WEBVTT - Lab 043: Understanding HIV Part II 0:00:02.640 --> 0:00:05.840 I'm Tt and I'm Zachiah, and from Spotify. This is 0:00:05.880 --> 0:00:34.199 Dope Labs. Welcome to Dope Labs, a weekly podcast that 0:00:34.280 --> 0:00:37.959 mixes hardcore science, pop culture, and a healthy dose of friendship. 0:00:38.040 --> 0:00:40.760 This week, we're continuing our two part series on HIV. 0:00:40.960 --> 0:00:42.680 There's just so much to cover we couldn't fit it 0:00:42.680 --> 0:00:45.600 all into one episode. Yes, and last week we really 0:00:45.680 --> 0:00:48.519 dug deep into the science behind HIV and the history 0:00:48.560 --> 0:00:52.000 of HIV vaccine development. We talked about the structure of HIV, 0:00:52.159 --> 0:00:54.800 remember the glaco proteins, and how it infects the body. 0:00:55.000 --> 0:00:57.800 We also talked about how an HIV vaccine could work 0:00:58.040 --> 0:01:02.040 and why developing an HIV vaccine is so difficult to achieve. 0:01:02.200 --> 0:01:04.200 So this week we're going to shift from the science 0:01:04.280 --> 0:01:06.800 to the people. Because we know science doesn't happen in 0:01:06.800 --> 0:01:09.280 a vacuum. Our goal is to take what we learned 0:01:09.280 --> 0:01:13.399 in part one and overlay some cultural context. Sound good, 0:01:13.880 --> 0:01:27.200 Let's get into the recitation, all right, So what do 0:01:27.280 --> 0:01:30.280 we know. Let's unpack the thing that we always say, 0:01:30.280 --> 0:01:32.680 which is that science doesn't happen in a vacuum. There 0:01:32.680 --> 0:01:35.200 are factors that determine whether or not something is science 0:01:35.240 --> 0:01:38.840 worthy or research worthy, and you have to consider what's 0:01:38.880 --> 0:01:41.840 the climate, what's the political or social climate. Is it 0:01:41.920 --> 0:01:44.240 even seen as urgent? It also depends on if a 0:01:44.280 --> 0:01:47.160 certain demographic is affected by certain diseases. 0:01:47.480 --> 0:01:47.760 Right. 0:01:48.000 --> 0:01:52.280 Also beyond just who's affected, is there stigma around even 0:01:52.360 --> 0:01:53.640 working on these things? 0:01:53.960 --> 0:01:55.360 Is there any type of health risk? 0:01:55.400 --> 0:01:58.560 What's understood or not understood at the time where we're 0:01:58.560 --> 0:02:02.160 trying to make discovery, all right? And there's also scientific 0:02:02.160 --> 0:02:04.600 communication that is a branch off of the science. So 0:02:04.640 --> 0:02:06.680 it's when the science is being done, when the research 0:02:06.720 --> 0:02:10.440 and development is being done, how it's communicated to the population, 0:02:10.600 --> 0:02:11.079 if at all. 0:02:11.280 --> 0:02:11.679 Mm hmm. 0:02:11.919 --> 0:02:14.600 That's a very good point. So these are all really vague, 0:02:14.639 --> 0:02:16.280 and I think that takes us right into what we 0:02:16.360 --> 0:02:19.919 want to know. We want to know the specifics around this. Yeah, 0:02:19.960 --> 0:02:23.000 which communities are affected the most by HIV and has 0:02:23.040 --> 0:02:27.720 it changed over time? And how has that affected vaccine development? 0:02:27.760 --> 0:02:28.240 Who were the. 0:02:28.200 --> 0:02:31.200 Decision makers, what was the initial guidance that affected the 0:02:31.200 --> 0:02:36.840 scientific response to HIV diagnosis, prevention, public health interventions, treatments, medicine, 0:02:36.840 --> 0:02:39.280 and eventually vaccine development. And then a question that I 0:02:39.320 --> 0:02:42.680 have is if and when the vaccine does become available 0:02:43.080 --> 0:02:46.639 What is the strategy moving forward for the scientists and 0:02:46.680 --> 0:02:49.280 the people in the medical field that will be administering 0:02:49.320 --> 0:02:52.440 these vaccines. We've already seen what happened with COVID. What's 0:02:52.480 --> 0:02:54.440 the game plan for the HIV vaccine. 0:02:54.600 --> 0:02:55.959 Let's jump into the dissection. 0:03:07.880 --> 0:03:11.160 You all know Christine doctor daniels by now. Christine recently 0:03:11.160 --> 0:03:13.720 finished her postdoc at Duke University, where she worked on 0:03:13.760 --> 0:03:17.280 developing and testing new or novel vaccine candidates. One of 0:03:17.320 --> 0:03:19.400 the reasons we really wanted to talk to Christine for 0:03:19.440 --> 0:03:23.040 this series is because of her unique background. She's not 0:03:23.200 --> 0:03:25.960 just focused on the biology of a vaccine. My background 0:03:26.000 --> 0:03:28.919 from undergrad is actually a medical anthropology. I'm always interested 0:03:28.919 --> 0:03:31.800 in how the cultural lens impacts the way people experience 0:03:31.840 --> 0:03:34.640 and treat disease. If we really want to understand the 0:03:34.680 --> 0:03:38.240 story of the HIV vaccine from all angles, we need 0:03:38.280 --> 0:03:41.600 to understand not just the science but also the culture 0:03:41.680 --> 0:03:42.440 around HIV. 0:03:42.800 --> 0:03:43.600 So let's dive in. 0:03:43.920 --> 0:03:45.960 So we're going to start with a little bit of history. 0:03:46.160 --> 0:03:48.000 In part one, we talked about a couple of different 0:03:48.080 --> 0:03:51.320 vaccine trials that show various levels of success. There was 0:03:51.320 --> 0:03:54.040 the first large scale Phase three clinical trial of VAX 0:03:54.200 --> 0:03:57.720 zero zero four in nineteen ninety eight, but that ultimately failed. 0:03:58.200 --> 0:04:00.240 And then fast forward to two thousand and three. Read 0:04:00.320 --> 0:04:02.680 the RV one four to four trial was the first 0:04:02.680 --> 0:04:06.160 clinical trial with some proven efficacy, but it was only 0:04:06.240 --> 0:04:09.160 around about thirty percent, which isn't anywhere near enough to 0:04:09.160 --> 0:04:11.640 get approval. But I mean, when you think about it, 0:04:11.800 --> 0:04:15.280 nineteen ninety eight, two thousand and three, isn't that twenty 0:04:15.360 --> 0:04:17.520 years after HIV was first discovered. 0:04:17.560 --> 0:04:21.120 If we think about historically HIV it's origin, people started 0:04:21.160 --> 0:04:23.440 realizing that they were infected around the seventies, but we 0:04:23.440 --> 0:04:26.560 didn't see a big push towards trying to develop treatments 0:04:26.600 --> 0:04:29.159 for it until late eighties early nineties. 0:04:29.480 --> 0:04:32.359 A's was first diagnosed in nineteen eighty one. The virus 0:04:32.600 --> 0:04:35.600 HIV was first isolated and confirmed to be the cause 0:04:35.640 --> 0:04:39.240 of AIDS in nineteen eighty three. So, yeah, nineteen eighty 0:04:39.240 --> 0:04:41.239 three to two thousand and three, that's a big gap. 0:04:41.480 --> 0:04:44.360 To do these numbers justice, we really have to paint 0:04:44.360 --> 0:04:47.839 the picture of what nineteen eighty one looked like. Yeah, 0:04:48.080 --> 0:04:51.800 so just picture it. It's nineteen eighty one. The number 0:04:51.800 --> 0:04:54.840 one song from the year is Betty Davis Eyes by 0:04:54.920 --> 0:04:58.000 Kim Carnes, I don't know that song, but the number 0:04:58.040 --> 0:05:01.599 two song is Endless Love by Diana Ross and lyon 0:05:01.680 --> 0:05:05.039 On Richie which we know and Lady by Kenny Rodgers. 0:05:05.520 --> 0:05:07.839 And then with movies, the top movies. 0:05:07.480 --> 0:05:10.120 In nineteen eighty one were Indiana Jones, Raiders of the 0:05:10.160 --> 0:05:12.960 Lost Arc, one of Our Phaves, Superman two, so that 0:05:13.160 --> 0:05:16.760 is with Christopher Reeves, and then nine to five with 0:05:17.279 --> 0:05:20.640 The Woman We Love Dolly Parton our Hero. And you know, 0:05:20.960 --> 0:05:23.360 even when you think about what did the technology look 0:05:23.400 --> 0:05:26.240 like in Superman two, right, we didn't have all these 0:05:26.279 --> 0:05:28.359 advances in technology that make it hard for us to 0:05:28.400 --> 0:05:31.400 think back to what healthcare workers and doctors had in 0:05:31.400 --> 0:05:34.920 the nineteen eighties. Just for some additional perspective, gloves were 0:05:35.000 --> 0:05:37.440 used to protect doctor's hands back in the day, so 0:05:37.440 --> 0:05:40.560 people were using gloves in surgery, but not in other places. 0:05:40.600 --> 0:05:42.640 So not if you were getting blood drawn, not if 0:05:42.640 --> 0:05:45.520 you had like a little outpatient procedure, No gloves just 0:05:45.520 --> 0:05:47.880 out here. And when people were using gloves, it was 0:05:47.920 --> 0:05:50.719 often thought to protect doctor's hands at the onset of 0:05:50.800 --> 0:05:53.040 glove use. But then later on in the nineteen eighties, 0:05:53.120 --> 0:05:55.960 with aids becoming more prevalent, people started using gloves more, 0:05:56.360 --> 0:05:59.920 just as like universal precautions for healthcare workers everywhere. Glove 0:06:00.160 --> 0:06:04.160 didn't become required by OSHA, which sets your occupational safety standards, 0:06:04.480 --> 0:06:07.400 until nineteen ninety two, and that was to protect workers 0:06:07.440 --> 0:06:09.840 who came in contact with body fluids. So you can 0:06:09.880 --> 0:06:12.120 imagine people didn't know what was going on. That's less 0:06:12.120 --> 0:06:14.240 than thirty years ago. Could you imagine a doctor coming 0:06:14.279 --> 0:06:16.839 towards you and being like, hey, let's take a look 0:06:16.839 --> 0:06:19.320 in that eyeball and touching your eye. 0:06:19.440 --> 0:06:22.720 No, just fingerprint to sclera. I don't think so. 0:06:22.800 --> 0:06:33.479 Thank God for everyone, No way. In nineteen eighty one, 0:06:33.760 --> 0:06:36.920 the population in the US who tested positive for HIV 0:06:37.200 --> 0:06:40.720 was estimated to be ninety three percent male and fifty 0:06:40.760 --> 0:06:44.120 six percent white. Sixty three percent of positive cases were 0:06:44.160 --> 0:06:47.560 transmitted via male to mail sexual contact, and twenty five 0:06:47.600 --> 0:06:51.320 percent from intravenous drug use. During this time, the stigma 0:06:51.360 --> 0:06:54.599 and discrimination against those most effective, gay people and people 0:06:54.640 --> 0:06:58.000 who injected drugs was staggering, and so there wasn't a 0:06:58.000 --> 0:07:01.960 big political push to try to fund or direct research 0:07:02.000 --> 0:07:04.919 efforts towards addressing this problem because it wasn't affecting the 0:07:04.920 --> 0:07:08.840 dominant population. In fact, many people in positions of power 0:07:09.000 --> 0:07:12.160 allowed their own personal beliefs to affect their actions and 0:07:12.280 --> 0:07:18.000 responses to the HIV crisis, not only politicians, but insurance companies, researchers, 0:07:18.120 --> 0:07:22.200 drug manufacturers, doctors, and support systems like folks, family and 0:07:22.240 --> 0:07:26.480 friends who believe that the specific behaviors associated with contracting 0:07:26.680 --> 0:07:29.600 HIV were inherently wrong, and because they thought they were 0:07:29.640 --> 0:07:33.239 inherently wrong, they then considered these groups undeserving of help 0:07:33.480 --> 0:07:36.480 or of maximum effort to control the spread of HIV. 0:07:36.760 --> 0:07:39.560 It's a very controversial issue. A lot of our policy 0:07:39.600 --> 0:07:41.960 is influenced by religious beliefs. A lot of people use 0:07:42.040 --> 0:07:45.320 religion as an excuse to discriminate against certain people who 0:07:45.320 --> 0:07:48.080 have behaviors or lifestyles that they don't agree with. People 0:07:48.080 --> 0:07:50.960 are you know, I'm a Christian, so I can't support 0:07:51.040 --> 0:07:53.720 gay marriage or say anything, And that's not in the Bible. 0:07:53.760 --> 0:07:56.560 You're using the text and interpreting a certain way to 0:07:56.560 --> 0:07:58.680 push a certain agenda. And so it's not religion that 0:07:58.720 --> 0:08:00.960 it is dictating that these groups should be ostracized. 0:08:01.040 --> 0:08:03.080 It's your interpretation of that. 0:08:03.360 --> 0:08:07.320 And your interpretation is subjective. That's a choice that people make, 0:08:07.720 --> 0:08:11.640 but also everyone doesn't subscribe to the same religious beliefs, 0:08:11.840 --> 0:08:14.760 So who's to say that one section of the population 0:08:14.840 --> 0:08:18.000 gets to make the decision for everyone else? And objectively, 0:08:18.120 --> 0:08:21.240 these are human beings. We all deserve access to healthcare, 0:08:21.280 --> 0:08:25.000 secure housing, you know, the basics. The media also failed 0:08:25.040 --> 0:08:28.239 to cover the epidemic properly. During the first three years 0:08:28.240 --> 0:08:31.400 of the HIV epidemic, the New York Times only ran 0:08:31.680 --> 0:08:34.160 three stories on it, and none of them made the 0:08:34.160 --> 0:08:37.520 front page. And geography was also an issue that impeded 0:08:37.520 --> 0:08:41.760 widespread education, prevention, and treatment of HIV and AIDS. At 0:08:41.760 --> 0:08:44.560 the outset, most cases were being reported in New York 0:08:44.559 --> 0:08:47.760 and California, so lawmakers in other states were reluctant to 0:08:47.840 --> 0:08:50.960 use funds on HIV that could have been spent otherwise 0:08:51.000 --> 0:08:53.320 on roads, education or infrastructure. 0:08:53.440 --> 0:08:54.800 It sounds so much like COVID. 0:08:54.880 --> 0:08:58.000 This is that vacuum that don't exist, all these different 0:08:58.080 --> 0:09:03.240 things that affect how we digest the information and how 0:09:03.280 --> 0:09:05.600 we interact with all of these new things. I mean, 0:09:05.640 --> 0:09:08.880 we just went through media, geography, religious believe I mean, 0:09:08.880 --> 0:09:12.000 think about the outset of COVID, right, some people weren't 0:09:12.000 --> 0:09:13.600 covering it or they were saying, oh, this is only 0:09:13.640 --> 0:09:15.400 in China, it doesn't matter for the United States. And 0:09:15.440 --> 0:09:17.559 then even when it was in the United States, when 0:09:17.600 --> 0:09:20.320 it was affecting New York and California, again, our most 0:09:20.360 --> 0:09:24.400 densely populated areas in other states weren't doing the things 0:09:24.400 --> 0:09:27.920 that they needed to do, like implementing mask mandates or 0:09:28.240 --> 0:09:31.840 ramping up testing, and here we are seeing the exact 0:09:31.840 --> 0:09:34.120 same thing because they want to spend those dollars elsewhere. 0:09:34.360 --> 0:09:35.920 This is why it was so important for us to 0:09:35.920 --> 0:09:39.720 start out with the history of this virus, because you 0:09:39.760 --> 0:09:41.320 don't know where you're going if you don't know where 0:09:41.320 --> 0:09:44.520 you came from, and history often repeats itself, and so 0:09:44.880 --> 0:09:48.320 knowing the history helps us better prepare for things like 0:09:48.360 --> 0:09:50.680 this in the future. It should have helped us with COVID, 0:09:51.000 --> 0:09:54.760 but it didn't because we have chosen to stay blissfully 0:09:54.840 --> 0:09:58.240 unaware of some of these outside factors that are also 0:09:58.440 --> 0:09:59.120 playing a role. 0:09:59.280 --> 0:10:01.760 It took a lot of time for people to adopt 0:10:01.760 --> 0:10:06.040 that more inclusive mindset, and so that's stalled the focus 0:10:06.120 --> 0:10:09.760 on HIV vaccine development and treatment development, and so we 0:10:09.760 --> 0:10:12.319 didn't start to see that arise until people who didn't 0:10:12.320 --> 0:10:14.520 come from those stigmatized groups started to be infected at 0:10:14.600 --> 0:10:18.560 higher rates. Once we started seeing heterosexual white men or 0:10:18.600 --> 0:10:21.880 heterosexual women and other people that are part of the 0:10:21.920 --> 0:10:24.400 dominant culture become affected, then it became a problem. Once 0:10:24.440 --> 0:10:27.760 we started seeing celebrities become affected and high profile people 0:10:28.040 --> 0:10:30.880 start dying, then it becomes a problem that the average 0:10:30.880 --> 0:10:34.640 person cares about. Today, approximately one point two million people 0:10:34.679 --> 0:10:37.560 have HIV. That's a little under half of one percent 0:10:37.679 --> 0:10:39.280 of the US population. 0:10:39.000 --> 0:10:43.360 And that percentage is disproportionately higher among marginalized groups, including 0:10:43.440 --> 0:10:46.240 sex workers, trans people, and people of color. 0:10:46.440 --> 0:10:48.720 But we also know that we have some blind spots. 0:10:48.760 --> 0:10:52.239 I think it's important to know and understand that statistics 0:10:52.240 --> 0:10:55.840 don't paint a full picture. Data is helpful to see 0:10:56.080 --> 0:11:00.120 overall trends, but most data is incomplete. Some of these 0:11:00.160 --> 0:11:03.080 statistics and the way that some of these numbers are 0:11:03.080 --> 0:11:04.880 put together, you have to take them all with a 0:11:04.880 --> 0:11:06.720 grain of salt. There are so many factors that go 0:11:06.800 --> 0:11:09.440 into how the data is collected. Do people feel comfortable 0:11:09.440 --> 0:11:12.320 with disclosing this information? Who are they asking, how are 0:11:12.320 --> 0:11:15.600 they asking? Are the questions clear? And it gets even 0:11:15.640 --> 0:11:20.560 more complicated when you start to go down into marginalized communities, 0:11:20.559 --> 0:11:23.720 Black folks people who are living with disabilities, people in 0:11:23.760 --> 0:11:29.920 the LGBTQIA community, all of these populations, they've been excluded 0:11:30.040 --> 0:11:33.320 from so many of these conversations. It's been used to 0:11:33.880 --> 0:11:39.839 violate them in the past. Disclosing meant loss of jobs, Disclosing. 0:11:39.320 --> 0:11:42.560 Meant social stigma. It completely changes your life. 0:11:42.640 --> 0:11:45.160 That provides a lot more context t t about why 0:11:45.200 --> 0:11:49.400 we see sex workers or trans people or people of 0:11:49.440 --> 0:11:53.280 color with higher rates of HIV in these slices of 0:11:53.320 --> 0:11:56.760 the population because they have higher risks. These categories aren't 0:11:56.800 --> 0:11:59.760 biological and so when you see these things come together 0:12:00.080 --> 0:12:03.480 because of social influences, and these types of gaps can 0:12:03.559 --> 0:12:06.360 potentially lead to problems where people affected the most are 0:12:06.440 --> 0:12:18.360 excluded or misrepresented in studies. Another thing that's changed a 0:12:18.440 --> 0:12:20.719 lot since nineteen eighty one is that there has been 0:12:20.760 --> 0:12:24.880 a lot more education and media coverage. Yes, movies and 0:12:24.920 --> 0:12:27.320 TV shows have evolved in terms of the stories that 0:12:27.360 --> 0:12:30.360 they tell about people living with HIV. One that I've 0:12:30.360 --> 0:12:34.120 been really enjoying lately is It's a Sin on HBO Max, 0:12:34.480 --> 0:12:37.240 which tells the story of the early eighties and the 0:12:37.280 --> 0:12:40.480 identification of AIDS and that it leads to HIV from 0:12:40.520 --> 0:12:43.880 the perspective of a group of friends living in I 0:12:43.880 --> 0:12:46.640 think they're in London, and you see how they're like, oh, no, 0:12:47.000 --> 0:12:48.839 this is only issue if you sleep with American boys. 0:12:48.960 --> 0:12:49.880 Oh my goodness. 0:12:50.160 --> 0:12:53.080 And that was the framework and the mindset, which doesn't 0:12:53.080 --> 0:12:54.680 feel that different from this is only an issue if 0:12:54.720 --> 0:12:57.120 you traveled to China with COVID. Remember in the real 0:12:57.160 --> 0:13:02.360 world when Pedro Zamora, that was my first introduction to someone. 0:13:02.400 --> 0:13:05.640 He's not a fictional character that had HIV and they 0:13:05.640 --> 0:13:08.360 were showing him on television, and I felt like his 0:13:08.400 --> 0:13:12.040 story really impacted what people generally thought about folks with 0:13:12.200 --> 0:13:15.320 HIV and really humanized that population a lot. 0:13:15.440 --> 0:13:15.800 You know what. 0:13:15.840 --> 0:13:20.400 I remember that movie with Denzel Washington called Philadelphia. 0:13:20.640 --> 0:13:24.320 Yes, another really good one. I loved that movie. 0:13:24.720 --> 0:13:28.240 Well known celebrities, including Billy Porter and Jonathan van Ness 0:13:28.240 --> 0:13:31.479 have recently talked openly about their HIV diagnoses. 0:13:31.679 --> 0:13:33.719 Now, all of a sudden, there's all of these campaigns 0:13:33.800 --> 0:13:37.319 and committees and small organizations that are leading efforts to 0:13:37.360 --> 0:13:40.400 try to devote attention and funding and resources towards addressing 0:13:40.440 --> 0:13:41.000 this problem. 0:13:41.200 --> 0:13:42.160 But the problem wasn't new. 0:13:42.200 --> 0:13:44.000 The problem has been there, it just wasn't pushed to 0:13:44.080 --> 0:13:46.440 the forefront of attention, and so that's kind of what 0:13:46.800 --> 0:13:49.560 stalled the efforts. Let's take a break and when we 0:13:49.640 --> 0:13:52.040 come back, we'll keep talking about why it's taken so 0:13:52.120 --> 0:14:15.240 long to develop an HIV vaccine. We're back and we 0:14:15.240 --> 0:14:17.280 want to tell you about our lab for next week. 0:14:17.440 --> 0:14:20.280 Next week, we're celebrating the end of twenty twenty one 0:14:20.480 --> 0:14:22.920 with our annual end of the year mixtape. We'll be 0:14:22.960 --> 0:14:25.400 talking about the biggest moments from twenty twenty one and 0:14:25.440 --> 0:14:27.520 doing a mini dissection on each of them. 0:14:27.560 --> 0:14:30.520 And in January, we're really excited about a four part 0:14:30.560 --> 0:14:33.320 series we're doing all about wellness, self care and how 0:14:33.360 --> 0:14:35.160 to brush up on your habits in the new year, 0:14:35.360 --> 0:14:37.080 and we want you to be a part of it. 0:14:37.240 --> 0:14:39.320 We want to know your new year's resolutions for twenty 0:14:39.360 --> 0:14:41.600 twenty two. Are you making a list or did you 0:14:41.640 --> 0:14:43.160 skip resolutions altogether? 0:14:43.680 --> 0:14:45.960 What are you focusing on? We want to hear from you. 0:14:46.000 --> 0:14:48.720 Call us at two zero two five six seven seven 0:14:48.800 --> 0:14:57.040 zero two eight and leave us a message. Okay, let's 0:14:57.040 --> 0:14:59.200 get back to the dissection. In the first part of 0:14:59.240 --> 0:15:02.760 the dissection discussed some of the social and behavioral context 0:15:03.080 --> 0:15:06.960 around who is predominantly affected by AHIV, and so now 0:15:07.000 --> 0:15:08.800 it all makes sense as to why it's been an 0:15:08.880 --> 0:15:12.480 uphill battle to developing AHIV vaccine. So at the onset, 0:15:12.640 --> 0:15:15.320 you have people who feel like this isn't worth investing in, 0:15:15.440 --> 0:15:19.560 from our political leaders to big corporations, and we saw 0:15:19.680 --> 0:15:22.280 what it took for something that affected everybody for us 0:15:22.320 --> 0:15:24.520 to get things going just in twenty twenty. 0:15:24.800 --> 0:15:25.359 Imagine. 0:15:25.400 --> 0:15:28.960 Also, what we're talking about is nineteen eighties science. Okay, yeah, 0:15:29.160 --> 0:15:31.320 science with acid wash genes. 0:15:31.440 --> 0:15:32.280 Yes, Okay. 0:15:33.360 --> 0:15:35.640 I don't know how many advances you can make with 0:15:35.720 --> 0:15:38.880 acid wash gens and all that hairspray and all that hairspray. 0:15:39.960 --> 0:15:43.840 But you got to give these scientists credit. Okay, they 0:15:43.840 --> 0:15:46.440 continue to work on this and work on this. Just 0:15:46.480 --> 0:15:49.760 to give you some perspective. In the early stages, so 0:15:49.840 --> 0:15:51.640 like around nineteen eighty five, I think that's when they 0:15:51.760 --> 0:15:56.320 first had the like official HIV diagnostic test. Okay, So 0:15:56.360 --> 0:15:58.680 we're talking about nineteen eighty one to nineteen eighty five 0:15:59.080 --> 0:16:03.240 with no standard test, right, these are people observing symptoms 0:16:03.280 --> 0:16:05.760 and trying to figure out what could possibly be going 0:16:05.800 --> 0:16:08.680 on in these different patients. That first test, the way 0:16:08.720 --> 0:16:12.040 it was designed, you could get a non reactive kind 0:16:12.080 --> 0:16:15.000 of like negative test result. That negative window was eight 0:16:15.000 --> 0:16:17.880 to ten weeks after exposure, So you needed to wait 0:16:17.920 --> 0:16:22.120 at least ten weeks after exposure or potential exposure for 0:16:22.200 --> 0:16:25.360 you to be able to say confidently negative or positive. 0:16:25.480 --> 0:16:26.480 That's a long time. 0:16:26.600 --> 0:16:29.320 That is a very very long time. 0:16:29.600 --> 0:16:33.480 So fast forward, I mean, now that's not the case anymore, right, 0:16:33.560 --> 0:16:36.480 But so from nineteen eighty five to nineteen ninety one 0:16:36.560 --> 0:16:38.160 they got that down from eight to ten weeks to 0:16:38.480 --> 0:16:40.600 tests that only had a two to three week window. 0:16:40.680 --> 0:16:42.240 It's mind boggling to me that they were able to 0:16:42.240 --> 0:16:44.120 make that type of progress without the tools that we 0:16:44.200 --> 0:16:45.800 have available right now. 0:16:46.440 --> 0:16:53.080 All they had were traffer keepers. You can put in 0:16:53.080 --> 0:16:54.480 your lab notes in a Traffer keeper. 0:17:02.200 --> 0:17:04.520 And so what we also have to consider is what 0:17:04.680 --> 0:17:07.640 population or what group of the population was most affected 0:17:07.680 --> 0:17:10.760 by HIV and are these the same people who are 0:17:10.760 --> 0:17:16.439 making decisions about drugs, treatment policy, public health support? Are 0:17:16.440 --> 0:17:19.320 those the people making the decisions around HIV? And Christine 0:17:19.320 --> 0:17:22.640 says that representation in those spaces is absolutely crucial. 0:17:22.760 --> 0:17:25.600 When you think about from a research standpoint, the people 0:17:25.680 --> 0:17:27.760 that are in a position to decide the questions that 0:17:27.920 --> 0:17:30.480 research don't look like the populations that are affected. So 0:17:30.600 --> 0:17:32.800 if those people aren't in the room, they can't direct 0:17:32.800 --> 0:17:35.440 the questions, and so we see a lot more research 0:17:35.480 --> 0:17:38.320 funding or research done on things that impact the dominant culture, 0:17:38.359 --> 0:17:40.800 such as breast cancer, instead of things like sickle cell 0:17:40.920 --> 0:17:43.919 that affect predominantly African Americans or minorities. So we have 0:17:43.960 --> 0:17:46.439 the funding issue, we also have the representation issue. If 0:17:46.440 --> 0:17:48.800 we're not in the room, we can't drive the conversation, 0:17:48.920 --> 0:17:49.679 we can't direct it. 0:17:49.760 --> 0:17:54.639 Doctor Daniel's identity is inastricably linked to her work. Diseases 0:17:54.680 --> 0:17:57.720 she chooses to research are the ones that most frequently 0:17:57.800 --> 0:17:59.960 impact people who share her identity. 0:18:00.040 --> 0:18:02.200 I personally don't think you can separate the two. Well, 0:18:02.240 --> 0:18:04.560 I can't because of my identity. I am a black woman, 0:18:04.600 --> 0:18:06.399 and so the way I approach research, the way I 0:18:06.400 --> 0:18:08.879 think about the questions that I'm researching, is always going 0:18:08.920 --> 0:18:12.080 to be influenced by my identity, and so the diseases 0:18:12.119 --> 0:18:15.160 I choose to research are typically diseases that more frequently 0:18:15.280 --> 0:18:18.800 impact people with my identity or similar identities. Christine saw 0:18:18.800 --> 0:18:21.600 the disparities and how they can affect decisions that are 0:18:21.600 --> 0:18:24.399 made firsthand when COVID started and when the COVID pandemic 0:18:24.440 --> 0:18:27.400 first started, we were in these multi day symposiums working force, 0:18:27.480 --> 0:18:29.560 just trying to understand what was going on. So, what's 0:18:29.600 --> 0:18:32.280 infecting these people, how is it happening, how is it spreading, 0:18:32.400 --> 0:18:34.199 what do we do to contain it, how do we 0:18:34.240 --> 0:18:36.399 treat it, how is it working, and things like that, 0:18:36.440 --> 0:18:38.760 and who do we prioritize. And in one of them, 0:18:38.880 --> 0:18:41.520 race only came up one time because a person asked 0:18:41.680 --> 0:18:45.360 about the prevalence amongst minority communities. The person said that 0:18:45.680 --> 0:18:49.320 because African Americans have higher rates of obesity and hypertension, 0:18:49.560 --> 0:18:51.520 that that's why it's more prevalent amongst us, and that's 0:18:51.520 --> 0:18:54.120 why we're dying because we have all these pre existing conditions, 0:18:54.200 --> 0:18:54.800 and that was it. 0:18:54.880 --> 0:18:58.080 If you're not acknowledging the context in which people are 0:18:58.119 --> 0:19:02.240 living when talking about pre existing conditions, you're not painting 0:19:02.280 --> 0:19:03.040 the full picture. 0:19:03.040 --> 0:19:04.240 You're not telling the whole story. 0:19:04.520 --> 0:19:08.040 Race is not a biological category, So we're talking about 0:19:08.040 --> 0:19:12.240 things like access to good healthcare, socioeconomic status, even things. 0:19:12.040 --> 0:19:15.160 Like your ability to social distance. Not everybody can do that. 0:19:15.280 --> 0:19:17.840 Your housing conditions or the type of job you have 0:19:18.080 --> 0:19:21.000 might make it impossible for you to do that. One 0:19:21.000 --> 0:19:23.919 thing Christine talked about that was really interesting was that 0:19:23.960 --> 0:19:27.680 disparities and representation can also lead to disparities in terms 0:19:27.760 --> 0:19:31.080 of technology and access. I worry we're developing more and 0:19:31.080 --> 0:19:33.960 more high tech technologies because we can, but we won't 0:19:34.000 --> 0:19:36.320 be able to actually benefit the people who need it 0:19:36.320 --> 0:19:39.480 the most because now it's cost prohibitive, because so much 0:19:39.520 --> 0:19:42.560 money goes into developing them that now it won't be 0:19:42.640 --> 0:19:44.760 marketed at a price point that the people who needed 0:19:44.760 --> 0:19:47.280 it most, the people who was designed for, can benefit 0:19:47.320 --> 0:19:47.680 from it. 0:19:47.720 --> 0:19:49.280 Do you have to be in a hospital to get 0:19:49.280 --> 0:19:51.840 administered this? How feasible is it for someone to go 0:19:52.000 --> 0:19:54.600 and get competitive doses of something? I don't think that 0:19:54.840 --> 0:19:57.160 scientists think enough about who they're trying. 0:19:56.960 --> 0:19:59.120 To help, and that's something that we're seeing with COVID right. 0:19:59.240 --> 0:20:01.440 One of the things was that the vaccine had to 0:20:01.480 --> 0:20:05.679 be refrigerated. And which countries can afford to buy these therapies. 0:20:06.280 --> 0:20:07.160 That's important. 0:20:07.359 --> 0:20:08.439 That's such a good point. 0:20:08.480 --> 0:20:11.280 I mean, what's the point of a treatment if only 0:20:11.320 --> 0:20:14.240 the top one percent can afford the drug? We talked 0:20:14.240 --> 0:20:16.080 about prep in part one of the series and how 0:20:16.080 --> 0:20:19.040 it's an effective preventative drug for HIV, but. 0:20:19.040 --> 0:20:22.320 We didn't mention the cost. A thirty day supply of 0:20:22.440 --> 0:20:26.800 PREP costs one thousand, seven hundred and fifty eight dollars. 0:20:27.160 --> 0:20:30.479 That means annually it could add up to over twenty 0:20:30.520 --> 0:20:31.880 one thousand dollars. 0:20:32.119 --> 0:20:34.080 That is ridiculous. 0:20:34.200 --> 0:20:36.280 In July of this year, the federal government passed the 0:20:36.359 --> 0:20:39.960 law mandating insurers to cover PREP drugs one hundred percent, 0:20:40.040 --> 0:20:43.920 including clinic visits associated with PREP. That's a big deal. 0:20:44.200 --> 0:20:48.280 That's huge. Yeah, And the CDC just released new guidelines. 0:20:47.760 --> 0:20:51.240 Right and it added a recommendation to doctors to inform 0:20:51.440 --> 0:20:55.200 all sexually active adults and adolescents about PREP. I think 0:20:55.200 --> 0:20:58.399 that's going to go a long way in raising awareness 0:20:58.480 --> 0:20:59.640 and reducing stigma. 0:21:00.320 --> 0:21:01.800 Scientists care about the science. 0:21:01.800 --> 0:21:04.440 They want the coolest technology and the most high tech thing, 0:21:04.520 --> 0:21:07.800 But people from different identities think about them and think 0:21:07.840 --> 0:21:10.639 about how would this work, Like would my friend cousin's 0:21:10.680 --> 0:21:12.520