Answered Prayers and an HIV 'Vaccine' 40 Years Later

David Kirby, 32, who suffered complications from AIDS, is in his hour of death in April 1990. His father, Bill, cradles his head while his mother, Kay, and sister, Susan, look on, locked into their family tableau of grief. His mother, Kay, asked photojournalist, Therese Frare, who had been taking photographs at the Ohio hospice, to come into the room for his final moments. "He wanted to get the word out there about how devastating AIDS was to families and communities," said Frare, to LIFE. David had been a gay activist in California. When he learned in the late 1980s that he had contracted HIV, he asked his estranged family whether he could come home to die, and they welcomed him.

Nine months after his death, LIFE magazine published the photograph. Two years later, Benetton colorized the photo and used it as an ad in its AIDS-awareness campaign. Some saw the global fashion brand as exploitative, but David Kirby's father, Bill ,saw the ad as an opportunity for education. "Benetton is not using us, we're using Benetton," he said, according to Time (December 14, 2016).

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David Kirby's mother, Kay, holds a photograph of her son before HIV ravaged his body. Ohio photographer Art Smith took the photo. (Photo by Theresa Frare)

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My little black dress did not take me to dinners, dances or other happy social occasions when I was thirtysomething in San Francisco in the 1980s.

I wore it to funerals or, as we began calling them, celebrations of life.

The AIDS pandemic swept through the city by the bay like an out-of-control fire. It felt like the number of deaths was multiplying exponentially. The ringing of the telephone and the sound of an old friend's voice would make my breath catch in my throat. Almost inevitably, there would be news of someone else contracting HIV, someone else getting sick, someone else dying.

We became familiar with the pain, fatigue and blisters of shingles, along with the makeup that helped mask the condition, at least, for a time, until it did not matter anymore; the dry cough, fever and weight loss of pneumocystic pneumonia, and the slow wasting of the once healthy and robust bodies of our friends and acquaintances.

When would it stop?

All the beauty and the talent that we lost too soon and so suddenly wounded us. None of us, the sick and their loved ones, had yet honed the skills of a good death because we were too young. We did not possess the fortitude for death. Amazingly, many of us found the strength because we had no choice.

I feel as though I gained a reprieve of 40 years from death.

Some say that we have not addressed the psychological effects of the COVID-19 pandemic, which spread worldwide in 2020. Hell, I have not recovered from the AIDS pandemic, whose first cases were reported in 1981.

Mourning is not a set period of weeks, months or years. It washes over us in waves over time.

Compounded with grief was the fear of contracting HIV, the human immunodeficiency virus, which destroys the immune system, and of transmitting it to others. AIDS, or acquired immune deficiency syndrome, is the most advanced stage of HIV infection.

HIV is spread through contact with genitals, such as during sex without a condom, according to the Mayo Clinic. It also is spread through contact with blood, such as when people share needles or syringes. It also is possible for a woman with untreated HIV to spread the virus to a child during pregnancy, childbirth or breastfeeding.

In San Francisco, there was testing, testing, testing, and the interminable wait for our "status".

Why did my blood test HIV-negative each time? Why did I survive?

"More tears are shed over answered prayers than unanswered ones," said the mystic, St. Teresa of Avila, who wrote extensively, and Truman Capote, whose novel, Answered Prayers, takes its name from her truth.

Survivor's guilt.

Piled on top of the heaviness of mass deaths and the fear of sickness and death was the hurt and anger caused by the crisis being ignored by public health officials, laughed at by politicians, condemned by religious leaders, and patients being ostracized by stigma.

A 'Vaccine'

How we hoped for a vaccine that would obliterate the pandemic.

Over four decades, great strides have been taken in the treatment and prevention of HIV. A positive status is no longer an almost certain death sentence . . . with treatment. In the United States, treatment is available; in developing countries, not so.

Now, there is a 'vaccine' of sorts, approved by the U.S. Food and Drug Administration (FDA) last month.

Taken twice a year, the injections will prevent infection of HIV. They are an antiviral which blocks the pathways through which the virus can replicate within the body, reported Expresso (June 19).

They must be taken permanently because they are not vaccines, which cause the body to develop antibodies that fight the virus when it enters the immune system.

The drug, whose active ingredient is lenacapavir (the trade name is Yeztugo), awaits a decision from the European Medicines Agency (EMA). In February, the European agency gave the Gilead Sciences' application urgent status as it considers the product to be of great interest to public health.

The twice-yearly injection offers a more convenient alternative to the current standard of care for HIV prevention, a daily pill called Truvada, reported National Public Radio (June 18). Truvada, also manufactured by Gilead, is a brand name of emtricitabine/tenofovir disoproxil. Generic versions also are available, according to HIV gov.

Some patients face stigma taking a daily medication and, therefore, skip doses, rendering the drug less effective, reported National Public Radio. For example, researchers reported that some single women in South Africa said that taking a daily pill raised suspicion from their partners.

"The cost of the injections -- roughly $28,000 a year -- could price out many. While Gilead is taking steps to broaden access, the high price coupled with the U.S.'s steep cuts to foreign aid could prevent people in countries with the highest HIV burden from benefiting," reported National Public Radio.

The FDA's approval makes lenacapavir available today in the United States, which sees about 31,000 of the 1.3 million new HIV infections each year worldwide.

"For the moment, countries are paying approximately $40 per person per year for oral PrEP (pre-exposure prophylaxis)," said Carmen Peréz Casas, senior strategy lead at Unitaid, a global health initiative, which helps reduce the cost of treatments for HIV/AIDS, tuberculosis and malaria. "Anything that diverges drastically from that level of price will really impose a big stress on budget lines for HJV."

In principle, lenacapavir could be manufactured for even less than that, according to Andrew Hill, a pharmacology researcher at Liverpool University. He and his colleagues calculated that the drug could be mass-produced for just $25 for the two biannual doses., which includes a 30 percent profit margin.

Millions Will Die Due to Trump Cuts

If other countries follow the FDA's lead with approval, lenacapavir could become increasingly available in the coming months and years.

However, the drastic cuts of the Trump administration, in power since January, to foreign aid -- including HIV prevention -- do not bode well.

"Because of the cuts in funding, we're going to see millions of people die from HIV in the next several years, " said Andrew Hill, the pharmacology researcher at Liverpool University.