatments
The most promising of
the newest class of anti-HIV drugs, raltegravir
(trade name: Isentress),
attacks the disease by zapping a viral enzyme, which
interrupts the virus’s life
cycle. Used in tandem with
other drugs, raltegravir
has proven effective at
keeping the “viral load”—
the amount of HIV in the
bloodstream—to a minimum. Other drugs that are
like it, part of a class called
integrase inhibitors, are in
the pipeline. —M.A.