Bridging The Ivory Tower: Spotlighting Significant HIV Research

Towers are typically massive structures carefully constructed to be impossible to scale. Likewise, ivory is rare and opulent, purposely proffered to a select few.

First coined by French literary critic Sainte-Beuve, the term Ivory Tower functions as a metaphor and tool of imagery. A symbol. A simultaneous beacon of inspiration and a cautionary tale. Whether one looks to Merriam-Webster or Britannica, The Ivory Tower refers to individuals, often intellectuals, who operate in a secluded space (The Tower) and lack the desire or ability to translate lofty thoughts to actions. The thoughts are too fancy (the ivory). Typically used negatively, the term critiques those out of touch with the reality of the issues they pontificate about. A architect colleague once explained the gap between research and practice; it is like him drawing a breathtaking bridge that he knows will and can never be built- all you can do is admire the rendering. Some research feels like a fantastic symphony performing in a soundproof room. No matter how brilliant, the audience who yearns for it most may never hear. Or have access to the music. 

This silence was evident at the end of 2024. As an academic, I was aware of numerous groundbreaking studies and scientific advancements related to HIV. Yet, even those actively involved in HIV advocacy outside academia were largely unaware of this research. This urgency drives me to bridge the gap between research and practice, to ensure that the brilliance of research is not confined to the Ivory Tower. 

End Of 2024 Breakthroughs for HIV Research

Recognizing and appreciating significant advancements in the dynamic realm of research, treatment, and disease is crucial. On December 1st, the Journal of the American Medical Association published new antiretroviral clinical guidelines. The guidelines show that for the first time, long-term injectables are officially recommended as a substitute for those who may struggle with daily pills. The study makes little mention of feasibility or affordability, focusing on prescriptions instead of the policies that make securing the medication likely. 

Then, on December 3rd, the CDC unveiled its revised Recommendations for HIV Screening in Clinical Settings. The recommendations were open for public comment until January 2nd. The CDC's updated draft recommendations propose at least one lifetime HIV test for everyone aged 15 and older, removing the previous upper age limit. 

In addition to clinical updates, the end of 2024 witnessed a series of breakthroughs that demand attention. October and December saw the emergence of a blend of biomedical advancements and social critiques. Notably, a study published in November presented a detailed racialized statistical analysis of HIV policy.

“As an academic, I was aware of numerous groundbreaking studies and scientific advancements related to HIV. Yet, even those actively involved in HIV advocacy outside academia were largely unaware of this research. ”

October, 2024: Global Insights & Gene Editing

While rare, it has been known that some living with HIV may never show symptoms, regardless of viral load. Published in October 2024, researchers in Spain recently discovered why. Spotlighted by Nature as one of the top ten studies of the year, the research team found that individuals resistant to HIV replication produced lower levels of a specific protein- CCR5. Typically, most strains of HIV enter cells by latching onto CCR5, but some people have a genetic mutation that virtually eliminates CCR5 in the body, making replication of HIV impossible. In theory, academics argue this discovery is a game-changer as gene-editing tools like CRISPR may someday be able to eliminate the protein. A study published in May 2024 has already shown it’s possible on a small scale. Researchers in Thailand discovered that using CRISPR alongside ARTs was significantly more effective than using pills alone. 

Even from my Ivory Tower, I can see that CRISPR is far from feasible. Again, in October 2024, Spanish researchers published a study revealing the astronomical price of CRISPR-based cell therapy- $2.2 million per patient. Inequitable would be an understatement. I cannot envision an instrument loud enough nor bridge long enough to overcome this outrageous number. In fact, the researchers call the technological development an ethical dilemma for public health. I fear that even if research related to CRISPR takes off, Black gay men will be left in the shadows. This is especially true considering CRISPR already has a built-in bias, documenting Black genes as “inferior.”

December, 2024: Lenacapavir

Lenacapavir, a twice-yearly injection, offers a new means of protecting against HIV. 

The impact of the drug was celebrated toward the end of the year. Awarded Science’s Breakthrough of The Year in December, a study found Lenacapavir to be 100% effective in protecting against HIV. Of the 5,000 adolescent girls and women in South Africa and Uganda who received an injection, not a single one acquired HIV. These results are astounding, setting a nearly unmatched standard for preventative power. When we discuss the efficacy and impact of most treatments, we focus on how well a prescription can treat, not prevent, a health condition.  Building off this study in November 2024, a second trial featured over 2,000 participants and included cisgender men, transgender individuals, and nonbinary people from four continents—Lenacapavir still maintained an efficacy rate of 99.99%. 

The potential impact of Lenacapavir on Black queer men cannot be overstated. As highlighted by NPR, adherence to a quarterly PrEP schedule is challenging for many, structurally impossible for some, and others may face barriers to consistent access. In contrast, lenacapavir’s twice-a-year injections allow for a more manageable form of protection, especially if transportation, proximity, or location are the barriers. However, like CRISPR, the efficacy of this treatment cannot ring louder than the echoes of capitalism. 

The estimated cost of Lenacapavir is, an estimated, $42,000 per year. A figure that NBC News calls “wildly expensive.”  This is worrisome and disheartening, considering 56% of Black queer adults live below the federal poverty level. 

An Under-Discussed Study You Should Know About: Stopping 32,000 New Cases of HIV

Most of the research discussed above surrounds STEM and/or biomedical advancements. These are incredibly important and necessary, especially considering that HIV is an infectious disease. However, these approaches can also be utilized to find flaws in HIV policy. For instance, published in the December 2024 edition of AIDS Patient Care and STDS, a team of researchers developed statistical analysis to project what would happen if Tennessee and other states in the South rejected clear federal guidance related to disproportionate populations and HIV. Some states continue to shift resources away from disproportionately affected (DA) groups, particularly men who have sex with men and transgender individuals. According to the researchers, if this pattern continues, at least 32,000 new cases of HIV will emerge in the South by 2030. On the other hand, prioritizing disproportionately impacted groups would cut cases by an estimated 45-47%. This research has the potential to influence policy-making significantly, ensuring that resources are allocated where they are most needed and, ultimately, saving lives. 

Data is crucial, and as an academic, I firmly believe in the power of research. However, I also acknowledge that research is gatekept and inaccessible. Therefore, I always recommend checking Open-Access databases or Google Scholar. More importantly, Google Alerts allows one to receive personalized updates on articles and research. For example, I receive a weekly email with all stories featuring “HIV criminalization.” 

Speaking to researchers, I believe that if we don’t break down the tower's walls and invite others in, all stakeholders lose. For HIV work, the general public may not benefit from research-backed or well-informed policies, processes, or practices. Consider the scenario where nearly 30,000 more people could acquire HIV due to a shift in resources. If states remain unchanged, what is the role of research? While I may not have the answer, I am confident that the solution does not lie solely within the Ivory Tower.