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.”
Get the Morning Rundown
Get a head start on the morning’s top stories.SIGN UPTHIS SITE IS PROTECTED BY RECAPTCHA PRIVACY POLICY | TERMS OF SERVICE
“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.
In a landmark ruling, a federal court has ordered the Defense Department to end a long-standing Pentagon policy forbidding enlisted military service members from deploying in active duty outside the continental U.S. and being commissioned as officers if they have HIV.
Supporters hailed it as overdue legal affirmation that people receiving effective antiretroviral treatment for HIV are essentially healthy and pose no risk to others.
The judgment topples one of the country’s last major pillars of HIV-related employment discrimination. Federal law has for decades barred employers from discriminating against people with HIV under the Americans with Disabilities Act of 1990. The military has stood alone as the sole U.S. employer maintaining such explicit discriminatory practices.
“This is one of the biggest rulings for people living with HIV and enshrining their protections under the Constitution in decades,” said Kara Ingelhart, a senior attorney at Lambda Legal, which along with a team of private-practice attorneys litigated the cases.
Sgt. Nick Harrison.Lambda Legal
The Pentagon still bans people with HIV from enlisting in the military or from being commissioned out of military academies. The new ruling, which could affect those other prohibitions, concerns service members who are diagnosed after they enter the military.
U.S. District Judge Leonie Brinkema of Eastern Virginia ruled Wednesday in the two cases, Harrison v. Austin and Roe & Woe v. Austin, in which a trio of men sued the military for HIV-related discrimination. The Air Force tried to discharge two pseudonymous plaintiffs, while the D.C. Army National Guard denied Sgt. Nick Harrison a commission in the Judge Advocate General’s Corps, or JAG Corps, because they had HIV.
Brinkema ruled that the Pentagon’s policy qualifying HIV as a chronic condition requiring a waiver was scientifically outdated and that it unfairly treated people with the virus differently from other service members living with chronic health conditions requiring routine medication.
“This is the first decision securing the rights of people living with HIV that is rooted in the equal protection clause of the Constitution,” said Scott Schoettes, a former Lambda attorney in private practice in Chicago, who is co-counsel in the two cases.
Brinkema, who was appointed by President Bill Clinton in 1993, has ordered the Air Force to rescind the discharges of the two airmen. She further ordered the Army to rescind and reconsider its denial of Harrison’s JAG Corps application.
Under the ruling, the Pentagon can no longer use the virus as a reason to discriminate against asymptomatic HIV-positive service members whose viral loads are undetectable thanks to antiretroviral treatment. In particular, the Pentagon may not separate, discharge or deny applications for deployment from such people.
The Justice Department could appeal the ruling to the 4th U.S. Circuit Court of Appeals. In January 2020, the court upheld a preliminary injunction in the case of the two airmen, blocking the Air Force from discharging them while their case was litigated.
President Joe Biden’s 2020 campaign platform included a measure supporting the right of people with HIV to serve fully in the military. Ingelhart expressed hope that the administration will compel the Pentagon to reverse the remaining policies that discriminate based on HIV status.
The Defense Department is the world’s largest employer, with 3 million service members worldwide.
The Pentagon referred questions to the Justice Department, which declined to comment.
Get the Morning Rundown
Get a head start on the morning’s top stories.SIGN UPTHIS SITE IS PROTECTED BY RECAPTCHA PRIVACY POLICY | TERMS OF SERVICE
In defending the two cases, the military argued that service members with HIV pose a theoretical risk to others, such as on the battlefield.
After the Pentagon appealed the injunction to the 4th Circuit in 2019, a group of former military leaders filed an amicus brief supporting the plaintiffs. The brief criticized as scientifically outdated the Pentagon’s policy qualifying HIV as a chronic condition requiring a waiver and argued that the policy compromised military readiness.
Effective antiretroviral treatment for HIV has been on the market since 1996. Today, HIV is typically treated with a once-a-day pill.
Scientists have known for decades that HIV cannot be transmitted through casual contact. Extensive research led the global HIV scientific community to conclude in the late 2010s that people with undetectable viral loads thanks to HIV treatment cannot transmit the virus through sex.
According to Lambda Legal, nearly all of the approximately 2,000 members of the U.S. military living with HIV have undetectable viral loads.
Today, people treated for HIV have near-normal life expectancies.
“The military is being forced to acknowledge the current science regarding HIV: It is easily treatable; there are zero documented cases of transmission in combat; and, most importantly, it is never a reason for discrimination,” said Sarah Warbelow, the legal director of the Human Rights Campaign, who was not involved with the litigation.
Harrison, 45, an Oklahoma native who joined the military in 2000, was diagnosed with HIV in 2012 after he returned from a tour of duty in Kuwait. In May 2018, he sued the Army and the Defense Department for denying his application to become a military lawyer with the JAG Corps.
“It’s nice to see the court make a decision placing science over stigma,” Harrison said of the judge’s ruling.
In December 2018, Harrison’s legal team further sued the Air Force and the Justice Department on behalf of two airmen who received notifications discharging them from service because their HIV statuses prevented their potential deployment to the Middle East.
The policy, codified in a February 2018 memorandum and dubbed “Deploy or Get Out,” outraged the HIV community by forcing some HIV-positive service members out of the military, not previously a common practice, if they faced potential deployment.
Harrison said he keeps in touch with the two other plaintiffs, as well as a collection of fellow HIV-positive members of the military. “We’re looking forward to the opportunity to go forward with our lives and to continue to serve the military in the best way possible,” he said.
His lawyers have also sued the Navy and the Air Force on behalf of a pair of cadets who were blocked from commissioning in the military after their military academy graduations because they had HIV. The case, Deese and Doe v. Austin, which is pending in U.S. District Court for Maryland, is in the discovery phase after the court denied the Pentagon’s request for dismissal.
To mark the 12th anniversary of the Affordable Care Act (ACA), the Department of Health & Human Services (HHS) is hosting a weeklong celebration to praise its accomplishments. But in the name of health equity for transgender people, who are adversely affected by HIV/AIDS, HHS is also asking for more.
In a letter shared exclusively with LGBTQ Nation, the HIV/AIDS Bureau (HAB) of the Health Resources and Services Administration (HRSA) is asking the Ryan White HIV/AIDS Program (RWHAP) to leverage its existing infrastructure and resources to not only continue providing direct HIV/AIDS care to transgender people, but to provide gender-affirming care as well.
Established thirty years ago, RWHAP serves low-income people with HIV. Today, approximately 50% of those diagnosed with HIV receive support through it annually.
Rates of HIV viral suppression among transgender patients of RWHAP are lower than the organization’s overall average – 84.5 percent versus 89.4 percent. As such, the letter says more must be done to ensure transgender people are not left behind.
“HRSA’s HIV/AIDS Bureau sent this to Ryan White HIV/AIDS Program service providers to reaffirm the importance of providing culturally-affirming health care and social services to the transgender community as a key component to improving the lives of transgender people with HIV and eliminating health disparities,” Dr. Laura Cheever, Associate Administrator of the HRSA HIV/AIDS Bureau, told LGBTQ Nation.
“While not a new policy or approach to the services delivered by the program, The letter builds on initiatives that support patient-centered, trauma-informed, and inclusive environments of care for Ryan White HIV/AIDS Program clients. The goal is to help reduce medical mistrust and other barriers to antiretroviral therapy adherence for transgender people with HIV.”
The letter asserts that “providing gender-affirming care is an important strategy to effectively address the health and medical needs of transgender people with HIV.” The program, it says, already serves about 11,600 trans people (2.1% of those served overall) that would benefit from these services.
It goes on to say that funds directed toward RWHAP are allowed to be used for certain types of gender-affirming care and support, including hormone therapy, behavioral and mental health services for those experiencing discrimination and/or gender dysphoria, and cost-sharing assistance for insurance coverage, which would give trans people greater access to the care they need. It also said several RWHAP AIDS Drug Assistance Programs already provide access to hormone therapy.
Because it is an outpatient ambulatory health care program, though, the letter says RWHAP cannot provide surgeries or inpatient care.
The letter also urges RWHAP to provide other types of support to transgender people living with HIV/AIDS, such as housing, case management, and treatment services for substance abuse.
The letter, signed by Cheever, emphasizes the need to “provide affirming, whole person care to transgender people with HIV.”
“This is true especially of Black and Hispanic/Latino/a transgender women who are disproportionally impacted by HIV and other intersecting social and health challenges,” it says.
“While transgender Ryan White HIV/AIDS Program clients receiving HIV medical care have reached higher viral suppression rates than the national average, we recognize that we need to do more to support this community,” Cheever said in a press release.
“To help achieve the goals of the National HIV/AIDS Strategy, including achieving health equity and ending the HIV epidemic, we will continue to support and share evidence based, evidence informed, and emerging interventions that focus on the specific needs of this community to improve the health and lives of transgender and gender diverse people with HIV.”
Also in recognition of the 12th anniversary of the ACA, HHS is hosting a weeklong celebration, with each day focusing on different communities the ACA has reached.
Today’s focus is “Celebrating Health of LGBTQI+ and Communities of Color.” According to HHS, the ACA has reduced the number of uninsured LGBTQ people by almost 50% since 2010.
Since taking office, the Biden administration has also restored an ACA provision banning discrimination in its health care programs on the basis of sex, which includes sexual orientation and gender identity.
HHS also said the ACA has also helped community organizations dedicate more resources to HIV/AIDS care through RWHAP.
While the One Male Condom is not markedly different from the hundreds of other condoms on the market, it is the first that will be allowed to use the “safe and effective use” label for reducing sexually transmitted infections during anal sex. It is also approved for use as a contraceptive and as a means to reduce STIs during vaginal intercourse.
“This landmark shift demonstrates that when researchers, advocates, and companies come together, we can create a lasting impact in public health efforts,” Davin Wedel, president and founder of Boston-based Global Protection Corp, maker of the One Male Condom, said in a statement. “There have been over 300 condoms approved for use with vaginal sex data, and never before has a condom been approved based on anal sex data.”
Courtney Lias, director of the FDA’s Office of GastroRenal, ObGyn, General Hospital and Urology Devices, noted that the risk of STI transmission during anal intercourse is “significantly higher” than during vaginal intercourse.
“The FDA’s authorization of a condom that is specifically indicated, evaluated and labeled for anal intercourse may improve the likelihood of condom use during anal intercourse,” Lias said in a statement. “Furthermore, this authorization helps us accomplish our priority to advance health equity through the development of safe and effective products that meet the needs of diverse populations.”
Anal sex poses the highest risk for contracting HIV, with the risk of HIV transmission from receptive anal sex about 18 times higher than receptive vaginal sex. Gay and bisexual men accounted for 69 percent of the 36,801 new HIV/AIDS diagnoses in the U.S. in 2019, according to the Centers for Disease Control and Prevention. Queer men of color were overrepresented within this group, with Black men representing 37 percent, Latino men representing 32 percent and white men representing 25 percent of these new diagnoses, according to the CDC.
One Male Condoms are available in standard, thin and fitted versions, and the fitted version is available in 54 different sizes.
A clinical trial of 252 men who have sex with men and 252 men who have sex with women found the One Male Condom has a failure rate of 0.68 percent for anal sex and 1.89 percent for vaginal sex, according to the FDA, which defined condom failure as condom slippage or breakage.
Dr. Will DeWitt, clinical director of anal health at the Callen-Lorde Community Health Center in New York City, said the newly approved condoms could be a helpful tool for HIV/AIDS prevention.
“The hope would be that people would be more willing to use condoms for anal sex and to have that direct encouragement would increase the rates of people using them,” DeWitt said. “Condoms still remain an important tool for people who don’t want to or can’t use PrEP.”
PrEP, or pre-exposure prophylaxis, is typically taken in the form of a daily pill to prevent HIV/AIDS in people who are not diagnosed with the virus. Last year, the FDA also approved an injectable PrEP shot that can be given every two months.
DeWitt did, however, add that he is worried the One Male Condom name and marketing could alienate those who engage in anal sex but do not identify as male.
“Anal sex really does belong to everyone,” DeWitt said. “Even if it’s the perspective of who has to wear the condom, it’s not just male bodies and male identified folks who need to use it.”
While health experts have long encouraged the use of condoms for STI prevention through anal sex, DeWitt said FDA’s official approval is long overdue.
“Here we are in 2022, and we are only now getting condoms approved for anal sex,” DeWitt said, noting that it’s been more than three decades since the start of the HIV crisis. “It’s a little frustrating that it’s taken this long to have this kind of official endorsement.
