A very slight man, standing 5'4" and weighing 135 pounds, by size and mannerism you might think he's a drag queen. But this out-and-proud 26-year-old gay white man has a rare and powerful weapon in the war against AIDS; a healthy immune system.
And today -- May 21st, 1999 -- David is joining 2,500 others in the United States (mostly gay men) who are volunteering their healthy bodies in search of what many agree is the only way to eradicate HIV from this planet; today David gets an injection enlisting him into the AIDSVAX army -- a study of an experimental HIV vaccine currently in Phase III efficacy testing.
Why, you ask, is this so monumental? Gay men have been volunteering for drug studies for many years. The critical difference is that most of those men were volunteering in the hopes of a potential benefit for themselves and others via discovery of new and effective anti-HIV drugs. While all those volunteers have been vital to the advances in HIV-related medicine over the past many years and all their contributions extraordinary, it still begs the question: What possible benefit could a healthy, HIV-negative gay man expect to gain from participating in such a trial?
Skeptics might suspect the motive to be publicity, as has been seen in some other cases. That can't be a motive for David -- otherwise he wouldn't be asking us to call him David Matthews instead of by his real name. Many participants in various types of research studies around the world are motivated to participate due to the money offered -- David is receiving no monetary compensation for his effort. Yet others who have participated in such trials are health care professionals who have a special interest in the areas of immunology or vaccinology -- David works in a gay bar and does hair on the side. So why volunteer for a study in a medical field still in its infancy when you know that doing so will probably preclude you from future, possibly more promising studies? On this morning, an hour before the moment of injection, David is happy to talk about it.
"Not many people my age are HIV-negative anymore in our homosexual community," said David, referring to Indianapolis. David has what he considers to be four very close friends, and all of them are HIV-positive. "I've lost enough friends and I'm going to lose more. Out of my group of friends I'm the only one who's HIV-negative. Hopefully I can stay that way." Ask him what he hopes to get out of it, and David's answer is amazingly selfless. "Well, either the vaccine myself, or one more study done and over with so this thing can end finally. Once and for all."
When David talks about his concerns with the experimental vaccination, his motives for participation seem even more altruistic. "They say you can't get HIV from the vaccine, but the only thing I wonder is, how are they really going to know? Are they going to eventually inject the [subjects] with the live HIV? Hell, is this just one more attempt by the government to shoot up the gay community with HIV, kind of like a gay holocaust?"
The mere idea seems too far-fetched even for Chris Carter to create an episode of the X-Files out of. But, for a variety of reasons, David's comments can be understood. From the historically recorded and unimaginable moral and ethical violations by past government researchers (e.g., the Tuskegee Experiments) to the long history of governmental negligence regarding HIV and AIDS, it is easy to understand the environment of mistrust between the gay community and the medical and political establishments. For years, urban legends about a government infection conspiracy and hidden cures have been rampant. And even with these fears and concerns as David's reality, and even though he remarkably doesn't consider himself an AIDS activist, he's still going for the injection.
At the young age of 26, HIV and AIDS have been around as long as David Matthews has been sexually active. He was given the HIV prevention message throughout his teen years and has been sexually active as long, but as is the case with many young gay men, unsafe and safer-sex practices are an equal part of his sexual reality. "Sometimes it's hard to teach an old dog new tricks," he says as he admits that even though he's always been aware of HIV, he has not and does not always use condoms.
"If it's just a one night stand, I'll use them. When I start dating somebody, I kind of let that go. Stupidly." 1998 brought the reality of that comment close to home. He began dating a man we'll call Fred, who told David he had tested negative for HIV nine months prior to the beginning of their relationship. After their relationship developed, David was on the receptive end of unsafe anal sex with Fred on more than one occasion.
"Three months later, he tested positive and had a T-cell count of 39. He knew all along," speculates David. It's been about six months since David stopped seeing Fred, and so far David has had two negative HIV test results. Today when he goes for his experimental vaccine, not only is there a whole world of science and technology that he may barely understand -- if at all -- being injected into his blood; he also finds out the results of his third HIV test.
Ask him if he will continue to have unprotected anal sex even after this experience and David's answer is brutally honest: "Probably". While most could agree that all these issues could be a lot for a 26-year-old, David said it's better than an appointment at the free clinic. "I just want to get it over with. I'd rather get a vaccine shot than a shot for gonorrhea or the clap or anything like that."
On the way to the hospital David stops for a pack of cigarettes and a cheeseburger at a combination Shell/McDonald's. Between there and the hospital the only conversation he initiates about the purpose of today's trip is "I hate getting shots." At the hospital, David opts for the parking garage instead of the cheaper parking lot, noting "They pay for parking." A remarkably unremarkable day.
The wing of the hospital where the study is housed, called the "Community Medical Research Institute", is not what you expect a hospital to be like. No noise, almost no staff, and no other patients in sight. After signing in five minutes early for his 11 a.m. appointment, David is shown to a hospital room that's been converted into a waiting room. Here the décor is exactly what you'd expect a hospital to be like. The only hint that this area houses an HIV vaccine study so far is the ample supply of POZ magazines lying among the Redbook, Family Circle and Woman's Day. David picks the one with Greg Louganis on the cover and starts looking for pictures.
Jane, the sugary-sweet research nurse, ushers David to the doctor for HIV test results and a physical. David feels a little uncomfortable around the doctor, but the negative HIV test result make it all worthwhile. Next comes a set of questions about his sexual practices. Yes he's a bottom. Yes he's had unprotected receptive anal sex. No he doesn't rim. No he doesn't have a regular sex partner.
Next, it's time to see Jane again for more answers to more questions, this time about numbers of sex partners, their HIV status, and drug and alcohol use. David is honest about his drink and drug habits, but later admits privately that his answer of four different sex partners in the last six months was considerably under-exaggerated. After all, everyone knows these tests allow for some margin of error.
Jane tells David they're looking to enroll about 100 people at this test site, and he is just about their half-way point in recruiting volunteers. So far there are only three women, and Jane expects there won't be any more women enrolled; the rest of the test participants will be men who have sex with men. The worst side-effect Jane's been told of by study participants is pain at the injection site and possibly some mild flu-like symptoms for a day, two at the most. Four vials of blood are drawn for base-line testing. Aside from scheduling the next follow-up appointment, there's only one thing left to do.
There's no drumroll, no fanfare. Jane doesn't seem nervous, and David seems even less so. "Surely I'm not the most nervous person in the room," I think to myself. "Are their hearts beating as fast as mine?" Before I can finish that thought, it's over. David doesn't break a sweat. Jane doesn't even blink. But, I realize at that moment, the three of us shared a critical piece of HIV history when Jane injected David with either a placebo or 300 micrograms of the experimental AIDSVAX. I also realize at that moment that David was instantly transformed from a gay bartender and hairdresser into a gay hero and AIDS activist. And he doesn't even know it.
Afterwards David doesn't seem too upset that he underestimated his number of sexual partners with Nurse Jane. He shrugs. "They know I'm (promiscuous). That's why I'm there. I don't want to sit there and look (worse)." While it's hard to understand why David would go through all this trouble to volunteer for the study and then lie about his number of sexual partners, it doesn't appear any worse than the lack of information David has been given about the study.
He doesn't really talk about the vaccine itself. His mind still appears to be stuck on the particulars of the interactions with the doctor. "The doctor was kind of strange." He never mentions of possible dangers or downfalls of the vaccine.
David knows little if anything about HIV protein envelopes, genes or DNA. He doesn't really know the scientific background to the vaccine he's just accepted. He doesn't know some leading HIV vaccine researchers feel the experimental AIDSVAX has virtually no chance of protecting him from HIV. And the best part is he doesn't care, which proves the altruism behind his motivation. Still grasping to comprehend his thoughts and feelings about this experience, I ask him if he considers himself a soldier in the war against AIDS. "I wouldn't say a soldier. Maybe a girl scout."
David Matthews has agreed to allow us to follow him through the AIDSVAX Phase III efficacy trial. Look for further updates on David's progress in future issues of Positively Aware.