A Cure for AIDS by 2010 ... "at the Latest" Martin Delaney–the man who may be in the best position to bring about that hopeful scenario–is coming to Houston by Paul Simmons

For most Americans, the red, angry scowl of playwright Larry Kramer is the public face of AIDS activism. Even though Kramer long ago retired from the work, his hostile, controversial style left an indelible impression.

But for Americans living with HIV/AIDS, another figure is better known and arguably more important: former Jesuit seminarian Martin Delaney. If Kramer is the Darth Vader of AIDS advocacy, Delaney is the chief of its Jedi council.

Delaney is founding director of San Francisco’s Project Inform, the nation’s most influential HIV treatment information and advocacy organization. Although half a dozen other groups nationwide do similar work, with a staff of 25 and annual contributions of more than $2 million, Project Inform is the powerhouse. (By contrast, the Center for AIDS in Houston, the flagship treatment advocacy organization in the southern United States, has a staff of five and annual receipts of slightly less than $500,000.)

While well briefed on the particulars of AIDS research and clinical care–he sits on the federal panel that issues treatment guidelines–Delaney generally eschews the detailed policy work efforts pursued by other activists; instead, he focuses on painting a broad vision of the future, coloring it with sunny California optimism. In a January 2001 essay for POZ magazine, he declared flatly that science would produce a "functional cure" for HIV by 2010–"at the very latest." At public presentations, he delivers the same message with a full-throated buoyancy that connects readily with HIVers.

The Annual Retrovirus Conference–which convened in Chicago this past February–is the largest meeting of AIDS researchers in the United States. At the 2001 conference, federal authorities backed off from their treatment mantra of "hit hard, hit early" that had pushed almost every HIVer into anti-HIV drug therapy. (In addition to their high costs, anti-HIV drugs are inconvenient and toxic.) The new recommendation is for infected people to wait until the CD4 count, an important measure of immune function, has dropped to 350 before starting a treatment regimen. Delaney calls this one of the most important recent developments in AIDS, saying this new approach is a rejection of the "sink and drain" model of therapy.

Also at this year’s conference, Anthony Fauci, M.D., the federal government’s top AIDS researcher, presented early information on a one-week-on, one-week-off treatment plan. Using data from a small study, Fauci showed how it might be possible for HIVers to cut their time on drugs in half. "I find that very intriguing," Delaney says. If Fauci’s experiment pans out in the long run, "it’s a major finding." But Delaney holds out for something even more startling for his functional cure: "I think it needs to go even further than that. Ideally, I’d like us to get to the place where you could take people off treatment and leave them off it." It may be, Delaney says, that Fauci’s approach is the "best you can do. But I’m jazzed on the notion of ... viral control without drugs."

An integral component of that notion is interleukin-2 (IL-2), an immune booster. Researchers, including some in Houston, are now investigating IL-2 in two large studies. But those studies will take several years to complete, and some people are anxious to have IL-2 on the market sooner. The U.S. Food and Drug Administration (FDA) routinely grants accelerated, or early, approval to anti-HIV drugs. But there’s no precedent for giving early approval to immune boosters for people with HIV, and it’s unclear if the FDA will make an exception for IL-2. But Delaney would. "In terms of accelerated licensure, I think they [the makers of IL-2] have got as good data as we’ve seen from some other drugs. The only downside of IL-2 use, obviously, is the side effects during those days the person takes it. Beyond that, I think the case is inarguable that it produces genuine, lasting improvements in CD4 ... well beyond what we get with antivirals alone."

His comments mark the first time a U.S. AIDS activist has publicly declared support for the early approval of IL-2, which may put him at odds with advocates who want to wait until the studies are complete. But Delaney counters: "Why is it that only people with the right insurance or a clever doctor [have access to IL-2]? . . . Why isn’t it more widely available?"

If many people with HIV lack the right insurance, it may be because the demographics of the epidemic have changed sharply in the last several years. What was once a disease almost exclusively associated in the public mind with gay white men has now spread to include significant numbers of black heterosexuals. Yet high-powered treatment activism remains largely the province of Anglo gay males. "Well," Delaney says, "the activists that are there aren’t just going to disappear and go away, so maybe that makes it a little harder for new people to break in. But the obstacle [to more minority activists] is that their own agencies don’t support them to do this kind of work. So to bring more people of color in as activists, you’re going to have to see a change of heart on behalf of their agencies, and you’re going to have to see a willingness on our part to act as mentors to bring them on board."

Although not a minority, one new player already on board is George W. Bush, winner of a close and contested November presidential election. Delaney suggests, tentatively, that HIVers may have less to fear from Bush than previously thought. "This guy is an enigma so far. He says one thing, but he tends to be doing things that are more favorable, or look more favorable, than we’ve expected so far. It seems like he’s getting the conservatives more angry than he is us. If that’s the case, I’m not nearly as worried as I thought I’d be." In a recent address to Congress, President Bush reaffirmed his support for doubling the budget of the National Institutes of Health, which is the federal agency responsible for federal research on AIDS.

Houston’s HIV-infected population includes a large segment with advanced disease and few remaining treatment options. But Delaney’s optimism covers them, too. "Don’t be so sure you’re left behind. We were writing people off for dead in 1996, but they’re still with us."

Delaney’s brand of treatment and policy optimism will be on display in Houston at a community workshop hosted by the Center for AIDS on Wednesday, April 18, at the Houston Museum of Health and Medical Science, 1515 Hermann Dr. A light buffet reception begins at 6:30 p.m., with a treatment update from Delaney at 7 p.m. Free and open to the public.

Paul Simmons, a registered nurse certified in HIV/AIDS nursing, is director of treatment information and advocacy at the Center for AIDS. He also chairs the Houston advisory board for the Community Programs for Clinical Research on AIDS, a federal program for HIV research. His e-mail address is paul@centerforaids.org.