She slid the needle out of my forearm and pressed a cotton ball in firmly. A tiny red bubble leaked out before she reached it. The cotton slurped it up.
"It's inside you now," she said.
I shuddered. I had not expected a remark like that, or the fleeting panic it set off.
I had just enrolled in an HIV vaccine study. It was a Phase III trial, overseen by the NIH and CDC, which meant it had already proven safe—now we were proving efficacy. We—I liked that. Except we were disproving efficacy, more likely.
The consent form ran more than twenty pages. I read every line. I needed to be sure. My counselor was thorough, knowledgeable and caring. She was not letting me sign until I demonstrated I understood all the risks. Honestly though, they were minimal. I really wasn't worried at all.
Until she injected that first dose into my vein. And muttered the obvious.
God. Something was alive inside me. Tiny strands of DNA were making their way up my arm, toward my heart, to be pumped through every living tissue in my body. The DNA was manufactured synthetically, but identical in outward appearance to the deadly virus. Close enough to fool my body, hopefully. But inert, so it wouldn't kill me.
The side effects, if I had any, were due within 48 hours. Possibilities included nausea, mild fever, and a sore throat. Those were signals my immune system had ramped into overdrive. My throat would ache because the lymph nodes there had swollen to full capacity to pump out killer T-cells and macrophages to battle some disturbing invasion. All-out war raging inside my bloodstream.
It failed. That first injection was ten years ago, at Denver Health Medical Center. AidsVax was the most promising AIDS vaccine ever, the first to reach Phase III. I spent three years in the study, got a fresh injection and a free HIV test and a lot of counseling every six months. In February 2003, two decades into the search for a vaccine, VaxGen, the company that had developed the concoction announced its results. No statistical impact.
Today, Kiwan, a very professional counselor at Project Achieve in the East Village in New York City, slipped a fresh needle into my arm.
No vaccine yet: this was my first visit, and I'm still being vetted. She took a blood sample to check for prior exposure to a certain cold virus. If I've had that cold, I'm out.
This new trial is testing two different vaccines in combination. One of them uses a common cold virus as a delivery vector. For complicated reasons, a previous vaccine study indicated there might be a slight increased risk for contracting HIV if my body already created antibodies to this specific cold. It may well have been a statistical anomaly, and there may be no relationship whatsoever, but just in case, they are excluding people who have had the cold, for our own safety. I appreciate that.
I'll also be out if it turns out I got the actual vaccine in the VaxGen trial. It was a double-blind study, with one-third of us getting a placebo. They were supposed to tell me which group I was in when it was over, and I think they did, I just can't remember. That seems odd. I have this inkling that I turned out to be placebo, but . . . it's foggy. I saw the news accounts of the failure weeks earlier, so it was moot by then anyway. If my body had mounted a defense from those injections, it was futile.
If I don't qualify for this study, there will be more. Unfortunately. This afternoon, my counselor mentioned that there were now several vaccine trials in progress simultaneously. Mine was called 505. "That's basically just the next available number," she said.
"Wow," I said. "That's how many they've tried now?"
"I guess so."
"Five hundred four failures. Yow."*
I already know this vaccine won't prevent infection. Or if it does, I'll play not even a bit part in determining that. They are not even trying to evaluate prevention in this study. Researchers are going after AIDS every way they can think of, and this approach is to pre-condition my body so that if it is infected, it will fight the virus more effectively.
Huh. What a sobering goal. Not so glamorous to be a part of that project. A non-cure. Just something to lessen the damage.
Well . . . I thought about it a second. Did I really want to bother?
Yes. Yes, of course. Millions of people will be infected with HIV. If this thing works, and it prevents half or a quarter or whatever fraction of those millions from progressing all the way to sickness and death . . . that's damn good, too.
I also learned that the 504 accomplished something after all. This study—this whole strategy to attack the virus—grew out those "failures." We learned a great deal.
And we learned they were truly safe. VaxGen was the first large trial (I think the first to include thousands of human lab rats.) Conceptually, it was safe, now we have hundreds of thousands of subjects like me from a multitude of similar studies walking around healthy to prove it.
This time, I had to force myself through the consent form. They know what they're doing. I don't foresee even mild fear.
Some other group is searching for a true preventive. Someone is working on a cure. And then there's my group, should I be accepted. I had no idea until this afternoon that someone was working this strategy. I was glad to learn they are. And to play an itty bitty part to help them.
You can too. Oh, surely you saw the pitch coming. You might be scared the first time they inject you. I was. It passed. It was replaced, quickly, by the fear that I'd feel invincible with this promising new body armor possibly sealing me off from AIDS from the inside. That's a whole nother story, which I'll tell another day.
It's moot now. Nobody is that hopeful anymore. HIV is one wily organism, and the chance of outsmarting it with any particular agent is low. That's why we have to try more than five hundred times.
Project Achieve is part of the HIV Vaccine Trials Network (HVTN). That's their logo up there. "Hope takes action," it says. They've got a point. Millions of people are dying. I've been hoping for an end to the scourge more than half my life. Hope isn't enough. Somebody has to do something. That can be you.
It's not hard, or risky, and it's only scary a little while.
If you're male, 18-50 and HIV-negative, you're eligible for this trial. (I don't think you have to be gay, but you might have to be sexually active. I'll find out.) Other trials have different criteria. HVTN is running trials in 27 cities on four continents (including Africa and South America).
If you live in New York, LA, Chicago, Seattle, San Francisco, Atlanta, Birmingham, Nashville, DC, Philadelphia, Boston, or Rochester, there is a site near you, and it needs your help.
My counselor also handed me $50 when I left, and a subway card with two fares. That was unexpected, but nice. You're not going to get rich off the study, but every visit, they pay you something for your time.
Think about it. Better yet, talk to someone. Click on any city here for contact info in your town. Or call 1-800-448-0440.
Someday, there will be a cure. Help make it sooner.
* All quotes are from memory. They are close. I'm sure they're not exact. The first one, in the title, was quite awhile ago, but it's been rattling inside me the whole time.
Since I'm making author's notes, yes "nother" is a word. People use it every day. Listen.
Update, Jan 7:
Well, I learned this week that I was indeed indeed in the vaccine pool last time. My coordinator hoped that it was long enough ago that I could participate again, but the word came back no—and that I probably never can again.
Drat. (Although who knows. Maybe someone will do a study, or include a cohort, on people with prior vaccine exposure. Probably not, though.)
I'm going to see if there's some other way I can participate. It's important, folks. And it's really quite easy. Please consider checking into it. Thanks.