Scientist David Ho: The Man Who Could Beat AIDS

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by Alice Park

Dr. David Ho was sitting in the audience during an AIDS meeting in 2007 when the presenter flashed a cartoon onscreen to make a point. Along with his colleagues, Ho chuckled at the image of a blindfolded baseball player swinging mightily at an incoming pitch. But as amused as the scientists were, they were sobered too; they knew that the player in the cartoon was them. A swing and a miss, the image was saying, one of many in the long battle against AIDS.

Ho certainly got the message. For nearly a quarter of a century, he and other AIDS scientists had been whiffing repeatedly, failing to make contact as HIV stymied them again and again. Powerful drugs to foil HIV could do only so much. To corral the epidemic and truly prevent HIV, only a vaccine would do. The problem was that no vaccine strategy had ever succeeded in blocking the virus from infecting new hosts, and that wasn't likely to change in the near future. "It struck a special chord with me," says Ho of the baseball image. "I think it accurately pictured our chance of success. We all felt that frustration." (See the top 10 medical breakthroughs of 2009.)

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Since that meeting, much has changed, but the fundamental problem of developing an effective AIDS vaccine remains. On the positive side, in 2009, scientists announced that they had developed the first vaccine to show any effect against HIV infection — although that effect is, by all measures, modest. The vaccine's ability to reduce the risk of new HIV infection 31% is nowhere near the 70% to 90% that public-health experts normally view as a minimum threshold for an infectious-disease vaccine. Even further behind in development, but still promising, are two new antibodies identified by a group of researchers working at a number of labs that, at least in a dish, seem to neutralize the virus and thwart attempts to infect healthy cells.

The excitement over those advances, however, has been tempered by the still raw memories of a humbling retreat in 2007, after a highly anticipated shot against the virus was deemed a failure. While nobody expected spectacular results, neither did anyone expect such a stunning defeat, and the scientific community is still struggling to recover from it. "We are still a long ways away from having an effective HIV vaccine that physicians can reach into the cabinet and pull out in a vial and inject into a person," says Dr. Bruce Walker, an HIV expert at Harvard Medical School. (See the top 10 scientific discoveries of 2009.)

That may be true, but Ho, who has been working to develop an HIV vaccine of his own, now believes that a traditional shot, one that relies on snippets of a virus to both awaken and prod the immune system to churn out antibodies, may not be the best way to fight HIV. Rather than expecting the body to do all the work of first recognizing then mounting an attack against the virus, why not just present the body with a ready-made arsenal of antibodies that can home in on HIV? It's the immunological equivalent of a frozen dinner; the already cooked antibodies eliminate all the hard work of prepping and priming the immune system to do battle.

It's a bold strategy and one that has never been tried before in the AIDS field, but Ho is willing to stake his reputation and that of his nearly 20-year-old facility, the Aaron Diamond AIDS Research Center (ADARC) in New York City, on his hunch. So is the Bill & Melinda Gates Foundation, which has steered nearly $7 million his way to pursue the theory. Ho has redirected more than half of his lab to the project, and the results so far have reignited his passion for discovery; he's now back at the lab bench overseeing experiments.

Ho can't help breaking into a grin whenever he discusses the new project, and smiles haven't come easily to him of late. In the 1990s, he and ADARC established themselves as leaders in the AIDS field by pioneering the early use of the antiretroviral (ARV) cocktails that have reduced the death rate from AIDS (for which Ho was named TIME's Person of the Year in 1996). But in recent years, the center has suffered a series of setbacks, including a scientific paper that required a partial retraction, and the departure of key scientists. These challenges have some in the field wondering whether ADARC — and its golden-boy director — are on the verge of the next big breakthrough in AIDS or are wandering down yet another detour in the long and maddening fight against the disease.

First Responder
Whatever successes Ho does or doesn't have ahead of him, he long ago earned his credentials in the AIDS field. As a physician at the University of California, Los Angeles, in the early 1980s, he began keeping a diary of patients who were rushed to the emergency room with a mysterious amalgam of symptoms such as pneumonia, cancer and, most important, a devastating drop in immune function. After a few months, he noticed a pattern: most of the patients were gay men. Intrigued, he became nearly obsessive about chronicling the growing wave of cases. Within two years, Ho and the rest of the world would know that they were seeing the first cases of AIDS.

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Ho's preoccupation with HIV only grew as the virus continued to baffle scientists. Expecting the unexpected was the best way to confront HIV, he soon learned, and he quickly amassed an impressive array of scientific firsts in the field. As director of ADARC, which was founded in 1991 and was one of the first research centers dedicated solely to the study of AIDS, he led a team that pioneered the "hit 'em early and hit 'em hard" approach to drug therapy, now the core of the ARV-cocktail treatment that is keeping millions of HIV-positive patients alive. His lab showed how HIV therapies would be most effective in the days and weeks immediately after HIV infected a new host. That understanding came from their breakthrough finding that rather than sitting latent for years after infection, as many experts believed at the time, HIV was actively challenging the immune system from Day One. Soon after that revelation, ADARC scientists were the first to add to existing data on how HIV worked by identifying a second, key receptor that the virus uses to invade cells.

Vaccines in Vain
But while AIDS scientists began making inroads in developing drug therapies, designing a vaccine was proving nearly impossible. Despite all that they have learned about HIV, experts are still missing one essential ingredient: to this day, they do not know exactly what cells or immune responses could protect the body from HIV infection. Could an antibody that binds to and neutralizes the virus do the trick? Are T cells, specially formulated to recognize portions of HIV's surface proteins, the solution? Or, as many experts now suspect, is some elusive combination of those factors the key to outwitting HIV? (See TIME's photo-essay "Access to Life.")

Without an answer, developing vaccines is a very halting process. "The virus is a moving target," says Dr. Gary Nabel, director of the Vaccine Research Center at the National Institutes of Health (NIH). "It is constantly changing its genetic makeup through mutations. It's also a moving target because the proteins of the virus surface are actually moving themselves — they are conformationally flexible. The net result is that the immune system never gets a really good look at them."

It didn't take long before these futile efforts began to wear on the researchers in the field, not least of all those at ADARC, where Ho's group was attempting to develop its own vaccine — with little success. The center — which had earned such laurels for its ARV triumph — began to suffer a scientific slump and lack of direction, according to those who left in the early 2000s. Some blame Ho's management style, which, they say, changed in the aftermath of media attention that came with his recognition as Person of the Year. They describe a highly competitive atmosphere in which members scrambled to claim key projects and kept certain studies under wraps out of fear that colleagues would poach their ideas. Frustrated, several high-level faculty members, none of whom agreed to be quoted by name, decamped. (Watch TIME's video "New Hope for Kids with AIDS.")

"ADARC was a great experience," says one, who now heads an immunology lab at a major university. "Those were really great times, and you don't experience them often in an academic career. The structure put in place for the first few years was magnificent and very collegial. But unfortunately the happy ending didn't go forth."

The malaise at the lab, which Ho attributes to personality conflicts among the faculty, began to infect the quality of the science. In 2002, Ho generated headlines when he thought he had found the X factor made by immune cells that protected some people from developing AIDS. It turned out, however, that his conclusion was premature. Other cells had contaminated his results, and he was forced to issue a "retraction of an interpretation" of the paper describing the study. "It was an embarrassing moment for us, but we fixed it ourselves," says Ho. "It was certainly a low point in our history here."

ADARC had plenty of company. Vaccine efforts were progressing elsewhere in the AIDS community, but unevenly. Testing for one candidate, made by Merck, began in 2004 with much fanfare and ended three years later with disappointing results: not only had the vaccine not offered protection against HIV infection, but it actually seemed to increase the risk for some people. Because of the Merck results, the NIH, which had a similar vaccine in the works, put off plans for its own study.

"The year to two years after the disclosure of those results had to be among the most bleak of times for AIDS-vaccine scientists," says Nabel. "We questioned just about everything we were doing."

The Clouds Part
But by early 2007, Ho had already glimpsed the possibility of an answer. In Houston the biotech firm Tanox had developed a compound that it thought might interest him. Ho knew Tanox well. He is a friend of one of the company's co-founders and is a member of its scientific-advisory board, so if the scientists there thought they were onto something, he suspected it was worth a look.

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He flew to Houston, where he was given a briefing on a new agent called ibalizumab, an antibody that appeared able to block HIV's entry into healthy cells. In the 200 or so HIV-positive patients tested in the early trial, the compound was effective, but Tanox was worried about resistance. No matter how promising ARV drugs were, HIV inevitably found a way to evade them. So while the agent seemed to reduce the burden of virus in the blood up to 90% in patients with full-blown AIDS, no one knew how long the viral standoff would last. The company's leaders wanted Ho's opinion on whether the agent was worth developing further.

Looking at the numbers, Ho saw more than just another member of the growing arsenal of ARV cocktails. Each of the ARVs focuses on thwarting just one of several different steps in HIV's infection process. Ibalizumab works at the critical juncture where the virus meets a healthy CD4 cell — a critical component of the immune system — essentially interposing itself between the two and preventing infection. If ibalizumab was so good at tamping down HIV in AIDS patients who were already infected, then maybe it could be tweaked to prevent AIDS in the first place. In other words, maybe it could become a vaccine — just a whole different kind of vaccine that bypassed the traditional, and frustrating, process of figuring out what the immune system needs to fight HIV. (See pictures of the Red Cross.)

Ho didn't even wait to leave the meeting before phoning his lab with instructions to investigate the literature on ibalizumab. "He was so excited about it," says Yaoxing Huang, who received the call and is now one of the two researchers Ho has diverted to investigating the compound. Barely three years later, that initial enthusiasm has only grown, spreading throughout the labs that occupy two floors at ADARC's Lower East Side facility.

What the ADARC scientists are struggling to achieve is a thorough understanding of how ibalizumab operates and how they can control those machinations. The CD4 cell is a bit like an immunological sentinel, endowed with the ability to recognize snippets of various pathogens, from common influenza to HIV, and mark them for destruction by other cells. Once attached to a CD4, HIV begins an intricate series of steps to gain entry into the cell. Ibalizumab is able to disrupt this intricate molecular choreography by binding to the CD4 and serving as an immunological snare. With the antibody stuck to the CD4 receptor, the virus is physically unable to complete the necessary contortions it must perform to slide into the cell and take over its genetic machinery to pump out more virus.

That's the beautifully elegant scenario that attracted Ho to the antibody, but the problem is that tying up CD4 this way may not be such a good idea. Taking so many of the body's essential defense cells out of commission means the patient may be left vulnerable to any number of other infectious agents — exactly the immunocompromised position that AIDS patients are trying to avoid. That was the fear that Ho's lab members expressed when he broached the idea.

"My initial reaction was, Are you crazy?" recalls Sandy Vasan, a researcher at ADARC who, along with Ho and Huang, is now heading the ibalizumab studies. A clinician who sees patients, Vasan says, "It's really scary to want to put an antibody on CD4. You need CD4." (See "The Year in Health 2009: From A to Z.")

But Ho believes ibalizumab is more agile than that. CD4, it turns out, is like a marina with several docks; HIV berths in one, and ibalizumab in another, leaving the cell free to fight other pathogens. "If CD4's binding site to HIV is with its nose, then this antibody is binding to the back of CD4's neck," Ho says. That means the cell's ability to function as a pathogen troller is not impaired by being coupled to ibalizumab. "There is a solid scientific rationale for what they are attempting to do," says Harvard's Walker.

The lab is now working with monkeys to test whether ibalizumab can head off infection not just with the notoriously weaker lab strains of HIV but also but with naturally circulating strains as well. The idea is to hit the antibody with the most potent HIV around, so if the strategy doesn't work, Ho can shut down the project, before it gets too far along.

Ho is hoping it won't come to that. He is not under any illusion that a successful antibody-based treatment will have the sweeping effect of the polio or measles or smallpox vaccines — essentially wiping out the diseases in treated populations. Instead, an ibalizumab-based therapy will be just one of many weapons against HIV, albeit a very powerful one. "At our first meeting on this, I said I have a strategy that I feel will work," Ho recalls. "It was truly my gut feeling."

It takes more than instinct to make good science, of course, and Ho is keenly aware of that. But like a talented batter, he's hoping that a combination of intuition and technical skill will guide him to make contact. A solid hit would be nice — but Ho is still trying for a home run.

'It doesn't seem right' - washingtonpost.com

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A group plagued by service, cost complaints is awarded $4.5 million. How?

By Debbie Cenziper
Monday, October 19, 2009

Alexander Harrington walked into the house "where miracles happen every day" with a single suitcase and $3 to his name, fresh out of prison and determined not to spend another day doped up in dark alleyways.

At 59, he had been living with HIV for more than a decade. Now, he was four years sober with grandchildren he wanted to see. While visiting a local medical clinic, he had heard about a house of second chances, part of a District-funded AIDS nonprofit group called Miracle Hands Community Development Corp., that provided emergency housing, counseling, job training and help with finding a permanent place to live.

Harrington moved into the house in Northeast Washington in April.

In a bedroom with filthy floors that he shared with three other men, he waited for counseling and job training. He waited for a chance to learn where he might go once his limited stay at the house had ended.

After a few weeks, he caught a bus to the D.C. Health Department's HIV/AIDS Administration to seek services there. He was told he'd get a call back and waited some more.

Then, on a Friday afternoon in May, as men lounged around the steamy house and a single supervisor sat in the dining room, Harrington struggled with the news that it was time to go. He said he left Miracle Hands without job training or a lead on permanent housing.

"It doesn't seem right," he said, packing his suitcase for the streets.

In a city fighting to control a devastating AIDS epidemic, Miracle Hands promised to reach into the poorest pockets of the District, offering a lifeline in African American neighborhoods long overlooked by established AIDS groups.

But the nonprofit group, which became one of the most heavily funded AIDS organizations in the city, has been racked by complaints from city monitors, former clients and other AIDS groups about a lack of services and supplies, missing records and questionable expenses, The Washington Post found.

Twice, monitors suggested the city withhold money to the group. But former HIV/AIDS Administration housing chief Debra Rowe continued to provide steady support to Miracle Hands, which over five years was awarded about $4.5 million, much of it from Rowe's department.

Included was $420,000 in housing funds for a highly anticipated job training center that more than three years later has yet to open. Meanwhile, more than 400 people with HIV or AIDS are on a years-long waiting list for supportive housing.

"It was not a wise decision," HIV/AIDS Administration spokesman Michael Kharfen said of funding the renovation.

The story of Miracle Hands shows how start-up nonprofit groups that pledged to help the sick in a city with the nation's highest AIDS rate were able to draw millions from a D.C. agency that time and again failed to ensure its money was well spent. From 2004 to 2008, the HIV/AIDS Administration -- entrusted with spending the city's AIDS dollars -- paid more than $25 million to groups marked by financial problems or questions about the quality of care and services, including Miracle Hands.

Miracle Hands officials defend their programs, saying they are properly staffed and equipped and especially needed in the District's poorest neighborhoods.

From its headquarters in a 14,000-square-foot warehouse on Queens Chapel Road NE and rental houses throughout the city, Miracle Hands said it has provided support groups, housing and a day treatment center offering showers, meals and therapy. Group officials said that they offer support to housing clients but that the services are optional.

Miracle Hands' executive director is 52-year-old Cornell Jones, who once ran a massive cocaine ring on the streets of Northeast. Arrested in the 1980s, he served time in prison and emerged to start Miracle Hands in the late 1990s to help ex-offenders, the homeless and troubled children. He had business ventures as well: Next door to Miracle Hands, Jones opened a popular nightclub called D.C. Tunnel.

"This deadly disease . . . is not a gay, white Dupont Circle disease anymore. . . . The [city] didn't have a clue how to attack that population," Jones said. "We came in with some new ideas . . . and try to give these clients everything that they need."

Jones and Rowe said they have a long-standing professional relationship. Like Jones, Rowe had overcome a drug past, serving time in prison for heroin and cocaine charges before building a career focused on people with AIDS.

One Miracle Hands supervisor said Rowe visited frequently and would help Jones with paperwork.

"She did a lot of work for Miracle Hands," supervisor James Lynch-Bey said.

But Jones said Rowe did not favor his group, noting that Miracle Hands applied for funding through a competitive process. City officials, however, said department heads such as Rowe supervise the selection process, weigh in on how grants are awarded and monitor the money.

Rowe also had a personal connection to Miracle Hands: Three of her family members and a friend were hired by Jones.

Rowe, 50, said she never benefited personally from Miracle Hands and did not provide favored treatment to any group. She said she did the best she could under difficult circumstances, taking over a housing department that funded and monitored many struggling nonprofit groups.

"It was a mess," she said. "Everybody said that Debra Rowe was the one that can fix it."

When asked by The Post about Miracle Hands' performance, Rowe said that the HIV/AIDS Administration's "records speak for themselves" and that if she had found "serious discrepancies" she would have stepped in.

She acknowledged that her 28-year-old son was hired by Jones to work as a Miracle Hands housing staffer and that her father and uncle worked parking lot duty at D.C. Tunnel.

Rowe said she saw no conflict. She said she did not realize her father and uncle worked there until she visited the club. Her son, she said, took the job in 2003, when Rowe was a public health adviser at the HIV/AIDS Administration but a year before she had taken over as housing chief. One Miracle Hands roster showed Rowe's son's salary was $29,120.

Rowe also said she had referred her friend Danette Williams to Miracle Hands when Williams needed a job. Jones hired Williams as the Miracle Hands program director in 2004; she is now the deputy director.

In December 2006, the FBI launched a probe into the District's AIDS funding, Rowe's connections and others involved in funding decisions, seizing files from Miracle Hands and Rowe. Rowe and her attorney said the case was recently closed.

FBI Supervisory Special Agent Darlene G. Hoyns, however, said the case remains active.

Williams said Miracle Hands has recently received praise from the HIV/AIDS Administration, citing high marks on a capacity assessment, which considered such criteria as experience and the completion of invoices.

City officials, however, say the assessment does not measure the quality of services or a program's overall success.

Despite the FBI investigation and complaints about services, the HIV/AIDS Administration continued to provide grant money to Miracle Hands, with more than $700,000 awarded this year. Kharfen said recent site visits for the group have not identified deficiencies, although the city no longer funds the group's long-term housing and day programs.

"It shows you how embedded the culture is here," said Ron Harris, a local AIDS case manager. "It's that Debra Rowe mind-set: Everybody gets paid."

'That's my people'

Rowe said she had met Jones years ago while trying to encourage young people to get tested for HIV. She said she would often recruit at D.C. Tunnel, where she liked to watch go-go guitarist Chuck Brown play.

Rowe and Jones had both come a long way.

Jones was once a drug kingpin with international ties. A police search of his home when he was arrested for drug distribution in 1985 found $870,000 in cash, plus jewelry, furs, 28 airline tickets to Las Vegas, five guns, cocaine, a currency-counting machine and a drug identification kit.

He was paroled in 1995 after serving nine years of a 27-year sentence. Three years later, Jones opened Miracle Hands to take in people from the streets.

"That's my people. That's who I knew all my life," Jones said. "I was a fairly decent criminal. I thought I could be a fairly decent manager . . . for that population as well."

Jones based the operation in the warehouse, part of a complex of buildings in an industrial park in Northeast that was purchased through a limited liability company, managed by Jones, for $1.4 million in 2002.

Rowe had rebuilt her life as well, completing a master's degree in human services after serving 15 months in prison on drug charges. In 1999, seven years out of prison, she took a job at the HIV/AIDS Administration.

Miracle Hands started receiving money shortly before Rowe was promoted to interim housing director in late 2004. The $10 million-a-year program is funded by the U.S. Department of Housing and Urban Development.

Monitors quickly began to note problems, with one writing that Miracle Hands' invoices were "routinely late and lack[ed] requisite documentation." Jones wasn't meeting monitors for site visits at Miracle Hands and had skipped training sessions at the HIV/AIDS Administration, records show.

Williams said Jones opted to skip meetings early on because he worried that his criminal past would taint the organization.

"He realized that due to his history, many would perceive Miracle Hands as being a 'rogue' organization," Williams said.

HIV/AIDS Administration monitors also found that insurance information, spending plans, and employee résumés and contracts were missing.

Still, Jerry Brown, a friend and colleague of Rowe's at the HIV/AIDS Administration, noted improvements and recommended future partnerships with Miracle Hands.

In mid-2005, a monitor noted that Miracle Hands had billed the city for "questionable" jobs. Among the payments: $9,000 for an unnamed computer specialist and $3,600 for an unnamed mental health professional, with the monitor writing, "Who/Where/Agency?"

Williams told The Post that the issues pointed out by monitors were "small."

For part of its tenure, Miracle Hands also lacked a basic requirement for doing business in the District: a license.

Monitors repeatedly asked Miracle Hands about the license and other required documentation, records show. Monitor Rony Mohram wrote directly to Rowe and others in August 2005: "Since we are precluded from continuing to fund out of compliance vendors, please advise me on what to do in regards with this matter."

Monitor Jonathan Alston responded: "We should withhold payment of any outstanding invoices until they comply. That's my suggestion."

By then, Rowe had risen to interim housing chief at the agency. She defended Miracle Hands, responding in an e-mail that the group had been seeking a license for eight months. Rowe forwarded a letter that she had received from Williams. The two women had met years earlier when they worked with another AIDS group, the Abundant Life Clinic.

Williams appealed to Rowe in a letter about the licensing delay, writing, "Your consideration and understanding in this matter is greatly appreciated."

The matter was dropped, records show. Miracle Hands received a business license in mid-2005, more than two years after the group started receiving grants. Rowe told The Post that licensing in the city can be long and tedious.

"There are other groups that didn't have it," she said.

Years later, Miracle Hands' records continue to show lapses: The nonprofit group has never filed a federal tax return, IRS records show. Williams said the recent returns could not be filed because records had been seized by the FBI.

'Out of proportion'

Some reports have praised Miracle Hands for well-kept houses and a strong management team.

One monitor once wrote, "My recommendation for this provider is to continue to do great work for the community." A quality-assurance consultant noted the group's managers had "compassion, dedication and cultural proficiency."

Time and again, however, Miracle Hands was criticized for inconsistencies in record-keeping, billing and client care.

An independent audit for 2005 by an outside firm found that Miracle Hands had made only one payment to an employee that year and owed nearly $60,000 in outstanding salaries.

Williams said employees weren't always paid on time because of delays in processing invoices at the city.

In 2006, monitors found more problems, noting that Miracle Hands again had not turned in paperwork required to do business with the city, such as proof of liability insurance. Monitors continued to call on Miracle Hands for missing audits, client reports and budgets.

The same year, HIV/AIDS Administration official Gunther Freehill e-mailed Rowe about a Miracle Hands job-readiness program, saying: "They have billed a total of about $6,600 for the first four months of their grant and have reported nothing more than that they are preparing curriculum. The costs are a little out of proportion."

There were other problems at a day program run by Miracle Hands out of a ramshackle house in Southeast. In May 2006, a housing case manager documented dirty and dangerous conditions: peeling wallpaper, soiled carpets, an uneven stairwell and no fire escape. The report was forwarded to Rowe.

Staffers at other AIDS groups also noticed the conditions.

"The house was in terrible shape," said Priscilla Norris, head nurse at the Northwest AIDS hospice Joseph's House, who visited the day program about two years ago. "There was no day treatment. It was just a place to go and watch TV."

One afternoon in the spring, The Post found men sitting side by side in the living room watching TV. The house was hot, with the windows held open by books. The ceilings had holes, and the floor was lopsided. The only place for napping was a closet with a ripped cot. The upstairs meeting room had no books, no pencils, no computers, no paper.

When The Post made an arranged visit last month, a card table was set up in the living room. Seven men were talking to case manager Willie Cheeks.

As Jones and Williams looked on, Cheeks said, "In order to be competitive out there, you have to have a skill."

One of the men responded, "In the institution, I had heard that this program was very instrumental."

Jones said that in the past, the HIV/AIDS Administration provided little money for his group's day program. Still, he said, clients are offered hot meals and therapy. Williams added that computers and supplies are stored to prevent theft and that the cot is offered only if a client is not feeling well. She also said that the house has new carpeting, a new stove and a restored front porch and that other repairs have been made.

Besides its day program, Miracle Hands says it offers job training in its warehouse, a squat, rundown building with worn carpeting and a vast room in the back. One day in the spring, The Post found that the only person there was the group's finance manager, Malik Savage. There was one sheet of drywall, a couple piles of wood on the floor and a single computer in the back, which Savage said was once used to teach telecommunications. Donated computers were piled one on top of the other in a storage room.

Williams said they had not been set up because they were missing hard drives.

A budget from a 2007 grant shows that Miracle Hands proposed charging $60,000 for use of the warehouse for job training. But the budget included only $1,000 for supplies associated with the training courses, such as drywall, metal studs, screw guns, tape and wiring.

Williams said the contractors who teach the classes bring supplies.

Harris, the local AIDS case manager, said he has repeatedly tried to refer clients to the Miracle Hands job-training programs but was never able to reach anyone.

"It was a brick wall," he said. "I never heard of anyone who did job training there."

Williams said the job programs were "comprehensive." Miracle Hands officials said there will always be some disgruntled clients.

"Miracle Hands is a good organization, committed and steadfast to its mission to help those in need," Williams said.

Former Miracle Hands client Michael Tyree also cited a lack of supplies in the group's housing program, where he stayed for two months in 2007. Sick with AIDS and throat cancer, he said he often couldn't find food and slept on beds without sheets or blankets.

"The whole house was completely dirty. They didn't feed you at all," Tyree said. "To me, Miracle Hands was just about the money. They say they were helping people, but they weren't."

Tyree now lives at the nonprofit Joseph's House. He has his own room in the basement with pictures of his nieces on the wall.

Sitting on his bed one spring morning, bundled in a red bathrobe, he said, "This feels like my home."

'The darndest places'

While Jones was operating Miracle Hands, he was struggling to keep his nightclub afloat.

City dispatchers had received 77 calls for service to D.C. Tunnel between 2006 and 2008 after reports of assaults, theft, disorderly conduct and destruction of property. The club was the site of two shootings within 90 days last year.

D.C. Police Chief Cathy L. Lanier requested at the time that the city revoke the club's alcohol license. Jones and his partners agreed to sell the club, pay a $10,000 fine and not apply for a liquor license for four years.

Jones said he saw nothing wrong with running a nightclub next to a program that is supposed to help people with HIV, many of whom are recovering addicts.

"The club was there first," Jones said, adding that it did not open until 10 p.m., after the AIDS program had closed. "The club only opened after the sun goes down. That's when the party comes out."

Said Rowe, "People start [AIDS groups] in the darndest places."

Under Rowe's tenure, the Miracle Hands warehouse next to the nightclub got a big boost from the city:

In 2005, she moved to give Miracle Hands $335,000 to renovate the warehouse, which was supposed to create a state-of-the-art job-training center.

"I had the vision for a job-training center for people living with HIV/AIDS," Rowe told The Post.

Before the grant was approved, however, Health Department supervisor Charles Nichols urged Rowe in an e-mail to justify the money because it was to be given to Miracle Hands without competitive bidding.

"The sole-source justification to allow Miracle Hands to receive these funds must address . . . why we should renovate a building for them. . . . I prefer you issue a competitive [request] so that we can make sure we are getting the best value for our resources," Nichols wrote.

HIV/AIDS Administration officials say Nichols eventually called off the noncompetitive deal.

In 2006, through a competitive process, Miracle Hands was awarded $279,000 for the renovation from Rowe's department. Miracle Hands was the only bidder, Rowe said.

Rowe also signed off on an $84,000 advance on the grant money, records show, in part so Miracle Hands could hire a general contractor for the renovation.

Yet no work was being done. Month after month, monitors noted the lack of progress, with monitor Sheree Avent writing in November 2006, "This issue has been brought to the attention of . . . Debra Rowe." Avent later followed up in an e-mail to Rowe: "Construction has not begun. . . . It is my recommendation that . . . [funding] levels need to be modified."

Grants supervisor Carine Mathurin followed up, e-mailing Rowe: "Shouldn't we de-obligate some of this money?"

Rowe e-mailed back: "No, the funds should not be de-obligated . . . [the Housing program] is well aware of the start-up issues in reference to this grant . . . [the Housing program] is fine with this."

In late 2006, Jones submitted a $494,000 estimate for the renovation work from El Cos. of Chantilly. But the address on the estimate does not exist, according to the U.S. Postal Service. The company has no phone listing in the District or Virginia.

The contact on the estimate was Edward Hunter, who is the stepbrother of Savage, the Miracle Hands finance manager, records and interviews show.

Williams said Miracle Hands solicited quotes from other contractors. She could not provide any of the proposals, saying the paperwork was seized by the FBI.

She said Hunter has construction experience and noted that the company has a trade name registration in the District. His estimate, Williams said, was far below those provided by other companies.

Edward Hunter said his business is a sole proprietorship and has not done any work in the District or Virginia. He said he does not recall how he heard that Miracle Hands was looking for a contractor.

"I was trying to get my business off the ground. . . . I figured I'd get lucky and get an opportunity," Hunter said.

As for the problems with his company's address on the estimate, he said that his wife rented space at a real estate office on the street he had listed and that it is possible numbers were transposed.

In March 2007, Rowe's department issued a second grant for the renovation, this time for $140,000, bringing the city's total investment over two years to $420,000.

Two months later, Avent, the monitor, wrote that the location for the project had changed.

Instead of renovating the Miracle Hands warehouse, work would be done at another warehouse owned by Jones two doors down, on the far side of the nightclub. Avent said she had requested a new work plan and time frame for completion of the project.

She also noted renovations at the new location were lagging, writing, "The rehabilitation work was a few weeks behind schedule and should be completed by August."

Through last year, however, monitors continued to document delays at the new site. A report issued by Miracle Hands last October said the project was scheduled to be completed within two months.

The facility has still not opened -- more than three years after the renovation money was first awarded. Williams said Miracle Hands ran out of money and needs $300,000 more. She added that much of the project has been done, including architectural plans and work on windows, walls and plumbing.

"What we have to do is nickel-and-dime it," she said.

Neither Miracle Hands nor the city could provide invoices or receipts to account for the $420,000. Kharfen, the HIV/AIDS Administration spokesman, said the agency has no plans to provide more money for the project, adding that the city's housing dollars must be invested in housing.

Rowe said Miracle Hands continues to work to complete the project.

"It was a lot of people's dreams," she said.

In April 2008, Rowe was removed from her $97,000-a-year job as the AIDS housing chief and subsequently left city government.

She is now an administrator with a new nonprofit group for ex-offenders, Returning Citizens United.

Jones is a founding member.

"Where else would I turn except to still work on behalf of that marginalized population?" Rowe said.

Staff researcher Meg Smith contributed to this report.

Thailand wins praise for AIDS vaccine trial - Reuters

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Mon Sep 28, 2009 5:53am EDT

By Tan Ee Lyn and Martin Petty

HONG KONG/BANGKOK, Sept 28 (Reuters) - An experimental AIDS vaccine that appears to be the first to protect people was mired for years in controversy, and credit for its success must go to Thailand where the trial was conducted, experts said.

The trial was criticised five years ago by 22 prominent U.S. scientists who doubted it would have any effect. Washington was accused of wasting more than a $100 million by funding it.

But Thai health authorities and their U.S. partners at the National Institutes of Health and the Walter Reed Army Institute of Research pressed on with the trial involving 16,000 volunteers in a country at the forefront of the battle against HIV.

"It was a tough decision. I am glad we made it," said Dr. Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases, who defied the criticism and continued the trial.

The trial vaccine was made using two failed products -- Sanofi-Pasteur's (SASY.PA: Quote, Profile, Research, Stock Buzz) ALVAC canary pox/HIV vaccine and AIDSVAX, made by a San Francisco company called VaxGen and now owned by the non-profit Global Solutions for Infectious Disease.

Donald Burke, dean of the University of Pittsburgh's Graduate School of Public Health, said the trial was controversial from the start and had been dismissed by prominent U.S. scientists because of the failure of previous vaccine tests.

"But given the importance of the AIDS epidemic, the decision was made to go forward regardless of these criticisms. It was a difficult choice, but a courageous choice," said Burke, who was head of AIDS research at Walter Reed before retiring in 1997.

Burke isolated the AIDS virus taken from a young HIV-infected Thai soldier in 1989 after Thai army doctors discovered an HIV outbreak among young recruits in Chiang Mai in northern Thailand. That virus sample went on to become one of the seed viruses in the experimental vaccine, Burke said.

"To their credit the Thais did a remarkable job on this," Dr. Eric Schoomaker, the Surgeon General of the U.S. Army, told reporters. "They did remarkable job of recruiting volunteers and conducting this trial almost flawlessly."

The $105 million trial was sponsored and paid for by the U.S. government and results showed it cut the risk of infection by 31.2 percent among 16,402 volunteers over three years.

THAI TRIUMPH

Those results mark a triumph for Thailand, a country of 67 million people where a booming sex industry had stoked fears of a major epidemic. Local authorities battled hard against a disease that threatened to spiral out of control some 20 years ago.

Experts had predicted that 4 million people would be infected by 2000 if nothing was done to slow the spread of HIV. But a massive government-led Aids education and prevention campaign in the early 1990s had an enormous effect.

HIV prevalence among injecting drug users in Thailand was as high as 30-50 percent in 1991, and 33.2 percent among female sex workers in 1994, according to UNAIDS. The number of infections has since been reduced to 20,000 annually from 140,000 in 1991.

Billboards and airwaves were bombarded with safe sex messages while health workers promoted condom use in the country's notorious sex trade. Leading the campaign was "Mr Condom", family planner-turned Public Health Minister, Meechai Viravaidya.

Health check-ups were made available to sex workers for free. Men were discouraged from visiting prostitutes and condom usage in Bangkok's brothels rose from 15 percent in the early 1990s to 98 percent by 2000.

Infection rates fell and the exercise remains widely cited as a model in disease prevention among health experts -- although numbers have shown signs of creeping up in the last few years among some high risk groups, such as gay and bisexual men.

Today, about 610,000 people in Thailand are now living with AIDS, according to UNAIDS.

"We are still strengthening a very strong platform," said Punnee Pitisuttithum, head of the HIV/AIDS research unit at Bangkok's Mahidol University, which has been involved in vaccine trials since 1994. "Before this trial, we had many disappointments but with this result, we see some light at the end of the tunnel." (Additional reporting Maggie Fox in Washington; Editing by Jason Szep)

In Africa, Courts Shape Views on AIDS - washingtonpost.com

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By Karin Brulliard
Washington Post Foreign Service
Saturday, September 12, 2009

LIVINGSTONE, Zambia -- As African countries still struggle to control the deadly AIDS epidemic, they are also grappling with debates over what rights and duties to give those living with the disease -- a growing segment of the population that remains largely hidden.

Across the continent, lawmakers are considering whether to make criminals of those who infect others with HIV, allow bosses to test workers for the virus, punish women who pass it to their babies and give constitutional protections to those with HIV.

Such questions are increasingly landing in courtrooms, presenting judges with cases that mix current science, individual rights and a devastating public health crisis. One, involving two Zambia air force members who say they were unfairly discharged because they have HIV, goes to trial here next month.

Similar questions are raised worldwide, but nowhere do they carry more weight than in a region where as many as one in five adults has HIV and in an era in which anti-retroviral drugs are keeping more people alive. Laws crafted to deal with such a vast constituency, experts say, could help curb the epidemic -- or deepen a stigma that fuels its spread.

"HIV is a systemic issue in southern Africa. It's a huge social problem, and it inevitably becomes a legal one," said Adila Hassim, head of litigation at the AIDS Law Project in Johannesburg. "There's so many ways people with HIV are affected that it does require a whole set of rules."

But those rules are hotly debated. The United Nations and most health and human rights organizations back policies that emphasize rights for people with HIV, an approach that has generally been favored by officials in African nations, at least a dozen of which have passed or are considering HIV-specific legislation. But those officials also face pressure to protect the uninfected.

Laws criminalizing the transmission of HIV have been adopted from western to southern Africa, for example, with backing from some women's groups despite human rights advocates' contention that they deepen stigma. In Botswana, protests by activists have failed to stop employers from testing and excluding infected job applicants. A recent proposal in Rwanda would require HIV tests for many -- an idea supported by observers who say that relying on people to seek testing "can deprive other people of their right to life," as one University of Pretoria researcher wrote in South Africa's Star newspaper.

"It's a very tricky situation, a catch-22," said the attorney general of the island nation of Mauritius, Jayarama Valayden, who successfully lobbied against a proposed HIV criminalization law that had popular support. African nations passing such laws, he said, are "reacting to public opinion."

In some places with unsettled HIV policies, African courts are weighing in, sometimes guided by colonial-era constitutions that never accounted for a large class of people with a deadly infectious disease.

The case of the Zambian airmen, lawyers involved say, could help answer contentious questions in a nation where 15 percent of adults have HIV: Is discrimination on the basis of HIV status unconstitutional? Can the military test recruits or members for HIV and ban those who are positive?

"There are those who feel it's the fault of a person who gets HIV to suffer the consequences . . . others say the best way to deal with HIV is to adopt a human rights approach," said Paul Mulenga, the airmen's attorney. "Zambian society is split."

The two men, Stainley Kingaipe and Charles Chookole, joined the Zambian air force in 1991 and began as members of the band. Kingaipe, 40, eventually transferred to the mechanical fleet, while Chookole, 41, became an academy instructor and armory guard.

Over the next decade, both men said, air force doctors treated them -- Kingaipe for a swollen leg; Chookole for leg pain, a fungal infection and tuberculosis. The men said they and a group of other airmen were summoned in 2001 for a medical checkup where, for the first time, their blood was drawn.

Days later, Kingaipe and Chookole said, doctors instructed them to take three white pills twice a day but did not say what they were for. A year later, they were told they were permanently and medically unfit for service and discharged -- though both felt healthy and said they had been fulfilling their duties as normal. Chookole, in fact, had been promoted to sergeant two months earlier.

"I was confused," recalled Chookole, who said that his boyhood dream was to join the military and that he has been unable to find work since. "Somebody is telling you you are unfit. But I was dressed in full uniform. I did not come before them on a stretcher."

Upon their discharge, the two men said that they discovered the pills were anti-retroviral drugs to treat HIV -- and that they were HIV-positive.

They want their jobs back and have filed a lawsuit alleging that they were subjected to HIV testing without their knowledge, violating their rights to privacy and protection from inhumane and degrading treatment, and unfairly dismissed.

A military spokesman did not respond to requests for comment, and a Zambian air force lawyer reached by telephone would say only that Kingaipe and Chookole's case is "nonsense." In court filings, the Zambian government said the men were not tested for HIV and were discharged because Kingaipe had Karposi's sarcoma, largely an AIDS-related form of cancer, and Chookole had tuberculosis.

At the time of their discharge, the Zambian military had no policy on HIV. In 2003, it announced a draft policy banning HIV-positive recruits, which one military official called necessary because "defense is not kindergarten or Red Cross. We need people who are fit." The policy, finalized last year, does not allow the military to discharge those who contract the virus after recruitment.

Some Western militaries, including that of the United States, bar potential recruits who are HIV-positive. But the topic of HIV and the military has generated more debate in Africa, where strapped governments offer infrequent medical care. A 2004 study of Zambia's 22,000-member military found a 29 percent prevalence rate, according to a U.S. Defense Department report.

Those kinds of figures have stirred concerns that the virus is weakening African militaries, and that HIV-positive peacekeepers on the continent might fall ill or spread the virus while deployed, either through wounds or sexual activity -- a particularly sensitive subject given accusations of rape that have long plagued U.N. peacekeeping forces.

"My taxpayer money is paying for the defense force, which is supposed to be providing security. That's also a right," said Lindy Heinecken, a military sociologist at the University of Stellenbosch in South Africa. "The military is a unique organization . . . the circumstances that you are asking them to live and work in are different to going to a factory."

Activists say those arguments are outdated, given the advent of anti-retroviral drugs that can keep people with HIV healthy, and only fuel stigma. Militaries, they say, should not ban all HIV-positive soldiers but should assess fitness for duty through general health exams. That is also the view of the United Nations, which does not require HIV testing for peacekeepers.

"In this society, unless you want to go and look for people from Sweden for your armed forces, you're not going to get away from HIV," said Hassim of the AIDS Law Project. "You must have a nuanced policy."

That view has been backed by recent court rulings in Namibia and South Africa, which found blanket bans unconstitutional. Mulenga said the case of Kingaipe and Chookole could pave the way for a similar challenge to the Zambian military's ban on HIV-positive recruits.

But that would require excluded recruits to come forward, and in a society in which HIV is still considered shameful, he said, few are as brave as Kingaipe and Chookole.

Indeed, the two men said neighbors and acquaintances sometimes whisper that their HIV status makes them "already dead," as Kingaipe put it. He thinks the air force also thought as much.

"Maybe they thought because of my status, I was also hopeless," said Kingaipe, who now works as a security guard, earning half as much as he did in the military. "It's not true."

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Cambodia: ‘AIDS Colony’ Violates Rights

July 28, 2009

The Cambodian government should urgently address dangerous conditions in a de facto AIDS colony it has created and immediately stop sending HIV-affected families there, more than 100 international HIV/AIDS and social justice organizations and experts said in a joint letter delivered on July 27, 2009 to Cambodia's prime minister and health minister.

In June 2009, the Cambodian government forcibly relocated 20 HIV-affected families living in Borei Keila, a housing development in Phnom Penh, to substandard housing at Tuol Sambo, a remote site 25 kilometers from the city. Another 20 families were moved there on July 23. The families were resettled into crude, green metal sheds that are baking hot in the daytime and lack running water and adequate sanitation. Just meters away, higher-quality brick housing is being built, with the assistance of a nonprofit group, for other homeless families slated for resettlement at Tuol Sambo. Even before the HIV-affected families were resettled at the site, local people referred to the green sheds as "the AIDS village."

"By bundling people living with HIV together into second-rate housing, far from medical facilities, support services, and jobs, the government has created a de facto AIDS colony," said Shiba Phurailatpam of the Asia-Pacific Network of People Living with HIV/AIDS. "It's hard to understand how a government that has received international recognition for its HIV-prevention efforts could so callously ignore the basic rights of people living with HIV."

Dozens of organizations and individuals based in the Asia-Pacific region signed the letter, joined by groups and individuals from many nations, ranging from Canada and the United States to India and Tanzania.

The letter stresses that conditions at Tuol Sambo do not meet minimum international standards for even temporary emergency housing. The shelters are flanked by open sewers, with only one public well for all of the relocated families. They are crowded into the poorly ventilated metal sheds, where the afternoon heat is so intense they often cannot remain in their rooms, and they fear their antiretroviral (ARV) medication will deteriorate.

"The housing conditions in Tuol Sambo pose serious health risks for families living there," said Rebecca Schleifer, health and human rights advocate at Human Rights Watch. "People living with HIV have compromised immune systems and are especially vulnerable. For them, these substandard conditions can mean a death sentence or a ticket to a hospital."

The organizations also expressed deep concern about discrimination against HIV-affected families in the screening and allocation process for on-site replacement housing being built at Borei Keila. After two years of denying eligibility to HIV-affected families for this housing, the authorities have now said that at least 11 HIV-affected families previously slated to be sent to Tuol Sambo are in fact eligible. Those families remain at Borei Keila, but are still waiting for the housing they have been promised.

Increasing property values in Cambodia's capital city have left thousands of urban poor people vulnerable to forced evictions to make way for commercial development. The development of the Borei Keila site was approved in 2003 with the understanding that the developer would build new housing on site for those displaced by the project. With few exceptions, however, the HIV-affected families thus far displaced have not even been screened for eligibility for this housing.

When living at Borei Keila, these people worked as day laborers, motorcycle taxi drivers, cleaners, and seamstresses. Now, most have no prospects of work at or near Tuol Sambo. Their economic situation is worsened by the fact that a return trip to Phnom Penh to go to work or to visit hospitals costs the equivalent of about US$5 - for families who earn only $1.50 to $3 a day.

"The Cambodian government needs to establish a fair and open process for all to receive the housing and services they need," said Kevin Moody of The Global Network of People living with HIV (GNP+). "People living with HIV - like all others - need adequate living conditions that do not threaten their health and a way to earn a livelihood, so that they can provide for themselves and their families. Grouping families affected by HIV in this way exposes them to further stigma and discrimination; steps must be taken to end this discrimination now."

The groups called on the Cambodian government to:

• Cease moving HIV-affected families to the Tuol Sambo site;
• Improve conditions at Tuol Sambo to meet minimum standards for adequate shelter, sanitation, and clean water;
• Ensure full access to quality medical services, including antiretroviral treatment, treatment of opportunistic infections, primary health care and home-based care;
• Work with relevant agencies and consult with the families already at Tuol Sambo to address immediate and long-term concerns regarding housing, health, safety, and employment, and reintegration into society in a manner that protects their rights and livelihoods; and
• Employ a transparent and fair screening process to determine eligibility for on-site housing at Borei Keila, and allow eligible families to move in immediately (including the 11 HIV-affected families already approved). For those found ineligible, authorities should provide other adequate housing.

"Living with HIV with dignity means more than just ARVs," said Aditi Sharma of the International Treatment Preparedness Coalition. "It means these families should have a healthy environment with adequate nutrition, proper sanitation and a continuum of care that addresses the social, psychological, legal, and economic consequences of living with HIV."