PANCAP Collaborates with Callen-Lorde to strengthen PrEP Services in the Region

Under the Multi-country Global Fund (GF) Grant Project for the Caribbean, three (3) additional countries, Antigua and Barbuda, Belize and Guyana, have advanced with the implementation of Pre-exposure Prophylaxis (PrEP).  Technical support for the advancement of these countries to implement this high impact prevention service was provided by the Pan American Health Organisation (PAHO) and PANCAP.  Barbados, a recipient under the grant, has provided support to the three (3) countries by transferring knowledge and experience over the years.  Approximately seven (7) countries in the Caribbean are currently implementing PrEP as opposed to two (Barbados and Bahamas) in 2019, all at different levels of implementation.

Under the current Global Fund project, with the technical guidance and support of PAHO, a comprehensive PrEP guidance package was developed to support countries in initiating PrEP services.  The purpose of the package is to facilitate the standardization of the services, data collection, and monitoring across the Region.  In addition, the package includes generic clinical guidelines (based on recommendations from World Health Organisation – WHO guidelines) for PrEP and nPeP for key populations, clinical intake forms, social media products, brochures, PrEP registration, monitoring and training tools.

To further strengthen PrEP implementation in the Region and with the technical support of PAHO, PANCAP is collaborating with Callen-Lorde, a Global leader in Key Population health care in the United States.  The partnership will support in-country capacity building to generate demand for PrEP and skills critical to providing quality PrEP services to key populations.

Due to the pandemic, onsite, in-person capacity building in New York was not possible.  However, the collaboration will move forward with country visits by experts from Callen -Lorde to strengthen the national services based on the specific needs and concerns of the Member States mentioned above.

In May, a virtual planning session was held with the team from Callen-Lorde, PAHO, PANCAP and national teams from the individual countries to determine the level of implementation and technical expertise critical to strengthening PrEP services.

Mr Collin Kirton, Officer-in-Charge, PANCAP, lauded the collaboration, “This initiative with Callen-Lorde is building on ongoing work which commenced with the support of PAHO in 2018.  Callen-Lorde brings many years of programme implementation and clinical experience to this initiative and our Region.  I am pleased that Callen-Lorde will support your technical assistance needs and urge you to clearly define these so that the technical assistance is intentional, targeted and will be most useful in advancing PrEP programmes in our Region”.

Caribbean Regional Network of People Living with HIV and AIDS (CRN+) undergoes organisational restructuring

The Caribbean Regional Network of People Living with HIV/AIDS (CRN+) facilitated a virtual election for new directors to serve on its board.  The election was held on 28 January 2022.

Mr William Moultrie III was elected the new Chair, Mr Ricky Pascoe, Vice-Chair; Ms Renatta Langlais, Secretary, Ms Christel Charles, Treasurer, Mr Marten Colom, Assistant Secretary, Mr Kenny White, Assistant Treasurer and Ms Diana Weekes, Board Member.

With the installation of a new Board of Directors, CRN+ plans to focus on advocacy for People Living with HIV (PLHIV) across the Region.  The mandate of the new board includes increasing representation for PLHIV and further establishing CRN+ as “the authentic voice” for and on behalf of PLHIV.

Mr Moultrie III expressed his satisfaction with the new board, stating, “now is the time to change how we operate.  We need to act more, and we need to be inclusive; we need to unite PLHIV.  These are the critical keys for our success.”

More Territories ready to Invest in Social Contracting

Several Caribbean countries have graduated to middle-income status over the past ten (10) years, and more are transitioning out of eligibility for external funding from traditional donors. This has increased the burden on countries to fund and manage their priority health programmes without external support. Further, the economic impact of COVID-19 has put increased burden on countries where the expertise of HIV programmes has been leveraged but without budgetary increases.

Civil Society Organisations (CSOs) and Community-Based Organisations (CBOs) have been critical players in their national HIV responses, providing expertise for efficient service delivery and deeper penetration into general, key and vulnerable populations. External donors have traditionally supported these non-government entities; hence CSOs will be significantly impacted by the decrease in funding. This risk of losing the gains made over the past decades would further isolate the key and vulnerable communities.

Social contracting has been proposed for several years as a viable option to sustain the critical work by CSOs and CBOs in their country’s HIV response.

In early 2021 the CARICOM Secretariat, via PANCAP, advanced this mechanism by developing a tool kit to guide countries on the process should they consider social contracting a viable option. Later in 2021, PANCAP examined seven (7) countries to determine if they already had a funding mechanism to support non-government players or were interested in establishing or strengthening social contracting as a financing option. The latter would be a mechanism by which governments would finance programmes, interventions and other activities implemented by CSOs to respond to HIV and AIDS through a public tender.

Barbados, Guyana and Jamaica have already commenced implementation or have decided to pilot social contracting. However, other countries were identified as being near ready to advance should 1) the appropriate advocacy be provided and 2) domestic funding be identified. Antigua and Barbuda was one such country.

The AIDS Secretariat, Antigua and Barbuda, convened a workshop in March with critical CSOs to increase their understanding of social contracting and its benefits. This was followed by individual in-person organisation meetings to explore their capacity and interest in receiving public resources. Sessions were then held with senior government gatekeepers, including the Ministry of Health Wellness and Environment and the Ministry of Finance, to identify procurement processes, a potential package of services, and gaps in targets.

Weeks of hard work culminated on 31 March 2022, when discussions were held between CARICOM-PANCAP and the Ministry of Health, Wellness and the Environment in Antigua and Barbuda on social contracting. Honourable Molwyn Morgorson Joseph, Minister of Health, Wellness and the Environment, indicated his strong support for the tremendous work of the National AIDS Secretariat and the work of CSOs in reaching key populations. He also expressed his confidence in social contracting being a valuable tool to support Antigua and Barbuda’s national response.

Minister Joseph intends to meet with CSO partners to recognise their work and has reached out to CARICOM for additional support in developing the critical programme documents and government submissions to start a pilot in the next fiscal year, 2023-2024. Antigua and Barbuda would be the first country in the Organisation of Eastern Caribbean States (OECS) to implement social contracting.

Image: Office of the Minister of Health, Wellness and the Environment, Antigua and Barbuda (left to right): Ms Ena Henry, Permanent Secretary, Ms Sandra McLeish PANCAP Consultant; Honourable Molwyn Morgorson Joseph, Minister of Health, Wellness and the Environment; Dr Rhonda Sealy-Thomas, Chief Medical Officer and Ms Delcora Williams, AIDS Programme Manager.

National AIDS Commission (NAC) Belize Launches HIV Self-testing Pilot Project

On Tuesday 8 March 2022, the National AIDS Commission (NAC) Belize launched its HIV Self-testing (HIVST) Pilot Project to increase HIV testing and prevention, particularly focusing on reaching men. The HIVST Pilot Project is supported by the Caribbean Med Labs Foundation (CMLF) under the PANCAP-CVC-COIN Multi-Country Regional Grant of which Belize is a beneficiary.

As part of the pilot project, CMLF provided the NAC with fifty (50) OraQuick HIVST kits.

“The OraQuick HIVST kits that we’re piloting have been pre-approved by the World Health Organization (WHO) and is 99% reliable, convenient, and private”, stated Mr Enrique Romero, Executive Director, NAC, Belize.

The Belize Pilot Project is facility-based and implemented by Civil Society Organizations – Belize Family Life Association (BFLA) and Belize’s Civil Society Organization Hub (CSO-Hub) through Go Joven Belize. The pilot project will allow for the documentation of testing experiences as well as validation of results to determine test kit reliability as well as inform decision-making for subsequent implementation.

An estimated 5,500 persons living in Belize are HIV positive. In 2020, 193 persons were newly infected with HIV: 89 females and 104 males, the majority being young adults ages 20-39. There were also 94 AIDS-related deaths.

“Majority of persons becoming infected with HIV are young adults, particularly members of vulnerable populations, sex workers, men who have sex with men (MSM) and transgender persons; this is the population we are targeting under this Pilot,” stated Mr Romero.

The HIVST Pilot Project in Belize comes at a most crucial time. Since the start of the pandemic, testing across the country has slowed, and progress made in HIV prevention could be lost.  Incidents of stigma and discrimination have also increased.

Viewing HIVST as a pathway of empowerment, the NAC is reenergized and remains optimistic about the future of HIV prevention, diagnosis, and treatment in Belize.

Persons interested in participating in the ongoing pilot can visit BFLA or the CSO-Hub for testing.

To support National AIDS Programmes and Civil Society Organisations in the implementation of HIVST, PANCAP has developed and distributed a series of instructional videos including a step-by-step demonstration on how to use an HIVST kit.  The videos are available for download on the PANCAP website and YouTube Channel.

World TB Day Press Conference, Monday, 21 March, at 15:30 CET

World Tuberculosis (TB) Day is observed on 24 March each year to raise awareness and understanding about one of the world’s top infectious killers and catalyze action to address its devastating health, social, and economic impact around the world. The theme of World TB Day 2022 – ‘Invest to End TB. Save Lives.’ – conveys the urgent need to invest resources to ramp up the fight against TB and achieve the commitments to end TB made by global leaders. This is especially critical in the context of the COVID-19 pandemic and the ongoing conflict in Eastern Europe, the African Region and the Middle East that has put progress at risk.

At the press briefing, WHO will release new guidelines on addressing TB in children and adolescents.  Over 1.1 million children and adolescents under 15 years fell ill with TB globally in 2020, and 226 000 children and adolescents lost their lives from this preventable and curable disease. COVID-19 has had an additional negative and disproportionate impact on children and adolescents with TB or at risk, with increased TB transmission in the household, less care-seeking and access to health services. In 2020, an estimated 63% of children and young adolescents below 15 years with TB were not reached with or not officially reported to have accessed life-saving TB diagnosis and treatment services; the proportion was even higher – 72% – for children under 5 years. Almost two-thirds of eligible children under 5 did not receive TB preventive treatment and therefore remain at risk of getting sick.

TB is the second top infectious killer after COVID-19 in the world claiming over 4100 lives each day.

More information and communications material can be found at this link:

https://www.who.int/campaigns/world-tb-day/2022

Speakers:

  • Dr Tereza  KASAEVA – Director, Global Tuberculosis Programme, World Health Organization
  • Dr Kerri VINEY –  Team Lead, Vulnerable Populations, Communities and Co-morbidities Unit, Global TB Programme, WHO
  • Ciara GOSLETT, Adolescent drug-resistant TB survivor, South Africa

Date/time: Monday, 21 March 2022, 15:30hrs CET/Geneva

Zoom link:
https://who-e.zoom.us/j/96325516384
Passcode: vpcTBvpc22

Phone access:

International numbers available: https://who-e.zoom.us/u/adGUxXUf24

Webinar ID: 963 2551 6384

Numeric Passcode for phone access: 9325008211

Media Contact:

Christian Lindmeier
Communications Officer
Tel:      +41 22 791 1948
Mob:   +41 79 5006552
lindmeierch@who.int

PANCAP-PAHO to host webinar on Public Health Interventions for reducing HIV deaths

The Pan-Caribbean Partnership against HIV and AIDS (PANCAP), in collaboration with the Pan American Health Organisation (PAHO), will host a webinar on public health interventions for reducing HIV deaths through expanded HIV testing, rapid staging of HIV individuals, rapid screening of opportunistic infections (Tuberculosis, Cryptococcosis and Histoplasmosis), and rapid treatment initiation.

The virtual event will be facilitated by Dr Omar Sued, Advisor, HIV/STI Care and Treatment, PAHO and hosted by Dr Shanti Singh-Anthony, Coordinator, Knowledge Management, PANCAP.

The webinar will be held on Thursday 17 March 2022, during the following times:

Belmopan, Belize                               09:00 AM CST

Eastern Time, ET                               10:00 AM EST

Georgetown, Guyana                         11:00 AM GYT

Kingston, Jamaica                              10:00 AM EST

Port-au-Prince, Haiti                           11:00 AM EST

Port-of-Spain, Trinidad and Tobago    11:00 AM AST

Suriname Time, SRT                           12:00 PM SRT

All regional stakeholders involved in the HIV response are invited to register and participate using the following link: https://register.gotowebinar.com/register/6301012388664543503

For more information, please contact:

Timothy Austin

Senior Project Officer, Communications

PANCAP Coordinating Unit

CARICOM Secretariat

Turkeyen, Greater Georgetown, Guyana

Email:      taustin.consultant@caricom.org

Tel: (592) 222-0001-75, Ext. 3409  | Visit www.PANCAP.org

WHAT IS PANCAP?

PANCAP is a Caribbean regional partnership of governments, regional civil society organisations, regional institutions and organisations, bilateral and multilateral agencies and contributing donor partners, which was established on 14 February 2001.  PANCAP provides a structured and unified approach to the Caribbean’s response to the HIV epidemic, coordinates the response through the Caribbean Regional Strategic Framework on HIV and AIDS to maximise efficient use of resources and increase impact, mobilises resources and build capacity of partners.

Guyana’s transgender community calls for protection under anti-discrimination laws

Marcia John (not her real name), a Guyanese transgender woman, readied to leave a transgender support group meeting. She slipped off her black wig, replacing it with a bandana and hat. Her employer only allows her to perform her duties if she presents as a man.

“I have no choice,” she said. “I have to work.”

In 2018, the Caribbean Court of Justice ruled that an 1893 Guyana law that prohibited cross-dressing was unconstitutional. Last August, lawmakers formally removed that section from the law books. But for Ms John and other transgender women, this has not been enough to transform how they navigate social spaces. Intolerant attitudes remain, with sometimes dire implications for transgender people’s welfare and livelihoods.

Led by the University of the West Indies Rights Advocacy Project, the cross-dressing law challenge started with a constitutional action filed in the Guyana High Court in 2010. Eight years and two appeals later, the litigants earned a historic win.

“At the heart of the right to equality and non-discrimination lies a recognition that a fundamental goal of any constitutional democracy is to develop a society in which all citizens are respected and regarded as equal,” the Caribbean’s final appellate court ruled in 2018.

Reflecting on the impact of the landmark law reform effort, Alessandra Hereman, Guyana Trans United (GTU) Project Coordinator, said that the main benefit has been more visibility.

“The community’s increased media presence in the lead-up to the case brought transgender issues into the public space. People realised that transgender Guyanese exist and are part of our society. Some thought we should be treated equally, and others held on to their religious beliefs. But transgender issues were brought to the fore and were part of public discourse,” she said from GTU’s Georgetown office.

Formed in 2012, GTU has worked over the past decade to facilitate the dialogue and sensitisation needed alongside key law and policy reforms to create a safe and empowering social context for transgender people. They contribute to the ongoing effort to shift the attitudes and perceptions of healthcare providers around sexual orientation and gender identity. This work strengthens the community’s access to health services, including HIV prevention, testing and treatment. With support from UNAIDS, GTU also trained journalists on covering transgender people and issues ethically and accurately.

“Law reform is essential, but it is not a stand-alone,” said James Guwani, the Director of the UNAIDS Caribbean Sub-Regional Office. “Alongside strategies like judicial review and political advocacy, there must be ongoing community dialogue and targeted efforts to increase social inclusion.”

At present, GTU has two high law and policy reform priorities. First, Guyana’s Prevention of Discrimination Act of 1997 makes no mention of sexual orientation or gender identity.

“Employers use the lack of this protected status to discriminate against lesbian, gay, bisexual and transgender (LGBT) persons. Amending that legislation would mean that if you violate the rights of an LGBT person, there would be some mechanism for redress. Having that in place will tell people you can’t discriminate because there will be consequences,” Ms Hereman explained.

The CARICOM Secretariat, through the Pan Caribbean Partnership against HIV and AIDS (PANCAP), has developed a model anti-discrimination bill to guide Caribbean countries in creating anti-discrimination laws. PANCAP continues to advocate with regional stakeholders, including policymakers, for countries to adopt the model as it provides for the protection of persons against discrimination, including discrimination involving harassment, victimisation and vilification on the grounds of HIV status, sexual orientation, etc. It is hoped that the model will lead to more access to health care for key populations with the overarching goal of a Caribbean free of AIDS and new HIV infections, in which all people are happier, healthier, productive, safe and respected.

Next on GTU’s list is the revision of the Teachers’ Code of Conduct to be inclusive of the needs of LGBT students.

“They must know that they have a duty to create an enabling environment for all students so that LGBT pupils have an opportunity to learn without bullying,” Ms Hereman said.

Lack of gender recognition legislation and the criminalisation of sex between people of the same sex remain challenges in the Guyana and wider Caribbean contexts. The United Caribbean Trans Network has mounted a campaign around gender identity recognition, while the Society against Sexual Orientation Discrimination (SASOD) is working to remove Sections 351 to 353 of the Criminal Law (Offences) Act, which make sex between men punishable with life imprisonment. However, GTU is first prioritising issues that it says go to the heart of transgender people’s ability to get an education and access employment. Exclusion from these spaces compounds their vulnerability to poverty, violence and disease.

“We occupy the lowest socioeconomic level in society. Guyana is now an oil-producing nation. LGBT people should have opportunities as well,” Ms Hereman insisted.

Preparing the Region for Pre-Exposure Prophylaxis (PrEP)

Friday, 25 February 2022 (PANCAP Coordinating Unit, CARICOM Secretariat): The Pan-Caribbean Partnership against HIV and AIDS (PANCAP), the mechanism that provides a structured and unified approach to the Caribbean’s response to the HIV epidemic, collaborated with regional stakeholders for a three-day capacity building activity for health care providers in Belize on the Clinical Management of Pre-exposure Prophylaxis (PrEP) for serodiscordant couples and Key Populations. 

Pre-exposure Prophylaxis (PrEP) is the use of antiretroviral (ARV) drugs by persons without HIV infection to prevent the acquisition of HIV.  

It is an effective prevention strategy that is recommended to reduce HIV infections, especially in Men who have sex with men (MSM), Sex Workers and the Transgender population.

The training was implemented in collaboration with the Pan American Health Organisation (PAHO), Ministry of Health and Wellness and the National AIDS Commission (NAC), Belize.

Health care providers were emersed in an in-depth discussion on the most recent World Health Organisation (WHO) recommendations on PrEP, Non-occupational HIV Post-Exposure Prophylaxis (nPEP) and new scientific evidence and implementation data emerging from the field. 

Participants were also exposed to WHO guidance on PrEP programming.  In addition, the capacity building activity provided a space for participants to share experiences as Belize prepares for PrEP and nPEP implementation.

Mr Enrique Romero, Executive Director, National AIDS Commission (NAC) Secretariat, Belize, highlighted that PrEP is a key implementation strategy for HIV prevention under Belize’s HIV National Strategic Plan (NSP).  He also stated that Belize would be implementing a PrEP pilot programme in 2022, and the capacity building exercise would be integral to the pilot’s success.  

The Executive Director further emphasised that the involvement of civil society organisations would be at the core of the PrEP implementation, specifically concerning awareness and education for Key Populations. 

Ms Sandra Jones, Technical Advisor HIV/STI, TB & Viral Hepatitis, PAHO/WHO – Subregional Program Coordination, Caribbean, underscored the significance of the training activity as more countries in the Region commence PrEP implementation.  Antigua and Barbuda, Belize and Guyana have joined four other countries that have established PrEP services, including The Bahamas, Barbados, Haiti and Jamaica. 

Ms Jones further highlighted that PAHO and PANCAP collaborated on the development of training materials, guidelines and videos for capacity building within National HIV Programmes to ensure the standardisation of PrEP training materials for the Region. In addition, information, education and communication products were developed for community health promotion, including brochures and social media posters accessible via the PANCAP website. 

The PrEP training activities were supported by the Multi-country Caribbean grant for PANCAP, Caribbean Vulnerable Communities Coalition (CVC) and Centro de Orientación e Investigación Integral (COIN) via the Global Fund to Fight AIDS, Tuberculosis and Malaria.

– ENDS –

Contact: 

Timothy Austin 

Senior Project Officer, Communications 

PANCAP Coordinating Unit 

CARICOM Secretariat 

Turkeyen, Greater Georgetown, Guyana

Email:      taustin.consultant@caricom.org 

Tel: (592) 222-0001-75, Ext. 3409  | Visit www.PANCAP.org 

Helpful links:

What is PrEP?

https://www.paho.org/en/topics/combination-hiv-prevention/pre-exposure-prophylaxis-prep 

WHAT IS PANCAP? 

PANCAP is a Caribbean regional partnership of governments, regional civil society organisations, regional institutions and organisations, bilateral and multilateral agencies and contributing donor partners, which was established on 14 February 2001.  PANCAP provides a structured and unified approach to the Caribbean’s response to the HIV epidemic, coordinates the response through the Caribbean Regional Strategic Framework on HIV and AIDS to maximise efficient use of resources and increase impact, mobilises resources and build capacity of partners. 

Zero Discrimination Day will be held on Tuesday 1 March

Zero Discrimination Day will be observed on Tuesday 1 March under the theme “Remove laws that harm, create laws that empower”.  The Region will be highlighting the urgent need to take action against discriminatory laws.

In many countries, laws result in people being treated differently, excluded from essential services, or subject to undue restrictions on how they live their lives, simply because of who they are, what they do, or who they love.  Such laws are discriminatory—they deny human rights and fundamental freedoms.

Civil Society Organisations and other stakeholders will be advocating for the removal of discriminatory laws and the enactment of laws that protect people from discrimination.

On Zero Discrimination Day, we celebrate the right of everyone to live a full and productive life—and live it with dignity and free from discrimination.

Please find below this year’s theme in French and Spanish.  A campaign brochure and social media materials will be available on PANCAP.org in the coming days.  Bookmark the campaign page here: https://pancap.org/pancap-events/zero-discrimination-day/ 

Spanish – Abolamos leyes discriminatorias, creemos leyes empoderantes
French – Abolissons les lois discriminantes, adoptons des lois protectrices

Scientists have possibly cured HIV in a woman for the first time

An American research team reported that it has possibly cured HIV in a woman for the first time. Building on past successes, as well as failures, in the HIV-cure research field, these scientists used a cutting-edge stem cell transplant method that they expect will expand the pool of people who could receive similar treatment to several dozen annually.

Their patient stepped into a rarified club that includes three men whom scientists have cured, or very likely cured, of HIV. Researchers also know of two women whose own immune systems have, quite extraordinarily, apparently vanquished the virus.

Carl Dieffenbach, director of the Division of AIDS at the National Institute of Allergy and Infectious Diseases, one of multiple divisions of the National Institutes of Health that funds the research network behind the new case study, told NBC News that the accumulation of repeated apparent triumphs in curing HIV “continues to provide hope.”

“It’s important that there continues to be success along this line,” he said.

In the first case of what was ultimately deemed a successful HIV cure, investigators treated the American Timothy Ray Brown for acute myeloid leukemia, or AML. He received a stem cell transplant from a donor who had a rare genetic abnormality that grants the immune cells that HIV targets natural resistance to the virus. The strategy in Brown’s case, which was first made public in 2008, has since apparently cured HIV in two other people. But it has also failed in a string of others.

This therapeutic process is meant to replace an individual’s immune system with another person’s, treating their cancer while also curing their HIV. First, physicians must destroy the original immune system with chemotherapy and sometimes irradiation. The hope is that this also destroys as many immune cells as possible that still quietly harbor HIV despite effective antiretroviral treatment. Then, provided the transplanted HIV-resistant stem cells engraft properly, new viral copies that might emerge from any remaining infected cells will be unable to infect any other immune cells.

It is unethical, experts stress, to attempt an HIV cure through a stem cell transplant — a toxic, sometimes fatal procedure — in anyone who does not have a potentially fatal cancer or other condition that already makes them a candidate for such risky treatment.

Dr. Deborah Persaud, a pediatric infectious disease specialist at the Johns Hopkins University School of Medicine who chairs the NIH-funded scientific committee behind the new case study (the International Maternal Pediatric Adolescent AIDS Clinical Trials Network), said that “while we’re very excited” about the new case of possible HIV cure, the stem cell treatment method is “still not a feasible strategy for all but a handful of the millions of people living with HIV.”

Pushing the envelope in HIV-cure science
Dr. Yvonne J. Bryson, a pediatric infectious disease specialist at UCLA’s David Geffen School of Medicine, described the new case study Tuesday at the virtually held annual Conference on Retroviruses and Opportunistic Infections.

The “New York patient,” as the woman is being called, because she received her treatment at New York-Presbyterian Weill Cornell Medical Center in New York City, was diagnosed with HIV in 2013 and leukemia in 2017.

Bryson and Persaud have partnered with a network of other researchers to conduct lab tests to evaluate the woman. At Weill Cornell, Dr. Jingmei Hsu and Dr. Koen van Besien from the stem cell transplant program paired with infectious disease specialist Dr. Marshall Glesby on patient care.

This team has long sought to mitigate the considerable challenge investigators face in finding a donor whose stem cells could both treat a patient’s cancer and cure their HIV.

Traditionally, such a donor must have a close enough human leukocyte antigen, or HLA, match to maximize the likelihood that the stem cell transplant will engraft well. The donor must also have the rare genetic abnormality conferring HIV resistance.

This genetic abnormality largely occurs in people with northern European ancestry, and even among people native to that area, at a rate of only about 1 percent. So for those lacking substantial similar ancestry, the chance of finding a suitable stem cell donor is particularly low.

In the United States, African Americans comprise about 40 percent and Hispanics about 25 percent of the approximately 1.2 million people with HIV; whites comprise some 28 percent.

Cutting-edge treatment
The procedure used to treat the New York patient, known as a haplo-cord transplant, was developed by the Weill Cornell team to expand cancer treatment options for people with blood malignancies who lack HLA-identical donors. First, the cancer patient receives a transplant of umbilical cord blood, which contains stem cells that amount to a powerful nascent immune system. A day later, they receive a larger graft of adult stem cells. The adult stem cells flourish rapidly, but over time they are entirely replaced by cord blood cells.

Compared with adult stem cells, cord blood is more adaptable, generally requires less of a close HLA match to succeed in treating cancer and causes fewer complications. Cord blood, however, does not typically yield enough cells to be effective as a cancer treatment in adults, so transplants of such blood have traditionally been largely limited to pediatric oncology. In haplo-cord transplants, the additional transplantation of stem cells from an adult donor, which provides a plethora of cells, can help compensate for the paucity of cord blood cells.

“The role of the adult donor cells is to hasten the early engraftment process and render the transplant easier and safer,” van Besien said.

For the New York patient, who has a mixed-race ancestry, the Weill Cornell team and its collaborators found the HIV-resistant genetic abnormality in the umbilical cord blood of an infant donor. They paired a transplant of those cells with stem cells from an adult donor. Both donors were only a partial HLA match to the woman, but the combination of the two transplants allowed for this.

“We estimate that there are approximately 50 patients per year in the U.S. who could benefit from this procedure,” van Besien said of the haplo-cord transplant’s use as an HIV-cure therapy. “The ability to use partially matched umbilical cord blood grafts greatly increases the likelihood of finding suitable donors for such patients.”

Another benefit of relying on cord blood is that banks of this resource are much easier to screen in large numbers for the HIV-resistance abnormality than the bone marrow registries from which oncologists find stem cell donors. Before the New York patient became a candidate for the haplo-cord treatment, Bryson and her collaborators had already screened thousands of cord blood samples in search of the genetic abnormality.

The woman’s transplant engrafted very well. She has been in remission from her leukemia for more than four years. Three years after her transplant, she and her clinicians discontinued her HIV treatment. Fourteen months later, she still has experienced no resurgent virus.

Multiple ultrasensitive tests can detect no sign in the woman’s immune cells of any HIV capable of replicating, nor can the researchers detect any HIV antibodies or immune cells programmed to go after the virus. They also drew immune cells from the woman and in a laboratory experiment attempted to infect them with HIV — to no avail.

“It would’ve been very difficult to find a match plus this rare mutation unless we were able to use cord blood cells,” Dr. Bryson said at Tuesday’s conference. “It does open up this approach for a greater diversity of population.”

Remaining cautious
At this stage, Bryson and her colleagues consider the woman in a state of HIV remission.

“You don’t want to over-call it,” Bryson said of favoring the word “remission” over “cure” at this stage.

Case in point: Johns Hopkins’ Deborah Persaud was the author of a case study she first presented in 2013 of a child in Mississippi who was in a state of what at the time she called a “functional cure.” After apparently contracting HIV from her mother in utero, the baby was treated with an atypically intensified antiretroviral regimen shortly after birth. When Persaud announced the case study, the toddler had been off of HIV treatment for 10 months with no viral rebound. News of this supposed HIV cure swept the globe and ignited a media frenzy. But the child’s virus wound up rebounding 27 months after her treatment interruption.

If enough time passes without any signs of active virus — a few years — the authors of this latest case study would consider the New York patient cured.

“I’m excited that it’s turned out so well for her,” Bryson said. The apparent success of the case, she said, has given researchers “more hope and more options for the future.”

Why is HIV so difficult to cure?
When the highly effective combination antiretroviral treatment for HIV arrived in 1996, Dr. David Ho, who was one of the architects of this therapeutic revolution and is the director of the Aaron Diamond AIDS Research Center in New York City, famously theorized that given enough time, such medications could eventually eradicate the virus from the body.

To date, there are a handful of cases of people who were started on antiretrovirals very soon after contracting HIV, later went off treatment and have remained in viral remission with no rebounding virus for years.

Otherwise, Ho’s prediction has proved false. During the past quarter century, HIV-cure researchers have learned in increasingly exacting detail what a daunting task it is not only to cure HIV, but to develop effective curative therapies that are safe and scalable.

HIV maintains such a permanent presence in the body because shortly after infection, the virus splices its genetic code into long-lived immune cells that will enter a resting state — meaning they stop churning out new viral copies. Antiretrovirals only work on replicating cells, so HIV can remain under the radar of such medications in resting cells for extended periods, sometimes years. Absent any HIV treatment, such cells may restart their engines at any time and repopulate the body with massive amounts of virus.

Timothy Brown’s case, published in 2009, ignited the HIV-cure research field, which has seen soaring financial investment since.

In 2019, researchers announced two new cases of HIV remission following treatments that mirrored what Brown received. These included London resident Adam Castillejo, who had Hodgkin lymphoma, and a man in Düsseldorf, Germany, who had AML.

More than three years have passed since these two men have been off of HIV treatment with no viral rebound. Consequently, the authors of each of their case studies — University of Cambridge’s Ravindra K. Gupta and Dr. Björn Jensen of Düsseldorf University Hospital — each recently told NBC News their respective patient was “almost definitely” cured of the virus.

Since 2020, scientists have also announced the cases of two women whose own immune systems have apparently cured them of HIV. They are among the approximately 1 in 200 people with HIV known as “elite controllers,” whose immune systems can greatly suppress viral replication without medication. In their cases, their bodies went even further and apparently destroyed all functional virus.

A less toxic treatment
Another major upside of the haplo-cord transplant the New York patient received, compared to the treatment of her three male predecessors, is that the use of cord blood — for not entirely understood reasons — greatly reduces the risk of what’s known as graft vs. host disease. This is a potentially devastating inflammatory reaction in which the donor cells go to war with the recipient’s body. The men in the three other HIV-cure cases all experienced this, which in Brown’s case caused prolonged health problems.

Brown died at 54 in September 2020 from recurrent leukemia.

The New York patient was the second person with HIV to receive a haplo-cord transplant in hopes of curing the virus. However, the first person died of his cancer soon after his 2013 treatment.

By contrast, the New York patient, Bryson said, remains “asymptomatic and healthy.”

“She’s enjoying her life,” Bryson said.