Depending on whose statistics one goes by, either Miami-Dade or Broward County has the highest rate of new HIV infections in the entire country. Palm Beach County is not that far behind by any metric.
"Yes, they still talk about San Francisco, but we've got a problem on the east coast," says Dr. Robert Gallo, founder of the Institute of Human Virology in Baltimore. "The I-95 corridor is like the roads in Africa for truck drivers and heterosexual sex."
Gallo co-discovered HIV as the cause of AIDS and will be Grand Marshal of this Sunday's 25th Anniversary AIDS Walk Miami. He is careful to stress that "this is not a gay man's disease. That wasn't the problem in Africa. If there were no gay sex on Earth, we would still be talking about HIV."
In Africa, HIV is transmitted "principally, by far" through heterosexual sex. In Miami and Fort Lauderdale, according to Gallo's most recent statistics, about three-quarters of new infections can be connected to sex between males. "But the rest are heterosexual," he tells us. "The numbers associated with heterosexual sex are not small. Drug use is small. It's the smallest cause in Miami. You go to Florida, it's sex."
As for what to do about it, Gallo says, "Test, test, test. Treat, treat, treat. Test as much as you've got dimes in the bank. And we could use a version of the President's Emergency Plan For AIDS Relief here in the United States."
But at 76, Gallo is still at the forefront of HIV/AIDS research. He spoke to Cultist from his laboratory where, amongst other projects, some of the most promising work on an AIDS vaccine is taking place. About a minute into the call, he took us off speakerphone, laughing, "I'm still strong enough to lift up a phone."
One of his current projects involves CCR5, a surface protein on white blood cells that many forms of HIV use as a means of cellular entry. If the vaccine for AIDS does eventually come out of Gallo's lab, blame Cultist for it not happening about 30 minutes earlier, since that's about how long it took for Gallo to explain his research.
He pointed to the progress made in the understanding of CCR5 by Edward Berger of the National Institute of Allergy and Infectious Diseases and the story of the Berlin Patient, the media sobriquet for HIV patient Timothy Ray Brown. Brown received a bone marrow transplant from a donor with a mutated CCR5 gene and has been considered by many to be the first person cured of HIV.
"They happened to have a Nordic guy," Gallo says. The significance? Put most simply, the idea is that if a person lacks both of the normal CCR5 genes, it becomes much harder for him to become infected by HIV. According to Gallo, the prevalence of this genetic construct is least common in Africa and becomes more common in populations as one looks north, all the way to Northern Europe (home to Nordic guys) where there are the highest rates of people being born without them and where "these people are virtually uninfectable."
Gallo continues, "You need [the genes] to fight West Nile virus, so that explains it in Africa, but in our society, you don't need it." There is a movement among junk scientists towards total body radiation as way to eliminate CCR5, but Gallo cautions that if this were attempted, "you'd kill people. But what if you give me your stem cells and I give them back after I've removed CCR5?"
The solution might be in endonucleases, enzymes that can digest RNA and could be used to work within the cells and target CCR5. If a person were to have his CCR5 removed, it's possible that he would join the ranks of Gallo's virtually uninfectable.
"We didn't develop this from scratch," Gallo says. "We like to be original but why, when we're working with 5,500 people here in Baltimore and another 770,000 in Africa and the Caribbean? We have all of these resources under one roof and hell, we didn't start it but I don't care if we're late in the research if we're not late in the clinical application."
For those of us hoping to squeeze the AIDS Walk into a packed weekend schedule, it's easy to see scientists like Gallo as rare creatures functioning in a world different from ours. After all, it's not like we're curing AIDS, we might tell ourselves as we give the nacho cheese sauce dispenser another pump.
Gallo, however, disagrees.
"We've done some things well that we can feel good about," he says with almost a delirious level of modesty. "But the person that keeps our building going, we're dead without them. The foundations, the people who pay taxes, who give us money...we can't do anything without money."
Which is why rather than focusing on his research, Gallo has been fussing for the past three weeks on a grant application he is filing with some Italian partners. But beyond money sources, there is a vast network of people who implement and make Gallo's work possible.
"The people taking care of patients, the activists getting in the faces of people," Gallo says. "It's not us alone. It's an enormous team. Yes, we're more proximal to what's new. And that can be an ego trip when you're in a moment of time and there's something that no one on Earth but you and your colleagues know."
Gallo cites one of those people taking care of patients in his own Institute as a sign that things are changing. Not so many years ago, an HIV-positive worker in the clinic downstairs from Gallo's office told him that "he was tired of the drugs and that he'd rather 'go upstairs.' He was talking about death. He said the drugs were causing him to lose his memory and that we were wasting our time, chasing a fantasy while taking time away from something else you could be doing."
But Gallo's Institute and other HIV/AIDS researchers have made important advances since then. Not long ago, Gallo says, that same clinician came back to him and said, "You've changed my mind. I now think it's practically within feasibility."
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How long it will take, Gallo doesn't know.
"But if our colleague downstairs is right, if he's been able to come around intellectually," Gallo says, "then maybe things are changing."