I'm gonna have to bum some folks out . . .

May 18, in addition to being the anniversary of the eruption of Mt. Saint Helens, is HIV Vaccine Awareness Day, sponsored by the HIV vaccine trials network -- in turn funded by the National Institute of Allergy and Infectious Disease.

Sigh. HIV is a slow motion disaster which is much more than you typical everday public health problem. It is a social, political, cultural, ethical, and economic thicket of brambles that messes with everybody's mind, whether they are infected or likely to become infected, or not. The truth about HIV is seldom what anybody wants to believe. In earlier days of the epidemic here in the U.S., factions within the gay community were initially among the most resistant to efforts to promote behavioral change, which they saw as attacks on gay sexuality and freedom. Of course, proprietors of bath houses were also making money off of unsafe sex. The stigma associated with HIV, and the people most likely to be affected by it -- gay men and IDUs -- were major obstacles to an effective public health response and to an adequate investment in medical research. Once we realized that, although the virus happened to take hold in the gay population here, it was an equal opportunity menace, the federal government defined Haitian immigrants as a "risk group," because they happened to be affected by a heterosexually transmitted epidemic, rather than recognizing that it is what people do, not who they are, that puts them at risk for HIV. Churches are often opponents of effective pubilc health measures to combat HIV. I'm so weary of some people's "moral values" that I can't even bring myself to discuss it here.

Then there is the terrible story of HIV in Africa, a continent with more than enough burdens. The threat of devastating breakouts of HIV in south Asia and Eastern Europe. The moral torment of seeing the vast majority of infected people go without treatment because the drug companies don't want any threats to their profits and the Bush administration would rather defend their shareholders and executives than the poor people of the planet. The indescribable pain of seeing friends sicken and die young, in a pointless random harvest.

Of course we all just want it to go away. That is why there is a sort of movement, a political correctness among people who work in the field of HIV that a vaccine is coming soon. Campaigns are underway to convince people to enroll in HIV vaccine trials, to get the government to spend more on vaccine development, and even a widespread conspiracy theory that an effective vaccine already exists but the drug companies are suppressing it so they can continue to sell anti-retroviral drugs.

The cold truth: there is no usable HIV vaccine in sight, and it may even be that an HIV vaccine is impossible.

1. Like influenza, HIV continually mutates and recombines. That means that a vaccine that is effective against one or more strains today may not be effective against other strains that emerge. This is a reallybig problem when it comes to HIV because it would be counterproductive and unethical to give people an only partly effective vaccine. People who believe they are protected, but really aren't, might engage in unsafe behavior and put themselves and others at higher risk than if they weren't vaccinated.
2. HIV infects important immune system cells, called helper T-cells. It is hard to design a vaccine that stimulates the same cells that the virus infects.
3. HIV not only exists as free virus particles, but becomes embedded in the DNA of cells of infected people. These infected cells may be capable of transmitting infection.
4. We really don't know what sort of immune response would be effective against HIV. The body in fact mounts an immune response naturally in response to acute HIV infection, and effectively suppresses circulating free virus for a time. But it can't eliminate the virus, which gradually erodes the immune system until it finally destroys it.

False hope is very dangerous when it comes to HIV, because for one reason or another -- often totally opposite reasons -- people generally don't want to do what is necessary to attack this epidemic.

Sorry for the downhead riff. I hate HIV. But I know we aren't close to beating it.