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People with HIV as a percentage of population in 2005. The South Bronx, Central Brooklyn, Harlem, and lower Manhattan have the highest proportions of people living with HIV in the city.
Source: NYC Department of Health & Mental Hygiene, 2007
With 64 percent of the world’s HIV-positive people, sub-Saharan Africa is the location most often thought of as the epicenter of the HIV/AIDS epidemic, so much so that the epidemic in the United States is often forgotten.
   “There is a widespread misperception that HIV is under control here, but the HIV incidence in some New York City populations is higher than in many African countries,” says Wafaa El-Sadr, M.D., professor of clinical medicine and epidemiology and chief of infectious diseases at Harlem Hospital.
   Two new grants recently awarded to Dr. El-Sadr and Scott Hammer, M.D., the Harold C. Neu Professor of Infectious Diseases, will allow Columbia to continue to focus needed attention on the HIV/AIDS epidemic in New York City.
   With support from a $20 million, seven-year grant from the NIH, the Columbia Collaborative HIV/AIDS Clinical Trials Unit, led by Dr. Hammer, provides New Yorkers with access to the latest drugs and vaccine candidates in clinical trials. A highlight of this grant is the close collaboration of adult and pediatric clinical HIV research at CUMC with Philip LaRussa, M.D. professor of clinical pediatrics, as the principal investigator of the latter.
   An additional $3 million, seven-year grant will help the Center for Innovative Research to Control AIDS, directed by Dr. El-Sadr, test ways other than vaccines to prevent HIV transmission.
   Both grants were awarded in March as part of a reorganization of the HIV/AIDS clinical trials networks of the National Institute of Allergy and Infectious Disease (NIAID). Columbia has been a part of the networks since 1987, when the networks were established to carry out the next generation of HIV/AIDS vaccine, prevention, and treatment research.
   Drs. Hammer and El-Sadr have been fighting AIDS since the epidemic began in the early 1980s, when patients filled hospitals with a mysterious disease that had no known cause, no treatment, and no hope for survival.
   Though the outlook for people with HIV in the United States has dramatically improved since then, New York City is still the epicenter of the HIV/AIDS epidemic in this country. More than 100,000 New Yorkers are living with HIV and the city has more AIDS cases than San Francisco, Los Angeles, Miami and Washington D.C., combined.
   Progress in further reducing the spread of the virus has also stalled, and in some groups infections are on the rise. Among young gay men of color in New York City and several other urban areas in the United States, the virus is spreading at a rate twice that in Uganda.
The trends in New York City reflect what is happening across the country: More and more women are getting HIV, and blacks and Latinos are disproportionately affected.

Inner Cities See HIV Rise
“Cities in the United States with disenfranchised populations face similar problems,” Dr. Hammer says. “Our inner cities present us in some respects with our own ‘developing world’ challenges.”
   The Columbia Collaborative HIV/AIDS Clinical Trials Unit gives people with HIV in northern Manhattan all-important access to clinical trials. The unit conducts clinical trials for drugs to treat AIDS itself, as well as the co-infections that are common among people with HIV, and the debilitating side effects of current AIDS treatments.
   Clinical trials give patients access to new drugs and new strategies to make treatments more effective, more durable and more tolerable,” Dr. Hammer says. “The advances we’ve seen to date would not have been possible without a commitment on everyone’s part to a strong clinical research effort.”
   With medical care integrated into the research clinics, trial participants receive the best HIV treatment available.
   “We don’t just recruit people for studies. We reach out to the community to get important feedback, to learn what kinds of studies they want to see, and to provide useful information to help people protect themselves and maintain their health,” Dr. Hammer says. “We enter into partnerships with HIV-infected patients and strive to provide them with decades of survival. Our goal is a full, productive life for people with HIV infection; the disease can now be considered chronic and manageable over the long-term.”
   Despite the effectiveness of today’s antiretroviral drugs, vaccines remain the best chance of ultimately beating HIV. The Columbia Collaborative HIV/AIDS Clinical Trials Unit – the only NIH-funded HIV Vaccine Trials Network site in the city (in collaboration with the New York Blood Center and principal investigator, Dr. Beryl Koblin) – is currently testing vaccines in Phase I and II trials, including early efficacy trials. The current generation of vaccine candidates may not prevent HIV infection, but may alter its course once an individual becomes infected.
   “We hope these vaccines can slow the progress of the disease in someone who becomes infected,” Dr. Hammer says. “By reducing the amount of virus in the body, the vaccines may also help reduce further transmission in the population.”
   Since a vaccine that completely prevents infection may be a decade or more away, the Center for Innovative Research to Control AIDS will continue Dr. El-Sadr’s efforts to identify other means of prevention, including vaginal microbicides that would give women more control over prevention. Other efforts include behavioral interventions and the use of antiretroviral drugs as a means to prevent acquisition of HIV.
   “Even with a vaccine available, other prevention strategies should still be useful,” Dr. El-Sadr says. “One intervention will not bring the transmission rate down to zero, so there is room for a menu of effective preventions, with some targeted to specific populations.”

Goal: Learn Status/Receive Care
One big impediment to prevention strategies that is often forgotten, Dr. El-Sadr says, is the large numbers of people – about one in four in New York City – unaware that they are infected with HIV. Because most HIV infections are transmitted by people who do not know they have the virus, simply increasing the number of people who know their status may significantly reduce the spread. Such knowledge coupled with behavioral interventions can go a long way to stemming the spread of HIV.
   “Studies show that people who know their status adopt appropriate behaviors to reduce the spread of the virus,” Dr. El-Sadr says. “People who find out they’re negative are motivated to adopt behaviors to stay that way. And people who are positive adopt behaviors to prevent spread to others.”
   The advent of rapid HIV tests that can produce results in 10 minutes has led Dr. El-Sadr to introduce testing in non-traditional settings, including emergency departments, in outpatient and inpatient services at Harlem Hospital Center, and at community street fairs.
   “When we find people who are positive, counselors take them by the hand to the clinic and we assure them we will take care of them,” Dr. El-Sadr says. “We’re always surprised by the number of individuals we find who never suspected that they had HIV.”

—Susan Conova

Columbia HIV/AIDS Clinical Research Sites

The research led by Drs. Hammer and El-Sadr is not possible without collaboration with other researchers who bring a wealth of expertise and have gained the trust of their communities. Clinical research sites and their leaders are listed below.

HIV Prevention and Treatment Research, CUMC, PI: Scott Hammer, M.D. (treatment, vaccine trials)

Harlem Family Center, Harlem Hospital, PI: Wafaa El-Sadr, M.D. (treatment and prevention trials)

New York Blood Center, Bronx, PI: Beryl Koblin, Ph.D. (vaccine and prevention trials)

New York Blood Center, Union Square; PI: Beryl Koblin, Ph.D. (vaccine and prevention trials)

IMPAACT at CUMC; PI: Philip LaRussa, M.D., professor of clinical pediatrics (maternal, pediatric and adolescent treatment and prevention trials)

University of Medicine & Dentistry of New Jersey, PI: Sally Hodder, M.D. (prevention trials)

Bronx-Lebanon Hospital Center, PI: Jessica Justman, M.D., assistant professor of clinical medicine (in Epidemiology) (microbicide trials)