《影片》到 2030 年終結芝加哥的愛滋病毒
www.thelancet.com/hiv 2023 年 5 月 26 日線上發表 https://doi.org/10.1016/S2352-3018(23)00131-5
美國和世界各地的衛生領導人制定了結束愛滋病毒流行的策略。 但愛滋病毒的終結真的就在眼前嗎？ 重要的是，「結束疫情」的定義是什麼？
「伊利諾伊州朝向歸零」是一項全州範圍內的倡議，旨在到2030 年結束美國該州的愛滋病毒流行。該計畫透過與愛滋病毒感染者、社區組織、醫療保健提供者、政府機構和其他機構的合作進行協調，由芝加哥愛滋病基金會、伊利諾州和芝加哥公共衛生處負責。 《愛滋病毒與朝向歸零之旅》是一部基於該倡議的紀錄片，探討了愛滋病毒流行的終結真正意味著什麼的問題。 這部電影追溯了美國愛滋病的歷史，重點關注芝加哥的經歷，從生活在芝加哥的積極分子、長期倖存者、新診斷者、臨床醫生、研究人員和社區領袖的角度講述了這個故事。
芝加哥是美國最大的城市之一，也是主要的大都市中心，但也許由於其地處中西部，在愛滋病毒流行之初，芝加哥仍然在一定程度上免受愛滋病毒感染。 傑夫·貝裡 (Jeff Berry) 自 1989 年確診以來一直是愛滋病毒/愛滋病倡導者，他於 1981 年來到芝加哥擔任 DJ，當時正是報告第一例病例的時候。 他說：「疫情尚未蔓延到那裡，但我們已經開始聽到來自紐約、洛杉磯和舊金山的同性戀癌症報告」。 「我們很多人都以為我們會倖免於難，而且不會受到打擊。 但事實證明，只是花了更長的時間才出現」。
第一個報告的愛滋病病例是在美國東海岸和西海岸發現的，但病毒不可避免地會傳播到芝加哥，而且這種傳播並不需要很長時間。 貝裡指出，在他工作的俱樂部，他的一些同事將不再在那裡。 「那是一段非常困難的時期。 我們失去了朋友、愛人、家人——而且沒有辦法治療」，他說。
倫斯洛·謝勒(Renslow Sherer) 是一位傳染病專家（美國伊利諾伊州芝加哥大學），他於1982 年見到了第一位愛滋病患者。同年，他與他人共同創立了芝加哥第一家愛滋病毒診所，並於1985 年共同創立了芝加哥愛滋病基金會。他說，診所只接診了少數患者，但在接下來的10 年裡，有1,800 名患者接受了治療，「我們是全國最大的診所之一」。
影片透過親身經歷者的敘述，展現了 20 世紀 80 年代的情況是多麼令人心碎和絕望。 愛滋病就像被判了死刑，除了缺乏任何有效的治療之外，愛滋病毒變得高度政治化，感染者受到恥辱和羞辱。
然而，隨著時間的推移，隨著治療和預防方面的進步開始顯現，這部電影無縫地從早期的焦慮轉變為審慎的樂觀情緒——結束這種流行病是一種真正的可能性。 1994年，美國愛滋病相關死亡率達到高峰，死亡人數達4萬人，但僅僅一年後，三聯療法的出現徹底改變了這個模式。 人們現在開始見證所謂的「拉撒路效應」(Lazarus effect)，以從死裡復活的聖經人物命名，因為許多在臨終關懷中虛弱和垂死的愛滋病患者恢復了相對健康和富有成效的生活。
下一個突破是暴露前預防，「這是讓我們實現歸零的領先發現之一」，謝勒說。 「這是『歸零』運動的前沿。 這是我們一生中最令人興奮的科學發現之一」。
最新數據顯示，2020 年，芝加哥的愛滋病毒新診斷數量是自 1987 年以來最少的，所有性別、所有年齡層以及黑人、拉丁裔和白人人口中的愛滋病毒新診斷數量均出現下降。 但正如 2001 年 23 歲時被診斷出的 Evany Turk 所指出的那樣，達到零意味著停止新的愛滋病毒感染，而結束流行病則完全是另一回事。 「我不相信這種廢話，因為如果我仍然感染愛滋病毒，你將如何結束流行病？」她說。「在找到治癒方法之前，我們無法消滅愛滋病毒，但在那之前，我們可以實現新愛滋病毒的零感染」。
貝裡還補充說道，雖然達到零會很棒，但工作不止於此。 他說：「導致愛滋病流行的因素，以及必須克服的恥辱以及結構性和社會障礙才能獲得有效的治療，這些因素仍然存在」。「即使愛滋病消失了，我們仍然需要解決這個問題，讓世界變得更美好」。
羅克珊‧納爾遜
《Screen》Ending HIV in Chicago by 2030
www.thelancet.com/hiv Published Online May 26, 2023 https://doi.org/10.1016/S2352-3018(23)00131-5
Health leaders in the USA and around the world have outlined strategies to put an end to the HIV epidemic. But is the end of HIV really in sight? And importantly, what defines “ending the epidemic”?
Getting to Zero Illinois is a state-wide initiative to end the HIV epidemic in the US state by 2030. The project is coordinated through partnerships with people living with HIV, community-based organisations, health-care providers, government agencies and others, coordinated by the AIDS Foundation Chicago, and the Illinois and Chicago Department of Public Health. HIV and the Journey Toward Zero is a documentary based on that initiative, and one that explores the question of what the end of the HIV epidemic really means. The film traces the history of AIDS in the USA, focusing on the Chicago experience, and tells the story from the perspectives of individuals living in Chicago who are activists, long-term survivors, newly diagnosed individuals, clinicians, researchers, and community leaders.
Chicago is one of the largest cities in the USA and a major metropolitan hub, but perhaps due to its Midwest location, remained somewhat shielded from HIV at the beginning of the epidemic. Jeff Berry, an HIV/AIDS advocate since his own diagnosis in 1989, came to Chicago in 1981 to work as a DJ, just at the time when the first cases were being reported. “The epidemic hadn’t hit there yet, but we were beginning to hear reports from New York City, Los Angeles, and San Francisco of the gay cancer”, he says. “A lot of us thought we were going to be spared and it wasn’t going to hit. But it turned out that it just took longer to show up.”
The first reported cases of AIDS were identified on the east and west coasts of the USA, but it was inevitable that the virus would find its way to Chicago, and it did not take very long. Berry noted that at the club where he worked, some of his coworkers would just no longer be there. “It was a very difficult time. We lost our friends, our lovers, our family members—and there was no way to treat it”, he says.
Renslow Sherer, an infectious disease specialist (University of Chicago, IL, USA), saw his first patient with AIDS in 1982. He went on to cofound Chicago’s first HIV clinic that same year and the AIDS Foundation of Chicago in 1985. At first, only a few patients were seen at the clinic, but during the next 10 years 1800 patients were treated and “we were one of the largest clinics in the country”, he says.
Through the words of individuals who lived it, the film demonstrates how heartbreaking and hopeless the situation appeared during the 1980s. AIDS was a death sentence and, aside from the lack of any effective treatment, HIV became highly politicised, and those infected were subjected to stigma and shame.
However, as time moves forward and as advances in treatment and prevention begin to take hold, the film seamlessly shifts gears away from the angst of the early days to cautious optimism—that an end to the epidemic was a real possibility. In 1994, AIDS-related mortality peaked in the USA with 40000 deaths, but only a year later, the advent of triple combination therapy totally changed the paradigm. People now began to witness the so-called “Lazarus effect”, named for the biblical figure who was raised from the dead, as many AIDS patients who were debilitated and dying in hospice care returned to relatively healthy and productive lives.
The next breakthrough was pre-exposure prophylaxis, “which is one of the leading discoveries that is getting us to zero”, says Sherer. “It’s the leading edge for the ‘getting to zero’ movement. It is one of the more exciting scientific discoveries of our lifetime.”
The most recent data show that in 2020, Chicago saw the fewest number of new HIV diagnoses since 1987, and declines were seen in all genders, in all age groups, and among Black, Latinx, and White populations. But as Evany Turk, who was diagnosed in 2001 at age 23, points out, getting to zero means halting new HIV acquisitions, and ending an epidemic is a whole other thing. “I don’t believe that verbiage because how will you end an epidemic if I’m still living with HIV?”, she says. “Until there’s a cure, we can’t end HIV, but until then, we can get to zero acquisition of new HIV.”
Berry also added that while it will be wonderful to get to zero, the work does not stop there. “The things that led to the AIDS epidemic, and to the stigma and structural and social barriers that had to be overcome to lead to effective treatment—those are still here”, he says. “Even if AIDS goes away, we still need to address that and make the world a better place.”
Roxanne Nelson