Assessing an Epidemic


Prominent AIDS Researcher Highlights Prevention Marcus Conant was one of the first physicians to diagnose and treat AIDS in 1981 and is a founder of the San Francisco AIDS Foundation. He advocates free PrEP as part of a public health policy.
Photo: Bill Sywak




December 1 was World AIDS Day in San Francisco and around the globe. Various events were held in the city, including a community update at the new Mission Bay UCSF campus on HIV cure research sponsored by the American Foundation for AIDS Research, and the UCSF AIDS Research Institute. This was followed in the evening by a World AIDS Day report on San Francisco’s progress towards the goals of zero new HIV infections, zero preventable HIV deaths, and zero stigmas. Towards evening the annual “Light in the Grove,” a commemoration and candlelight remembrance of those lost to AIDS, was held in the AIDS Grove in Golden Gate Park, while Christmas tree lighting ceremonies were held in the Castro and in the Rotunda of City Hall sponsored by the Castro Merchants and the Rainbow World Fund.


In recognition of World AIDS Day, the Courier checked in with Dr. Marcus Conant, one of the first physicians to diagnose  and treat Acquired Immune Deficiency Syndrome (AIDS) in 1981 and a founder of the San Francisco AIDS Foundation. Conant was a professor at UCSF in dermatology when he first identified Kaposi’s Sarcoma and AIDS in patients and went on to help develop many important AIDS medications.


When I first contacted Conant it was to weigh in on a debate between researchers at Stanford and those at the World Health Organization to determine the best way to invest limited HIV resources in preventing HIV  globally. According to the Center for Disease Control, the early release of a highly promising Pre-Exposure Prophylaxis (PrEP)
treatment called Truvada constituted “a major step forward in the global fight against HIV ... and could reduce the transmission of HIV worldwide.”


In contrast, the Stanford researchers maintained that programs with limited resources should prioritize the scaling-up of existing HIV treatment over using Truvada. While acknowledging that “PrEP really does work almost as good as a condom,” Conant was more preoccupied with the spread and treatment of HIV nationally. “We now have 40,000 people a year infected with HIV. As a nation that’s unacceptable.”

Using data supplied by the White House, one in eight Americans will have their infections go undetected. In Conant’s experience the realistic number is that one-quarter to one-third of the U.S. population does not know if they are infected. If they are among the lesser number that got tested and found out  they are infected with the HIV virus, most will not do anything about it.


If you are a white gay male in America, especially if you live along one of the coasts or dense urban areas, you have a 3 percent chance of getting HIV. If you are a black gay male, you have about a 40 percent chance of being HIV positive.
The reasons are many and varied and have to do with education, adequate medication and more.


Dr. Conant shifted his view to our national HIV/AIDS strategy and quoted President Obama as saying undiagnosed HIV still affects different ages, races, sexual orientations and even different regions of the country in disproportionate ways. Meanwhile our nation’s vision is to have “unfettered access to high quality, life-extending care, free from stigma and discrimination” for all citizens.


Saying it’s 36 years later and we still don’t have a national AIDS policy, Conant asserts that PrEP should be given for free to almost everyone in the country. On our national AIDS policy, Conant believes that our leaders just deliver feel-good messages. He wants Nancy Pelosi, Barbara Boxer and Jackie Spier to make it a priority to stop the AIDS epidemic. Indeed, he wants our medical schools to add two hours to their curricula just to deliver AIDS training to help stop the epidemic.


Finally, there are some positive actions to take in Dr. Conant’s recent assessment of HIV wellness. The first is that his goal would be to “Stop the Epidemic.” He would be far more aggressive with federal and even state policy to stop the epidemic. It would probably take five to eight years to see results.


Some targeted activities that are currently showing promise include special “candidate vaccines” that have a greater chance of working and growing more antibiotics early on so there is a greater chance to act. In addition, working on group goals should continue among the labs currently working on vaccines. A cause for optimism is a new strategy to treat people who are already infected, called “Shock and Kill.” This refers to the habits of a virus over time to fit into one’s body and take up semi-permanent residence there, coming out to do damage at later times. The strategy is to fight it from within.

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