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World AIDS Day 2015

From law to health to advocacy to science, UNLV professors tackle HIV prevention, education and treatment both domestically and abroad.

Campus News  |  Dec 3, 2015  |  By Keyonna Summers

UNLV researchers across multiple disciplines search for ways to combat HIV/AIDS. (R. Marsh Starks/UNLV Photo Services)

Nearly 35 years after HIV, the virus that causes AIDS, was discovered, researchers at UNLV continue to forge ahead in the quest for prevention, education and a possible vaccine or cure.

UNLV is commemorating World AIDS Day this December by recognizing the efforts of professors across multiple disciplines who are investigating the disease from the smallest building blocks of human genomes to its cross-continental impact on various communities. The university also offers a state-funded dental school program that trains students and faculty to treat the HIV/AIDS patients throughout the region and a law school program that explores HIV issues surrounding disenfranchised populations including immigrants and prison detainees. 

The international theme set by the Joint United Nations Programme on HIV/AIDS (UNAIDS) for the 2011-2015 World AIDS Day campaigns is "Getting to Zero," a strategy aimed at eliminating AIDS-related deaths, stigma/discrimination and the roughly 50,000 new HIV infections diagnosed around the world each year. There were 296 new HIV cases and 202 new AIDS cases diagnosed last year in Clark County alone, according to the Southern Nevada Health District.

We caught up with five professors who have tackled the issue from different angles to get their take on the disease's evolution and what the future holds.


Global

Echezona Ezeanolue said his interest in HIV was sparked as a child in his native Nigeria: “I grew up in an area where a lot of preventable diseases weren’t being prevented. My dream was to work to prevent them in the first place.”Echezona Ezeanolue

After earning his medical degree from University of Nigeria and completing a pediatric residency at Washington, D.C.’s Howard University, he began an infectious diseases fellowship in New Jersey, which then had the largest number of women with HIV. He trained his focus on prevention of mother-to-child transmission of prenatal infections such as HIV, hepatitis and syphilis.

After a 10-year stint at the University of Nevada, Reno, Ezeanolue joined UNLV’s School of Community Health Sciences this summer as a professor of pediatrics, epidemiology and biostatistics. As founding director of the university’s interdisciplinary Global Public Health Initiative, he is in the process of establishing opportunities overseas for students to tackle research that will prevent, educate and eliminate pandemic illnesses such as HIV/AIDS, malaria, and strokes/hypertension.

Ezeanolue's most recent research includes an NIH-funded project in Nigeria that used church-run baby showers to significantly reduce cases of mother-to-child HIV transmission, similar to results he helped yield in Southern Nevada. The next phase will involve using microchip technology to make the transport of results from rural areas to hospitals easier. Yet another project will aim to develop new screenings for sickle-cell anemia.

What’s the biggest obstacle you’ve encountered in your work?

Scientists often don’t think to create programs with results that will have longevity beyond the research period, he said.

The goal of global public health is to take interventions that scientists already know work and find innovative ways to implement them in various regions based on culture and other values. “It’s not about just looking at what works," Ezeanolue said. "A lot of projects we’ve seen work, but they’re not sustainable. So, we’re working on designing projects with sustainability in mind from the outset. If we get people to start getting mammograms, how do we get them to keep going when the researchers leave?”

Common misconception about HIV?

“That people don’t want to be tested. That’s not really true. It depends on how the testing is presented to them. For example, one of the things we did in Nigeria was couple it with testing for sickle cell and hepatitis. That way, you remove the stigma that’s associated with HIV testing, which is the biggest obstacle. If you find a way to present the testing in a way that is not stigmatizing, it actually increases the chance that people will get tested and, of course, testing is the first step to any prevention.”

Do you think you’ll see a cure in your lifetime? What’s standing in the way of a cure?

“I actually believe in my professional lifetime that we’re going to see a cure. There is so much progress that has been made. There’s a better understanding of how the virus is transmitted. So I think we’re going to see a cure in one of two ways: Preventing people from getting infected in the first place, or eradicating the virus once people get infected. In the meantime, we know enough already to stop the spread of HIV as an epidemic: We need to work on interventions.”


Community

When it comes to reaching at-risk community members — be it from the halls of Nevada’s state capitol to the halls of the local church or health clinic — UNLV professors Marya Shegog and Melva Thompson-Robinson have you covered.Marya Shegog

Both have worked with minorities and youths, often together, looking for creative ways to get these populations interested in the topic of HIV/AIDS education. 

Shegog is director of health programs for The Lincy Institute, a research think tank focused on improving Nevada's health and social services. An advocate for HIV/AIDS prevention and awareness in minority communities, she has increased capacity among community-based organizations throughout the U.S. to better meet local needs and worked with lawmakers to secure better access to HIV testing. Shegog is passionate about arming populations who need it most with relevant health information. Her work has addressed the HIV risk factors to various populations including black women and college students, as well as teens.

Research specialties for Thompson-Robinson — a professor of social and behavioral health, as well as executive director of the Center for Health Disparities Research in the School of Community Health Sciences — include African-American health and sexual health. Since 2010, she has led the Southern Nevada Teen Pregnancy Prevention Project, which partners with 40 faith-based organizations to coach black youths ages 14 to 19 on health and HIV/AIDS prevention. Other work has focused on advocacy for improved health legislation and on creating community programs that creatively reach and educate minority populations in a culturally-relevant and -appropriate manner.

Common misconceptions?

SHEGOG: “From a healthcare perspective, we’re often still working from a male-centered paradigm. Everybody thinks of HIV risk factors as flu-like symptoms. That is a risk factor for men. But for women, it can be something seemingly as harmless as a recurring yeast infection. She may go to her OBGYN, but not get diagnosed with HIV until she gets flu-like symptoms, which means she has very few T-cells left. So we find women are diagnosed later and have higher mortality rates. And low-income women may not go to a doctor at all for a pesky yeast infection. Another misconception is that wearing multiple condoms reduces your risk. It increases your risk because there’s a higher chance of the condom breaking.”

THOMPSON-ROBINSON: “A lot of people argue that (former NBA player) Magic Johnson has been detrimental for the African-American community because people look at him and say ‘He’s lived this long with HIV so it must not be that bad. If Magic can live forever, so can I.’ But, what they don’t see is the flip side of all the medications he has to take and everything else he has to go through to maintain his health.”Melva Thompson-Robinson

Biggest obstacle?

THOMPSON-ROBINSON: “The stigma is really, really a huge barrier and people don’t have the skills and the knowledge needed to have those discussions. So it’s a question of ‘How do we push that envelope? How do we reach the community where they are?’ Minority populations are often the most affected and infected, but often the least receptive of resources. We’re on the brink of losing a generation of adults and, on some level, their children to this disease.”

Do you think you’ll see a cure in your lifetime? What’s standing in the way of a cure?

SHEGOG: “I certainly have hope for a cure in my lifetime, or at least a vaccine. But it’s a mutating virus. So not only can you get HIV, but if you’re being treated you can be reinfected with a different strain. Most drug treatments are designed to stop replication of the virus, but mutations make it very hard to create a vaccination. The most common prevention we hear about is abstinence, which to me will never be a solution. A big challenge for women of color is to stop thinking of HIV as a special condition. Right now it’s an opt-in test that you have to request, but you don’t have to do that for cholesterol. I think it would be beneficial if it became an opt-out test that was a routine part of well-woman visits. People would know their status.”

THOMPSON-ROBINSON: “That’s hard for me to answer coming from the preventative, rather than the clinical side. I’d say there has to be a recognition within the African-American community, in particular. But the same thing could be said for the Hispanic community. There has to be a discussion among everybody that this is a problem we need to dedicate resources to and that those resources have to be applied in a culturally competent, culturally relevant, culturally appropriate manner. When speaking of Black women and HIV, for example, realize that she’s often the backbone of her family or community. So that information you give her won’t be relevant to a gay man or a white woman in some cases. If she’s living paycheck to paycheck, she can’t sit in a 10-week intervention for two to three hours at a time. Then you factor in whether she has children, and it becomes an even bigger issue. So then how do we intervene? That’s the challenge with prevention.”


Microscopic View

UNLV life sciences professor Martin Schiller’s contribution to the fight against HIV involves taking the smallest particles of genomes and DNA and putting them under a microscope to etch out results that pack a global punch.Martin Schiller

Schiller’s journey began several years ago while working with proteins called minimotifs at the University of Connecticut. After joining UNLV, where he was eventually named executive director of the Nevada Institute for Personalized Medicine (NIPM), Schiller and his student researchers pressed on. Today, NIPM’s HIV Toolbox — a web database accessed by scientists around the world looking for information about drugs, immune responses, and how to find or bind proteins to HIV — racks up thousands of pageviews a year. Schiller is also leading research on a UNLV supercomputer program that will help scientists map out which medications will be most effective in which parts of the world by evaluating genetic makeup.

But his premier project is HT-TALENs, a protein being tested as a possible HIV cure. A patent is pending on the revolutionary gene-editing technique, which essentially uses a wheat pathogen to cut the virus out of infected persons' DNA — ridding the body of potential to develop AIDS.

Biggest hurdle you’re trying to overcome?

“Whenever you do research, you always have different obstacles. It never goes as we predict. That’s a normal part of this work.”

NIPM churns out science that impacts others' lives. Does that, in turn, personally impact the researchers?

Researchers on the HT-TALENs project included students with post-doctoral, graduate, and undergraduate status, and even some assistance by a local high school junior. The results were published in PLoS ONE, a major peer-reviewed publication that carries extreme prestige, especially for young researchers. The work so inspired one of the lead authors that he switched career paths: Former UNLV undergraduate Horacio Guerra changed majors from a pre-med track to focus on scientific research. 

Do you think you’ll see a cure in your lifetime? What’s standing in the way of a cure?

“There are two obstacles to a cure: 1) The virus becomes part of the cell, so it’s hard to get rid of it, and 2) the virus mutates and avoids treatment. But do I think I’ll see a cure in my lifetime? Absolutely.”


Big Picture

Even in retirement, School of Community Health Sciences founding dean Mary Guinan’s advocacy for education and eradication of both HIV and the stigma patients face continues.Mary Guinan

Considered a pioneer in her field, Guinan was working for the Centers for Disease Control (CDC) as a herpes virologist in 1981 when she was called on to start investigating a new sexually-transmitted disease that turned out to be HIV. She went on to lead discoveries and educational outreach about this new disease, and also make strides as the first woman to serve as chief scientific advisor to the Director of the CDC. Proceeds from Adventures of a Female Medical Detective, her memoir set to be released in March 2016, will fund scholarships for UNLV public health students. She's also slated to be featured this spring in a CNN docu-series called "Decades" about her work in the 1980s. Oh, and apparently there's a story behind her reputation for wearing fabulous hats!

Biggest hurdle for HIV researchers?

“Prevention obstacles are the worst problem we have,” Guinan said.

For example, she said, some schools and religious organizations discourage education about sex and condoms. In Africa, drug treatment, condoms and other protective measures are scarce, especially for women and children (who must wait in line behind the few men who have access). Around the globe, stigma and discrimination — which caused HIV patients to lose friends, jobs and homes as the epidemic emerged in the 1980s — remains today.

Guinan supports celebrities and other individuals who share their diagnoses. “When people reveal that they have HIV infection and say ‘this is what happened to me,’ it helps others see that it crosses racial and socioeconomic lines. That anyone can get it. That it’s important to not be discriminatory and say ‘You deserve it, you’re a bad guy’,” Guinan said. “That’s equating infection with sin. We shouldn’t be catering to that train of thought. We have to disassociate the infection from sin in people’s minds. This is a health problem, not a moral problem.”

Is there an HIV misconception you’d like to set straight?

She recalls a study about five years ago in which 11 percent of respondents believed it was possible to contract AIDS from a toilet seat. “There never has been a case of HIV infection tracked through a toilet seat. I think this ignorance about the transmission is another part of making people afraid of things they shouldn’t be afraid of. For example, people shouldn’t be afraid to work in the same place as someone with HIV. (The misinformation) brings about discrimination,” Guinan said.

Do you think you’ll see a cure in your lifetime? What’s standing in the way of a cure?

“I don’t think I’ll see a cure in my lifetime,” Guinan said. “Maybe there’ll be a vaccine, which would be wonderful. But it hasn’t come after 33 years of trying.”

But the good news, she said, is that “you don’t have to die of AIDS or HIV infection. It could just be a chronic infection throughout their lifetime. It’s thousands of dollars a year for medications and there are side effects, but at least we can bring a semblance of normalcy to people with HIV infection. Before we had nothing: People just died and suffered terribly. It’s a civil rights issue now that all of the people with HIV infection should have access to the drug and should not have to pay incredibly high prices for access. It’s clear that if we’re going to try to be serious about eliminating this disease, we have to get the treatment to all of those infected.”