Read Forbes Q & A with Our Dr. Joseph Tucker on China’s Anti-Corruption Fallout: Sex Business Morphs, Disease Threat Remains

VIDEO: ‘Cure’ No Longer a ‘Four-Letter Word’ in AIDS Research, Says Our Dr. Joe Eron

VIDEO: HIV Cure is for Everyone, Not Only Those in Resource-Rich Settings, Says Our Dr. Joe Eron

Dr. David Wohl Speaks with WRAL about Starting ART as Soon as HIV Positive Diagnosis

UNC-GSK Company Launches & Sen. Tillis Tours Lab

YouTube Preview Image

The University of North Carolina at Chapel Hill, a leading global public research university with significant expertise in HIV basic and clinical research, and GSK, a global, research-based pharmaceutical and healthcare company with a legacy of success in developing treatments for HIV, announced on May 11 the creation of the dedicated HIV Cure center and a jointly owned new company that will focus on discovering a cure for HIV/AIDS. This unique public-private partnership will redefine the traditional way of conducting research and create a new model to seek the breakthroughs needed to tackle an extraordinarily challenging global health issue.

The HIV Cure center will be located on the UNC-Chapel Hill campus and will focus exclusively on finding a cure for HIV/AIDS. The new company, Qura Therapeutics, will handle the business side of the partnership, including intellectual property, commercialization, manufacturing and governance. Together, the HIV Cure center and Qura Therapeutics will serve as a catalyst for additional partners and public funding that will likely be needed to eradicate HIV worldwide. The collaboration is also expected to recruit and attract top talent from around the world. Click here to see photos from the announcement.

“The excitement of this public-private partnership lies in its vast potential,” said UNC-Chapel Hill Chancellor Carol L. Folt. “Carolina has been at the forefront of HIV/AIDS research for the last 30 years. This first of its kind, joint-ownership model is a novel approach toward finding a cure, and we hope it serves as an invitation to the world’s best researchers and scientists. Today, Carolina’s best are taking another major step in the global fight against HIV/AIDS.”

“Like UNC, GSK has a long legacy of HIV research success. From the development of the world’s first breakthrough medicine for HIV patients in the 1980s, to our leadership in the market today through ViiV Healthcare, we’re continuously challenging ourselves to meet the needs of patients,” GSK CEO Sir Andrew Witty said. “This partnership is a testament to our past and present leadership, innovation and commitment to this field. We are inspired by the confidence that with the right resources and research teams, we will be able to make a meaningful impact towards a cure for HIV.”

UNC Chancellor Carol Folt and Sen. Thom Tillis (R-NC)

UNC Chancellor Carol Folt and Sen. Thom Tillis (R-NC)

On May 27, Sen. Thom Tillis (R-NC) toured the home of the future lab space and asked UNC and GSK researchers to keep him informed about how the business model evolves and if Washington can do anything to assist this unique partnership. While on campus, the Senator also met with Chancellor Folt. Click here for more photos from this visit.

UNC-Chapel Hill and GSK will focus on the latest scientific approaches to curing HIV, including a leading research approach toward an HIV cure, sometimes called “shock and kill.” This approach seeks to reveal the hidden virus that persists in people with HIV infection despite successful drug therapy, and augment the patient’s immune system to clear these last traces of the virus and infected cells. Part of this new paradigm was first tested at UNC-Chapel Hill and in 2012 a team led by UNC-Chapel Hill researchers demonstrated that latent HIV might be unmasked by new therapies. Recently, researchers at the university received Food and Drug Administration approval for a study in HIV-positive volunteers to combine this technique and an immune-boosting strategy.

David Margolis, MD

David Margolis, MD

“After 30 years of developing treatments that successfully manage HIV/AIDS without finding a cure, we need both new research approaches to this difficult medical problem and durable alliances of many partners to sustain the effort that will be needed to reach this goal,” said Dr. David Margolis, Carolina professor of medicine and leader of the Collaboratory of AIDS Researchers for Eradication (CARE). “The ‘shock and kill’ approach has shown significant promise in early translational research on humans and has been the focus of research for the last several years.”

“Although today’s treatments for HIV mean that millions of lives have been saved, people still have to take a lifetime of treatments, which takes an emotional toll and places an economic burden on society that is particularly challenging in countries with limited resources,” said Zhi Hong, senior vice president and head of the Infectious Diseases Therapy Area Unit at GSK. “This is why we must dedicate the next 30 years to finding a cure and scaling it up so that one day we will end the HIV/AIDS epidemic.”

Through the new company, GSK will invest $4 million per year for five years to fund the initial HIV Cure center research plan, and a small research team from GSK will move to Chapel Hill to be co-located with UNC researchers. The University will provide world-class laboratory space on its medical campus for the HIV Cure center and the new company. GSK will be contributing its expertise and know-how in medicines discovery, development and manufacturing, and UNC-Chapel Hill will bring to the table its research and translational medicine capabilities, talent, as well as access to patients and funding.

GSK’s investment in the HIV Cure center is separate from its investment in the discovery of novel antiretroviral (ARV) therapies in support of ViiV Healthcare, a global specialist HIV company dedicated to delivering advances in treatment and care for people living with HIV and owned by GSK, Pfizer and Shionogi. GSK’s HIV Discovery Performance Unit will continue its work on new ARVs in the Research Triangle Park area of North Carolina. ViiV has significant clinical expertise and will play an advisory role to the HIV Cure center and Qura Therapeutics.

Links to media coverage of the announcement from around the world include:
The New York Times

Buzzfeed

The Science Times

The Wall Street Journal

Reuters

The Triangle Business Journal

The News & Observer

WRAL-TV

AIDSMeds

Dilemma X

Drug Store News

The Daily Tar Heel

 

 

Commencement 2015: Myron Cohen Shares Family’s Powerful Plea

Myron Cohen, MD

Myron Cohen, MD

Myron Cohen, MD, delivered the UNC School of Medicine’s commencement address on May 10, 2015. Below are his remarks, including a powerful story about a patient and his family Dr. Cohen encountered while working last Christmas. The family has given their permission for their story to be shared publicly. Dr. Cohen is the Director of UNC’s Institute for Global Health & Infectious Diseases, Chief of the Division of Infectious Diseases, and the Yeargan-Bate Eminent Professor of Medicine, Microbiology and Immunology, and Epidemiology in UNC’s School of Medicine.

Let me start out by thanking the class of 2015 for giving me the UNIQUE privilege of addressing their graduation.  It is a real privilege.

The place to start with any speech is “know your audience.”  But there are three audiences here today: UNC faculty, families of the graduating students, AND the students.

Let me dismiss any attempt to appeal to the faculty.  I have worked here for 35 years; the faculty know everything I could possibly say.  SORRY!

What about the families. Family members are bursting with pride. For the parents…you’re biggest and longest and most serious and precious investment is finally paying off. I know it seemed like yesterday that your child was an infant. BUT here they are… fully grown, and in a robe with the special green colors that signify that your child, today, will become a doctor of medicine. AS OF TODAY YOU can introduce your child as… “my son or (daughter) THE DOCTOR; …OR…have you met my son or daughter the DOCTOR… or, let me introduce you to my son or daughter …THE DOCTOR.”  PARENTS… THIS IS OBLIGATORY BEHAVIOR CONSISTENT WITH THE PRIDE YOU RIGHTLY FEEL.

And let us not forget that tomorrow is Mother’s Day. Everyone knows that the new doctor is expected to offer free medical advice to EVERYONE. But let me be clear that this requirement extends to the MOTHERS of the new doctors as well, who by virtue of today’s graduation are expected to offer medical advice as well. As far as I know my mother ran an urgent care clinic BEFORE they even existed.

Families: Congratulations. And doctors’ mothers: Happy Mother’s Day.

And now… what to say to our graduating medical students. First, a disclaimer. A small group of totally anonymous students in your class that included not to be mentioned class presidents advised me on what to say to you. Not to throw these anonymous students “under the bus”… but I’m just saying if you don’t like these comments there might well be someone else to blame.

Now about you … the class of 2015. You are, as you know, totally AWESOME. First, you survived four years of the most grueling schedule imaginable. FORGET the television show SURVIVOR. No reality show could capture YOUR ordeal. And through it all, you kept your good graces and most notably your sense of HUMOR. Indeed, THE CLASS OF 2015 won the Golden Humerus Award two years in a row. PARENTS, the Golden Humerus Award plays on a bad pun related to the upper arm bone. The award is given to the class with the funniest and most entertaining skit. CONGRATULATIONS CLASS HUMERUSES!

Now back to my speech. I started with a Google search under the heading “School of Medicine speeches” hoping for inspiration, and scarily this search brought up “the 10 most INSPIRATIONAL School of Medicine speeches.” Many of these speeches were given by TV doctors, or actors playing TV doctors. Dr. Oz is a biggie.

The more serious speeches talked about health care systems, or medical economics, and most often CONSTRAINTS in medicine that might make the career of a physician less attractive.

I reject these themes. MY FIRM BELIEF IS THAT TODAY YOU BEGIN THE MOST REWARDING CAREER IMAGINABLE.

I want to talk to the students about three ingredients of medicine that have been most meaningful to me.

FIRST… CHANGE! Medicine IS all about change. When I finished medical school there were no CT or MRI scanners. Diseases that now have names and causes were just a set of symptoms. There was no Lyme disease or Hepatitis C. I managed patients who survived polio and were living in an iron lung, a machine that none of today’s students have ever seen. The medicine you learned these past four years at UNC is unrecognizable from what I learned only four decades ago. What is MY point? You will FOR SURE see miraculous changes over the course of your career. IT IS CHANGE AND THE ANTICIPATION OF CHANGE THAT MAKES A CAREER IN MEDICINE SO EXCITING AND SO UNIQUE.

SECOND, Medicine is about being a citizen of the world, wherever you practice and whatever you do. Diseases do not respect borders. Now would seem to be a good time to talk about me. Why was I asked to give this speech? Shortly after I arrived at UNC -1981- we saw our first patients with AIDS, an infectious disease ultimately proven to be caused by a virus. I have spent my entire career working on this virus, in the US, Africa and China. After decades of research our group was able to show that the treatment of the HIV virus not only allows a person a normal lifespan, but treatment stops the spread of the virus to the next person. These results led to CHANGE in public health and medical policies. And this work showed me that medicine and public health and global health are married. Of course, UNC students already know this. Your curriculum is filled with issues that affect our entire species. Many of you chose to spend summers or rotations in resource-constrained countries. Twenty-eight of you also completed a degree in public health at UNC. You graduate today. Tomorrow -wherever you go- you might well be asked to deal with a patient from West Africa at risk for Ebola, or to make recommendations about measles vaccination. UNC graduates, AS WE INTENDED, you are citizens of the world.

Third, MEDICINE is all about humanity. When you started medical school you were told that your white coat was a ticket for people to share their stories, and often under the most difficult circumstances. Doctors get to know patients and their families in ways entirely different than everyone else. You will encounter great tragedy and great joy countless times. BACK TO ME. This past Christmas holiday, I was seeing patients at UNC hospital. We accepted the transfer of a 49-year-old man with diabetes and a fungal infection of the eye socket -the orbit- that can complicate diabetes. Some fungi thrive on the high sugar in diabetes, and the fungi can be aggressive and destructive.

Sadly, such fungal infections are most often fatal. When I met the patient and his wife, I had to let them know the full and terrible gravity of his infection. Our patient had been well only three days earlier, working as a car mechanic. I asked the patient’s wife to gather her five children from around the country to be with her for the ordeal I knew was in store. She looked at me and our students for several moments and said something so simple… but so powerful: … “PLEASE, PLEASE, WE NEED HIM.”

Why am I telling you this story? This family came to UNC Hospitals and entrusted the care of this most special person in our hands. What technology could we apply? Was there anything new in the literature? Could we assemble a team on a holiday to do everything possible? Were there any experimental agents or combinations of agents available? On the day of admission and for several days thereafter, the UNC surgeons took the patient back to the operating room to remove infected pieces of tissue from the sinuses and near the brain – difficult and dangerous surgery. In order to save his life, he lost his left eye. Day by day, we had no idea whether the patient would live or die, and we had to prepare for either outcome. In a few short days, our entire team got to know the family as well as we might over 20 years. After a very long, rocky month, our patient walked out of the hospital and is followed in our clinic today. Why am I telling you this story? All of this reminds me -as if I needed reminding- about the awesome responsibility we have been afforded. And about the privilege of witnessing great love, courage and fortitude that I believe doctors, and perhaps only doctors, are allowed to see. I know you graduates will have similar experiences.

And a note from the family, with whom I shared this speech getting permission to tell their story, “We pray and thank God for you and UNC hospital every day,” and by the way (they went on to say), “as YOU requested, you can have free car advice for life.”

Back to my Google search of inspirational speeches.  Most speakers had lists of things you are supposed to do.  What can I tell you?

What is the first rule of Infectious Diseases: Don’t get the disease yourself.  Wash your hands, wear a mask, don’t sit on the bed where stray needles may lurk, be on guard.  I can now reveal why infectious disease specialists send medical students FIRST into a hospital room to take a new patient’s history. THINK ABOUT A CANARY IN A COAL MINE.

Be compulsive. The difference between a good doctor and a bad doctor is taking the time to read and reread about a problem every time you see it. Check the labs OVER and OVER. Ask your patient about their history, and their travel, and their job, and their life OVER AND OVER again. Students who watch medical shows -especially HOUSE- know there is always a clue to the mystery in the HISTORY.

And NOW…the old cliché about balance. But here is the truth. You are NOT going to punch a time clock. There are no shifts that begin and end. You will read and worry about patients in your care 24 hours a day, 7 days a week. You must learn to compartmentalize this responsibility so as to enjoy your life.

Finally, look at you today.  You have come such a very long way through high school and college and work and four years at our School of Medicine. You are so, so deserving of the recognition we give you today. And… through your hard work and sacrifice and the sacrifice of your family, you are receiving an incredible privilege: you are NOW a doctor of medicine. And with this privilege and recognition comes responsibility: the responsibility to do your very best for your patients; the responsibility to contribute to the health of people in your community; and the opportunity for leadership for the graduates of UNC who will move to communities all over this great state.

Now you continue your training, and I know you are anxious. The euphoria of match day is gone and reality has set in. What are you worried about? Tomorrow your notes FINALLY go into the medical record; tomorrow you will write orders that count; tomorrow you can replace potassium without someone else’s permission; and tomorrow when someone says… “EXCUSE ME DOCTOR, you cannot just look around!!  YOU NEED TO ANSWER YOURSELF.  BUT LET ME ASSURE YOU……YOU are ready. You are prepared. CONGRATULATIONS DOCTORS!!!! ENJOY YOUR CAREER!

Blog: Making a Case for PrEP Personal

Adam Ward

Adam Ward

I am currently a “patient” taking Truvada. I say “patient” because I am not the type of patient who has historically taken FTC/TDF to suppress an existing HIV infection, but, rather, a member of a growing population of people taking Truvada as PrEP to prevent HIV infection. In this blog post, I hope to share a little bit about my story, my experiences and thoughts on PrEP, and close with a challenge to those of you reading who are health-care providers.

Reasons for starting PrEP
At the time of writing this blog post, I have been taking PrEP for a little over 8 months. I had learned of PrEP as a new tool for HIV prevention during a conference session while attending the annual Creating Change Conference in January of 2013, shortly after Truvada was approved by the FDA for this purpose, but I was still not clear on the evidence for, or against, PrEP. Nonetheless, I knew PrEP was an option. Fast-forward one year, and quite a bit had changed. The literature on PrEP seemed to proliferate exponentially, and more information had reached mainstream news and media outlets. I had also recently entered into a relationship with my [current] boyfriend. We had decided to be sexually monogamous with each other. We did not, however, have the degree of communication that the relationship needed, especially around this commitment, and discussion of STIs (including HIV) was minimal, save for us initially agreeing to use condoms when having sex together until we both got tested to ensure that we did not have an STI at the time. Fast-forward another 6 months, and I discovered that my boyfriend had been having unprotected sex with multiple other sex partners without disclosing this information to me. This isn’t an uncommon story, and I, too, had had sex with another person, though risk was low (oral sex only), and I did disclose this information to my partner. However, after this sudden discovery I became greatly concerned, anxious, and even paranoid about the possibility of having an STI… with HIV being the elephant in the room. That same day, I went to my local drug store and purchased the OraQuick in-home HIV test to give me at least some peace of mind, though doing calculations in my head at the same time of when I could expect to have an accurate result. I also made a commitment that day to begin taking PrEP – if I was still HIV-negative.

This was not the only reason I decided to start PrEP though. I had also grown very tired of thinking about sex, even non-relational sex (“hook-ups”), as risk. I was tired of calculating my risk, thinking about the data on transmission odds for different acts; tired of HIV being the elephant in the room, and most of all tired of framing sex as something to be fearful of. Ever since the first reports of “gay cancer” and “GRID,” and the onset of the AIDS epidemic, gay, bisexual, and other men-who-have-sex-with-men have been fearful of sex. Some have not, true, and some feel resigned to a fate of becoming HIV-positive, but I am not one of those people. Though I did not live through the early days of the epidemic, I am all too aware of the toll HIV took on the gay/MSM community. I am aware of the toll HIV continues to take, with 50,000 new infections diagnosed each year in the US since 2004, and the incidence increasing among MSM. I am all too aware of the realities of living with HIV, with a friend recently passing away from AIDS-related complications. These are also the reasons I decided to start taking PrEP – not only as a commitment to my personal health, but also as a commitment to those who have suffered, who currently suffer, and who will suffer from HIV/AIDS, and as a commitment to all gay, bisexual, and other MSM to work to de-stigmatize what MSM sex has become. As someone who considers himself an HIV prevention advocate, if I am not going to do it, who will?

Now, you may just say “use a condom!” This message is remarkably out of touch though. With 50,000 new HIV infections each year since 2004 in the US alone, and with the percentage increasing among MSM, it is clear that having condoms as the only prevention method is not working. Until there is an effective vaccine, I firmly believe that we must research, advocate for, and fund additional biomedical prevention methods. Truvada as PrEP is one such prevention method, and, if adhered to, a very effective one at that. By holding the belief that every man-who-has-sex-with-another-man should be using condoms with each and every sexual act, and by attempting to change the behaviors of those who do not, you are stigmatizing and shaming those who desire connection, intimacy, and heightened physical pleasure, and those who do not want to use condoms when having sex – whether in a mutually monogamous relationship or not. It is a reality that many MSM do not want to use condoms, will not use condoms, or will inconsistently use condoms when having sex. This was the reality in 1992, over a decade into the AIDS epidemic when contracting HIV meant a sure death, and it is the reality today, so we must acknowledge and accept it. I want to make it clear: I am not advocating for no condom usage, but I am saying that forcing condom usage on everyone does not and will not work, and that there must be other options. Personally, I prefer not to use condoms with every sexual act (I am more inclined to use condoms with anal sex than with oral sex, for instance, just knowing the risk involved), and I do not want to use condoms when I have sex with someone that I am dating. Thus, PrEP became a very good option for me.

After following up with my medical provider, I tested HIV-negative (using a fourth-generation HIV test), and also negative for other STIs. However, one of my main concerns with starting PrEP, aside from potential negative side effects, was the possibility of developing viral drug resistance if I somehow acquired HIV. After looking into the literature from the iPrEx trial, though, I was reassured to learn that the only people who developed drug resistance were those who had an undetected acute infection when starting Truvada (resistance to FTC only; no TDF drug resistant mutations or reduced phenotypic susceptibility were observed), and that drug resistance (to FTC) waned rapidly after discontinuing Truvada. With that knowledge, I decided to wait to begin PrEP until I got repeat testing 1 month later to ensure that I did not have an acute undetected infection. During that month, my boyfriend and I spent a great deal of time working on building trust back into our relationship; working on our communication; even going to couples’ counseling together, and, ultimately, deciding to stay together, though in a sexually non-monogamous relationship going forward. I can write a whole other blog post on relationships, and what that has meant for us (hint: lots of communication, honesty, and disclosure is included… and also love), but it also meant that we agreed to both start PrEP – as a commitment to each other’s health. I did not have sex during that month, either. Following a repeat negative result 1 month later, and being cleared medically, I next sought to acquire PrEP.

Experiences with acquiring PrEP
For my medical provider, I was the first patient to request to be prescribed PrEP. My provider was knowledgeable on PrEP, and willing to prescribe it to me, especially considering that I met the “high risk” criteria in the CDC guidelines. This scenario is not the case for everyone though. Unfortunately, some patients must be their own advocate, even to their medical provider, who may not be willing to prescribe PrEP and may instead approach safer-sex from a condom-only perspective. Some providers are also not aware of PrEP, and may require education themselves. I am making the assumption that those of you reading are aware. However, I want to comment on the “high risk” criteria established by the CDC. I truly believe these criteria should be considered exactly as they are framed – as guidelines, not as hard and fast rules of who should be, and who should not be, eligible for PrEP. For example, if, when taking a sexual history, a patient discloses behavior that places them at substantial risk of HIV acquisition, it could be important to consider discussing the option of PrEP with the patient. I believe, though, that anyone seeking PrEP as an HIV risk-reduction tool should be prescribed it (given they are medically eligible). If the “patient” is seeking PrEP, they have very likely already thought about risk, and about other prevention options. PrEP cannot only provide a reduction in risk, but also peace of mind. The World Health Organization currently recommends in their guidelines on HIV Prevention, Diagnosis, Treatment, and Care for Key Populations that ALL [emphasis added] men-who-have-sex-with-men should have the opportunity to choose PrEP if they feel that it meets their HIV prevention needs.

After being prescribed PrEP, I then sought to get my prescription filled. Of course, my first question was “how much is this going to cost?” The cost of Truvada in the US is about $1400/month – no small amount, by anyone’s standards. I had looked up information on Truvada on my insurance company’s website – it was considered a Tier 2 drug ($50 copay), but also a Specialty Drug, which may have meant that I also had to pay a 25% coinsurance premium; this would have made the drug unaffordable to me, as a graduate student. I called my insurance company, but they were not able to provide information on the actual cost until I got the prescription filled at a participating pharmacy.  Truvada was not available at the pharmacy of the health center I went to, so I sent the prescription to Walgreens Specialty Pharmacy. After “filling” the prescription, I found out that I only had to pay a $50 copay; a big relief. Later, I learned of Gilead’s Copay Assistance Program, which brought my out-of-pocket cost to $0. I have often thought about the cost of Truvada to my insurance company, versus the amount I pay for insurance (which is much less), but I will save the discussion on the economics and social justice of HIV prevention versus HIV treatment for another blog post. A 30-day supply of Truvada was then shipped directly to my apartment, so I began taking it.

Experiences on PrEP
While being on PrEP, I have had several side-effects – some “negative”, most “positive.” In terms of the “negative” side effects, for approximately the first month taking the drug I experienced a moderate amount of excess gas, which was humorous at times, but which also resolved quickly. I also experienced intermittent headaches, but these also resolved quickly, after the first two months. At follow-up evaluation with my medical provider, my renal function has remained good, so that is the extent of my “negative” side-effects on Truvada.

In terms of the “positive” side-effects, sex has become more of what I feel that it should be: healthy, enjoyable, and absent of fear. Not only have I remained HIV-negative, but I have also had immense positive mental health benefits. I feel that discussion of these “positive” side-effects is often absent in conversations on PrEP, as are conversations on the emotional aspect of sex in general. I have had peace of mind, and, although my risk behavior has been low since starting PrEP and has generally always been low, I have not sat anxious and consumed in fear while awaiting the results of an HIV test. I am also very open about being on PrEP, and have encouraged many friends to consider it as a prevention tool as well. This is another unmeasured benefit of PrEP: it has the potential to open up conversations on sex and on risk; conversations that many who are engaging in sex are not having. In fact, I believe that something you will find about those currently taking PrEP is that they are at least aware of risk, and want to reduce it. This may be one reason why most research studies have found that after starting PrEP, participants have not engaged in “riskier” behavior than they were already engaging in. My relationship with my boyfriend has also gotten healthier, and although that is not all attributable to PrEP, I do feel like the San Francisco AIDS Foundation message “love may have another protector” is applicable.

I intend to stay on Truvada as PrEP indefinitely, or until: 1) better or more convenient options become available, i.e. injectable forms of PrEP that require less frequent dosing, 2) an effective vaccine is developed, or 3) my insurance changes and cost becomes prohibitive. I really hope cost does not become the deciding issue.

Challenge to clinicians and health-care providers
My challenge to anyone reading this blog who provides health-care to someone who may be eligible for PrEP, is to meet your patient where they are. I recently had the privilege of sitting on a PrEP patient panel at the UNC’s Institute for Global Health & Infectious Diseases and the Greensboro Area Health Education Center’s Clinical Care in 2015: HIV, Hepatitis C, and Vulnerable Populations conference, also known as May Update, on May 4, 2015. During the panel discussion, a provider in the room stood up and commented that they could not believe we were “…saying it is okay to not use condoms.” If you read my blog post, you will see that is not exactly what I am saying; however, I am saying that some people do not or will not always use condoms (myself included), and for those people PrEP may be an important option. During that conference, the panel was also asked another question: “why are more MSM not seeking PrEP?” I have thought about this long and hard, and think it is for several reasons: 1) lack of awareness or knowledge about PrEP, 2) concern over cost, 3) fear of slut-shaming (i.e. being labeled a “Truvada Whore”), 4) lack of awareness of their actual risk for acquiring HIV, and 5) the fact that there is still a very public debate on PrEP, and that it is not even fully embraced by the medical community. That last reason is why I am writing this post – to plead with you to consider all aspects of the PrEP conversation, as well as current research, personal views aside. One last question that was asked to the panel: “do you think you are just looking for ‘the one’, one person to be intimate and loving with, and once you find them you will no longer need to be on PrEP?” While I appreciate the question, and am sure it is applicable to some people, if you don’t see the problem with that question I encourage you to look up heteronormativity, non-monogamy, and polyamory. My challenge to you is to try to understand your patient, and place yourself outside of your own lens and biases to meet them where they are.

If I can be of any help, as a current patient, please do not hesitate to reach out.
A few articles and sites I like:

A little bit about the author
Adam Ward is a 26-year-old gay, white, cisgender male. He currently holds a Master of Science in Comparative Biomedical Sciences, and a Graduate Certificate in LGBT Health Policy & Practice. He is passionate about working to eliminate health disparities impacting LGBT people, including HIV/AIDS, which he hopes to make a career of. He can be reached by e-mail at arward.ncsu@gmail.com.

 

Fred Sparling Turns Bad Luck into Prestigious Career

Fred Sparling, MD

Fred Sparling, MD

Fred Sparling, MD, believes in making the best out of a bad situation. It is a philosophy that guided his professional path leading him to his own research lab, chairing two departments at UNC and recently accepting the Association of American Physicians’ (AAP) highest honor.

“From bad luck you can find good luck,” says Sparling, who delivered the Kober Lecture on April 25. Named after the late physician George M. Kober, the lecture is presented every three years. Looking at the glass half full was the theme of Sparling’s address as he knew nearly half of the audience was junior investigators.

“I shared with them my mistakes and how I learned from them,” Sparling says. “For example, I was so busy completing my internship at Massachusetts General Hospital in Boston and courting the woman who would become my wife, that I missed the deadline to apply for training at the National Institutes of Health.  When a position was offered at the Venereal Diseases Research Laboratories at the CDC, located outside Atlanta in rural Georgia, I accepted immediately. Otherwise I would have been drafted.”

At first, Sparling was miserable. He spent his days culturing young women with gonorrhea, but had long periods of down time in between patients. Then he decided to use the time to his advantage and read everything he could find. His readings led him to focus on creating a genetic system to study Neisseria gonorrheae, the cause of gonorrhea. The ideas worked.

“I learned that I loved laboratory research, and reached out to Dr. Morton Swartz at Mass General, who suggested that I take further training in basic science,” Sparling says. “I began working with Dr. Bernie Davis at Harvard Medical School, working on genetics of antibiotic resistance and ribosome structure in E. coli, and published several papers, including a single author paper in the journal Science. This was all from seeing the glass as half full and not giving up even when I thought I had stumbled into a bad situation in Georgia.”

In 1969 Sparling was finishing a final year of clinical training as a fellow in infectious diseases at the MGH, and started looking for a real job. He accepted a faculty position at another university, but the job offer fell through. It was Thanksgiving time and he had three children to help his wife support. Joseph Pagano, MD, a well-respected virologist and chief of infectious diseases at UNC was looking to hire physician-scientists. He reached out to Sparling and made him an offer Sparling thinks would be unheard of today. It was another example of a time when bad luck turned good.

“At the time, UNC offered joint appointments in clinical and basic science. I was offered an appointment in medicine, and a joint appointment in microbiology, even though I had not yet met the chair of microbiology and had not given a seminar to the department of microbiology,” Sparling says. “Plus, I was given lab space where I was surrounded by great basic scientists from whom I learned a lot. I truly believe that if that first job offer had not been withdrawn, I wouldn’t have been given the opportunities to grow as a clinician and a researcher in the ways I did at UNC.”

Sparling’s career soared at UNC. His lab discovered that a single gene can cause multiple antibiotic resistance in the gonococcus, and then switched from studying ribosomes in E coli to a variety of topics affecting gonococci. He became the chief of the division of infectious diseases, and then the first chairman of UNC’s Division of Microbiology to not have a PhD. When a two-year search for a Chairman of the Department of Medicine failed to produce a candidate, Sparling reconsidered his decision to not be a candidate out of fear the lack of central leadership was beginning to take a toll on faculty. It meant giving up his job chairing microbiology and a reduction in the amount of time he could spend in his lab, but running the department of medicine also meant working with residents and recruiting faculty.

“I saw it as a chance to work with new people,” Sparling says. “I made lifelong friends. I even walked one of our interns down the aisle, when her family was not able to attend. It was a rewarding interpersonal time for me.”

Stan Lemon, MD, a UNC Professor of Medicine and hepatitis C virus researcher says Sparling continues to inspire him.

“Fred is a mentor, a close friend and a constant role model. I am always looking up to him. No one has been more successful in all three spheres of academic medicine – teaching, research and administration,” says Lemon. “But his biggest contribution has been in mentoring, and this was so evident in his Kober Lecture. It was pitched perfectly to a rising generation of physician-scientists, sharing facets of his incredible career with a unique blend of humor, humility and wise words.”

Forty-six years later and Sparling is a retired professor, but still sees patients in UNC’s ID Clinic.

“UNC is an unusual place because this career couldn’t have unfolded anywhere else,” Sparling says. “People value each other across turf boundaries and collaborate scientifically. I was able to have a career in microbiology and medicine. I grew without constraints and that’s what I hoped my lecture conveyed to a class of young physician-scientists.”

START Trial Results Prove HIV Treatment Should Start at Diagnosis

Our Dr. Ada Adimora’s Op-Ed Calls for Proactive Approach to Prevent Infectious Diseases among Injection Drug Users