All language subtitles for NOVA S49E12 Ending HIV in America 1080p WEBRip x264-BAE (1)_track3_[eng]

♪ ♪

NARRATOR:
It began as a
mysterious plague.

CECILIA CHUNG:
I was doomed to not live
very long.

MAN:
People are not realizing
how bad a disease it is,

and there's no cure for it.

NARRATOR:
A ferocious killer

that frustrated scientists
at every turn.

JOHN MASCOLA:
If we look at all the viruses
that we understand,

H.I.V. is far on the spectrum
of difficult.

NARRATOR:
But a long, worldwide
scientific quest

has provided a string
of spectacular discoveries.

MYRON COHEN:
The science that's developed
is, is, remarkable.

NARRATOR:
And after four decades,
it's led us to the brink

of what was once unthinkable:

the end of H.I.V. in America.

MONICA GANDHI:
We have prevention,

we have treatment,
and we have testing.

WOMAN:
There we go.

NARRATOR:
As scientists chip away
at the virus's defenses...

MICHAEL SAAG:
I'm just overwhelmed

at the progress that was made.

NARRATOR:
...a once-insurmountable foe
is finally on the ropes.

I think we definitely have
the tools

to end the epidemic in the U.S.

NARRATOR:
The U.S. government
has set a bold target:

cut new infections by another
90% by the year 2030.

But can we conquer the last mile

and the landmines
of accessibility

and stigma that lie
along the way?

"Oh, he's H.I.V.-positive.

How did he get it?"

TOMMY WILLIAMS:
It's just going to take a true

collaborative effort.

NARRATOR:
"Ending H.I.V. in America,"

right now, on "NOVA."

♪ ♪

♪ ♪

Hey.

This is Tommy from
U.A.B. outpatient.

WILLIAMS:
It's a lot of time
in the clinic,

meeting patients, especially for
the initial appointments.

Well, I'll see you when you
get here, lovely.

NARRATOR:
This phone is a lifeline

for 2,000 people
infected with H.I.V.

who depend on the 1917 Clinic

at the University of Alabama
at Birmingham.

WILLIAMS:
H.I.V. care,
which includes treatment

and research,
community engagement.

We also do H.I.V. testing.

Hey, Tommy!
Hey!

NARRATOR:
Tommy Williams is in charge
of connecting patients

with all the clinic has
to offer.

I can help you
with that.

I can help you with that
before you leave.

♪ ♪

NARRATOR:
In the United States,

more than one million people are
currently living with H.I.V.

But the burden is not felt
evenly across the population.

As they've been
since the outbreak began,

men who have sex with men
are by far the most affected.

(talking softly)

Men who have sex with men make
up, like, two to three percent

of the U.S. population,

and they make up about
two-thirds of H.I.V. diagnoses.

One is because,
anal sex, you have higher risk

of getting H.I.V.
just because of trauma

and the type of cells
that are in that area.

(card reader beeps)

NARRATOR:
Latesha Elopre,

an infectious disease specialist
at the 1917 Clinic,

says another key factor
is stigma.

Hi!
MAN:
Hey!

We saw each other last time.

ELOPRE:
There's still a lot of stigma
related to H.I.V.

And I think that's also
a huge barrier why people

don't always access
our preventative services

or come in to get tested.

♪ ♪

NARRATOR:
Race is another risk factor.

Compared to their
white counterparts,

the lifetime infection risk for
Black men is six times higher.

For Black women, it is nearly
12 times higher.

One reason patients are willing

to put their trust in
Tommy Williams

is that he knows where
they're coming from.

He's born and raised here
in Birmingham...

We're on the
east side of town.

NARRATOR:
...and he's H.I.V.-positive.

WILLIAMS:
There are times when I visit
a patient at bedside

and me disclosing
changes everything.

Like, something grows.

Something beautiful grows.

I became aware of H.I.V.
very young.

I think I was in the ninth
grade,

and, um...

This girl was, like,
"He's a sissy."

And then, so these guys was,
like, "You fruit loop,

"you're a fruit loop,
you got AIDS.

You got AIDS."

I wanted to believe that
I did not,

but I also believed that
if I didn't have AIDS,

it was just a matter of time.

I was, like, "I'm,
this is going to happen to me

and, um, and I'm going to die
from it."

So, you know,
one day, that day came.

NARRATOR:
Tommy was fortunate to contract
H.I.V. at a time when

highly effective medications
offered him a chance

at a long, healthy life.

You can live, and I'm living,
I'm thriving.

Okay! Oh, my God.

I'm so sorry I'm late
for this appointment.

NARRATOR:
It was a surprisingly difficult
road to get to this point.

The treatments available
to Tommy are revolutionary,

and the result of a decades-long
battle against H.I.V.

that never quite went
as planned.

♪ ♪

San Francisco has been an
epicenter, for both the disease

and innovative treatments.

GANDHI:
Good to see you, Donna.

Good to see you.

Come on back.

NARRATOR:
Dr. Monica Gandhi
heads up Ward 86 at the

University of California,
San Francisco,

the oldest dedicated H.I.V.
treatment unit in the world.

I can see your light reflex
in that eye.

GANDHI:
I always knew about Ward 86.

It was just in my head,
and I just wanted to be here.

I wanted to be a part of this.

And then in 2014, I became
the medical director of Ward 86,

which has been really
a privilege.

DONNA:
In 2004, when I had AIDS,

I asked God to just help me
to live with it.

And I've been doing just that.

NARRATOR:
When Ward 86
first opened in 1983,

an AIDS infection
was a death sentence.

Cecilia Chung arrived in San
Francisco in the early 1980s

to escape her strict
Hong Kong family

and to sample life
as a young gay man.

But she found a scene
much different

than what she'd pictured.

CHUNG:
When I tried to, like,
go on my adventure,

I would see maybe
five or six people

in one of the bars,

and it didn't take long for me
to figure out what's going on.

People were avoiding
talking about it,

but everybody knows that
if you haven't seen your friends

for more than a week,

chances are you never
see them again.

So this is Divas.

CHUNG:
When my mom came visit,

my mom say, "Don't sleep
with men, you will die."

So I never expected to live
past 30, and lo and behold,

I contracted H.I.V.
when I was 27, 28.

It was called gay cancer
and GRID--

Gay-Related Immunodeficiency.

♪ ♪

NARRATOR:
In May 1982,

when "The New York Times"
reported on so-called GRID,

it stated, "Epidemiologists
have found no evidence

"that the condition is spread
from person to person

"like influenza or measles.

The general public need not fear
an epidemic."

♪ ♪

It wouldn't take long to see
that confidence was misplaced.

By the early 1980s,
cases of the mysterious illness

were appearing in cities
all over the country.

♪ ♪

(knock at door)

Good afternoon.

SAAG:
We were seeing
more and more people,

especially from outside of
Birmingham,

coming in to see us.

And you could just feel
the epidemic beginning to crash

on our shores, if you will.

NARRATOR:
In Birmingham, Mike Saag

was just two years
out of medical school

when he saw his first case.

I remember were thinking,
"This is really unusual."

This guy was in his early 30s.

He had no reason to be sick.

Something was desperately wrong
with the immune system.

ELOPRE:
Any disease that
we've encountered in history

as an infectious diseases
provider,

the key has been to, number one,
identify that disease,

to learn and effectively treat
that illness.

And then the biggest,
the way to stop pandemics,

is to prevent it
from being spread.

So, immediately, all of
our attention begins to focus

on this causative agent.

NARRATOR:
Scientists around the world

began a frantic search
for clues.

And in the spring of 1983,
they found the culprit.

In the cells of sick patients,

scientists at the
Pasteur Institute in Paris

discovered the virus that would
come to be called H.I.V.

They found it in CD4 cells,

a type of white blood cell

that's critical
to the immune system.

They would come to know it
as a formidable enemy.

Like other viruses,

H.I.V. works by hijacking
the machinery

of the body's own cells.

By inserting its own genetic
material into the DNA

of the host CD4 cell,

it reprograms the cell
to produce the seeds

of its own destruction,

churning out more and more
copies of the virus

until the cell bursts open.

SAAG:
It turns that cell
into a virus factory

that then go into
the bloodstream

and start infecting other cells.

And that's how the infection
takes root.

NARRATOR:
It's a powerful two-punch combo:

rapid replication and weakening
the immune system,

killing the very cells that are
meant to defend against it.

When first infected,

patients usually experienced
a brief, mild illness.

Nothing that would signal
a serious disease.

The patient recovers.

But the virus stays active,
steadily multiplying,

and killing more and more
CD4 cells.

SAAG:
That relentless replication

ultimately damages
the immune system and leads to

the opportunistic infections
that we see every day,

what we would then call AIDS.

NARRATOR:
"Acquired Immunodeficiency
Syndrome"

left the body unable to
fight off most infections.

With the virus identified,

the race was on to find
a treatment.

And in 1987, there came what
looked like a breakthrough.

Hope for AIDS patients:
the drug AZT.

NARRATOR:
As scientists discovered,

AZT, a drug originally developed
to fight cancer,

was able to attack the virus
at a key vulnerable point.

H.I.V. is what's known
as a retrovirus,

only the third to be found
in humans.

A retrovirus's genetic material

is single-stranded RNA.

To hijack the cell's machinery,

it must convert that
to double-stranded DNA,

like the rest of the
human blueprint.

The virus uses an enzyme
called reverse transcriptase

to make that conversion.

AZT inhibits that enzyme,

preventing the RNA
from being converted.

In a quickly organized
clinical trial,

AZT stopped the disease
in its tracks.

CHUNG:
People were looking for

a vaccine and a cure.

So when AZT came out,

it offered some hope to us.

NARRATOR:
But that hope was short-lived.

It didn't take long for us
to realize that AZT

is not going to cure us.

LAWRENCE COREY:
It became very clear that people

who responded to AZT, after
three or four or five months,

started to lose their
CD4 T cells

and started to
lose weight again,

and not gain weight, and started
getting, uh, infections again.

NARRATOR:
Larry Corey was one of
the first researchers

to specialize in H.I.V.

COREY:
It was perceptually worse,
because you got better,

you were optimistic you got
better, and then you got worse.

MAN:
I've pretty much accepted
the fact that I'm going to die.

NARRATOR:
As scientists studied the virus,

they began to understand
how it was able

to evade the medication.

ELOPRE:
The virus can mutate,
and that was one of

the biggest issues that we had.

The virus can change itself
and basically change in a way

where that medication
stops working.

NARRATOR:
Drug resistance is driven by
mutation,

and H.I.V.'s capacity to mutate
is exceptional.

In fact, in the body,

H.I.V. mutates faster than any
other virus or any life form

that scientists have
ever measured.

COVID, or SARS-CoV-2,

there's mistakes made,
but it has a correction enzyme.

So it has a proofreader

that comes through, and if it
sees a mistake, corrects it.

H.I.V. doesn't have that enzyme.

NARRATOR:
Without the proofreader,

the virus churns out different
versions of itself-- variants.

H.I.V. does that more frequently
than any other virus.

NARRATOR:
So many mutations

means a greater chance that
the virus

will change enough to elude
the treatment.

GANDHI:
It's very wily,
it's very prone to change,

and it essentially just evolved
mutations

that made it evade AZT.

NARRATOR:
H.I.V.'s shapeshifting

was also sabotaging efforts
to create a vaccine.

The work began in the '80s

with fanfare and hope.

We hope to have such a vaccine
ready for testing

in approximately two years.

SAAG:
Margaret Heckler,
who was the secretary of HHS,

had a press conference,

and this is around 1985,
and she said, "Within two years,

we're going to have
an H.I.V. vaccine."

NARRATOR:
But the reality of the challenge
quickly set in.

Vaccines are designed
to trigger an immune response,

pushing the body to produce
proteins called antibodies,

which attach themselves
to invaders

and tag them for destruction.

It's a tried-and-true approach,

used to create vaccines
that eliminated smallpox,

measles, and polio in the U.S.

♪ ♪

COREY:
You make antibodies so that when

you get exposed to that agent,

one's body recognizes it
and therefore eliminates it

before it causes any disease.

It prevents you
from getting sick.

NARRATOR:
But with H.I.V., the challenges
were unprecedented.

Most antibodies bind to
and block only a single target,

a specific surface protein
on a virus.

But with H.I.V.
mutating so rapidly,

that target was
constantly moving.

Working on the early
vaccine trials,

John Mascola saw the problem
firsthand.

MASCOLA:
Those proteins surfaces,
they change.

So an antibody that sees one
strain of H.I.V.

doesn't necessarily see
another one.

So there's all this diversity
of H.I.V. in the world.

NARRATOR:
The number of variants
is stunning.

A vaccine must protect against
all of them.

MASCOLA:
I think there was a sense of

realism that set in that said,

"If we look at all the viruses
that we understand,

H.I.V. is far on the spectrum
of difficult."

Making a vaccine was gonna be

a pretty major
scientific obstacle.

NARRATOR:
A decade into the pandemic,

there was still no vaccine,

no cure, and no long-term
treatment.

Behavior changes,
like using condoms,

had slowed the pace
of new infections.

But the death toll kept rising.

♪ ♪

SAAG:
H.I.V. had become

the number-one killer
of young people

between the ages of 20 and 45
years of age

in major metropolitan centers.

NARRATOR:
And by 1992,

it was the number-one killer
of young men

in the country as a whole.

SAAG:
More than trauma, cancer,
suicide.

(chanting):
Typical day at the N.I.H.!
Watching people die!

NARRATOR:
Frustration was boiling over,

especially in communities
that were hardest-hit by AIDS.

And there was growing
recognition

that it wasn't only gay men
who were at risk.

♪ ♪

Because of the...
(cameras clicking)

...the H.I.V. virus
that I have attained, uh,

I will have to retire
from the Lakers.

NARRATOR:
NBA All-Star
Earvin "Magic" Johnson

put a new face on the epidemic.

CHRISTOPHER HAMLIN:
No one thought Magic Johnson,
not Magic Johnson.

We put our athletes
on a pedestal and think,

"Nothing will happen to them.

They're giants, they're heroes."

That's why I am going to be
a spokesman for this

H.I.V. virus, because I want
them to understand

that safe sex is the way to go.

I think sometimes we think,

"Well, only gay people
can get it, only...

Well, it's not going
to happen to me."

And here I am saying
that it can happen to anybody.

HAMLIN:
So, when Magic Johnson
disclosed his status,

it really was
an earthquake event.

NARRATOR:
When that earthquake
rattled through Birmingham,

the Reverend Chris Hamlin
was pastor

of the city's historic
16th Street Baptist Church.

Everything that is connected to
the African American community

has filtered through,
for the most part,

filtered through
the Black church.

NARRATOR:
16th Street had been
a major rallying point

during the civil rights
movement.

And also a target.

HAMLIN:
Sunday, September 15, 1963,

Klan placed sticks
of dynamite

underneath
an exterior stairwell.

And that Sunday morning,

young ladies were in
the restroom area,

getting ready for, for
morning worship,

when the bomb went off at 10:22.

NARRATOR:
It was a horrifying attack
that killed four girls.

But it cemented the role
of the Black church

as a powerful voice
in the community.

HAMLIN:
This is one place where
information can be disseminated.

We demonstrate that we, one,
are compassionate,

but also that we're responsible
for, for sharing information

that is healthy and helpful.

I've always had friends--
two, especially--

who confided in me that
they were gay,

and both of them died from
complications from, from AIDS.

Neither one of them
chose to tell me that

they were H.I.V.-infected.

But after their deaths, one of
the members of our church said,

"Oh, okay, as,
as pastor of 16th Street,

you've got to do more than
what you're doing."

And kind of insisted that
I do more.

And he was absolutely right.

NARRATOR:
Hamlin joined the board
of AIDS Alabama

and began to spread the word
about H.I.V.

to the greater African American
community.

I don't know if I was the first,
but in Birmingham,

I, I probably was one
of the first pastors

who openly talked about H.I.V.

If you are a Christian,
just live the life

of a believer in Christ

by demonstrating Godly love
to all people!

Regardless!

Live by the Golden Rule:

"Do unto others as you want
others to do unto you."

(churchgoers murmuring
in agreement)

H.I.V., especially in
the Black community,

has always been viewed as
a gay disease

and presented itself primarily
in the white gay community.

So we were, we were in denial:
"No, this is not about us.

"This has nothing to do with us.

This is about, about them."

But then, as time went on,
you began to see, you know,

"Oh, this is about us, too."

(chuckling)
Sir, what's going on?

NARRATOR:
Eventually, Hamlin became the
chaplain at the 1917 Clinic,

working side by side with
Mike Saag and Tommy Williams.

HAMLIN:
One of the challenges in the
Black community has always been,

human sexuality
is a taboo subject.

We do it,
but we don't talk about it.

And H.I.V. was
one of those things,

you had to talk about it.

NARRATOR:
Those same conversations
are still a challenge today.

WILLIAMS:
And stigma is so present
that it puts a chokehold

on, like, any type of
communication

happening around H.I.V.,
and any discussion

that happens around H.I.V.
and/or AIDS is going to have

a negative connotation to it.

SHIRLEY SELVAGE:
Hey!

(laughs):
You knew I was comin'.

NARRATOR:
Change is painstaking
and very personal.

I want it like the bob.

Like the picture!
Okay.

So before I came
to Birmingham,

you know, I married my
little high school sweetheart

and he went to the service,
and came back,

and we had a house built.

And I had my daughter then, and
I think she was, like, seven.

And he literally
didn't tell me,

like, until three years,
like, three years.

And when he told me,
he was, like,

"This is what
I've been going through,"

and gave me
this piece of paper.

NARRATOR:
Shirley's husband
was H.I.V.-positive.

SELVAGE (exhales):
It took me, like,

three months
to really share, because I,

my, the way I reacted to it,

and, you know,
tried to overdose, and do,

tried to have...

You know, suicidal thoughts
of doing things.

And finally,
when I told my grandmother,

she was, like,
"Well, Magic Johnson has it.

Girl, you better go
and live your life."

I'm, like, "You don't even
understand, when this get out."

And then she end up...

You know how grannies do,
honey.

They don't think
nothing wrong with nothing.

So she end up
telling family members,

and then that's how it just got
all out in the community.

Uh-huh.
And so I just totally,
like, isolated myself

from that community, until, up
until I moved to Birmingham.

Are we done?

I think we're done.

You should go and have
a look-see.
Ooh!

Ooh, I like this.

WILLIAMS:
Chaka Khan, let me rock you,
let me rock you, Chaka Khan.

(Selvage laughing)
That's all I want to do.

The thought process in
a lot of people is,

"Oh, he's H.I.V.-positive.

How did he get it?"

Or, "She's H.I.V.-positive.

What did she do to get it?"

And people who are living with
H.I.V.,

one of the things they fear most

is judgment, stigma,
and rejection.

♪ ♪

NARRATOR:
Back in the early '90s,

as Hamlin was starting
tough conversations about H.I.V.

with his congregation,

the scientific community

was racing the clock,
testing new ideas

to stem the tide of disease.
REPORTER: ...cancer-fighting
drug interferon...

NARRATOR:
Doctors, scientists,
and pharmaceutical companies

were experimenting
with new drugs

and trying them in combinations.

GANDHI:
The biggest lesson was that

H.I.V. is very clever

and can evade, uh, AZT or a
single agent.

And so it really taught us that
we have to kind of hit H.I.V.

on multiple points,
multiple parts

of it, of its replication
pathway

to get it to stop replicating.

And so it made us really
start thinking that two drugs,

and even three drugs,
were the most important way

to really hem H.I.V. in
on all sides.

NARRATOR:
Dozens of drugs and combinations
were tried,

including an entirely new class
of medication

called protease inhibitors.

They worked on the virus after

it had incorporated its genetic
material into the CD4 cells.

At that point,
the CD4 cells begin producing

long strings of
H.I.V. proteins...

♪ ♪

...which get snipped into
the building blocks

of new virus particles

by an enzyme called protease.

Protease inhibitors block
the molecular scissors

and stop the virus
from replicating.

The protease inhibitors
were tested in combination

with other drugs.

And one three-drug combination
stood out.

It was about to change the
trajectory of H.I.V. in America.

REPORTER:
The AIDS epidemic could well be
at a turning point.

REPORTER:
The three-drug combination...

REPORTER:
...can reduce the AIDS
death rate dramatically.

NARRATOR:
The shock wave rang out

from the 1996 International
AIDS Conference in Vancouver.

PETER PIOT:
The new combinations

of antiretroviral drugs
are holding out new hope.

And I just almost dropped
the pencil and said,

"Oh, my goodness."

This was so striking.

NARRATOR:
The headline:
a combination of three drugs,

two reverse transcriptase
blockers

and a protease inhibitor,

successfully kept
H.I.V.-positive patients

from developing AIDS.

I knew this was special.

NARRATOR:
It was the so-called
triple cocktail.

One drug on its own couldn't
keep up with H.I.V.'s mutations.

But the cocktail,
with its multiple drugs

targeting different parts
of the replication cycle,

beat back the virus before
it could evolve resistance.

So in patients who started
using it,

and we saw these
dramatic drops in virus,

and that was the beginning of,
at least for us,

using triple drug therapy.

I sort of watched at
San Francisco General,

the beginning of the year,
40% of our patients

in the inpatient setting
at this hospital

be living with AIDS,
um, really sick,

really didn't have those
antiretroviral therapies,

and then I just watched, over
the second half of my residency,

people rise from the dead.

Thank you.
Thank you.

GANDHI:
It was literally
a Lazarus effect

to watch these antiretroviral
therapies come out.

NARRATOR:
One by one,
the patients recovered.

Almost immediately,
annual deaths from H.I.V.,

steadily climbing
since the early 1980s,

began to plummet.

For the first time,
people could truly talk about

living with H.I.V.

JOHNSON:
The newest drug out,
which is doing great

and having great success with
it, it's called combination.

That's probably the reason,
uh,

for my good health,

as well as God,
just praying every night.

Thank you.
Thank you so much.

NARRATOR:
Triple therapy was
a life-saving breakthrough.

H.I.V. was no longer
an automatic death sentence.

But it was not without
its challenges.

There were some pretty
significant side effects.

And oftentimes,
it was a handful of pills.

It was like breakfast.

CHUNG:
It was, like, six pills

that you have to take
in the morning,

six pills you have to take
in the evening,

and they're, like,
about this size,

um, and it made me so sick.

But there wasn't
any other choices.

NARRATOR:
Even that changed fast.

Pharmaceutical companies
continued to work on new drugs

and new formulations that were
more effective,

easier to take,
and had fewer side effects.

Within a decade, the regimen
was down to a single pill a day.

It was called Atripla,

but it was three medications
all in one pill--

one pill once a day, big deal.

NARRATOR:
Treatments were
rapidly evolving,

but a vaccine remained elusive.

COHEN:
For all these years, it's been,

"We're gonna make a vaccine and
that's gonna fix the problem."

And, and certainly it's not
through lack of effort.

NARRATOR:
Billions of dollars had gone
into vaccine research,

with dozens of clinical trials,

but still no vaccine.

From 1981 to 2011,
that is 30 long, long years

where there was no effective
biomedical prevention strategy.

There was no vaccine, there was
no shot, there was no cream,

there was no, um, pill.

We had condoms, we had
abstinence, we had monogamy.

We had nothing in terms of
biomedical prevention strategy.

Now let me get my white coat.

It's the most important thing
in this.

NARRATOR:
The best prevention

traditionally comes
from vaccines,

but now,
a new approach was needed.

Myron Cohen was a
physician-researcher

at the University
of North Carolina.

I was charged and committed

to prevention in the absence of
a vaccine.

The idea was,

let's use antivirals to stop
the spread of H.I.V.

NARRATOR:
The concept was simple,
yet unorthodox.

It was based on the concept
of the viral load,

the amount of virus
in a patient's body.

The higher the viral load,

the more likely an infected
person is to infect others.

But if doctors treat
those patients earlier,

and more aggressively,
could they bring the viral load

down low enough that the virus
can't be passed on?

To what extent will we render
them no longer contagious?

We're gonna call that treatment
as prevention, or TASP.

NARRATOR:
Treatment as prevention was just
one half of the strategy.

We and others were also working
on the flip side of the coin.

So if we're gonna treat
the infected person

to try and stop transmission,

we're gonna take the uninfected
person and try and develop

safe and effective ways
to prevent the acquisition

of the virus through
pre-exposure prophylaxis.

NARRATOR:
Pre-exposure prophylaxis,

or PrEP, was not a completely
new concept.

Malaria prophylaxis has been
used for years.

You basically take a medication,

it's in your body,

and then you get exposed
to malaria

and prevents you from actually
getting malaria.

NARRATOR:
Not a vaccine,
but a short-term preventative.

So this made sense to me,

to use an H.I.V. medication
to prevent H.I.V. infection.

NARRATOR:
At least, that's what they
hoped.

And yet it meant giving
powerful treatment drugs

to people who were
totally healthy.

Initially, I said,
"What are we doing?

"Why are we giving medicines
to people who aren't infected?

That seems kind of crazy."

ELOPRE:
A lot of people were concerned

that it might increase
high-risk sexual behaviors.

REPORTER:
Some groups are concerned
using Truvada for prevention

would cause more H.I.V. cases.

It could be misinterpreted as,
you can engage in any

risky behavior that you want.

A catastrophe for AIDS
prevention in the United States.

NARRATOR:
There was also a question of
basic human nature:

would healthy people really
take this medicine?

The skepticism was, could people
take a pill every day,

which was hard enough to do
in the treatment world.

It's been harder to, for people

to take preventative
medications.

WOMAN:
How're you guys doing?

NARRATOR:
Despite the concerns,
the trials forged ahead.

In 2000, we started then
a series of trials.

NARRATOR:
The separate trials,
conducted in multiple countries,

looked at both sets of people:

those who might spread the virus

and those who might
get infected.

For H.I.V.-positive patients,

could antiviral medication
render them safe as partners,

no longer able to spread
the virus?

And could the same
antiviral drugs

shield healthy people
from infection?

It was a brand-new approach
to prevention.

The big PrEP study was called
iPrEx.

GANDHI:
Oh, there was a lot of pressure

riding on the study of iPrEx.

Everyone in H.I.V. was
waiting for it.

This was the first time
that there would be a pill

where you could prevent
getting H.I.V.

I was waiting with bated breath.

NARRATOR:
The answer came in the
closing days of 2010.

♪ ♪

GANDHI:
When I saw the results,

I was elated, I was amazed.

I was so excited.

NARRATOR:
In iPrEx,

PrEP cut the risk of
new infection by more than 70%

for people who stuck to
the regimen.

Further studies show PrEP cuts

the risk of H.I.V. infection
from having sex by 99%,

and at least 74% for people
who inject drugs.

PrEP relies on the same type of
drugs as are used for treatment.

Taken as a
preventative medication,

it creates a defensive shield.

GANDHI:
And the H.I.V.
comes into your body,

but that medication comes

and attacks it and prevents it

from essentially infecting
your cells.

NARRATOR:
That still left the TASP trial,

Cohen's landmark study
of treatment as prevention,

the second part of the strategy.

Their data were still
being analyzed

at the National Institutes
of Health.

It was a closely kept secret.

COHEN:
I got a call from the N.I.H.
saying,

"Can you come over
to the N.I.H.?"

So we all drove over
to the N.I.H.

They're in a room with
a large group of people,

including the leader,
Dr. Dieffenbach.

And then after a few minutes of,

of cajoling, he kind of...

There was a huge stack of papers

and he threw up this stack of
papers in the air and said,

"This is a home run."

NARRATOR:
Treatment as Prevention worked.

We reported that we stopped
the transmission of H.I.V.

by more than 96%.

NARRATOR:
An H.I.V.-positive person

whose treatment brings
the viral load so low

as to be undetectable

will not transmit the virus.

DAVID:
Me being undetectable

means be, being able to live
again,

actually live a normal life,
and not be scared.

♪ ♪

NARRATOR:
With TASP,
for infected patients,

undetectable equals
untransmissible.

It's now a
federal education campaign.

U equals U.

And you know
what that means:

that undetectable
is untransmissible.

(applauding)

GANDHI:
It's been huge, because
for science,

it really shows that
a preventative medication

can be taken every day
to prevent infection.

NARRATOR:
Together, U equals U and PrEP

showed a path forward.

For the first time,
people dared to imagine

the end of the epidemic.

Overnight, the world changed.

(whistles blowing,
crowd cheering)

NARRATOR:
Over the previous two decades,

new H.I.V. infections
in the U.S.

averaged nearly 60,000 a year.

As PrEP and U equals U came into
widespread use,

that number fell nearly by half,

while deaths have fallen
nearly a third.

GANDHI:
It really helps
with relationships,

helps with partnerships.

Watching the progression
and how many advances

we've had in H.I.V.
has been thrilling.

NARRATOR:
30 years after H.I.V.
was discovered,

doctors finally had both
treatment and prevention tools

at their disposal.

That still left the challenge
of getting them

to all the patients
who would need them,

the so-called last mile, that
could truly end the epidemic.

San Francisco,
with its large LGBTQ community

and long history
of fighting the disease,

is trying to lead the way.

In 2013, it set a goal

of being the first city
in the world

to eliminate H.I.V.
transmission altogether.

The plan focuses on
groups at highest risk,

people on the edge of society.

MIGUEL IBARRA:
Which way should we go?

WOMAN:
Eddy?
Eddy? Okay.

NARRATOR:
Miguel Ibarra leads
an outreach team

for the San Francisco Community
Health Center,

located in the Tenderloin.

Have they come and told y'all
about the linkage center yet?

NARRATOR:
The center works to bring
H.I.V. care,

along with other healthcare,
to the most vulnerable.

IBARRA:
You might be experiencing
homelessness.

You might be actively using.

You can show up here
to SF Community Health,

and you can meet with providers

who have walked in your shoes

and who have come out
on the other side.

NARRATOR:
With any disease, the last mile
is always the hardest.

The hardest cases,
the people hardest to reach.

You want a snack?

Here you go.

NARRATOR:
But by focusing on
this vulnerable population

and making antiviral medication
available for free--

that's PrEP and U equals U--

the city was down
to 131 new cases in 2020,

a 64% drop since the city set
its goal of ending the epidemic.

Would you like a rapid
COVID test to have?

NARRATOR:
But with COVID
came new challenges.

Prior to the COVID pandemic, we
were actually doing really well.

And I was seeing very few
barriers to, hopefully by 2030,

getting to the end of the
epidemic in San Francisco.

Essentially, our
homeless population increased,

and so did substance use.

And substance use
is a really big barrier

to taking medications every day

or to stay virologically
suppressed.

NARRATOR:
Cecilia Chung knows
the challenges firsthand.

In the 1990s, she ended up
on the streets, using drugs,

before managing to pull her life
back together.

Oh, my God,
that was 30 years ago.

CHUNG:
If somebody is homeless,

and they're very transient,
they move from place to place

and have to set up camps, um,
or live in a shelter,

where are they going to put
the medications?

A regular schedule is necessary

in terms of scheduling for

regular doctor's visits
and also blood work.

And not to mention, you know,

taking medications
on a daily basis.

NARRATOR:
Trans:Thrive,

part of the San Francisco
Community Health Center,

is tackling some of those
exact last-mile problems.

(talking in background)

ROYCE LIN:
So my name is Dr. Royce Lin,

and, uh, I'm a physician with

the San Francisco Department
of Public Health.

The work that we do here
is comprehensive.

We have psychosocial services,

including onsite, uh,
psychiatry,

medical social work.

Many of our clients here

face challenges from
multiple levels,

and H.I.V. oftentimes is pretty
low on the priority list,

compared to things like
mental health, housing,

where am I going to sleep
tonight?

JOHANNA BROWN:
My name is Johanna Brown.

I came to see my doctor,
Dr. Royce Lin,

to get some lab works done,
and to change some medication.

I see them for everything--
financially, medically, housing.

LIN:
How do we help people
who have lost hope

and lost the motivation?

And the work that lies ahead
is the hard work

of building somebody back up.

Helping people to find
the strength and the hope

to be able to continue.

NARRATOR:
In Alabama, the last mile
feels a lot longer.

HAMLIN:
In our clinic,

we're still seeing 12 to 14 new
patients every week--

every week.

So again, that kind of gives
the picture

that this virus
is still being transmitted.

Um, so there's a lot of work for
us to still do.

NARRATOR:
The Southeast is the region of
the United States where H.I.V.

has the largest footprint.

ELOPRE:
We make up about 50%
of H.I.V. diagnoses.

(chuckling):
About a third of the
U.S. population.

So there's a disparity there.

NARRATOR:
Just as it is in San Francisco,

a big part of the problem
is poverty.

WILLIAMS:
Poor healthcare,
access to resources,

low education, communication.

Con-- like, it's all of that.

If you're hungry,
you're not thinking about

your overall wellness
from a health standpoint.

HAMLIN:
We have a PrEP clinic
at our clinic.

It's, it's a wonderful tool.

The, the good news is, if you
take it and take it properly,

you would not contract H.I.V.

Unfortunately, uh,
if you don't have insurance...

(chuckling)

...you know, getting PrEP drugs
are, are near almost impossible.

All right, thank you.

NARRATOR:
While many states extend
at least some health insurance

to all residents,

Alabama, like most states
across the South, does not.

Ten percent of the
state population

has no health insurance at all.

Without insurance, the cost of
PrEP is nearly $2,000 a month.

An insurmountable obstacle
for almost anyone

who comes to see Tommy.

(chuckling):
Like, it's absurd.

They say,
"I want to get in care,

but I can't afford
the medication."

NARRATOR:
Through a variety of programs,

the federal government offers
subsidies

to offset the cost of PrEP
for those who qualify,

just as it heavily subsidizes
H.I.V. treatment.

♪ ♪

And yet, nationwide,
just one in four people

who would benefit from PrEP
has a prescription.

In Alabama, the figure
is even lower.

WILLIAMS:
I don't know a lot of

Black people in the
LGBTQ-plus community

that are on PrEP at all.

NARRATOR:
The reasons are complex, but
money is not the only factor.

Many patients,
especially younger ones,

are unaware that PrEP
is even an option.

I believe one of the
many reasons that the kids

aren't accessing PrEP is because

either they don't--
believe it or not--

know about it, they...

And if they know about it,
they don't really understand it.

Or they are not accurately
identifying their level of risk.

NARRATOR:
It all puts a premium
on patient education

and community outreach.

Thank you all for coming out
tonight.

ELOPRE:
There's been a huge push

to respectfully partner with
community-based organizations,

because now there's
a recognition that

you're just not going
to have the impact

if you're only doing things

from an ivory tower or
from a research institution,

where we haven't really
gained that trust.

Any of you would like to share
with me what your superpower is?

WOMAN:
I'm a mother.

I'm a father.
Mm-hmm.

I'm a friend.

I'm able to just
stand firm in my truth.

So when you have
a difficult situation,

sometimes you cannot
control that situation.

But you can control
how you respond to it.

Thanks for being amazing.

All of y'all are just...
extraordinary.

(group cheers and applauds)

♪ ♪

NARRATOR:
Throughout the long battle
against H.I.V.,

the goal has been to remove
scientific

and societal barriers
to make treatment easier.

Hey.
MAN:
Dude!

Hey!
How are ya?

NARRATOR:
And the next advance,
a new formulation of PrEP,

is trying to do both.

Some of the insurance issues
around...

NARRATOR:
Instead of a daily pill
to protect against infection,

the new iteration is an
extended-release injection

that lasts for two months.

Do you want to remain
on the injectable PrEP

or go back
to the daily pill?

The injectable.
Okay.

(chuckling):
"I won't forget to take
the pill."

I think I've forgotten to take
the pill once or twice

over the weekend.

And now it's, like,
"Okay, I know I've got my shot,

I'm good for my shot
until my next appointment,"

so I don't forget to take
the pill.

NARRATOR:
Every two months is just a first
step towards protection

that patients barely have to
think about.

GANDHI:
I think the next goal

would be an implant that
actually you put under the skin

and it protects you
for a full year.

NARRATOR:
Coming full circle,

variations of the drug
combinations

already approved for prevention

are now being tested
as a longer-acting treatment

for people who are
H.I.V.-positive.

Michael!

NARRATOR:
Tommy is one of the first people
to get it

as part of a clinical trial.

WILLIAMS:
I got put in the four-week arm.

I really wish it was
the eight-week.

'Cause I have to come
every month.

And that can be hard
for a lot of people.

Hey, Michael.

How are you today?
I'm fine.

Oh!
Have a seat.

Oh, goodness.

So today is gonna be
your last study visit.

And we can transition you

from the every-four-week
injection

to every-two-month
injection.

(laughing)

So you will go from
12 a year to six a year.

(laughing):
Why am I about to cry?

So...
I am so excited!

Yeah.

(laughing):
You know I've been wanting
that two,

that two-month
for the longest.

I know, I know, and so...
Oh, my God.

Bye-bye 30-day injections!
I know.

I don't wanna do it,

I don't wanna do it right now,
'cause I don't wanna be...

Oh, wow.
Okay.

(laughing):
Okay.
All right.

All right, I'll see you--
I'll see you.
Okay.

♪ ♪

NARRATOR:
The last mile,

like the rest of the victories
against H.I.V.,

will come one hard-earned
step at a time.

Which won't make crossing that
finish line any less remarkable.

I'm really glad
to see you.

SAAG:
And it really is

pretty miraculous
how we converted H.I.V.

from an almost-certain death
sentence

into something that I think
we can call

a chronic manageable condition.

HAMLIN:
When I first went to the clinic,
we had angel wings report.

When a patient died,
we would send out an email.

And initially there was, like,

two or three emails every day
of patients dying.

This week, we have not gotten
one angel wing email.

NARRATOR:
Healthcare workers
will continue to treat...

♪ ♪

...and scientists will continue
to innovate.

The toolkit, impressive as it
is, still needs to grow.

Especially as we tackle H.I.V.
in the rest of the world.

Longer-term PrEP options
are being tested,

as are new mRNA vaccines,

building on COVID-19 advances,
that sprang directly

from pioneering research
into H.I.V. vaccines.

H.I.V. was the NASA of COVID.

The COVID vaccine came out of
the Vaccine Research Center,

which was created to make
an H.I.V. vaccine.

The treatments that we use
for treating COVID

are really spun off completely
from H.I.V.

Remdesivir.

Paxlovid is a protease
inhibitor.

Imagine that!

GANDHI:
So ten years ago, if you had
told me

that prevention
could have dropped infections

by half without a vaccine,
I would not have believed it.

That was also miraculous.

MASCOLA:
I think PrEP can get us to zero.

It's just a matter
of the resources needed

to hold us there.

ELOPRE:
We have a medication

that you can take
that almost 100%

prevents you from getting H.I.V.
if you're exposed.

So 100%, if we were able to
improve access,

I think we could end
the epidemic.

HAMLIN:
Not one institution can be
isolated and say,

"I'm not affected by H.I.V.,"

or, "I'm not affected by
healthcare issues,"

because all of us are.

GANDHI:
I am very hopeful

now that we have the tools

to see the end of all new
H.I.V. infections,

the end of AIDS deaths,
and the end of AIDS stigma.

That is what I want to see
in my lifetime

and I absolutely know I can.

Big stick.

WILLIAMS:
We have the tools to stop it.

Let's do it.

♪ ♪

♪ ♪

ANNOUNCER:
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Or call 1-800-PLAY-PBS.

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are available with Passport.

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♪ ♪

♪ ♪