CINCINNATI – When it comes to studying HIV and AIDS, you might not expect a doctor to mention a deity or superstition.
But Dr. Carl Fichtenbaum at the University of Cincinnati has spent a better part of his life researching the disease – and sometimes, that’s the only answer that makes sense.
“What people do that gives them HIV, most other human beings have done before. If not for the grace of some higher power or just luck, one person gets it and another one doesn’t,” he said.
Fichtenbaum has been studying AIDS for more than 30 years, including the last 17 years at UC. In March, he kicked off a multi-year study looking at a new drug that may prevent the transmission of HIV – or the human immunodeficiency virus.
One of every two African-American men who have sex with other men will develop HIV in their lifetime, Fichtenbaum said. That number falls to a still-alarming one in six for white men. Greater Cincinnati has seen about 150 to 200 new cases of HIV every year for the past decade – something Fichtenbaum said he wants to change.
“We’re not making that dent. It’s time for us to bend that curve,” Fichtenbaum said. “I want to put myself out of business. I want to end the epidemic of HIV. I don’t want to leave my professional career and still have this hanging.”
It’s a tribute to UC Health’s research teams and the city itself, Fichtenbaum said, that Cincinnati landed this study limited to 45 sites worldwide by the HIV Prevention Trials Network.
“People have recognized that humans don’t always do very well at preventing things by having to take a pill every day,” Fichtenbaum said. “I have a pill that I take every morning, and I forgot it this morning. And I’m pretty good about that, so it happens to everybody.”
Truvada is a daily pill that has proven about 90 percent effective in preventing new HIV transmission since the FDA approved its use in 2012. It’s a form of PrEP, pre-exposure prophylaxis, but Fichtenbaum said one size does not fit all. That’s why they’re testing a new drug, cabotegravir (CAB), which could be injected once every two months as an alternative.
“Think of this like the development of birth control,” Fichtenbaum said, describing its progression from pills to shots and then implants and intrauterine devices.
It’s the next logical step, he said, in UC’s research into fighting AIDS. Previous studies have focused on treating HIV symptoms rather than preventing its contraction.
UC is aiming to enroll 70 participants in the study, but the hardest part is overcoming the stigma surrounding HIV and AIDS in Cincinnati.
“People don’t want to talk about it. Just because we don’t talk about it doesn’t make it go away. It’s here,” said Jaasiel Chapman, a clinical research community educator who UC hired specifically for this study. “We have individuals that don’t want to come here to Holmes Hospital because it’s known as the AIDS hospital. When you have someone that has cancer, you don’t hear they don’t want to go there because it’s the cancer hospital.”
Chapman previously worked at IV-Charis, a faith-based and minority-run HIV organization dedicated to Cincinnati’s highest-risk communities, which include people below 30 and African-Americans.
And Chapman’s counseling expertise seems to be helping make those connections, as Over-the-Rhine native Curtis Johnson said. He’s one of the first participants in the study who started taking PrEP in March.
“Had it not been for (Chapman), I wouldn’t have done it,” Johnson said. “The space that I’m in as a black, gay man at 39, I really want to be supported by other black, gay men of color. Not that a white man can’t support me. Not that a Latino man can’t support me, but it’s good when you see your own.”
Having had a harrowing HIV scare of his own, Johnson hopes his participation in the study can help lessen AIDS’ stigma in Cincinnati.
“What I’ve been taught in my mind is that sex is so dirty,” Johnson said. “You’re supposed to be holier than thou. You’re supposed to be heterosexual and all that jazz. So I really want to be able to give back (and) for people to ask me and not be ashamed or afraid to do it.”
Johnson describes a frantic phone call one stormy day in September that changed his life. The health department had told Johnson’s boyfriend of two years he was HIV positive.
“What am I going to do?” Johnson asked himself. “Because in my mind, I thought I gave it to him.”
Tests later revealed that Johnson did not have HIV, but Johnson said he fell into depression when he discovered his boyfriend had cheated on him with HIV-positive friends and had told family members he’d contracted HIV from Johnson.
Johnson said telling his “macho,” mechanic father about the situation was the toughest conversation he’d ever had.
“Regardless of whether you had it or not, you’re still my son,” Johnson’s father told him. “I’m glad you don’t, but now you know you have to protect yourself at all times. You can never put your health in somebody else’s hands.”
“He’s very much my gay supporter,” Johnson said of his father. “I never thought that I was going to have that. Being black and gay and growing up in the hood, you don’t get that. You either get the Bible bangers, or you get everybody just being unfair.”
By the end of March, Fichtenbaum and Chapman screened 11 people for the study and had eight more on the docket. So far, they’ve enrolled eight participants who are paid for the study, but they declined to reveal how much.
As part of the study, one group will receive CAB as a pill and a placebo pill for Truvada every day for the first five weeks. This group will also receive a CAB injection monthly for two months, and then for every two months afterward along with a daily placebo pill for Truvada for up to three and a half years.
A second group will be given a real Truvada pill and a placebo pill for CAB every day for five weeks. A placebo CAB injection will follow with real Truvada pills every day for up to three-and-a-half years.
Three-and-a-half years into the study, all participants in both groups will receive the real Truvada pill.
The randomized double blind trial is designed for HIV negative gay men or HIV negative transgender women who have sex with men.