1 00:00:01,333 --> 00:00:03,966 ♪ ♪ 2 00:00:06,700 --> 00:00:10,133 NARRATOR: It began as a mysterious plague. 3 00:00:10,133 --> 00:00:13,566 CECILIA CHUNG: I was doomed to not live very long. 4 00:00:13,566 --> 00:00:16,566 MAN: People are not realizing how bad a disease it is, 5 00:00:16,566 --> 00:00:18,300 and there's no cure for it. 6 00:00:18,300 --> 00:00:19,866 NARRATOR: A ferocious killer 7 00:00:19,866 --> 00:00:21,933 that frustrated scientists at every turn. 8 00:00:21,933 --> 00:00:25,300 JOHN MASCOLA: If we look at all the viruses that we understand, 9 00:00:25,300 --> 00:00:29,266 H.I.V. is far on the spectrum of difficult. 10 00:00:29,266 --> 00:00:33,700 NARRATOR: But a long, worldwide scientific quest 11 00:00:33,700 --> 00:00:37,600 has provided a string of spectacular discoveries. 12 00:00:37,600 --> 00:00:39,700 MYRON COHEN: The science that's developed is, is, remarkable. 13 00:00:39,700 --> 00:00:43,633 NARRATOR: And after four decades, it's led us to the brink 14 00:00:43,633 --> 00:00:45,533 of what was once unthinkable: 15 00:00:45,533 --> 00:00:49,133 the end of H.I.V. in America. 16 00:00:49,133 --> 00:00:51,600 MONICA GANDHI: We have prevention, 17 00:00:51,600 --> 00:00:53,600 we have treatment, and we have testing. 18 00:00:53,600 --> 00:00:56,433 WOMAN: There we go. 19 00:00:56,433 --> 00:00:58,900 NARRATOR: As scientists chip away at the virus's defenses... 20 00:00:58,900 --> 00:01:01,200 MICHAEL SAAG: I'm just overwhelmed 21 00:01:01,200 --> 00:01:03,300 at the progress that was made. 22 00:01:03,300 --> 00:01:08,533 NARRATOR: ...a once-insurmountable foe is finally on the ropes. 23 00:01:08,533 --> 00:01:09,833 I think we definitely have the tools 24 00:01:09,833 --> 00:01:11,466 to end the epidemic in the U.S. 25 00:01:11,466 --> 00:01:14,833 NARRATOR: The U.S. government has set a bold target: 26 00:01:14,833 --> 00:01:20,433 cut new infections by another 90% by the year 2030. 27 00:01:20,433 --> 00:01:23,666 But can we conquer the last mile 28 00:01:23,666 --> 00:01:25,633 and the landmines of accessibility 29 00:01:25,633 --> 00:01:28,466 and stigma that lie along the way? 30 00:01:28,466 --> 00:01:30,066 "Oh, he's H.I.V.-positive. 31 00:01:30,066 --> 00:01:31,766 How did he get it?" 32 00:01:31,766 --> 00:01:36,033 TOMMY WILLIAMS: It's just going to take a true 33 00:01:36,033 --> 00:01:38,200 collaborative effort. 34 00:01:38,200 --> 00:01:41,000 NARRATOR: "Ending H.I.V. in America," 35 00:01:41,000 --> 00:01:44,400 right now, on "NOVA." 36 00:01:44,400 --> 00:02:04,733 ♪ ♪ 37 00:02:09,933 --> 00:02:13,266 ♪ ♪ 38 00:02:21,066 --> 00:02:23,166 Hey. 39 00:02:23,166 --> 00:02:24,833 This is Tommy from U.A.B. outpatient. 40 00:02:24,833 --> 00:02:26,733 WILLIAMS: It's a lot of time in the clinic, 41 00:02:26,733 --> 00:02:29,600 meeting patients, especially for the initial appointments. 42 00:02:29,600 --> 00:02:32,266 Well, I'll see you when you get here, lovely. 43 00:02:32,266 --> 00:02:34,300 NARRATOR: This phone is a lifeline 44 00:02:34,300 --> 00:02:38,800 for 2,000 people infected with H.I.V. 45 00:02:38,800 --> 00:02:41,600 who depend on the 1917 Clinic 46 00:02:41,600 --> 00:02:44,266 at the University of Alabama at Birmingham. 47 00:02:44,266 --> 00:02:47,466 WILLIAMS: H.I.V. care, which includes treatment 48 00:02:47,466 --> 00:02:50,300 and research, community engagement. 49 00:02:50,300 --> 00:02:52,100 We also do H.I.V. testing. 50 00:02:52,100 --> 00:02:54,566 Hey, Tommy! Hey! 51 00:02:54,566 --> 00:02:58,100 NARRATOR: Tommy Williams is in charge of connecting patients 52 00:02:58,100 --> 00:02:59,800 with all the clinic has to offer. 53 00:02:59,800 --> 00:03:01,100 I can help you with that. 54 00:03:01,100 --> 00:03:02,533 I can help you with that before you leave. 55 00:03:02,533 --> 00:03:04,633 ♪ ♪ 56 00:03:04,633 --> 00:03:06,033 NARRATOR: In the United States, 57 00:03:06,033 --> 00:03:11,300 more than one million people are currently living with H.I.V. 58 00:03:11,300 --> 00:03:16,366 But the burden is not felt evenly across the population. 59 00:03:16,366 --> 00:03:19,266 As they've been since the outbreak began, 60 00:03:19,266 --> 00:03:23,433 men who have sex with men are by far the most affected. 61 00:03:23,433 --> 00:03:25,966 (talking softly) 62 00:03:25,966 --> 00:03:28,433 Men who have sex with men make up, like, two to three percent 63 00:03:28,433 --> 00:03:29,766 of the U.S. population, 64 00:03:29,766 --> 00:03:34,300 and they make up about two-thirds of H.I.V. diagnoses. 65 00:03:34,300 --> 00:03:36,566 One is because, anal sex, you have higher risk 66 00:03:36,566 --> 00:03:38,766 of getting H.I.V. just because of trauma 67 00:03:38,766 --> 00:03:40,966 and the type of cells that are in that area. 68 00:03:40,966 --> 00:03:42,433 (card reader beeps) 69 00:03:42,433 --> 00:03:43,700 NARRATOR: Latesha Elopre, 70 00:03:43,700 --> 00:03:47,500 an infectious disease specialist at the 1917 Clinic, 71 00:03:47,500 --> 00:03:50,633 says another key factor is stigma. 72 00:03:50,633 --> 00:03:52,100 Hi! MAN: Hey! 73 00:03:52,100 --> 00:03:53,933 We saw each other last time. 74 00:03:53,933 --> 00:03:55,666 ELOPRE: There's still a lot of stigma related to H.I.V. 75 00:03:55,666 --> 00:03:58,700 And I think that's also a huge barrier why people 76 00:03:58,700 --> 00:04:00,566 don't always access our preventative services 77 00:04:00,566 --> 00:04:03,066 or come in to get tested. 78 00:04:03,066 --> 00:04:05,333 ♪ ♪ 79 00:04:05,333 --> 00:04:08,600 NARRATOR: Race is another risk factor. 80 00:04:08,600 --> 00:04:11,100 Compared to their white counterparts, 81 00:04:11,100 --> 00:04:15,400 the lifetime infection risk for Black men is six times higher. 82 00:04:15,400 --> 00:04:21,400 For Black women, it is nearly 12 times higher. 83 00:04:21,400 --> 00:04:24,433 One reason patients are willing 84 00:04:24,433 --> 00:04:26,433 to put their trust in Tommy Williams 85 00:04:26,433 --> 00:04:29,866 is that he knows where they're coming from. 86 00:04:29,866 --> 00:04:32,966 He's born and raised here in Birmingham... 87 00:04:32,966 --> 00:04:34,900 We're on the east side of town. 88 00:04:34,900 --> 00:04:39,233 NARRATOR: ...and he's H.I.V.-positive. 89 00:04:39,233 --> 00:04:41,566 WILLIAMS: There are times when I visit a patient at bedside 90 00:04:41,566 --> 00:04:46,700 and me disclosing changes everything. 91 00:04:46,700 --> 00:04:48,366 Like, something grows. 92 00:04:48,366 --> 00:04:50,900 Something beautiful grows. 93 00:04:53,433 --> 00:04:55,266 I became aware of H.I.V. very young. 94 00:04:55,266 --> 00:04:57,500 I think I was in the ninth grade, 95 00:04:57,500 --> 00:04:59,833 and, um... 96 00:04:59,833 --> 00:05:02,666 This girl was, like, "He's a sissy." 97 00:05:02,666 --> 00:05:05,433 And then, so these guys was, like, "You fruit loop, 98 00:05:05,433 --> 00:05:08,333 "you're a fruit loop, you got AIDS. 99 00:05:08,333 --> 00:05:09,766 You got AIDS." 100 00:05:11,466 --> 00:05:15,100 I wanted to believe that I did not, 101 00:05:15,100 --> 00:05:18,600 but I also believed that if I didn't have AIDS, 102 00:05:18,600 --> 00:05:20,300 it was just a matter of time. 103 00:05:20,300 --> 00:05:22,433 I was, like, "I'm, this is going to happen to me 104 00:05:22,433 --> 00:05:24,733 and, um, and I'm going to die from it." 105 00:05:24,733 --> 00:05:28,333 So, you know, one day, that day came. 106 00:05:31,400 --> 00:05:37,000 NARRATOR: Tommy was fortunate to contract H.I.V. at a time when 107 00:05:37,000 --> 00:05:40,166 highly effective medications offered him a chance 108 00:05:40,166 --> 00:05:43,333 at a long, healthy life. 109 00:05:43,333 --> 00:05:48,000 You can live, and I'm living, I'm thriving. 110 00:05:48,000 --> 00:05:49,966 Okay! Oh, my God. 111 00:05:49,966 --> 00:05:52,633 I'm so sorry I'm late for this appointment. 112 00:05:52,633 --> 00:05:58,166 NARRATOR: It was a surprisingly difficult road to get to this point. 113 00:05:58,166 --> 00:06:01,833 The treatments available to Tommy are revolutionary, 114 00:06:01,833 --> 00:06:05,666 and the result of a decades-long battle against H.I.V. 115 00:06:05,666 --> 00:06:08,733 that never quite went as planned. 116 00:06:08,733 --> 00:06:13,233 ♪ ♪ 117 00:06:16,866 --> 00:06:21,300 San Francisco has been an epicenter, for both the disease 118 00:06:21,300 --> 00:06:23,400 and innovative treatments. 119 00:06:23,400 --> 00:06:24,633 GANDHI: Good to see you, Donna. 120 00:06:24,633 --> 00:06:26,133 Good to see you. 121 00:06:26,133 --> 00:06:27,500 Come on back. 122 00:06:27,500 --> 00:06:30,166 NARRATOR: Dr. Monica Gandhi heads up Ward 86 at the 123 00:06:30,166 --> 00:06:33,366 University of California, San Francisco, 124 00:06:33,366 --> 00:06:37,766 the oldest dedicated H.I.V. treatment unit in the world. 125 00:06:37,766 --> 00:06:40,000 I can see your light reflex in that eye. 126 00:06:40,000 --> 00:06:43,000 GANDHI: I always knew about Ward 86. 127 00:06:43,000 --> 00:06:44,866 It was just in my head, and I just wanted to be here. 128 00:06:44,866 --> 00:06:46,733 I wanted to be a part of this. 129 00:06:46,733 --> 00:06:50,333 And then in 2014, I became the medical director of Ward 86, 130 00:06:50,333 --> 00:06:52,700 which has been really a privilege. 131 00:06:52,700 --> 00:06:55,466 DONNA: In 2004, when I had AIDS, 132 00:06:55,466 --> 00:06:59,366 I asked God to just help me to live with it. 133 00:06:59,366 --> 00:07:01,466 And I've been doing just that. 134 00:07:01,466 --> 00:07:07,366 NARRATOR: When Ward 86 first opened in 1983, 135 00:07:07,366 --> 00:07:10,366 an AIDS infection was a death sentence. 136 00:07:14,700 --> 00:07:19,533 Cecilia Chung arrived in San Francisco in the early 1980s 137 00:07:19,533 --> 00:07:22,533 to escape her strict Hong Kong family 138 00:07:22,533 --> 00:07:26,600 and to sample life as a young gay man. 139 00:07:26,600 --> 00:07:28,800 But she found a scene much different 140 00:07:28,800 --> 00:07:30,433 than what she'd pictured. 141 00:07:30,433 --> 00:07:35,133 CHUNG: When I tried to, like, go on my adventure, 142 00:07:35,133 --> 00:07:37,266 I would see maybe five or six people 143 00:07:37,266 --> 00:07:39,133 in one of the bars, 144 00:07:39,133 --> 00:07:44,633 and it didn't take long for me to figure out what's going on. 145 00:07:44,633 --> 00:07:48,600 People were avoiding talking about it, 146 00:07:48,600 --> 00:07:51,733 but everybody knows that if you haven't seen your friends 147 00:07:51,733 --> 00:07:53,566 for more than a week, 148 00:07:53,566 --> 00:07:56,766 chances are you never see them again. 149 00:07:56,766 --> 00:07:59,733 So this is Divas. 150 00:08:02,700 --> 00:08:05,100 CHUNG: When my mom came visit, 151 00:08:05,100 --> 00:08:07,600 my mom say, "Don't sleep with men, you will die." 152 00:08:07,600 --> 00:08:12,800 So I never expected to live past 30, and lo and behold, 153 00:08:12,800 --> 00:08:16,200 I contracted H.I.V. when I was 27, 28. 154 00:08:16,200 --> 00:08:19,666 It was called gay cancer and GRID-- 155 00:08:19,666 --> 00:08:23,500 Gay-Related Immunodeficiency. 156 00:08:23,500 --> 00:08:25,633 ♪ ♪ 157 00:08:25,633 --> 00:08:27,766 NARRATOR: In May 1982, 158 00:08:27,766 --> 00:08:31,200 when "The New York Times" reported on so-called GRID, 159 00:08:31,200 --> 00:08:35,700 it stated, "Epidemiologists have found no evidence 160 00:08:35,700 --> 00:08:38,833 "that the condition is spread from person to person 161 00:08:38,833 --> 00:08:40,300 "like influenza or measles. 162 00:08:40,300 --> 00:08:45,033 The general public need not fear an epidemic." 163 00:08:45,033 --> 00:08:48,200 ♪ ♪ 164 00:08:48,200 --> 00:08:55,166 It wouldn't take long to see that confidence was misplaced. 165 00:08:55,166 --> 00:09:00,566 By the early 1980s, cases of the mysterious illness 166 00:09:00,566 --> 00:09:04,500 were appearing in cities all over the country. 167 00:09:04,500 --> 00:09:07,966 ♪ ♪ 168 00:09:07,966 --> 00:09:09,000 (knock at door) 169 00:09:10,366 --> 00:09:11,866 Good afternoon. 170 00:09:11,866 --> 00:09:13,566 SAAG: We were seeing more and more people, 171 00:09:13,566 --> 00:09:15,166 especially from outside of Birmingham, 172 00:09:15,166 --> 00:09:16,666 coming in to see us. 173 00:09:16,666 --> 00:09:21,000 And you could just feel the epidemic beginning to crash 174 00:09:21,000 --> 00:09:22,533 on our shores, if you will. 175 00:09:22,533 --> 00:09:25,933 NARRATOR: In Birmingham, Mike Saag 176 00:09:25,933 --> 00:09:27,966 was just two years out of medical school 177 00:09:27,966 --> 00:09:31,566 when he saw his first case. 178 00:09:31,566 --> 00:09:34,100 I remember were thinking, "This is really unusual." 179 00:09:34,100 --> 00:09:35,666 This guy was in his early 30s. 180 00:09:35,666 --> 00:09:37,166 He had no reason to be sick. 181 00:09:37,166 --> 00:09:43,566 Something was desperately wrong with the immune system. 182 00:09:43,566 --> 00:09:45,966 ELOPRE: Any disease that we've encountered in history 183 00:09:45,966 --> 00:09:47,733 as an infectious diseases provider, 184 00:09:47,733 --> 00:09:51,166 the key has been to, number one, identify that disease, 185 00:09:51,166 --> 00:09:54,400 to learn and effectively treat that illness. 186 00:09:54,400 --> 00:09:57,033 And then the biggest, the way to stop pandemics, 187 00:09:57,033 --> 00:09:59,366 is to prevent it from being spread. 188 00:09:59,366 --> 00:10:03,033 So, immediately, all of our attention begins to focus 189 00:10:03,033 --> 00:10:06,000 on this causative agent. 190 00:10:06,000 --> 00:10:08,600 NARRATOR: Scientists around the world 191 00:10:08,600 --> 00:10:12,233 began a frantic search for clues. 192 00:10:12,233 --> 00:10:16,400 And in the spring of 1983, they found the culprit. 193 00:10:16,400 --> 00:10:18,866 In the cells of sick patients, 194 00:10:18,866 --> 00:10:22,700 scientists at the Pasteur Institute in Paris 195 00:10:22,700 --> 00:10:28,600 discovered the virus that would come to be called H.I.V. 196 00:10:28,600 --> 00:10:32,166 They found it in CD4 cells, 197 00:10:32,166 --> 00:10:33,866 a type of white blood cell 198 00:10:33,866 --> 00:10:36,733 that's critical to the immune system. 199 00:10:36,733 --> 00:10:41,333 They would come to know it as a formidable enemy. 200 00:10:41,333 --> 00:10:44,900 Like other viruses, 201 00:10:44,900 --> 00:10:47,966 H.I.V. works by hijacking the machinery 202 00:10:47,966 --> 00:10:53,000 of the body's own cells. 203 00:10:53,000 --> 00:10:56,233 By inserting its own genetic material into the DNA 204 00:10:56,233 --> 00:10:59,000 of the host CD4 cell, 205 00:10:59,000 --> 00:11:02,966 it reprograms the cell to produce the seeds 206 00:11:02,966 --> 00:11:04,433 of its own destruction, 207 00:11:04,433 --> 00:11:08,733 churning out more and more copies of the virus 208 00:11:08,733 --> 00:11:12,866 until the cell bursts open. 209 00:11:12,866 --> 00:11:16,400 SAAG: It turns that cell into a virus factory 210 00:11:16,400 --> 00:11:17,833 that then go into the bloodstream 211 00:11:17,833 --> 00:11:19,766 and start infecting other cells. 212 00:11:19,766 --> 00:11:21,766 And that's how the infection takes root. 213 00:11:24,033 --> 00:11:27,600 NARRATOR: It's a powerful two-punch combo: 214 00:11:27,600 --> 00:11:32,066 rapid replication and weakening the immune system, 215 00:11:32,066 --> 00:11:35,400 killing the very cells that are meant to defend against it. 216 00:11:35,400 --> 00:11:38,000 When first infected, 217 00:11:38,000 --> 00:11:42,133 patients usually experienced a brief, mild illness. 218 00:11:42,133 --> 00:11:46,400 Nothing that would signal a serious disease. 219 00:11:46,400 --> 00:11:50,500 The patient recovers. 220 00:11:50,500 --> 00:11:55,966 But the virus stays active, steadily multiplying, 221 00:11:55,966 --> 00:12:00,600 and killing more and more CD4 cells. 222 00:12:00,600 --> 00:12:02,000 SAAG: That relentless replication 223 00:12:02,000 --> 00:12:05,333 ultimately damages the immune system and leads to 224 00:12:05,333 --> 00:12:07,966 the opportunistic infections that we see every day, 225 00:12:07,966 --> 00:12:09,900 what we would then call AIDS. 226 00:12:09,900 --> 00:12:14,066 NARRATOR: "Acquired Immunodeficiency Syndrome" 227 00:12:14,066 --> 00:12:18,466 left the body unable to fight off most infections. 228 00:12:18,466 --> 00:12:20,900 With the virus identified, 229 00:12:20,900 --> 00:12:23,333 the race was on to find a treatment. 230 00:12:26,000 --> 00:12:30,966 And in 1987, there came what looked like a breakthrough. 231 00:12:30,966 --> 00:12:33,700 Hope for AIDS patients: the drug AZT. 232 00:12:33,700 --> 00:12:35,800 NARRATOR: As scientists discovered, 233 00:12:35,800 --> 00:12:40,466 AZT, a drug originally developed to fight cancer, 234 00:12:40,466 --> 00:12:45,233 was able to attack the virus at a key vulnerable point. 235 00:12:45,233 --> 00:12:49,666 H.I.V. is what's known as a retrovirus, 236 00:12:49,666 --> 00:12:53,133 only the third to be found in humans. 237 00:12:53,133 --> 00:12:57,166 A retrovirus's genetic material 238 00:12:57,166 --> 00:13:00,933 is single-stranded RNA. 239 00:13:00,933 --> 00:13:03,233 To hijack the cell's machinery, 240 00:13:03,233 --> 00:13:07,166 it must convert that to double-stranded DNA, 241 00:13:07,166 --> 00:13:09,700 like the rest of the human blueprint. 242 00:13:09,700 --> 00:13:13,133 The virus uses an enzyme called reverse transcriptase 243 00:13:13,133 --> 00:13:16,633 to make that conversion. 244 00:13:16,633 --> 00:13:19,600 AZT inhibits that enzyme, 245 00:13:19,600 --> 00:13:22,733 preventing the RNA from being converted. 246 00:13:22,733 --> 00:13:26,200 In a quickly organized clinical trial, 247 00:13:26,200 --> 00:13:29,633 AZT stopped the disease in its tracks. 248 00:13:29,633 --> 00:13:32,100 CHUNG: People were looking for 249 00:13:32,100 --> 00:13:34,433 a vaccine and a cure. 250 00:13:34,433 --> 00:13:36,233 So when AZT came out, 251 00:13:36,233 --> 00:13:39,900 it offered some hope to us. 252 00:13:39,900 --> 00:13:43,633 NARRATOR: But that hope was short-lived. 253 00:13:43,633 --> 00:13:45,966 It didn't take long for us to realize that AZT 254 00:13:45,966 --> 00:13:47,366 is not going to cure us. 255 00:13:47,366 --> 00:13:50,400 LAWRENCE COREY: It became very clear that people 256 00:13:50,400 --> 00:13:54,533 who responded to AZT, after three or four or five months, 257 00:13:54,533 --> 00:13:56,533 started to lose their CD4 T cells 258 00:13:56,533 --> 00:13:58,400 and started to lose weight again, 259 00:13:58,400 --> 00:14:01,933 and not gain weight, and started getting, uh, infections again. 260 00:14:01,933 --> 00:14:05,366 NARRATOR: Larry Corey was one of the first researchers 261 00:14:05,366 --> 00:14:08,533 to specialize in H.I.V. 262 00:14:08,533 --> 00:14:11,300 COREY: It was perceptually worse, because you got better, 263 00:14:11,300 --> 00:14:14,033 you were optimistic you got better, and then you got worse. 264 00:14:14,033 --> 00:14:17,166 MAN: I've pretty much accepted the fact that I'm going to die. 265 00:14:17,166 --> 00:14:20,600 NARRATOR: As scientists studied the virus, 266 00:14:20,600 --> 00:14:23,466 they began to understand how it was able 267 00:14:23,466 --> 00:14:25,100 to evade the medication. 268 00:14:25,100 --> 00:14:27,366 ELOPRE: The virus can mutate, and that was one of 269 00:14:27,366 --> 00:14:29,433 the biggest issues that we had. 270 00:14:29,433 --> 00:14:33,100 The virus can change itself and basically change in a way 271 00:14:33,100 --> 00:14:35,133 where that medication stops working. 272 00:14:35,133 --> 00:14:39,366 NARRATOR: Drug resistance is driven by mutation, 273 00:14:39,366 --> 00:14:44,333 and H.I.V.'s capacity to mutate is exceptional. 274 00:14:44,333 --> 00:14:45,866 In fact, in the body, 275 00:14:45,866 --> 00:14:50,966 H.I.V. mutates faster than any other virus or any life form 276 00:14:50,966 --> 00:14:53,266 that scientists have ever measured. 277 00:14:53,266 --> 00:14:55,366 COVID, or SARS-CoV-2, 278 00:14:55,366 --> 00:15:01,266 there's mistakes made, but it has a correction enzyme. 279 00:15:01,266 --> 00:15:02,900 So it has a proofreader 280 00:15:02,900 --> 00:15:06,066 that comes through, and if it sees a mistake, corrects it. 281 00:15:06,066 --> 00:15:08,333 H.I.V. doesn't have that enzyme. 282 00:15:08,333 --> 00:15:10,200 NARRATOR: Without the proofreader, 283 00:15:10,200 --> 00:15:15,266 the virus churns out different versions of itself-- variants. 284 00:15:15,266 --> 00:15:18,766 H.I.V. does that more frequently than any other virus. 285 00:15:18,766 --> 00:15:20,866 NARRATOR: So many mutations 286 00:15:20,866 --> 00:15:23,600 means a greater chance that the virus 287 00:15:23,600 --> 00:15:27,400 will change enough to elude the treatment. 288 00:15:27,400 --> 00:15:29,400 GANDHI: It's very wily, it's very prone to change, 289 00:15:29,400 --> 00:15:33,000 and it essentially just evolved mutations 290 00:15:33,000 --> 00:15:35,900 that made it evade AZT. 291 00:15:35,900 --> 00:15:38,566 NARRATOR: H.I.V.'s shapeshifting 292 00:15:38,566 --> 00:15:44,000 was also sabotaging efforts to create a vaccine. 293 00:15:44,000 --> 00:15:46,666 The work began in the '80s 294 00:15:46,666 --> 00:15:49,733 with fanfare and hope. 295 00:15:49,733 --> 00:15:53,433 We hope to have such a vaccine ready for testing 296 00:15:53,433 --> 00:15:55,400 in approximately two years. 297 00:15:55,400 --> 00:15:58,866 SAAG: Margaret Heckler, who was the secretary of HHS, 298 00:15:58,866 --> 00:16:00,300 had a press conference, 299 00:16:00,300 --> 00:16:04,333 and this is around 1985, and she said, "Within two years, 300 00:16:04,333 --> 00:16:07,266 we're going to have an H.I.V. vaccine." 301 00:16:07,266 --> 00:16:12,733 NARRATOR: But the reality of the challenge quickly set in. 302 00:16:12,733 --> 00:16:16,300 Vaccines are designed to trigger an immune response, 303 00:16:16,300 --> 00:16:21,066 pushing the body to produce proteins called antibodies, 304 00:16:21,066 --> 00:16:23,000 which attach themselves to invaders 305 00:16:23,000 --> 00:16:25,733 and tag them for destruction. 306 00:16:25,733 --> 00:16:28,333 It's a tried-and-true approach, 307 00:16:28,333 --> 00:16:32,300 used to create vaccines that eliminated smallpox, 308 00:16:32,300 --> 00:16:35,000 measles, and polio in the U.S. 309 00:16:35,000 --> 00:16:38,433 ♪ ♪ 310 00:16:38,433 --> 00:16:40,666 COREY: You make antibodies so that when 311 00:16:40,666 --> 00:16:43,166 you get exposed to that agent, 312 00:16:43,166 --> 00:16:45,866 one's body recognizes it and therefore eliminates it 313 00:16:45,866 --> 00:16:48,100 before it causes any disease. 314 00:16:48,100 --> 00:16:50,900 It prevents you from getting sick. 315 00:16:50,900 --> 00:16:55,500 NARRATOR: But with H.I.V., the challenges were unprecedented. 316 00:16:55,500 --> 00:17:01,300 Most antibodies bind to and block only a single target, 317 00:17:01,300 --> 00:17:05,033 a specific surface protein on a virus. 318 00:17:05,033 --> 00:17:08,433 But with H.I.V. mutating so rapidly, 319 00:17:08,433 --> 00:17:12,066 that target was constantly moving. 320 00:17:12,066 --> 00:17:15,500 Working on the early vaccine trials, 321 00:17:15,500 --> 00:17:20,100 John Mascola saw the problem firsthand. 322 00:17:20,100 --> 00:17:22,033 MASCOLA: Those proteins surfaces, they change. 323 00:17:22,033 --> 00:17:24,866 So an antibody that sees one strain of H.I.V. 324 00:17:24,866 --> 00:17:27,633 doesn't necessarily see another one. 325 00:17:27,633 --> 00:17:31,300 So there's all this diversity of H.I.V. in the world. 326 00:17:31,300 --> 00:17:35,400 NARRATOR: The number of variants is stunning. 327 00:17:35,400 --> 00:17:38,200 A vaccine must protect against all of them. 328 00:17:38,200 --> 00:17:39,833 MASCOLA: I think there was a sense of 329 00:17:39,833 --> 00:17:42,666 realism that set in that said, 330 00:17:42,666 --> 00:17:44,633 "If we look at all the viruses that we understand, 331 00:17:44,633 --> 00:17:48,566 H.I.V. is far on the spectrum of difficult." 332 00:17:48,566 --> 00:17:50,733 Making a vaccine was gonna be 333 00:17:50,733 --> 00:17:54,133 a pretty major scientific obstacle. 334 00:17:54,133 --> 00:17:57,566 NARRATOR: A decade into the pandemic, 335 00:17:57,566 --> 00:18:00,366 there was still no vaccine, 336 00:18:00,366 --> 00:18:03,366 no cure, and no long-term treatment. 337 00:18:03,366 --> 00:18:06,700 Behavior changes, like using condoms, 338 00:18:06,700 --> 00:18:09,866 had slowed the pace of new infections. 339 00:18:09,866 --> 00:18:12,833 But the death toll kept rising. 340 00:18:14,866 --> 00:18:18,133 ♪ ♪ 341 00:18:18,133 --> 00:18:19,266 SAAG: H.I.V. had become 342 00:18:19,266 --> 00:18:22,366 the number-one killer of young people 343 00:18:22,366 --> 00:18:24,266 between the ages of 20 and 45 years of age 344 00:18:24,266 --> 00:18:27,866 in major metropolitan centers. 345 00:18:27,866 --> 00:18:29,266 NARRATOR: And by 1992, 346 00:18:29,266 --> 00:18:32,433 it was the number-one killer of young men 347 00:18:32,433 --> 00:18:35,533 in the country as a whole. 348 00:18:37,766 --> 00:18:40,866 SAAG: More than trauma, cancer, suicide. 349 00:18:40,866 --> 00:18:42,933 (chanting): Typical day at the N.I.H.! Watching people die! 350 00:18:42,933 --> 00:18:45,500 NARRATOR: Frustration was boiling over, 351 00:18:45,500 --> 00:18:49,900 especially in communities that were hardest-hit by AIDS. 352 00:18:49,900 --> 00:18:52,933 And there was growing recognition 353 00:18:52,933 --> 00:18:57,700 that it wasn't only gay men who were at risk. 354 00:18:57,700 --> 00:18:59,433 ♪ ♪ 355 00:18:59,433 --> 00:19:03,866 Because of the... (cameras clicking) 356 00:19:03,866 --> 00:19:07,833 ...the H.I.V. virus that I have attained, uh, 357 00:19:07,833 --> 00:19:10,833 I will have to retire from the Lakers. 358 00:19:10,833 --> 00:19:14,800 NARRATOR: NBA All-Star Earvin "Magic" Johnson 359 00:19:14,800 --> 00:19:17,033 put a new face on the epidemic. 360 00:19:17,033 --> 00:19:21,333 CHRISTOPHER HAMLIN: No one thought Magic Johnson, not Magic Johnson. 361 00:19:21,333 --> 00:19:24,066 We put our athletes on a pedestal and think, 362 00:19:24,066 --> 00:19:25,766 "Nothing will happen to them. 363 00:19:25,766 --> 00:19:27,333 They're giants, they're heroes." 364 00:19:27,333 --> 00:19:29,633 That's why I am going to be a spokesman for this 365 00:19:29,633 --> 00:19:32,700 H.I.V. virus, because I want them to understand 366 00:19:32,700 --> 00:19:34,800 that safe sex is the way to go. 367 00:19:34,800 --> 00:19:36,233 I think sometimes we think, 368 00:19:36,233 --> 00:19:39,500 "Well, only gay people can get it, only... 369 00:19:39,500 --> 00:19:41,433 Well, it's not going to happen to me." 370 00:19:41,433 --> 00:19:43,300 And here I am saying that it can happen to anybody. 371 00:19:43,300 --> 00:19:47,233 HAMLIN: So, when Magic Johnson disclosed his status, 372 00:19:47,233 --> 00:19:50,200 it really was an earthquake event. 373 00:19:50,200 --> 00:19:54,566 NARRATOR: When that earthquake rattled through Birmingham, 374 00:19:54,566 --> 00:19:57,366 the Reverend Chris Hamlin was pastor 375 00:19:57,366 --> 00:20:02,133 of the city's historic 16th Street Baptist Church. 376 00:20:02,133 --> 00:20:05,166 Everything that is connected to the African American community 377 00:20:05,166 --> 00:20:07,600 has filtered through, for the most part, 378 00:20:07,600 --> 00:20:09,266 filtered through the Black church. 379 00:20:09,266 --> 00:20:13,700 NARRATOR: 16th Street had been a major rallying point 380 00:20:13,700 --> 00:20:15,800 during the civil rights movement. 381 00:20:15,800 --> 00:20:19,800 And also a target. 382 00:20:21,666 --> 00:20:23,666 HAMLIN: Sunday, September 15, 1963, 383 00:20:23,666 --> 00:20:26,366 Klan placed sticks of dynamite 384 00:20:26,366 --> 00:20:28,466 underneath an exterior stairwell. 385 00:20:28,466 --> 00:20:31,100 And that Sunday morning, 386 00:20:31,100 --> 00:20:33,366 young ladies were in the restroom area, 387 00:20:33,366 --> 00:20:35,500 getting ready for, for morning worship, 388 00:20:35,500 --> 00:20:39,533 when the bomb went off at 10:22. 389 00:20:39,533 --> 00:20:43,700 NARRATOR: It was a horrifying attack that killed four girls. 390 00:20:43,700 --> 00:20:46,300 But it cemented the role of the Black church 391 00:20:46,300 --> 00:20:49,033 as a powerful voice in the community. 392 00:20:49,033 --> 00:20:53,933 HAMLIN: This is one place where information can be disseminated. 393 00:20:53,933 --> 00:20:56,633 We demonstrate that we, one, are compassionate, 394 00:20:56,633 --> 00:21:01,366 but also that we're responsible for, for sharing information 395 00:21:01,366 --> 00:21:02,666 that is healthy and helpful. 396 00:21:02,666 --> 00:21:06,866 I've always had friends-- two, especially-- 397 00:21:06,866 --> 00:21:10,566 who confided in me that they were gay, 398 00:21:10,566 --> 00:21:15,400 and both of them died from complications from, from AIDS. 399 00:21:15,400 --> 00:21:17,866 Neither one of them chose to tell me that 400 00:21:17,866 --> 00:21:20,066 they were H.I.V.-infected. 401 00:21:20,066 --> 00:21:23,066 But after their deaths, one of the members of our church said, 402 00:21:23,066 --> 00:21:25,100 "Oh, okay, as, as pastor of 16th Street, 403 00:21:25,100 --> 00:21:27,433 you've got to do more than what you're doing." 404 00:21:27,433 --> 00:21:30,066 And kind of insisted that I do more. 405 00:21:30,066 --> 00:21:31,366 And he was absolutely right. 406 00:21:31,366 --> 00:21:34,566 NARRATOR: Hamlin joined the board of AIDS Alabama 407 00:21:34,566 --> 00:21:37,666 and began to spread the word about H.I.V. 408 00:21:37,666 --> 00:21:41,000 to the greater African American community. 409 00:21:41,000 --> 00:21:43,000 I don't know if I was the first, but in Birmingham, 410 00:21:43,000 --> 00:21:46,133 I, I probably was one of the first pastors 411 00:21:46,133 --> 00:21:49,000 who openly talked about H.I.V. 412 00:21:49,000 --> 00:21:52,666 If you are a Christian, just live the life 413 00:21:52,666 --> 00:21:54,333 of a believer in Christ 414 00:21:54,333 --> 00:21:59,100 by demonstrating Godly love to all people! 415 00:21:59,100 --> 00:22:01,433 Regardless! 416 00:22:01,433 --> 00:22:03,500 Live by the Golden Rule: 417 00:22:03,500 --> 00:22:08,500 "Do unto others as you want others to do unto you." 418 00:22:08,500 --> 00:22:10,800 (churchgoers murmuring in agreement) 419 00:22:10,800 --> 00:22:12,400 H.I.V., especially in the Black community, 420 00:22:12,400 --> 00:22:15,633 has always been viewed as a gay disease 421 00:22:15,633 --> 00:22:19,766 and presented itself primarily in the white gay community. 422 00:22:19,766 --> 00:22:22,466 So we were, we were in denial: "No, this is not about us. 423 00:22:22,466 --> 00:22:24,066 "This has nothing to do with us. 424 00:22:24,066 --> 00:22:25,833 This is about, about them." 425 00:22:25,833 --> 00:22:30,133 But then, as time went on, you began to see, you know, 426 00:22:30,133 --> 00:22:31,966 "Oh, this is about us, too." 427 00:22:31,966 --> 00:22:33,700 (chuckling) Sir, what's going on? 428 00:22:33,700 --> 00:22:38,966 NARRATOR: Eventually, Hamlin became the chaplain at the 1917 Clinic, 429 00:22:38,966 --> 00:22:43,833 working side by side with Mike Saag and Tommy Williams. 430 00:22:43,833 --> 00:22:46,600 HAMLIN: One of the challenges in the Black community has always been, 431 00:22:46,600 --> 00:22:49,900 human sexuality is a taboo subject. 432 00:22:49,900 --> 00:22:51,500 We do it, but we don't talk about it. 433 00:22:51,500 --> 00:22:53,766 And H.I.V. was one of those things, 434 00:22:53,766 --> 00:22:55,066 you had to talk about it. 435 00:22:57,233 --> 00:23:00,733 NARRATOR: Those same conversations are still a challenge today. 436 00:23:00,733 --> 00:23:06,466 WILLIAMS: And stigma is so present that it puts a chokehold 437 00:23:06,466 --> 00:23:07,933 on, like, any type of communication 438 00:23:07,933 --> 00:23:11,166 happening around H.I.V., and any discussion 439 00:23:11,166 --> 00:23:14,600 that happens around H.I.V. and/or AIDS is going to have 440 00:23:14,600 --> 00:23:16,700 a negative connotation to it. 441 00:23:18,300 --> 00:23:19,466 SHIRLEY SELVAGE: Hey! 442 00:23:19,466 --> 00:23:21,066 (laughs): You knew I was comin'. 443 00:23:21,066 --> 00:23:24,566 NARRATOR: Change is painstaking and very personal. 444 00:23:24,566 --> 00:23:26,366 I want it like the bob. 445 00:23:26,366 --> 00:23:28,466 Like the picture! Okay. 446 00:23:28,466 --> 00:23:32,133 So before I came to Birmingham, 447 00:23:32,133 --> 00:23:36,100 you know, I married my little high school sweetheart 448 00:23:36,100 --> 00:23:38,000 and he went to the service, and came back, 449 00:23:38,000 --> 00:23:39,833 and we had a house built. 450 00:23:39,833 --> 00:23:44,033 And I had my daughter then, and I think she was, like, seven. 451 00:23:44,033 --> 00:23:47,333 And he literally didn't tell me, 452 00:23:47,333 --> 00:23:50,733 like, until three years, like, three years. 453 00:23:50,733 --> 00:23:53,833 And when he told me, he was, like, 454 00:23:53,833 --> 00:23:55,700 "This is what I've been going through," 455 00:23:55,700 --> 00:23:57,166 and gave me this piece of paper. 456 00:23:57,166 --> 00:24:00,733 NARRATOR: Shirley's husband was H.I.V.-positive. 457 00:24:00,733 --> 00:24:03,066 SELVAGE (exhales): It took me, like, 458 00:24:03,066 --> 00:24:05,933 three months to really share, because I, 459 00:24:05,933 --> 00:24:09,633 my, the way I reacted to it, 460 00:24:09,633 --> 00:24:13,366 and, you know, tried to overdose, and do, 461 00:24:13,366 --> 00:24:15,700 tried to have... 462 00:24:15,700 --> 00:24:20,133 You know, suicidal thoughts of doing things. 463 00:24:20,133 --> 00:24:22,133 And finally, when I told my grandmother, 464 00:24:22,133 --> 00:24:26,566 she was, like, "Well, Magic Johnson has it. 465 00:24:26,566 --> 00:24:29,000 Girl, you better go and live your life." 466 00:24:29,000 --> 00:24:31,466 I'm, like, "You don't even understand, when this get out." 467 00:24:31,466 --> 00:24:33,600 And then she end up... 468 00:24:33,600 --> 00:24:35,233 You know how grannies do, honey. 469 00:24:35,233 --> 00:24:38,300 They don't think nothing wrong with nothing. 470 00:24:38,300 --> 00:24:40,100 So she end up telling family members, 471 00:24:40,100 --> 00:24:43,200 and then that's how it just got all out in the community. 472 00:24:43,200 --> 00:24:46,533 Uh-huh. And so I just totally, like, isolated myself 473 00:24:46,533 --> 00:24:51,933 from that community, until, up until I moved to Birmingham. 474 00:24:51,933 --> 00:24:53,666 Are we done? 475 00:24:53,666 --> 00:24:55,166 I think we're done. 476 00:24:55,166 --> 00:24:56,633 You should go and have a look-see. Ooh! 477 00:24:56,633 --> 00:24:58,200 Ooh, I like this. 478 00:24:58,200 --> 00:25:01,033 WILLIAMS: Chaka Khan, let me rock you, let me rock you, Chaka Khan. 479 00:25:01,033 --> 00:25:03,333 (Selvage laughing) That's all I want to do. 480 00:25:03,333 --> 00:25:04,900 The thought process in a lot of people is, 481 00:25:04,900 --> 00:25:07,266 "Oh, he's H.I.V.-positive. 482 00:25:07,266 --> 00:25:08,733 How did he get it?" 483 00:25:08,733 --> 00:25:09,933 Or, "She's H.I.V.-positive. 484 00:25:09,933 --> 00:25:11,366 What did she do to get it?" 485 00:25:11,366 --> 00:25:13,833 And people who are living with H.I.V., 486 00:25:13,833 --> 00:25:14,833 one of the things they fear most 487 00:25:14,833 --> 00:25:18,300 is judgment, stigma, and rejection. 488 00:25:18,300 --> 00:25:23,033 ♪ ♪ 489 00:25:23,033 --> 00:25:24,866 NARRATOR: Back in the early '90s, 490 00:25:24,866 --> 00:25:29,433 as Hamlin was starting tough conversations about H.I.V. 491 00:25:29,433 --> 00:25:31,200 with his congregation, 492 00:25:31,200 --> 00:25:33,533 the scientific community 493 00:25:33,533 --> 00:25:37,266 was racing the clock, testing new ideas 494 00:25:37,266 --> 00:25:40,533 to stem the tide of disease. REPORTER: ...cancer-fighting drug interferon... 495 00:25:40,533 --> 00:25:45,033 NARRATOR: Doctors, scientists, and pharmaceutical companies 496 00:25:45,033 --> 00:25:47,600 were experimenting with new drugs 497 00:25:47,600 --> 00:25:50,833 and trying them in combinations. 498 00:25:50,833 --> 00:25:52,333 GANDHI: The biggest lesson was that 499 00:25:52,333 --> 00:25:54,000 H.I.V. is very clever 500 00:25:54,000 --> 00:25:58,300 and can evade, uh, AZT or a single agent. 501 00:25:58,300 --> 00:26:02,533 And so it really taught us that we have to kind of hit H.I.V. 502 00:26:02,533 --> 00:26:05,166 on multiple points, multiple parts 503 00:26:05,166 --> 00:26:06,833 of it, of its replication pathway 504 00:26:06,833 --> 00:26:10,333 to get it to stop replicating. 505 00:26:10,333 --> 00:26:13,366 And so it made us really start thinking that two drugs, 506 00:26:13,366 --> 00:26:16,200 and even three drugs, were the most important way 507 00:26:16,200 --> 00:26:18,933 to really hem H.I.V. in on all sides. 508 00:26:18,933 --> 00:26:23,433 NARRATOR: Dozens of drugs and combinations were tried, 509 00:26:23,433 --> 00:26:28,033 including an entirely new class of medication 510 00:26:28,033 --> 00:26:31,733 called protease inhibitors. 511 00:26:33,866 --> 00:26:37,033 They worked on the virus after 512 00:26:37,033 --> 00:26:42,066 it had incorporated its genetic material into the CD4 cells. 513 00:26:42,066 --> 00:26:44,266 At that point, the CD4 cells begin producing 514 00:26:44,266 --> 00:26:47,433 long strings of H.I.V. proteins... 515 00:26:47,433 --> 00:26:50,833 ♪ ♪ 516 00:26:50,833 --> 00:26:52,966 ...which get snipped into the building blocks 517 00:26:52,966 --> 00:26:55,166 of new virus particles 518 00:26:55,166 --> 00:26:57,466 by an enzyme called protease. 519 00:27:01,266 --> 00:27:04,266 Protease inhibitors block the molecular scissors 520 00:27:04,266 --> 00:27:07,266 and stop the virus from replicating. 521 00:27:08,833 --> 00:27:13,433 The protease inhibitors were tested in combination 522 00:27:13,433 --> 00:27:15,600 with other drugs. 523 00:27:15,600 --> 00:27:19,133 And one three-drug combination stood out. 524 00:27:19,133 --> 00:27:23,466 It was about to change the trajectory of H.I.V. in America. 525 00:27:23,466 --> 00:27:27,000 REPORTER: The AIDS epidemic could well be at a turning point. 526 00:27:27,000 --> 00:27:28,566 REPORTER: The three-drug combination... 527 00:27:28,566 --> 00:27:30,933 REPORTER: ...can reduce the AIDS death rate dramatically. 528 00:27:30,933 --> 00:27:33,400 NARRATOR: The shock wave rang out 529 00:27:33,400 --> 00:27:37,800 from the 1996 International AIDS Conference in Vancouver. 530 00:27:37,800 --> 00:27:39,500 PETER PIOT: The new combinations 531 00:27:39,500 --> 00:27:43,133 of antiretroviral drugs are holding out new hope. 532 00:27:43,133 --> 00:27:45,166 And I just almost dropped the pencil and said, 533 00:27:45,166 --> 00:27:46,166 "Oh, my goodness." 534 00:27:46,166 --> 00:27:47,666 This was so striking. 535 00:27:47,666 --> 00:27:52,433 NARRATOR: The headline: a combination of three drugs, 536 00:27:52,433 --> 00:27:55,133 two reverse transcriptase blockers 537 00:27:55,133 --> 00:27:58,433 and a protease inhibitor, 538 00:27:58,433 --> 00:28:00,333 successfully kept H.I.V.-positive patients 539 00:28:00,333 --> 00:28:02,333 from developing AIDS. 540 00:28:02,333 --> 00:28:04,700 I knew this was special. 541 00:28:04,700 --> 00:28:08,566 NARRATOR: It was the so-called triple cocktail. 542 00:28:08,566 --> 00:28:14,633 One drug on its own couldn't keep up with H.I.V.'s mutations. 543 00:28:14,633 --> 00:28:17,400 But the cocktail, with its multiple drugs 544 00:28:17,400 --> 00:28:21,033 targeting different parts of the replication cycle, 545 00:28:21,033 --> 00:28:25,000 beat back the virus before it could evolve resistance. 546 00:28:25,000 --> 00:28:26,966 So in patients who started using it, 547 00:28:26,966 --> 00:28:29,866 and we saw these dramatic drops in virus, 548 00:28:29,866 --> 00:28:33,666 and that was the beginning of, at least for us, 549 00:28:33,666 --> 00:28:35,066 using triple drug therapy. 550 00:28:35,066 --> 00:28:37,366 I sort of watched at San Francisco General, 551 00:28:37,366 --> 00:28:40,366 the beginning of the year, 40% of our patients 552 00:28:40,366 --> 00:28:42,366 in the inpatient setting at this hospital 553 00:28:42,366 --> 00:28:46,500 be living with AIDS, um, really sick, 554 00:28:46,500 --> 00:28:49,000 really didn't have those antiretroviral therapies, 555 00:28:49,000 --> 00:28:52,600 and then I just watched, over the second half of my residency, 556 00:28:52,600 --> 00:28:53,800 people rise from the dead. 557 00:28:53,800 --> 00:28:55,700 Thank you. Thank you. 558 00:28:55,700 --> 00:28:57,466 GANDHI: It was literally a Lazarus effect 559 00:28:57,466 --> 00:29:00,233 to watch these antiretroviral therapies come out. 560 00:29:00,233 --> 00:29:04,300 NARRATOR: One by one, the patients recovered. 561 00:29:04,300 --> 00:29:08,833 Almost immediately, annual deaths from H.I.V., 562 00:29:08,833 --> 00:29:11,833 steadily climbing since the early 1980s, 563 00:29:11,833 --> 00:29:16,466 began to plummet. 564 00:29:16,466 --> 00:29:20,733 For the first time, people could truly talk about 565 00:29:20,733 --> 00:29:22,833 living with H.I.V. 566 00:29:22,833 --> 00:29:25,200 JOHNSON: The newest drug out, which is doing great 567 00:29:25,200 --> 00:29:28,900 and having great success with it, it's called combination. 568 00:29:28,900 --> 00:29:30,933 That's probably the reason, uh, 569 00:29:30,933 --> 00:29:32,133 for my good health, 570 00:29:32,133 --> 00:29:34,033 as well as God, just praying every night. 571 00:29:34,033 --> 00:29:36,066 Thank you. Thank you so much. 572 00:29:36,066 --> 00:29:39,533 NARRATOR: Triple therapy was a life-saving breakthrough. 573 00:29:39,533 --> 00:29:43,433 H.I.V. was no longer an automatic death sentence. 574 00:29:43,433 --> 00:29:46,566 But it was not without its challenges. 575 00:29:46,566 --> 00:29:48,866 There were some pretty significant side effects. 576 00:29:51,200 --> 00:29:52,933 And oftentimes, it was a handful of pills. 577 00:29:52,933 --> 00:29:54,300 It was like breakfast. 578 00:29:54,300 --> 00:29:56,966 CHUNG: It was, like, six pills 579 00:29:56,966 --> 00:29:59,866 that you have to take in the morning, 580 00:29:59,866 --> 00:30:01,466 six pills you have to take in the evening, 581 00:30:01,466 --> 00:30:03,133 and they're, like, about this size, 582 00:30:03,133 --> 00:30:06,600 um, and it made me so sick. 583 00:30:06,600 --> 00:30:08,966 But there wasn't any other choices. 584 00:30:10,400 --> 00:30:12,800 NARRATOR: Even that changed fast. 585 00:30:12,800 --> 00:30:16,433 Pharmaceutical companies continued to work on new drugs 586 00:30:16,433 --> 00:30:19,366 and new formulations that were more effective, 587 00:30:19,366 --> 00:30:24,100 easier to take, and had fewer side effects. 588 00:30:24,100 --> 00:30:28,866 Within a decade, the regimen was down to a single pill a day. 589 00:30:28,866 --> 00:30:30,133 It was called Atripla, 590 00:30:30,133 --> 00:30:32,366 but it was three medications all in one pill-- 591 00:30:32,366 --> 00:30:34,900 one pill once a day, big deal. 592 00:30:37,433 --> 00:30:40,200 NARRATOR: Treatments were rapidly evolving, 593 00:30:40,200 --> 00:30:41,666 but a vaccine remained elusive. 594 00:30:41,666 --> 00:30:43,266 COHEN: For all these years, it's been, 595 00:30:43,266 --> 00:30:45,733 "We're gonna make a vaccine and that's gonna fix the problem." 596 00:30:45,733 --> 00:30:49,100 And, and certainly it's not through lack of effort. 597 00:30:49,100 --> 00:30:52,533 NARRATOR: Billions of dollars had gone into vaccine research, 598 00:30:52,533 --> 00:30:55,133 with dozens of clinical trials, 599 00:30:55,133 --> 00:30:59,233 but still no vaccine. 600 00:30:59,233 --> 00:31:03,400 From 1981 to 2011, that is 30 long, long years 601 00:31:03,400 --> 00:31:06,733 where there was no effective biomedical prevention strategy. 602 00:31:06,733 --> 00:31:09,233 There was no vaccine, there was no shot, there was no cream, 603 00:31:09,233 --> 00:31:11,133 there was no, um, pill. 604 00:31:11,133 --> 00:31:15,500 We had condoms, we had abstinence, we had monogamy. 605 00:31:15,500 --> 00:31:18,800 We had nothing in terms of biomedical prevention strategy. 606 00:31:18,800 --> 00:31:21,600 Now let me get my white coat. 607 00:31:21,600 --> 00:31:24,533 It's the most important thing in this. 608 00:31:24,533 --> 00:31:25,933 NARRATOR: The best prevention 609 00:31:25,933 --> 00:31:27,700 traditionally comes from vaccines, 610 00:31:27,700 --> 00:31:31,700 but now, a new approach was needed. 611 00:31:31,700 --> 00:31:35,700 Myron Cohen was a physician-researcher 612 00:31:35,700 --> 00:31:39,500 at the University of North Carolina. 613 00:31:39,500 --> 00:31:41,533 I was charged and committed 614 00:31:41,533 --> 00:31:44,833 to prevention in the absence of a vaccine. 615 00:31:44,833 --> 00:31:47,800 The idea was, 616 00:31:47,800 --> 00:31:51,933 let's use antivirals to stop the spread of H.I.V. 617 00:31:51,933 --> 00:31:55,700 NARRATOR: The concept was simple, yet unorthodox. 618 00:31:55,700 --> 00:31:59,966 It was based on the concept of the viral load, 619 00:31:59,966 --> 00:32:04,000 the amount of virus in a patient's body. 620 00:32:04,000 --> 00:32:05,400 The higher the viral load, 621 00:32:05,400 --> 00:32:11,833 the more likely an infected person is to infect others. 622 00:32:11,833 --> 00:32:14,766 But if doctors treat those patients earlier, 623 00:32:14,766 --> 00:32:17,933 and more aggressively, could they bring the viral load 624 00:32:17,933 --> 00:32:23,400 down low enough that the virus can't be passed on? 625 00:32:23,400 --> 00:32:26,733 To what extent will we render them no longer contagious? 626 00:32:26,733 --> 00:32:30,033 We're gonna call that treatment as prevention, or TASP. 627 00:32:30,033 --> 00:32:36,100 NARRATOR: Treatment as prevention was just one half of the strategy. 628 00:32:36,100 --> 00:32:39,200 We and others were also working on the flip side of the coin. 629 00:32:39,200 --> 00:32:41,066 So if we're gonna treat the infected person 630 00:32:41,066 --> 00:32:42,500 to try and stop transmission, 631 00:32:42,500 --> 00:32:45,400 we're gonna take the uninfected person and try and develop 632 00:32:45,400 --> 00:32:48,633 safe and effective ways to prevent the acquisition 633 00:32:48,633 --> 00:32:51,533 of the virus through pre-exposure prophylaxis. 634 00:32:51,533 --> 00:32:55,500 NARRATOR: Pre-exposure prophylaxis, 635 00:32:55,500 --> 00:32:59,266 or PrEP, was not a completely new concept. 636 00:32:59,266 --> 00:33:02,466 Malaria prophylaxis has been used for years. 637 00:33:02,466 --> 00:33:04,566 You basically take a medication, 638 00:33:04,566 --> 00:33:05,900 it's in your body, 639 00:33:05,900 --> 00:33:08,333 and then you get exposed to malaria 640 00:33:08,333 --> 00:33:10,600 and prevents you from actually getting malaria. 641 00:33:10,600 --> 00:33:14,466 NARRATOR: Not a vaccine, but a short-term preventative. 642 00:33:14,466 --> 00:33:16,566 So this made sense to me, 643 00:33:16,566 --> 00:33:19,966 to use an H.I.V. medication to prevent H.I.V. infection. 644 00:33:19,966 --> 00:33:22,566 NARRATOR: At least, that's what they hoped. 645 00:33:22,566 --> 00:33:26,800 And yet it meant giving powerful treatment drugs 646 00:33:26,800 --> 00:33:29,900 to people who were totally healthy. 647 00:33:29,900 --> 00:33:31,766 Initially, I said, "What are we doing? 648 00:33:31,766 --> 00:33:34,566 "Why are we giving medicines to people who aren't infected? 649 00:33:34,566 --> 00:33:35,966 That seems kind of crazy." 650 00:33:35,966 --> 00:33:38,833 ELOPRE: A lot of people were concerned 651 00:33:38,833 --> 00:33:41,966 that it might increase high-risk sexual behaviors. 652 00:33:41,966 --> 00:33:44,900 REPORTER: Some groups are concerned using Truvada for prevention 653 00:33:44,900 --> 00:33:47,466 would cause more H.I.V. cases. 654 00:33:47,466 --> 00:33:49,666 It could be misinterpreted as, you can engage in any 655 00:33:49,666 --> 00:33:51,166 risky behavior that you want. 656 00:33:51,166 --> 00:33:53,800 A catastrophe for AIDS prevention in the United States. 657 00:33:53,800 --> 00:33:57,633 NARRATOR: There was also a question of basic human nature: 658 00:33:57,633 --> 00:34:02,533 would healthy people really take this medicine? 659 00:34:02,533 --> 00:34:06,100 The skepticism was, could people take a pill every day, 660 00:34:06,100 --> 00:34:09,800 which was hard enough to do in the treatment world. 661 00:34:09,800 --> 00:34:11,466 It's been harder to, for people 662 00:34:11,466 --> 00:34:12,700 to take preventative medications. 663 00:34:12,700 --> 00:34:14,166 WOMAN: How're you guys doing? 664 00:34:14,166 --> 00:34:17,900 NARRATOR: Despite the concerns, the trials forged ahead. 665 00:34:17,900 --> 00:34:21,533 In 2000, we started then a series of trials. 666 00:34:21,533 --> 00:34:25,666 NARRATOR: The separate trials, conducted in multiple countries, 667 00:34:25,666 --> 00:34:27,866 looked at both sets of people: 668 00:34:27,866 --> 00:34:30,066 those who might spread the virus 669 00:34:30,066 --> 00:34:32,233 and those who might get infected. 670 00:34:32,233 --> 00:34:34,900 For H.I.V.-positive patients, 671 00:34:34,900 --> 00:34:39,666 could antiviral medication render them safe as partners, 672 00:34:39,666 --> 00:34:42,566 no longer able to spread the virus? 673 00:34:42,566 --> 00:34:46,133 And could the same antiviral drugs 674 00:34:46,133 --> 00:34:49,366 shield healthy people from infection? 675 00:34:49,366 --> 00:34:52,366 It was a brand-new approach to prevention. 676 00:34:52,366 --> 00:34:56,966 The big PrEP study was called iPrEx. 677 00:34:56,966 --> 00:34:58,666 GANDHI: Oh, there was a lot of pressure 678 00:34:58,666 --> 00:35:00,966 riding on the study of iPrEx. 679 00:35:00,966 --> 00:35:03,366 Everyone in H.I.V. was waiting for it. 680 00:35:03,366 --> 00:35:06,900 This was the first time that there would be a pill 681 00:35:06,900 --> 00:35:09,900 where you could prevent getting H.I.V. 682 00:35:09,900 --> 00:35:11,533 I was waiting with bated breath. 683 00:35:13,400 --> 00:35:18,100 NARRATOR: The answer came in the closing days of 2010. 684 00:35:18,100 --> 00:35:21,033 ♪ ♪ 685 00:35:21,033 --> 00:35:22,533 GANDHI: When I saw the results, 686 00:35:22,533 --> 00:35:24,300 I was elated, I was amazed. 687 00:35:24,300 --> 00:35:26,066 I was so excited. 688 00:35:26,066 --> 00:35:28,900 NARRATOR: In iPrEx, 689 00:35:28,900 --> 00:35:33,566 PrEP cut the risk of new infection by more than 70% 690 00:35:33,566 --> 00:35:37,033 for people who stuck to the regimen. 691 00:35:37,033 --> 00:35:39,566 Further studies show PrEP cuts 692 00:35:39,566 --> 00:35:45,733 the risk of H.I.V. infection from having sex by 99%, 693 00:35:45,733 --> 00:35:49,733 and at least 74% for people who inject drugs. 694 00:35:49,733 --> 00:35:55,233 PrEP relies on the same type of drugs as are used for treatment. 695 00:35:55,233 --> 00:35:57,733 Taken as a preventative medication, 696 00:35:57,733 --> 00:35:59,433 it creates a defensive shield. 697 00:35:59,433 --> 00:36:02,566 GANDHI: And the H.I.V. comes into your body, 698 00:36:02,566 --> 00:36:03,866 but that medication comes 699 00:36:03,866 --> 00:36:05,600 and attacks it and prevents it 700 00:36:05,600 --> 00:36:07,866 from essentially infecting your cells. 701 00:36:07,866 --> 00:36:11,933 NARRATOR: That still left the TASP trial, 702 00:36:11,933 --> 00:36:15,700 Cohen's landmark study of treatment as prevention, 703 00:36:15,700 --> 00:36:19,166 the second part of the strategy. 704 00:36:19,166 --> 00:36:22,333 Their data were still being analyzed 705 00:36:22,333 --> 00:36:24,700 at the National Institutes of Health. 706 00:36:24,700 --> 00:36:29,033 It was a closely kept secret. 707 00:36:29,033 --> 00:36:31,433 COHEN: I got a call from the N.I.H. saying, 708 00:36:31,433 --> 00:36:32,600 "Can you come over to the N.I.H.?" 709 00:36:32,600 --> 00:36:34,433 So we all drove over to the N.I.H. 710 00:36:34,433 --> 00:36:37,000 They're in a room with a large group of people, 711 00:36:37,000 --> 00:36:39,366 including the leader, Dr. Dieffenbach. 712 00:36:39,366 --> 00:36:41,700 And then after a few minutes of, 713 00:36:41,700 --> 00:36:43,633 of cajoling, he kind of... 714 00:36:43,633 --> 00:36:45,133 There was a huge stack of papers 715 00:36:45,133 --> 00:36:47,833 and he threw up this stack of papers in the air and said, 716 00:36:47,833 --> 00:36:49,266 "This is a home run." 717 00:36:50,866 --> 00:36:55,133 NARRATOR: Treatment as Prevention worked. 718 00:36:55,133 --> 00:36:57,133 We reported that we stopped the transmission of H.I.V. 719 00:36:57,133 --> 00:36:58,800 by more than 96%. 720 00:36:58,800 --> 00:37:01,900 NARRATOR: An H.I.V.-positive person 721 00:37:01,900 --> 00:37:04,866 whose treatment brings the viral load so low 722 00:37:04,866 --> 00:37:06,500 as to be undetectable 723 00:37:06,500 --> 00:37:10,600 will not transmit the virus. 724 00:37:10,600 --> 00:37:11,900 DAVID: Me being undetectable 725 00:37:11,900 --> 00:37:13,766 means be, being able to live again, 726 00:37:13,766 --> 00:37:16,200 actually live a normal life, and not be scared. 727 00:37:16,200 --> 00:37:17,733 ♪ ♪ 728 00:37:17,733 --> 00:37:21,366 NARRATOR: With TASP, for infected patients, 729 00:37:21,366 --> 00:37:25,200 undetectable equals untransmissible. 730 00:37:25,200 --> 00:37:28,333 It's now a federal education campaign. 731 00:37:28,333 --> 00:37:29,766 U equals U. 732 00:37:29,766 --> 00:37:31,666 And you know what that means: 733 00:37:31,666 --> 00:37:34,400 that undetectable is untransmissible. 734 00:37:34,400 --> 00:37:36,000 (applauding) 735 00:37:36,000 --> 00:37:38,533 GANDHI: It's been huge, because for science, 736 00:37:38,533 --> 00:37:42,066 it really shows that a preventative medication 737 00:37:42,066 --> 00:37:44,366 can be taken every day to prevent infection. 738 00:37:44,366 --> 00:37:47,533 NARRATOR: Together, U equals U and PrEP 739 00:37:47,533 --> 00:37:49,900 showed a path forward. 740 00:37:49,900 --> 00:37:53,033 For the first time, people dared to imagine 741 00:37:53,033 --> 00:37:55,566 the end of the epidemic. 742 00:37:55,566 --> 00:37:57,166 Overnight, the world changed. 743 00:37:57,166 --> 00:38:02,433 (whistles blowing, crowd cheering) 744 00:38:02,433 --> 00:38:05,266 NARRATOR: Over the previous two decades, 745 00:38:05,266 --> 00:38:08,000 new H.I.V. infections in the U.S. 746 00:38:08,000 --> 00:38:11,800 averaged nearly 60,000 a year. 747 00:38:11,800 --> 00:38:14,866 As PrEP and U equals U came into widespread use, 748 00:38:14,866 --> 00:38:18,166 that number fell nearly by half, 749 00:38:18,166 --> 00:38:21,266 while deaths have fallen nearly a third. 750 00:38:23,300 --> 00:38:26,233 GANDHI: It really helps with relationships, 751 00:38:26,233 --> 00:38:28,666 helps with partnerships. 752 00:38:28,666 --> 00:38:31,066 Watching the progression and how many advances 753 00:38:31,066 --> 00:38:33,100 we've had in H.I.V. has been thrilling. 754 00:38:33,100 --> 00:38:37,166 NARRATOR: 30 years after H.I.V. was discovered, 755 00:38:37,166 --> 00:38:41,000 doctors finally had both treatment and prevention tools 756 00:38:41,000 --> 00:38:43,633 at their disposal. 757 00:38:45,766 --> 00:38:48,233 That still left the challenge of getting them 758 00:38:48,233 --> 00:38:50,266 to all the patients who would need them, 759 00:38:50,266 --> 00:38:56,400 the so-called last mile, that could truly end the epidemic. 760 00:38:56,400 --> 00:39:00,700 San Francisco, with its large LGBTQ community 761 00:39:00,700 --> 00:39:03,966 and long history of fighting the disease, 762 00:39:03,966 --> 00:39:06,700 is trying to lead the way. 763 00:39:06,700 --> 00:39:10,033 In 2013, it set a goal 764 00:39:10,033 --> 00:39:12,633 of being the first city in the world 765 00:39:12,633 --> 00:39:16,066 to eliminate H.I.V. transmission altogether. 766 00:39:16,066 --> 00:39:19,700 The plan focuses on groups at highest risk, 767 00:39:19,700 --> 00:39:24,666 people on the edge of society. 768 00:39:24,666 --> 00:39:25,966 MIGUEL IBARRA: Which way should we go? 769 00:39:25,966 --> 00:39:27,666 WOMAN: Eddy? Eddy? Okay. 770 00:39:27,666 --> 00:39:32,133 NARRATOR: Miguel Ibarra leads an outreach team 771 00:39:32,133 --> 00:39:34,300 for the San Francisco Community Health Center, 772 00:39:34,300 --> 00:39:36,466 located in the Tenderloin. 773 00:39:36,466 --> 00:39:39,666 Have they come and told y'all about the linkage center yet? 774 00:39:39,666 --> 00:39:41,633 NARRATOR: The center works to bring H.I.V. care, 775 00:39:41,633 --> 00:39:45,200 along with other healthcare, to the most vulnerable. 776 00:39:45,200 --> 00:39:47,866 IBARRA: You might be experiencing homelessness. 777 00:39:47,866 --> 00:39:49,366 You might be actively using. 778 00:39:49,366 --> 00:39:52,133 You can show up here to SF Community Health, 779 00:39:52,133 --> 00:39:54,833 and you can meet with providers 780 00:39:54,833 --> 00:39:58,966 who have walked in your shoes 781 00:39:58,966 --> 00:40:01,133 and who have come out on the other side. 782 00:40:01,133 --> 00:40:07,333 NARRATOR: With any disease, the last mile is always the hardest. 783 00:40:07,333 --> 00:40:11,066 The hardest cases, the people hardest to reach. 784 00:40:11,066 --> 00:40:13,400 You want a snack? 785 00:40:15,033 --> 00:40:17,200 Here you go. 786 00:40:17,200 --> 00:40:20,166 NARRATOR: But by focusing on this vulnerable population 787 00:40:20,166 --> 00:40:23,566 and making antiviral medication available for free-- 788 00:40:23,566 --> 00:40:26,133 that's PrEP and U equals U-- 789 00:40:26,133 --> 00:40:32,200 the city was down to 131 new cases in 2020, 790 00:40:32,200 --> 00:40:38,300 a 64% drop since the city set its goal of ending the epidemic. 791 00:40:38,300 --> 00:40:40,833 Would you like a rapid COVID test to have? 792 00:40:40,833 --> 00:40:45,733 NARRATOR: But with COVID came new challenges. 793 00:40:45,733 --> 00:40:48,133 Prior to the COVID pandemic, we were actually doing really well. 794 00:40:48,133 --> 00:40:51,933 And I was seeing very few barriers to, hopefully by 2030, 795 00:40:51,933 --> 00:40:54,366 getting to the end of the epidemic in San Francisco. 796 00:40:54,366 --> 00:40:57,466 Essentially, our homeless population increased, 797 00:40:57,466 --> 00:41:00,633 and so did substance use. 798 00:41:00,633 --> 00:41:01,866 And substance use is a really big barrier 799 00:41:01,866 --> 00:41:03,366 to taking medications every day 800 00:41:03,366 --> 00:41:04,900 or to stay virologically suppressed. 801 00:41:04,900 --> 00:41:09,233 NARRATOR: Cecilia Chung knows the challenges firsthand. 802 00:41:09,233 --> 00:41:14,566 In the 1990s, she ended up on the streets, using drugs, 803 00:41:14,566 --> 00:41:18,966 before managing to pull her life back together. 804 00:41:18,966 --> 00:41:22,100 Oh, my God, that was 30 years ago. 805 00:41:22,100 --> 00:41:23,600 CHUNG: If somebody is homeless, 806 00:41:23,600 --> 00:41:27,933 and they're very transient, they move from place to place 807 00:41:27,933 --> 00:41:31,933 and have to set up camps, um, or live in a shelter, 808 00:41:31,933 --> 00:41:35,133 where are they going to put the medications? 809 00:41:35,133 --> 00:41:38,366 A regular schedule is necessary 810 00:41:38,366 --> 00:41:41,033 in terms of scheduling for 811 00:41:41,033 --> 00:41:43,733 regular doctor's visits and also blood work. 812 00:41:43,733 --> 00:41:45,466 And not to mention, you know, 813 00:41:45,466 --> 00:41:47,800 taking medications on a daily basis. 814 00:41:47,800 --> 00:41:50,633 NARRATOR: Trans:Thrive, 815 00:41:50,633 --> 00:41:53,633 part of the San Francisco Community Health Center, 816 00:41:53,633 --> 00:41:57,700 is tackling some of those exact last-mile problems. 817 00:41:57,700 --> 00:42:00,400 (talking in background) 818 00:42:00,400 --> 00:42:02,666 ROYCE LIN: So my name is Dr. Royce Lin, 819 00:42:02,666 --> 00:42:04,066 and, uh, I'm a physician with 820 00:42:04,066 --> 00:42:05,466 the San Francisco Department of Public Health. 821 00:42:05,466 --> 00:42:09,200 The work that we do here is comprehensive. 822 00:42:09,200 --> 00:42:11,600 We have psychosocial services, 823 00:42:11,600 --> 00:42:15,366 including onsite, uh, psychiatry, 824 00:42:15,366 --> 00:42:17,600 medical social work. 825 00:42:17,600 --> 00:42:18,966 Many of our clients here 826 00:42:18,966 --> 00:42:21,766 face challenges from multiple levels, 827 00:42:21,766 --> 00:42:25,600 and H.I.V. oftentimes is pretty low on the priority list, 828 00:42:25,600 --> 00:42:28,333 compared to things like mental health, housing, 829 00:42:28,333 --> 00:42:29,966 where am I going to sleep tonight? 830 00:42:29,966 --> 00:42:32,466 JOHANNA BROWN: My name is Johanna Brown. 831 00:42:32,466 --> 00:42:35,166 I came to see my doctor, Dr. Royce Lin, 832 00:42:35,166 --> 00:42:39,000 to get some lab works done, and to change some medication. 833 00:42:39,000 --> 00:42:44,466 I see them for everything-- financially, medically, housing. 834 00:42:44,466 --> 00:42:48,300 LIN: How do we help people who have lost hope 835 00:42:48,300 --> 00:42:50,833 and lost the motivation? 836 00:42:50,833 --> 00:42:53,900 And the work that lies ahead is the hard work 837 00:42:53,900 --> 00:42:57,366 of building somebody back up. 838 00:42:57,366 --> 00:43:02,266 Helping people to find the strength and the hope 839 00:43:02,266 --> 00:43:06,000 to be able to continue. 840 00:43:06,000 --> 00:43:11,700 NARRATOR: In Alabama, the last mile feels a lot longer. 841 00:43:11,700 --> 00:43:13,200 HAMLIN: In our clinic, 842 00:43:13,200 --> 00:43:16,566 we're still seeing 12 to 14 new patients every week-- 843 00:43:16,566 --> 00:43:17,566 every week. 844 00:43:17,566 --> 00:43:20,200 So again, that kind of gives the picture 845 00:43:20,200 --> 00:43:22,933 that this virus is still being transmitted. 846 00:43:22,933 --> 00:43:25,333 Um, so there's a lot of work for us to still do. 847 00:43:25,333 --> 00:43:30,100 NARRATOR: The Southeast is the region of the United States where H.I.V. 848 00:43:30,100 --> 00:43:33,200 has the largest footprint. 849 00:43:33,200 --> 00:43:36,233 ELOPRE: We make up about 50% of H.I.V. diagnoses. 850 00:43:36,233 --> 00:43:38,633 (chuckling): About a third of the U.S. population. 851 00:43:38,633 --> 00:43:39,666 So there's a disparity there. 852 00:43:39,666 --> 00:43:43,400 NARRATOR: Just as it is in San Francisco, 853 00:43:43,400 --> 00:43:47,200 a big part of the problem is poverty. 854 00:43:47,200 --> 00:43:51,500 WILLIAMS: Poor healthcare, access to resources, 855 00:43:51,500 --> 00:43:55,633 low education, communication. 856 00:43:55,633 --> 00:43:57,433 Con-- like, it's all of that. 857 00:43:59,566 --> 00:44:01,466 If you're hungry, you're not thinking about 858 00:44:01,466 --> 00:44:05,133 your overall wellness from a health standpoint. 859 00:44:05,133 --> 00:44:08,566 HAMLIN: We have a PrEP clinic at our clinic. 860 00:44:08,566 --> 00:44:10,333 It's, it's a wonderful tool. 861 00:44:10,333 --> 00:44:14,100 The, the good news is, if you take it and take it properly, 862 00:44:14,100 --> 00:44:17,166 you would not contract H.I.V. 863 00:44:17,166 --> 00:44:20,566 Unfortunately, uh, if you don't have insurance... 864 00:44:20,566 --> 00:44:21,833 (chuckling) 865 00:44:21,833 --> 00:44:25,633 ...you know, getting PrEP drugs are, are near almost impossible. 866 00:44:25,633 --> 00:44:28,566 All right, thank you. 867 00:44:28,566 --> 00:44:31,233 NARRATOR: While many states extend at least some health insurance 868 00:44:31,233 --> 00:44:33,000 to all residents, 869 00:44:33,000 --> 00:44:38,066 Alabama, like most states across the South, does not. 870 00:44:38,066 --> 00:44:41,066 Ten percent of the state population 871 00:44:41,066 --> 00:44:43,900 has no health insurance at all. 872 00:44:43,900 --> 00:44:50,233 Without insurance, the cost of PrEP is nearly $2,000 a month. 873 00:44:50,233 --> 00:44:53,733 An insurmountable obstacle for almost anyone 874 00:44:53,733 --> 00:44:56,433 who comes to see Tommy. 875 00:44:56,433 --> 00:44:58,466 (chuckling): Like, it's absurd. 876 00:44:58,466 --> 00:45:00,633 They say, "I want to get in care, 877 00:45:00,633 --> 00:45:01,900 but I can't afford the medication." 878 00:45:01,900 --> 00:45:05,400 NARRATOR: Through a variety of programs, 879 00:45:05,400 --> 00:45:08,033 the federal government offers subsidies 880 00:45:08,033 --> 00:45:12,300 to offset the cost of PrEP for those who qualify, 881 00:45:12,300 --> 00:45:15,633 just as it heavily subsidizes H.I.V. treatment. 882 00:45:15,633 --> 00:45:18,366 ♪ ♪ 883 00:45:18,366 --> 00:45:21,666 And yet, nationwide, just one in four people 884 00:45:21,666 --> 00:45:27,300 who would benefit from PrEP has a prescription. 885 00:45:27,300 --> 00:45:30,733 In Alabama, the figure is even lower. 886 00:45:34,533 --> 00:45:35,566 WILLIAMS: I don't know a lot of 887 00:45:35,566 --> 00:45:38,066 Black people in the LGBTQ-plus community 888 00:45:38,066 --> 00:45:40,500 that are on PrEP at all. 889 00:45:40,500 --> 00:45:45,033 NARRATOR: The reasons are complex, but money is not the only factor. 890 00:45:45,033 --> 00:45:48,800 Many patients, especially younger ones, 891 00:45:48,800 --> 00:45:52,800 are unaware that PrEP is even an option. 892 00:45:52,800 --> 00:45:54,766 I believe one of the many reasons that the kids 893 00:45:54,766 --> 00:45:57,466 aren't accessing PrEP is because 894 00:45:57,466 --> 00:45:59,166 either they don't-- believe it or not-- 895 00:45:59,166 --> 00:46:00,733 know about it, they... 896 00:46:00,733 --> 00:46:06,100 And if they know about it, they don't really understand it. 897 00:46:06,100 --> 00:46:08,733 Or they are not accurately identifying their level of risk. 898 00:46:08,733 --> 00:46:12,133 NARRATOR: It all puts a premium on patient education 899 00:46:12,133 --> 00:46:14,066 and community outreach. 900 00:46:14,066 --> 00:46:16,633 Thank you all for coming out tonight. 901 00:46:16,633 --> 00:46:19,100 ELOPRE: There's been a huge push 902 00:46:19,100 --> 00:46:23,400 to respectfully partner with community-based organizations, 903 00:46:23,400 --> 00:46:24,600 because now there's a recognition that 904 00:46:24,600 --> 00:46:25,800 you're just not going to have the impact 905 00:46:25,800 --> 00:46:27,066 if you're only doing things 906 00:46:27,066 --> 00:46:29,733 from an ivory tower or from a research institution, 907 00:46:29,733 --> 00:46:31,200 where we haven't really gained that trust. 908 00:46:31,200 --> 00:46:36,300 Any of you would like to share with me what your superpower is? 909 00:46:36,300 --> 00:46:38,033 WOMAN: I'm a mother. 910 00:46:38,033 --> 00:46:39,833 I'm a father. Mm-hmm. 911 00:46:39,833 --> 00:46:40,933 I'm a friend. 912 00:46:40,933 --> 00:46:43,800 I'm able to just stand firm in my truth. 913 00:46:43,800 --> 00:46:45,966 So when you have a difficult situation, 914 00:46:45,966 --> 00:46:50,800 sometimes you cannot control that situation. 915 00:46:50,800 --> 00:46:55,200 But you can control how you respond to it. 916 00:46:55,200 --> 00:46:57,033 Thanks for being amazing. 917 00:46:57,033 --> 00:47:00,800 All of y'all are just... extraordinary. 918 00:47:00,800 --> 00:47:04,766 (group cheers and applauds) 919 00:47:07,600 --> 00:47:10,366 ♪ ♪ 920 00:47:10,366 --> 00:47:13,800 NARRATOR: Throughout the long battle against H.I.V., 921 00:47:13,800 --> 00:47:16,866 the goal has been to remove scientific 922 00:47:16,866 --> 00:47:20,966 and societal barriers to make treatment easier. 923 00:47:20,966 --> 00:47:22,300 Hey. MAN: Dude! 924 00:47:22,300 --> 00:47:23,866 Hey! How are ya? 925 00:47:23,866 --> 00:47:28,166 NARRATOR: And the next advance, a new formulation of PrEP, 926 00:47:28,166 --> 00:47:29,533 is trying to do both. 927 00:47:29,533 --> 00:47:31,566 Some of the insurance issues around... 928 00:47:31,566 --> 00:47:35,000 NARRATOR: Instead of a daily pill to protect against infection, 929 00:47:35,000 --> 00:47:38,533 the new iteration is an extended-release injection 930 00:47:38,533 --> 00:47:40,733 that lasts for two months. 931 00:47:40,733 --> 00:47:42,866 Do you want to remain on the injectable PrEP 932 00:47:42,866 --> 00:47:43,866 or go back to the daily pill? 933 00:47:43,866 --> 00:47:44,933 The injectable. Okay. 934 00:47:44,933 --> 00:47:46,633 (chuckling): "I won't forget to take the pill." 935 00:47:46,633 --> 00:47:48,866 I think I've forgotten to take the pill once or twice 936 00:47:48,866 --> 00:47:50,266 over the weekend. 937 00:47:50,266 --> 00:47:52,200 And now it's, like, "Okay, I know I've got my shot, 938 00:47:52,200 --> 00:47:54,400 I'm good for my shot until my next appointment," 939 00:47:54,400 --> 00:47:56,366 so I don't forget to take the pill. 940 00:47:56,366 --> 00:48:01,466 NARRATOR: Every two months is just a first step towards protection 941 00:48:01,466 --> 00:48:03,866 that patients barely have to think about. 942 00:48:03,866 --> 00:48:05,166 GANDHI: I think the next goal 943 00:48:05,166 --> 00:48:08,700 would be an implant that actually you put under the skin 944 00:48:08,700 --> 00:48:10,100 and it protects you for a full year. 945 00:48:10,100 --> 00:48:14,166 NARRATOR: Coming full circle, 946 00:48:14,166 --> 00:48:17,000 variations of the drug combinations 947 00:48:17,000 --> 00:48:19,600 already approved for prevention 948 00:48:19,600 --> 00:48:22,900 are now being tested as a longer-acting treatment 949 00:48:22,900 --> 00:48:26,400 for people who are H.I.V.-positive. 950 00:48:26,400 --> 00:48:28,800 Michael! 951 00:48:28,800 --> 00:48:31,733 NARRATOR: Tommy is one of the first people to get it 952 00:48:31,733 --> 00:48:33,566 as part of a clinical trial. 953 00:48:36,500 --> 00:48:38,933 WILLIAMS: I got put in the four-week arm. 954 00:48:38,933 --> 00:48:40,633 I really wish it was the eight-week. 955 00:48:40,633 --> 00:48:42,233 'Cause I have to come every month. 956 00:48:42,233 --> 00:48:44,400 And that can be hard for a lot of people. 957 00:48:44,400 --> 00:48:45,866 Hey, Michael. 958 00:48:45,866 --> 00:48:47,266 How are you today? I'm fine. 959 00:48:47,266 --> 00:48:48,333 Oh! Have a seat. 960 00:48:48,333 --> 00:48:50,033 Oh, goodness. 961 00:48:50,033 --> 00:48:54,100 So today is gonna be your last study visit. 962 00:48:54,100 --> 00:48:56,100 And we can transition you 963 00:48:56,100 --> 00:49:00,366 from the every-four-week injection 964 00:49:00,366 --> 00:49:02,266 to every-two-month injection. 965 00:49:02,266 --> 00:49:05,300 (laughing) 966 00:49:05,300 --> 00:49:07,766 So you will go from 12 a year to six a year. 967 00:49:07,766 --> 00:49:10,533 (laughing): Why am I about to cry? 968 00:49:10,533 --> 00:49:13,300 So... I am so excited! 969 00:49:13,300 --> 00:49:15,066 Yeah. 970 00:49:15,066 --> 00:49:16,900 (laughing): You know I've been wanting that two, 971 00:49:16,900 --> 00:49:17,900 that two-month for the longest. 972 00:49:17,900 --> 00:49:19,800 I know, I know, and so... Oh, my God. 973 00:49:19,800 --> 00:49:23,600 Bye-bye 30-day injections! I know. 974 00:49:23,600 --> 00:49:25,000 I don't wanna do it, 975 00:49:25,000 --> 00:49:27,333 I don't wanna do it right now, 'cause I don't wanna be... 976 00:49:27,333 --> 00:49:28,533 Oh, wow. Okay. 977 00:49:28,533 --> 00:49:30,166 (laughing): Okay. All right. 978 00:49:30,166 --> 00:49:31,600 All right, I'll see you-- I'll see you. Okay. 979 00:49:31,600 --> 00:49:35,633 ♪ ♪ 980 00:49:35,633 --> 00:49:36,800 NARRATOR: The last mile, 981 00:49:36,800 --> 00:49:40,566 like the rest of the victories against H.I.V., 982 00:49:40,566 --> 00:49:43,933 will come one hard-earned step at a time. 983 00:49:43,933 --> 00:49:47,933 Which won't make crossing that finish line any less remarkable. 984 00:49:47,933 --> 00:49:49,133 I'm really glad to see you. 985 00:49:49,133 --> 00:49:50,400 SAAG: And it really is 986 00:49:50,400 --> 00:49:53,833 pretty miraculous how we converted H.I.V. 987 00:49:53,833 --> 00:49:56,066 from an almost-certain death sentence 988 00:49:56,066 --> 00:49:58,233 into something that I think we can call 989 00:49:58,233 --> 00:49:59,833 a chronic manageable condition. 990 00:49:59,833 --> 00:50:03,433 HAMLIN: When I first went to the clinic, we had angel wings report. 991 00:50:03,433 --> 00:50:05,966 When a patient died, we would send out an email. 992 00:50:05,966 --> 00:50:07,266 And initially there was, like, 993 00:50:07,266 --> 00:50:11,166 two or three emails every day of patients dying. 994 00:50:11,166 --> 00:50:16,000 This week, we have not gotten one angel wing email. 995 00:50:16,000 --> 00:50:19,800 NARRATOR: Healthcare workers will continue to treat... 996 00:50:19,800 --> 00:50:22,666 ♪ ♪ 997 00:50:22,666 --> 00:50:25,900 ...and scientists will continue to innovate. 998 00:50:25,900 --> 00:50:30,900 The toolkit, impressive as it is, still needs to grow. 999 00:50:33,300 --> 00:50:38,733 Especially as we tackle H.I.V. in the rest of the world. 1000 00:50:38,733 --> 00:50:41,766 Longer-term PrEP options are being tested, 1001 00:50:41,766 --> 00:50:43,966 as are new mRNA vaccines, 1002 00:50:43,966 --> 00:50:49,400 building on COVID-19 advances, that sprang directly 1003 00:50:49,400 --> 00:50:54,466 from pioneering research into H.I.V. vaccines. 1004 00:50:54,466 --> 00:50:56,600 H.I.V. was the NASA of COVID. 1005 00:50:56,600 --> 00:50:59,466 The COVID vaccine came out of the Vaccine Research Center, 1006 00:50:59,466 --> 00:51:02,066 which was created to make an H.I.V. vaccine. 1007 00:51:02,066 --> 00:51:04,666 The treatments that we use for treating COVID 1008 00:51:04,666 --> 00:51:07,566 are really spun off completely from H.I.V. 1009 00:51:07,566 --> 00:51:09,800 Remdesivir. 1010 00:51:09,800 --> 00:51:11,733 Paxlovid is a protease inhibitor. 1011 00:51:11,733 --> 00:51:13,233 Imagine that! 1012 00:51:13,233 --> 00:51:16,566 GANDHI: So ten years ago, if you had told me 1013 00:51:16,566 --> 00:51:18,866 that prevention could have dropped infections 1014 00:51:18,866 --> 00:51:21,666 by half without a vaccine, I would not have believed it. 1015 00:51:21,666 --> 00:51:23,633 That was also miraculous. 1016 00:51:25,133 --> 00:51:28,466 MASCOLA: I think PrEP can get us to zero. 1017 00:51:28,466 --> 00:51:30,466 It's just a matter of the resources needed 1018 00:51:30,466 --> 00:51:31,900 to hold us there. 1019 00:51:31,900 --> 00:51:33,733 ELOPRE: We have a medication 1020 00:51:33,733 --> 00:51:35,900 that you can take that almost 100% 1021 00:51:35,900 --> 00:51:38,633 prevents you from getting H.I.V. if you're exposed. 1022 00:51:38,633 --> 00:51:42,000 So 100%, if we were able to improve access, 1023 00:51:42,000 --> 00:51:43,400 I think we could end the epidemic. 1024 00:51:43,400 --> 00:51:46,233 HAMLIN: Not one institution can be isolated and say, 1025 00:51:46,233 --> 00:51:48,166 "I'm not affected by H.I.V.," 1026 00:51:48,166 --> 00:51:51,900 or, "I'm not affected by healthcare issues," 1027 00:51:51,900 --> 00:51:53,200 because all of us are. 1028 00:51:53,200 --> 00:51:54,600 GANDHI: I am very hopeful 1029 00:51:54,600 --> 00:51:56,133 now that we have the tools 1030 00:51:56,133 --> 00:51:59,000 to see the end of all new H.I.V. infections, 1031 00:51:59,000 --> 00:52:02,333 the end of AIDS deaths, and the end of AIDS stigma. 1032 00:52:02,333 --> 00:52:04,600 That is what I want to see in my lifetime 1033 00:52:04,600 --> 00:52:05,800 and I absolutely know I can. 1034 00:52:07,200 --> 00:52:08,333 Big stick. 1035 00:52:08,333 --> 00:52:10,066 WILLIAMS: We have the tools to stop it. 1036 00:52:10,066 --> 00:52:12,300 Let's do it. 1037 00:52:12,300 --> 00:52:15,200 ♪ ♪ 1038 00:52:34,600 --> 00:52:42,133 ♪ ♪ 1039 00:52:49,366 --> 00:52:54,233 ANNOUNCER: To order this program on DVD, visit ShopPBS. 1040 00:52:54,233 --> 00:52:56,966 Or call 1-800-PLAY-PBS. 1041 00:52:56,966 --> 00:52:59,833 Episodes of "NOVA" are available with Passport. 1042 00:52:59,833 --> 00:53:03,633 "NOVA" is also available on Amazon Prime Video. 1043 00:53:03,633 --> 00:53:08,833 ♪ ♪ 1044 00:53:17,633 --> 00:53:24,800 ♪ ♪