Desperately Seeking Subjects

The road to an AIDS vaccine starts at the gay bar.

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Lucky, the guy behind the window at a local gay bathhouse, looks surprised and slightly unnerved.

"I'm from the AIDS Clinical Trials Unit," says Ron Johnson, the registered nurse standing in the lobby. Undeterred by Lucky's cheerless reception, Johnson goes on to ask if he can drop off some posters, bar cards, and condoms advertising a new AIDS vaccine being tested at University Hospitals.

Lucky hesitates, seemingly bewildered by the concept.
Johnson goes on to explain that the materials will help attract volunteers needed to test the vaccine. It goes without saying that the club's members are exactly the kind of people Johnson is looking for--men engaging in high-risk sexual activities who would be among those to benefit most from an effective AIDS vaccine.

After some consideration, Lucky decides he won't let Johnson inside the bathhouse. But he does allow him to stuff the bag of condoms, posters, and cards under the window. Lucky takes them and disappears.

Johnson returns to his car and does a mental check of his itinerary. Next, he will bevisiting a couple of gay bars on the West Side. So far, none of the businesses have turned him away. And most of the employees have shown considerably more interest than Lucky.

"The gay community is desperate to do anything to help the cause," Johnson says. "This really is a chance to do that."

Already, AIDS has killed nearly twelve million people worldwide, and thirty million more are HIV-infected. In one year's time, an estimated 1.5 percent of the population the local vaccine trial is targeting--men who have sex with men--will contract the virus. Right now AIDSVAX, the first potential AIDS vaccine to be studied in large groups of humans, is still a slim hope. But at least it's a hope.

Cleveland is only the second city in Ohio to be involved in the AIDSVAX study, which is being conducted by California-based VaxGen. The company began this latest phase of research a year ago, hoping to enlist 5,000 volunteers in the United States, Canada, and Europe, and 2,500 in Thailand. In the last two months, the AIDS Clinical Trials Unit at University Hospitals has inoculated twenty volunteers. It needs to enlist sixty more.

Johnson thinks he'll find them by going on their turf and speaking their language. Hence the visit to gay bars and bathhouses--where some men still have anonymous, unprotected sex with each other--and the provocative poster advertising the study: A well-defined man dressed only in artful, strategically placed shadows, a stethoscope hanging invitingly around his neck.

Some of the same posters and bar cards were used by the AIDS Clinical Trials Program at the Ohio State University Medical Center. Dr. Michael Para, the program director at OSU, says between forty and fifty volunteers have signed up for the study in Columbus as a direct or indirect result of that marketing strategy.

"Either they were picked up and utilized, or it was the media [attention that drew volunteers], after they picked up that we were utilizing racy materials," he says.

Attracting volunteers is only the first step. The subjects must then be screened for HIV and educated about the vaccine, as well as what will be expected of them. Volunteers must be HIV-negative, and they must agree to take a total of seven shots over three years. Along with the shots, they receive HIV-prevention counseling and testing.

The vaccine does not include the live virus, so there is no way to actually contract AIDS from participating in the study. Instead, the vaccine includes two genetically manufactured proteins that mimic a part of the HIV's outer coat, which spark the production of antibodies to the real virus. Once the antibodies are mobilized, they will, in theory, kill the HIV if it ever enters the person's bloodstream through blood or body fluids.

The vaccine's effectiveness has not been established. In fact, a few volunteers from earlier studies have become HIV-infected, says Dr. Barbara Gripshover, the study's principal investigator at University Hospitals.

"We don't know if the vaccine works at all, and one-third are getting placebos," she says. "You can't think you're being protected . . . The reason for [the volunteers] doing this must be that they want to be part of the solution."

A viable vaccine has eluded scientists for the last two decades, in part because the virus mutates so rapidly. It multiplies ten billion times a day, and one person might have several strains of HIV in them, according to Gripshover. A vaccine that may eventually protect against one strain may not protect against others.

Still, a vaccine that protects against one strain is better than no protection at all.

Shortly after he heard about the study on television news, Dennis Hlad, 22, knew he wanted to be part of the search for a vaccine.

"I thought about it for a day or two," he says. "Then I just decided to do it. Anyone who is interested should at least go in for a consultation. It's a great thing, and it may help people sooner or later."

In the meantime, Johnson mans the phones. After news of the vaccine trials first hit the Cleveland media in April, the AIDS Clinical Trials Unit received about a hundred calls. Many of the callers just wanted more information, and others never followed up with their screenings. However, in a sad twist that shows the dire need for an effective vaccine, one aspiring volunteer was turned away. He discovered at the clinic that it was too late for him to contribute to the search for an AIDS vaccine.

His initial HIV test came back positive.

The AIDS Clinical Trials Unit can be reached at 216-368-AIDS. Jacqueline Marino can be reached at [email protected].

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