Dr. David Ho welcomed a group of community leaders, activists, physicians and public health professionals to ADARC for a discussion based on ENDGAME: AIDS in Black America, Renata Simone's latest film which premiered on Frontline last July. The panel also included: Vicki Sharp, MD, founder of the Center for Comprehensive Care; Monica Sweeney, MD, MPH, Assistant Commissioner of the Bureau of HIV/ AIDS Prevention and Control at the NYC DOHMH, and Nel Davis, a retired California nurse who was featured in the film.  

Renata Simone has been ADARC's friend and collaborator for almost 20 years, since Irene Diamond engaged her to direct a documentary on the HIV/AIDS epidemic. Most recently, she directed a short film commemorating ADARC's 20 years. She has devoted most of her career to telling the story of the epidemic on film, giving voices to its victims and warriors.

 Although AIDS was initially described as a white gay male disease, it has always affected black men, women and children. Today, close to half of all Americans infected with HIV are black. In ENDGAME, Ms. Simone tells the story of how, from the earliest days, prejudice, silence and stigma allowed the virus to spread deep into the black community.

In New York City, blacks account for almost half of the 111,000 people diagnosed with HIV, said Dr. Monica Sweeney. In her opinion, the epidemic needs to be addressed by a three-legged stool made up of government, community, and individuals. She reiterated that individual responsibility cannot be left out of the equation, and that people need to understand that if they engage in risk behavior, they can get infected with HIV.

Dr. Sharp discussed her work with a population that includes many formerly incarcerated people. Among her patients, blacks are poorer than non-blacks. They are less likely to achieve viral suppression, less likely to be referred to mental health services, and less likely to remain in treatment. She and Dr. Sweeney both remarked that several other illnesses that can cause premature death are also more prevalent in the black community, such as diabetes, hypertension, stroke, and renal disease. In Dr. Sharp's opinion, the high rate of incarceration among blacks plays an important role in the spread of HIV/AIDS, which is something also reflected in Ms. Simone's film.

ENDGAME makes it clear that the epidemic has reached every corner of the black community, including celebrities such as Magic Johnson, teenagers who have lived with HIV since birth, drug users, prisoners, educated gay men, and even church-going retirees. Nel Davis, a retired nurse, married a deacon of her church and later found his HIV diagnosis inside a Bible. Ms. Davis, who was infected by her new husband, knew very little about the disease and thought life was over when she was diagnosed. Now, she works educating people about the epidemic, and supporting newly diagnosed patients. She hopes that the disclosure of her status in Ms. Simone's film will help fight the stigma and shame associated with the virus.

You can watch ENDGAME in its entirety and read additional interviews on Frontline's website. If you would like a copy of Renata Simone's documentary that marked ADARC's 20^th anniversary, please contact Melissa Haber.  

Photo credit: Janice Carr - Centers for Disease Control

C. Difficile infection can cause severe and even life threatening symptoms, particularly among elderly patients and those who are immunosuppressed. C. difficile disease is the most common cause of bacterial diarrhea in immunocompromised  HIV-positive patients in a hospital setting.

There are more than 300,000 cases of C. difficile-associated diarrhea reported each year in the United States alone. No vaccine is currently available and measures to prevent infection through patient isolation and hand-hygiene and contact precautions have had limited success.

C. difficile causes symptoms by producing two potenttoxins (toxin A and toxin B).  Studies have shown that immunity against toxin A can be protective. Dr. Ho's group, led by Postdoctoral Fellow Chandrabali Ghose-Paul, will attempt to develop a vaccine that combines the non-toxic receptor binding domain of toxin A and toxin B with C. difficile flagellar proteins. These proteins make up the bacterial flagellum, and can trigger an immune response when recognized by Toll-like receptors, proteins that play a key role in the innate immune system.

"We believe that the incorporation of flagellin in our toxin A/B vaccine will serve as an adjuvant, boosting its effect, and resulting in a powerful and effective vaccine against C. Difficile," said Dr. Ghose-Paul.