The superhero named Vacuman arrived at La Cueva, a strobe-lit, subterranean gay disco in Lima, Peru, at midnight. Dressed in a white body leotard with a plunging neckline to show off his pecs, he danced his way to the stage accompanied by the Impacta Universe Boys, an entourage of buff young men in briefs and go-go boots.
It was quite the entrance, which was the point.
Vacuman is the creation of the Asociación Civil Impacta Salud y Educación, an HIV clinical research site in Lima and part of the global HIV Vaccine Trials Network based at Fred Hutchinson Cancer Research Center in Seattle. Played by an easy-on-the-eyes model, his job is to draw attention to the need for a vaccine against HIV/AIDS. And those disco patrons can help scientists develop one.
Impacta community educators and clinical trial recruiters accompanied the superhero on his monthly tour of Lima discos, bringing buckets of condoms to communities hit hardest by HIV along with information about a possible new path to a long-sought preventive vaccine.
That path is the AMP Study, for antibody mediated protection. HVTN-run clinical trials are underway in the United States, South America, Switzerland, and southern Africa to test whether an experimental antibody given by an intravenous “drip,” or infusion, can protect those who receive it from HIV infection.
The Americas portion of the study needs to enroll 2,700 gay men or transgender people who have sex with men — the groups in this region most affected by HIV. Deploying Vacuman, who has a Facebook page, an elaborate backstory and comic-book plots, is a way of cutting through the noise to recruit participants in a sprawling city of 10 million people.
If Impacta is the force behind the Vacuman campaign, the force behind Impacta is a determined leader who is a superhero in his own right. Before co-founding the research clinic in 2000, Dr. Jorge Sanchez rallied his country to fight AIDS, becoming the first openly gay man appointed by the Peruvian Ministry of Health to head its newly expanded AIDS program in 1995.
His battle against the virus had begun almost a decade before that. And decades later, he is fighting still.
“What I am always impressed with by Jorge, beyond what an incredibly good epidemiologist and thinker he is, is how committed he is to his community,” said Dr. Larry Corey, the founder and head of the HVTN. “He built Impacta — this research infrastructure, these buildings, these labs — and trained people and motivated a whole group of physicians. It is remarkably wonderful to see the influence of one man who wanted to change and shape the health of the community.”
Sanchez’s career is a history of HIV in Peru. For that matter, it is a history of the epidemic worldwide.
Like other infectious disease doctors of his generation, he remembers his first AIDS patient. It was 1986 — five years after AIDS was first identified in the United States and three years since the first case in Peru. Sanchez, then a young physician, arrived for his Sunday morning hospital shift to find that a patient thought to have AIDS had been admitted on Friday.
“No one touched him for 48 hours,” Sanchez said. “They wouldn’t walk into his room.”
In a recent interview in an Impacta office in Lima’s Barranco district, Sanchez recalled that he had headed straight to the room — and saw that the patient was someone he knew from medical school. Like Sanchez, he was gay, but neither man had been open about it as a student.
The friend was desperately ill and thin from the virus’ wasting effects. With antiretroviral treatment to contain HIV still a decade away, many who were infected delayed seeking care because they feared the very rejection that Sanchez’s friend received.
“At that time, there was much more stigma and discrimination,” Sanchez said. “Even if people knew they were positive, they didn’t go to get care until they were really, really sick at the end of the process because they were afraid of discrimination in hospitals.”
Sanchez couldn’t save his friend’s life. But he could at least offer humane care. Impelled by this encounter, he opened the first practice in Peru for HIV patients. All he could do medically for them at the time was try to treat the infections and cancers that took advantage of their ravaged immune systems and ease their suffering.
“It was so hard,” he said. “Everybody dies. It was really difficult as a physician to just say, ‘I cannot do anything for you.’ The only thing you could provide for your patients is care and love.”
At the time, of course, it meant everything. But his inability to stop or even treat the disease took a deeply personal toll. One day in 1990, he could not go on.
“A new patient came into my office, and even before talking to him, I started crying,” Sanchez said. “I just couldn’t see any more patients.”
Sanchez left Peru for Seattle to earn a master's of public health in epidemiology from the University of Washington, where he established relationships with fellow infectious disease researchers that continue to this day. In 1992, he began working as a consultant for the UW Center for AIDS and STD [sexually transmitted disease] Training, traveling to Central America and the Caribbean to provide research training to HIV programs and nongovernmental organizations.
Always when he traveled, he was homesick for Peru but could not find permanent work there, despite being one of the country’s foremost infectious disease experts.
“Basically, I didn’t get a job because the clinics believed that the waiting rooms would be full of gay people, and that would make their general population go away,” he said.
Peru eventually established a small government AIDS program. And as Sanchez’s research in that area became known, he was asked to head it. It took three offers — two of them withdrawn — before Ministry of Health officials accepted that Sanchez had no intention of hiding that he was gay and every intention of promoting condoms for prevention, neither of which went over well with the country’s Catholic hierarchy.
And so five years after leaving his clinic in despair over not being able to do enough, Sanchez was in a position to change how all HIV patients were treated.
As head of an expanded National AIDS and STD Control Program, he put hundreds of HIV prevention educators on the streets.
Cristina Magán was one of them. Now the president of Impacta’s community advisory board, she first met Sanchez when he was finishing his medical residency. She worked at a clinic that served sex workers and was concerned over high rates of HIV. When Sanchez began putting outreach programs in place, Magan volunteered to help.
“Dr. Jorge Sanchez was very proactive. He used to go with us to the field for workshops and to visit the transsexual sex workers,” she said, speaking through a translator after an advisory board meeting in Lima in December. “I most remember Dr. Sanchez doing night work, going to the streets to find the people in the community to get them to be tested and into prevention programs. … With a big budget and a whole team of people, he brought programs to the whole country.”
Remembering how his friend had been treated, Sanchez made STD clinics more welcoming to gay men by setting aside waiting rooms decorated with gay-themed posters and training gay men to work as patient advocates.
“It looked like a gay clinic inside of a Ministry of Health clinic, which was revolutionary for that time, 1995,” Sanchez said. “We had what now people call peer navigators. If a gay person was coming for an appointment, this guy accompanied him to pay his receipt, to go the pharmacy, the lab, whatever was needed.”
His staff grew to 25 people, the second largest AIDS program in South America after Brazil.
“Many of the most brilliant professionals were there,” said Maria del Rosario León, who worked for Sanchez then and now heads the Impacta Community Involvement Unit. “We had a special program for female sex workers, a special program for the gay and trans community. We were making a difference.”
AIDS had taken root during a tumultuous period for Peru. The 1980s and early 1990s brought car bombings, political murders and disappearances when the Maoist guerrilla group Sendero Luminoso, or Shining Path, waged an armed battle against the state and the army cracked down harshly in return.
Through all these upheavals, Sanchez worked to contain the AIDS epidemic. In 2000, the continuing political tumult cost him and his staff at the AIDS program their jobs. That did not stop him either.
He had earlier helped found a private, nonprofit AIDS service organization. Now he co-founded Impacta to add research to the mix.
“To have an answer to this epidemic, it’s important to have research,” said León, who followed him to Impacta. “That is how we are going to make a difference now.”
With help from Seattle colleagues — including Drs. Julie McElrath, now a Fred Hutch senior vice president and director of its Vaccine and Infectious Disease Division, and Connie Celum, a UW global health professor and co-director of its International Clinical Research Center — Impacta began as a UW subunit. Today it is independent and a vital unit of not just the HVTN but of two other global HIV networks, the HIV Prevention Network, which is co-directing the AMP Study, and the AIDS Clinical Trials Group, which focuses on treatments.
Last Dec. 1, the Impacta outreach team worked a World AIDS Day event at Plaza Mayor, the palm-treed oasis in the heart of Lima fronting its oldest cathedral (finished in 1622) and its presidential palace. Then they crawled through Lima’s infamous traffic to the Miraflores district. Just before midnight, the second part of their workday began: a private party at the Legendaris nightclub to honor AMP Study participants.
Vacuman was there, along with superheroes representing other HIV studies. An Impacta Universe boy dropped to the floor to do a few pushups before hitting the dance floor to “put happiness in the room,” as León described the go-go boys’ role, and to warm up the audience for the superheroes’ dance show. Luis “Lucho” Castro, a community educator who has been with Impacta almost since its founding, introduced the heroes and thanked the enthusiastic audience.
The HVTN sites in Peru and Brazil are responsible for roughly half the AMP Study’s targeted enrollment. Not only are the numbers challenging — 700 enrollees from Lima alone — but the “ask” is big: participants receive 10 intravenous infusions every other month, each one lasting 30 to 60 minutes.
But the potential payoff is even bigger. If antibodies are found to be protective, scientists can try to reverse-engineer a vaccine to elicit them or engineer other delivery methods to help end one of the largest and deadliest pandemics in history.
“Without volunteers,” Castro said in Spanish, “we wouldn’t have heroes.”
Castro’s cheerful emceeing belies his knowledge of the epidemic’s dark side. Like Sanchez and others who have worked in the field for decades, he has lost loved ones to AIDS. He had just found his calling as a field educator in the 1990s when a beloved friend was diagnosed, well before antiretroviral therapy became available to Peruvians in 2004. His most painful memory is of his friend’s family rejecting their dying son and brother.
Today, Castro passionately believes that information ends stigma. He honors his friend’s memory by helping people understand the need to get tested and treated in the short-term — and to get involved in scientific research to end the epidemic.
“Letting others know about research and studies is very important,” he said, speaking through a translator. “Changes in the epidemic have come about because of results of studies. And Dr. Sanchez is a leader in the scientific community for HIV in Peru.”
The changes that have taken place since the early days of AIDS were unimaginable that day, more than 30 years ago, when Sanchez recognized his old medical school friend in the emaciated face of his new patient. Still, he knows that the work is not finished. The epidemic in Lima, he said, is concentrated in gay men and transgender people who are poor and have little access to education or medical care. Those circumstances — and stigma that lingers beyond a disco’s welcoming circle — mean that people still show up at Lima hospitals as desperately ill as his friend was.
“I know we have made a lot of progress,” he said. “But the epidemic keeps growing. The volume of this epidemic will crush the budget of any country. There is no money to support forever HIV treatment. We need to go back to find the best way to prevent HIV transmission. That is the goal.”
Sanchez, who describes himself as a former partygoer turned homebody, appeared at the party that night to show his appreciation to the trial participants, though with typical modesty, he shook off Castro’s efforts to introduce him.
As Vacuman took the stage, Peru’s real HIV superhero slipped away to go home to his partner of 26 years. He would be back at work the next morning.
Editor's note: Fred Hutch News Service writer Mary Engel was in Lima and Iquitos, Peru, in December, where this story was reported. This is one of an occasional series of behind-the-scene stories on the HVTN’s AMP Study.
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Mary Engel is a former staff writer at Fred Hutchinson Cancer Center. Previously, she covered medicine and health policy for the Los Angeles Times, where she was part of a team that won a Pulitzer Prize for Public Service. She was also a fellow at the Knight Science Journalism Program at MIT. Follow her on Twitter @Engel140.