On June 5, thousands of cyclists participated in the fourth day of AIDS/LifeCycle, an annual bike ride from San Francisco to Los Angeles that this year raised more than $16 million for the fight against HIV/AIDS.
The event, one of the most high-profile HIV/AIDS fundraisers, corresponds with San Francisco outpacing the rest of California and the United States in HIV awareness — Americans are roughly twice as likely as San Franciscans to not know they are HIV-positive, according to data from the San Francisco Department of Public Health and HIV.gov.
Meanwhile, on the East Coast that same day, the U.S. Department of Health and Human Services, or HHS, dealt a blow to HIV/AIDS researchers at UCSF.
In a statement, HHS announced that it would tighten restrictions on fetal tissue research from elective abortions and cancel a contract with UCSF for this type of research — a decision that anti-abortion activists celebrated but that UCSF Chancellor Sam Hawgood condemned in a published response as “politically motivated, shortsighted, and not based on sound science.”
Searching for a cure
Paul Volberding, the director of the UCSF AIDS Research Institute, or ARI, first encountered AIDS while working as a clinician at San Francisco General Hospital in the early 1980s. Once a patient learns of their HIV diagnosis, they can begin taking medications that suppress the virus and that can potentially give the patient a normal lifespan, Volberding said — a far cry from the state of patient care at the height of the AIDS crisis.
“We are making progress,” Volberding said. “We’re better understanding the chronic nature of the virus and how it continues to survive in the host, but the challenge to really get rid of every last virus of the body is one that we’re not really close to yet.”
UCSF associate professor of laboratory medicine and ARI scientist Satish Pillai explained that the key challenge for researchers seeking to cure HIV infection is the latent HIV reservoir, a pervasive “pool of cells infected with HIV.” Although modern medications suppress HIV, the virus will return “in full force,” Pillai said, if a patient stops taking their HIV medication.
Human fetal tissue is used in research into HIV and other conditions to help simulate the human immune system by creating “humanized mice,” according to Pillai. Pillai, who is not directly involved in fetal tissue research, described this as a “preclinical intermediate” — a step between studying a novel therapy in a petri dish and testing it on a human subject.
According to Pillai, the two main options for HIV researchers looking for preclinical intermediates are either using humanized mice or using nonhuman primates by infecting them with simian immunodeficiency virus, which he described as being expensive, difficult and “fraught with pretty obvious ethical concerns.”
“If you take away this critical tool of a humanized mouse model for HIV infection, we’re really left with not very much to rigorously test any of the novel therapies that we’re coming up with,” Pillai said. “My very sincere fear is that there will be a huge reduction in the number of treatments that make it past the petri dish stage.”
‘From conception to natural death’
HHS laid the groundwork for its June statement when, early last year, it published its strategic plan for fiscal years 2018-22. Under the heading “Strategic Goal 3: Strengthen the Economic and Social Well-Being of Americans Across the Lifespan,” HHS stated, “A core component of the HHS mission is the dedication to serve all Americans from conception to natural death.”
HHS used similar language four more times in its strategic plan and once in its June statement, adding that it plans to convene an ethics advisory board to review research proposals involving the use of human fetal tissue from elective abortions.
Both former Berkeley Students for Life co-president Tamika Bassman, a recent campus graduate, and current Co-president Daniel Frise, a campus junior studying engineering, mathematics and statistics, reacted positively to the cancellation of UCSF’s fetal tissue research contract.
“I think that what one supports in the question surrounding whether or not these lines of research are good to pursue is kind of a secondary question,” Bassman said. “You won’t be able to have a very fruitful discussion about these secondary issues until we have a better understanding of our disagreements or maybe common ground on this issue of the morality of abortion.”
Pillai voiced concern over the immediate material effects of the change, saying there is a “direct scientific impact associated with that decision” and that it was “very clearly an unfortunate move.” He stated in a later email that although scientists can use stem cells from multiple types of human tissue — a common anti-abortion argument against fetal tissue research — nonfetal stem cells “do not have the same growth and differentiation potential as fetal cells, and therefore limit our development of new therapies.”
Prevalence, stigma and future prospects
The Alameda County and San Francisco public health departments each reported between 200 and 300 new HIV diagnoses in 2016. San Francisco that year had about 16,000 living residents with HIV, compared to about 6,000 in Alameda County. Roughly 70 percent of new diagnoses of HIV tend to involve men who have sex with men, which Volberding said contributes to the stigma around the virus.
“The first thing to recognize is that HIV remains a very stigmatizing infection. People are generally afraid of it,” Volberding said. “For many people with HIV infection, there’s a sense of embarrassment because it is relating to sexual activity — often gay sexual activity — or it’s related to injection drug use, and there are still in our society many stigmas attached to those activities, unfortunately.”
Volberding said his institute works with organizations such as the San Francisco AIDS Foundation, the East Bay AIDS Center, local public health departments and community groups to encourage people, particularly people from marginalized groups such as Black men who have sex with men, to seek diagnosis and treatment.
Volberding believes these kinds of efforts have reduced barriers to diagnosis, but like Pillai, he expressed concern over scientists’ abilities to test novel treatments because of the loss of UCSF’s contract and the increased federal restrictions. Because scientists still cannot cure HIV infection, Volberding said they benefit from having access to the humanized mouse model, adding that not having access “is a real challenge and a real problem.”
The Bay Area has for decades served as a driving force for HIV/AIDS research and awareness, but both Volberding and Pillai worry about the future prospects for new treatment approaches.
“I think basically, a lot of really promising therapies will hit a dead end because of this policy change,” Pillai said.