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The superheroes scurry down Castro Street, adjusting their costumes. An imposing Wonder Woman over 6 feet tall, and sporting a slight five o'clock shadow fidgets with her tissue-stuffed bustier, and settles her wig. The troupe sets up shop in front of the memorial on the corner of Castro and 18th, which marks a grim anniversary of AIDS: It has been 25 years since doctors noticed a strange pattern of illness among gay men in San Francisco. Now, after a quarter-century's agitation and activism, the city's gay men are being asked to take the next step to help end the epidemic. It's a strange sort of request, though. Will you have sex to end AIDS?
"Be a superhero and fight HIV! You can help us find a vaccine now!" proclaims silver-haired Storm, aka Jennifer Sarche, a community educator for the San Francisco Department of Public Health's HIV research section. She and her costumed colleagues have taken to the street to recruit volunteers for a study of the most promising HIV vaccine yet. Researchers are quietly excited by the product, developed by the pharmaceutical giant Merck, as it has already shown excellent results in lab and animal studies. The next step is to give the vaccine to individuals who are at risk for infection, and see if it protects them. In San Francisco, that means researchers need nonmonogamous men who have wild nights out. If they participate in the study, they'll be clubbing for a cause and having sex for science.
The pitch appeals to the purest altruistic thoughts, as volunteers get only a small stipend to cover transit costs and expenses. The participants are essentially putting their bodies on the line for the benefit of all: Even in San Francisco, where safe-sex education is ubiquitous, 10 to 15 people are still infected by HIV each week. The ads for the vaccine study that decorate buses and billboards invite men to imagine a day when they can "love without fear of infection," and ask them to help make it happen. "We don't know if this vaccine will protect anybody, and half the volunteers will be getting the placebo," Sarche says. "The people who are volunteering really are heroes."
At first glance the so-called "Step Study" seems morally questionable, as researchers will get results only if the volunteers engage in unprotected sex and put themselves at risk for infection. But Sarche explains that the Department of Public Health actively discourages volunteers from taking risks. "We ask people to decrease their risky behavior in these studies," she says. "We do risk-reduction counseling, give them condoms and lube, anything we can do. But we know, unfortunately, that counseling and condoms are not enough, and that's why we still need a vaccine." Researchers say that in past vaccine trials, participants have usually been more careful after receiving counseling. But the fact remains that 2 percent of the participants in the Step Study are expected to be infected during the four-year course of the trial.
Tai Trang is one of the 96 volunteers who has already stepped forward in San Francisco. "They were looking for high-risk people, and I guess I qualify," says the petite 42-year-old. He and his family emigrated from Vietnam in 1980, and he moved to San Francisco in 1991. He came out two years later, and admits that since then he has lived a somewhat decadent and dangerous version of the gay life. "Being a gay man in San Francisco, I have lots of sexual encounters with lots of different people, a lot of time with strangers," he says. "And sometimes, whether it's the influence of alcohol or the heat of the moment, you let your guard down and do things that you regret in the morning."
Trang says he has done volunteer work relating to AIDS for many years, and has done the 585-mile AIDS bicycle ride since 2000. When he began to see the posters around town asking for volunteers for the vaccine trial, it didn't seem like a big sacrifice. "I thought, somebody's got to do it. Why not me?" he says. He received the third and final shot a few weeks ago, and says he wonders all the time if he received the vaccine or the placebo. He can't help yearning for that extra feeling of safety like having an invisible suit of armor on but says he is motivated more by the potential benefit to the broader gay community. "I have a lot of friends living with AIDS, and you can see it, you can see people deteriorating. Even with the drug cocktail, you can see their faces change," he says. "I think the vaccine is the place to put money, because you're never going to completely stop people from taking risks. It's human nature."
Over the past decade, there have been previous bursts of hope for an HIV vaccine, and well-publicized failures. A vaccine developed by the South San Francisco company VaxGen made it all the way to a massive study involving more than 5,000 volunteers at the beginning of the millennium, and was widely touted as the best chance yet to stop the disease's spread. VaxGen's product relied on antibodies, the proteins used by the immune system to identify and neutralize free-floating viruses in the bloodstream. The hope was that the vaccine would use pieces of the HIV virus to train antibodies to recognize and mount an attack against the virus, should it enter the body. But in 2003, the disappointing results were announced: The vaccine had failed to prevent infection.
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