Jesse Clark, MD didn't end up researching the human immunodeficiency virus (HIV) by accident. He became a doctor because of HIV.
Growing up in the ’80s and ’90s as a gay man, he was part of a community under attack by the virus, and by a social stigma that came with it. Going into medicine was his way of helping his community fight back.
That was more than 30 years ago, and he remains in the fight today. "I keep doing it because there's still so much work to be done," he shares.
What started as a fight for his own community has become a global one. Dr. Clark now serves as director of the UCLA South American Program in HIV Prevention Research (SAPHIR) training program in Lima, Peru, and Rio de Janeiro, Brazil, and over his career has helped shift the landscape of HIV prevention and detection in Latin America.
Around the time Dr. Clark entered the field of HIV/AIDS research, the virus and associated acquired immunodeficiency syndrome began gaining global attention. To increase awareness, the first World AIDS Day took place in 1988, launched by two public information officers at the World Health Organization (WHO).
The annual recognition day, dedicated to bringing continued attention to AIDS, is one of 11 official global public health campaigns marked by the WHO.
The inaugural campaign was centered around children, adolescents, and young adults in an effort to frame HIV as a family disease. Though criticized at the time given that the disease was primarily impacting middle-class gay men in major U.S. cities, this framing was crucial. Around 44% of Americans in 1988 believed AIDS might be "God's punishment for immoral sexual behavior” according to Gallup, and framing the commemoration as a children’s issue made it more palatable to the general public.
Much has changed since then. Dec. 1, 2023 marked the 35th iteration of World AIDS Day; 2023 also is 41 years since AIDS was first identified by young UCLA immunologist Michael Gottlieb, MD. Over the decades since, the medical and societal understanding of HIV/AIDS has shifted dramatically, and great strides have been made in the field.
Honoring the clinicians and researchers
At the center of this shift is the core of HIV/AIDS clinicians and researchers, such as Dr. Clark, who grew into their medical careers during the height of the AIDS crisis. The clinical and empirical advancements surrounding the prevention, treatment, and eradication of the virus have been well-documented. The recruitment and retention of the experts who contributed to those developments have received less attention, but they are central to the story.
This year, the World AIDS Day theme was "Remember and Commit."
"Remembering" requires acknowledging the profound successes of the current generation of HIV/AIDS researchers and all they endured to fight against a virus as it devastated communities globally. "Committing" requires acknowledging that this work continues, that ending the epidemic of HIV/AIDS and reducing the burden of disease necessitates new solutions, new ideas, and a new generation of experts.
Judith Currier, MD, co-director of the UCLA-Charles Drew University (CDU) Center for AIDS Research, has dedicated her life to HIV/AIDS research. Among her myriad accomplishments, she shares that there is one she is most proud of: the group of physicians she has helped to train in the UCLA Department of Medicine (DoM) Infectious Disease (ID) Division to lead HIV/AIDS research, as the second-generation of leaders in the field.
"I've been here for 25 years," Dr. Currier says. "Over those 25 years, through the division of infectious diseases, and together with mentorship from Drs. Otto Yang and Thomas Coates, we brought in a cohort of people who are now succeeding as independent researchers in their own right – Drs. Debika Bhattacharya, Kara Chew, Jesse Clark, Jennifer Fulcher, Risa Hoffman, Jocelyn Kim, and Dr. Raphael Landovitz – just to name a few. We have an entire group of mid-career, highly funded investigators working on HIV because of the DoM's rich research environment. And that’s just within the ID Division of the DoM."
Dr. Currier isn't just speaking from the perspective of a proud mentor and colleague; the legacy of these physicians on a global scale in slowing the spread of HIV cannot be overstated.
Dr. Bhattacharya, co-director of the Viral Hepatitis Program of the Greater Los Angeles Veterans Affairs Healthcare System, has pioneered research on the management of HIV and HIV/viral hepatitis co-infection.
Dr. Landovitz, interim chief of the Infectious Diseases Division, and co-director of the Center for HIV Identification, Prevention and Treatment Services, oversaw a groundbreaking National Institutes of Health-funded study that demonstrated the efficacy of injectable pre-exposure prophylaxis (PrEP) for HIV prevention, which is now approved by the U.S. Food and Drug Administration.
Dr. Risa Hoffman, has collaborated on research that has improved clinical treatment strategies for pregnant and postpartum women living with HIV globally.
On aggregate, the current cohort of experts at UCLA's Department of Medicine has worked across multiple disciplines and geographic regions, both in wet labs and in clinics, to reduce the burden of HIV/AIDS and the inequitable proliferation of the virus.
“Since I started work in Malawi,” Dr. Hoffman shares, “lifespan has significantly lengthened for people living with HIV due to the scale-up of treatment, and perinatal transmission has significantly decreased.”
Dr. Hoffman’s research, carried out in partnership with colleagues from Malawi, was part of this shift, and even informed national policy. “It's really exciting to be part of an effort where you get to witness such tremendous progress over a relatively short time,” she continues.
While the majority of these experts, such as Dr. Hoffman, are focused on HIV/AIDS research, their eminence applies to the field of infectious diseases at large.
When the COVID-19 pandemic hit, the HIV research faculty joined in the response. They helped lead and enroll for pivotal clinical trials in treatments and vaccines, making important contributions to local and national efforts.
The application of HIV research to COVID-19 research, particularly with regard to vaccine and therapeutics development, was an obvious approach to the urgency and creativity demanded by the pandemic. In fact, though scientists have yet to find an effective vaccine for HIV, the methods learned from decades of researching HIV pathways and therapies paved the way for the unprecedented turnaround of the COVID-19 vaccine development and rollout.
"HIV researchers across UCLA were able to pivot to COVID-19 and Mpox," Dr. Currier shares. "And we will be here to do so for future infectious disease pandemics. Investing in the training of people who want to do this kind of work will pay off again and again."
Unfortunately, current HIV researchers are noticing that interest in the field is waning.
"An issue we're navigating is that there's been a drop off in interest in HIV as a field in the past 10 years or so," says Dr. Clark.
Dr. Currier also brought up the trend. "We're not finding as many people interested in working on HIV," she states, "because the disease is more manageable and there's a sense that the urgency isn't the same as it was in the beginning."
While the level of urgency may have leveled off, the problem remains pressing. In 2022, 1.3 million people globally were newly infected with HIV, and on average, more than 600,000 individuals die every year from the virus across the world. However, those effects are not felt equally, as the morbidity and mortality of HIV/AIDS continues to disproportionately impact underrepresented minority groups, people who are of lower income, and those in resource-constrained areas around the world.
In order to address these remaining challenges, a strong cohort of experts is needed to continue to work toward the ambitious goal set by the United Nations Programme on HIV/AIDS known as 95-95-95: By 2030, the goal is to have 95% of all people living with HIV know their status; 95% of all people diagnosed with HIV infection on antiretroviral therapy; and 95% of those on antiretroviral therapy experiencing viral suppression.
To reach this goal, there is a need to rev up interest in the field once again and recruit and retain the next generation of HIV/AIDS researchers.
UCLA's Department of Medicine is already doing so through a range of mentorship programs, targeted fellowships, and unique physician-scientist opportunities, and the impacts are being felt.
When asked about his proudest moment during his tenure in the field of HIV/AIDS, Dr. Clark had the same response as Dr. Currier, one of his mentors: "It's seeing the people I once worked with as first-year medical students now serving as assistant professors and building terrific careers in their own rights as researchers. Starting out, they would look to me for answers for everything, and now I go to them with questions. That's certainly my greatest success."
The goal is for this cycle of mentoring to continue. Doing so ensures physicians such as Dr. Clark can pass the torch along in the fight against HIV, just as it was passed to him.
Jenna Sherman is the author of this article.