This is a training on the research and development pipeline for new HIV prevention technologies - including PrEP, microbicides, and new male and female condoms. It was conducted by AIDS Foundation of Chicago's Jim Pickett on Thursday, October 9, 2014 in Chicago, Illinois. These slides have been revised and updated from the same training conducted in Bloomington, IL on Sept 29.

1. WELCOME
OCTOBER 9, 2014
CHICAGO – JOHN MARSHALL LAW SCHOOL
Exploring the Pipeline

2. PROJECT READY, SET, PREP – PLUS
EXPLORING
THE PIPELINE

3. 3

4. PRE-TEST
LET’S SEE WHAT WE KNOW
4

5. ARV-Based Prevention Pipeline (March 2014)
PRE-CLINICAL PHASE I PHASE II PHASE III PHASE IV
Pop Council
IPM
IPCP NIAID
Pop Council
R
IPM CONRAD IPM Gilead
CONRA
D
Albert Einstein
GSK CONRAD
IPM
CONRAD
Janssen
TaiMe
d
Pop Council
HPTN/ACT
G
IPM
IPM
IPM
IPM
PBS
IPM
R
IPM
R
Pop Council
RTI
Pop Council
Mintaka
ImQuest
ImQuest
DELIVERY SYSTEM
Oral pills
Vaginal gel
Vaginal film
Vaginal
tablet
Vaginal
ring
Long
acting
injectable
Thin film
polymer
Phosphate Nano-fiber
buffered
saline
PBS
R
Rectal gel
IPM
IPM
IPM
IPM
TFV/
FTC
TDF
/FT
C
MIV
150
TMC
278
MVA
DAR Darunavir
GRF
TFV
TDF
DAP
IQP IQP-0528
744
Tenofovir
Tenofovir
disoproxil
fumarate
MIV 150
Maraviroc MAb
GSK 744
Tenofovir
disoproxil
fumarate/emtricita
bine
Dapivirine
Ripilvirine
Monoclonal
antibody
Tenofovir/
emtricitabine
Griffithsin
DS00
3
DS003
(BMS793)
No drug tested
currently
5P1
2
5P12-
RANTES
TFV Tenofovir
prodrug
ACTIVE DRUG
RAL Raltegrav
ir
CDC
CONRAD
Adapted from AVAC Report 2013: Research & Reality.

10. 10

11. 11

12. OUR AGENDA
 Quick review treatment, PEP, PrEP
 Video: The Rectal Revolution is Here:
An introduction to rectal microbicide
clinical trials
 Microbicide research
 Rectal products
 Vaginal products
12

13. OUR AGENDA
 New PrEP
 New dosing strategies
 New oral drugs
 Long acting injectables
 New male and female
(receptive) condoms
 Multipurpose Technologies
 Interesting formulations
 Implementation
13

14. OUR AGENDA
 Pre/post test
 Evaluations
 Certificates of completion
 These slides are online at
www.myprepexperience.org

15. 15
Unrestricted
educational
grant from
Janssen
Therapeutics to
AFC
- 2014
Learn about
research &
development
of new
prevention
technologies

16. EXPECTATIONS AND DISCLAIMERS
16

17. THE ONLY
DUMB QUESTION
IS THE ONE YOU
DIDN’T ASK
17

18. 18
Discussion
Learning
The only
“dumb”
question is
the one you
didn’t ask
OUR TIME
TOGETHER

19. 19
>>> WHY IS THIS RELEVANT TO ME?

20. TREATMENT, PEP, PREP
REVIEW
20

21. PREVENTION REVOLUTION
SEISMIC CHANGES
21

22. HOW DOES HIV TREATMENT ACT AS PREVENTION?
22

23. 2011: TREATMENT IS
PREVENTION TOO
23

24. 24

25. 25

26. WHAT IS POST-EXPOSURE PROPHYLAXIS (PEP)?
26

27. WHAT IS PRE-EXPOSURE PROPHYLAXIS (PREP)?
27

28. 2010: PREP WORKS!
28

29. tinyurl.com/CDCprepguidelines
29
2014: Clinical Guidelines

30. Condomless is not “unprotected”
30
2014: Language Matters

31. THE DEVIL IS IN THE DETAILS
PREP ACCESS
31

32. ACCESSING PREP
Any medical provider who can write a
scrip can write one for Truvada as PrEP
Most HIV docs familiar with PrEP
Chicago:
 Research (Project PrEPare)
 UC and ACCESS Grand Blvd
 Howard Brown Health Center
 CORE Center – clinic coming soon
 Chicago PrEP Working Group
32

34. PREP WARM LINE
34
Just launched!
PrEPline, 855-448-7737
The CCC Pre-Exposure Prophylaxis Service
11 a.m. – 6 p.m. EST
http://nccc.ucsf.edu/2014/09/29/introducing-the-ccc-prepline/

35. HANDY BROCHURE!
35
Designed to help individuals talk to
their doctors about PrEP
Before, during, after visit
Questions to ask
Web resources
tinyurl.com/talkPrEPtoDr

36. ACCESSING PREP— INSURANCE
FDA approval of
Truvada enables
private ins to cover
Truvada
on
Medicaid
formulary
Ins companies
covering, so far
ADAP
does not
cover
PrEP
36

37. Insurance
Medicaid
Devil in the details
• Prior auth
• Deductibles
• Co-pays
• Tiers
• Confusion
37
ACCESSING PREP— INSURANCE

38. Gilead
support
programs
Medication
Assistance
Program
500% FPL
Co-pay
program
$300/mo.
38
NEWLY IMPROVED – OCTOBER 15, 2014

39. PREP UTILIZATION
39
A total of 2,319 unique individuals who started
TVD for PrEP between 01 Jan 2012 and 30 Sep
2013 were included in the analysis.
• 48.8% of PrEP users were women.
• Mean age was 38.2 ± 12.2 years
• Males were significantly older (39.5 ±
12.0) than females (36.8 ± 12.3).
p<0.0001
• 12.3% of individuals were under 25 years old.
• The proportion of males under 25 was
8.0% (95% CI 6.5 – 9.5) significantly lower
than that of women 16.8% (95% CI 14.6 –
19.0). p<0.0001
Overall distribution of TVD for PrEP
prescriptions by prescriber specialty:
• Family Practice (18%)
• Internal Medicine (16%)
• Infectious Diseases (11%)
• Nurse Practitioners (9%)
• Physician Assistants (9%)
WY
CO
ND
SD MI
OK AR
 Uninfected individuals receiving TVD for PrEP were:
DE
– 1.8 times more likely to be female (95% CI 1.6 – 1.9)
– 1.4 times more likely to be younger than 25 years old (95% CI
1.3 – 1.7)
MA
– 3.6 times more likely to be treated by a non-ID physician (95%
CI 3.2 – 4.1).
WA
OR
CA
NV
ID
UT
AZ
MT
NM
NE
KS
WI
MN
IA
MO
IL IN OH
KY
ME
NH
VT
RI
NY
CT
NJ
PA NY
C,
LI
A
K
TX
LA
AL GA
SC
NC
WV
MD
MS
TN
VA
FL
Midwest
16%
Northeast
25%
South
32%
West
27%
Prescribers of TVD for PrEP are located in 49 of the 50 U.S. states
Overall Midwest Northeast South West
Unique PrEP users n
(%)
2,319*
373
(16%)
570 (25%)
729
(32%)
604
(27%)
Mean age in years
(SD)
38 (12) 37 (12) 37 (12) 40 (12) 38 (12)
Younger <25 y/o 12.3% 16.4% 12.3% 9.7% 12.4%
Female 48.8% 53.6% 51.4% 51.4% 39.2%
Medicaid 9.9% 15.3% 15.3% 6.6% 5.1%

40. Chicago PrEP
Working
Group
Researchers
Medical
providers
HIV planning
members
Advocates
CBOs
40

41. TAKING PREP IS
THOUGHTFUL
RESPONSIBLE
CAREFUL
41
AWARE
PRO-ACTIVE
DISCIPLINED

42. TAKING PREP IS
SAFER SEX
42

43. 43

44. INVESTMENT
NEEDED
INFRASTRUCTURE
TRAINING
SOCIAL MARKETING
HEALTH CARE ACCESS
BEST PRACTICES
POLICY/ADVOCACY
FEDERAL
STATE
LOCAL
PUBLIC
PRIVATE
44

45. MORE DATA, MORE ENERGY AND
MORE RESOURCES
45
WOMEN
TRANSGENDER
WOMEN AND MEN

46. 46

47. VIDEO
THE RECTAL REVOLUTION IS HERE
AN INTRODUCTION TO RECTAL MICROBICIDE CLINICAL TRIALS
47

48. 48
tinyurl.com/RectalRevEnglish
tinyurl.com/RectalRevSpanish
youtube.com/IRMAadvocacy

49. 49
rectalmicrobicides.org

50. SHOWTIME…
50

51. DISCUSSION
51

52. BREAK TIME
52

53. www.hivresourcetracking.org

54. www.hivresourcetracking.org

55. STAGES OF CLINICAL TRIALS
55
Graphic courtesy International Partnership for Microbicides

56. PERSPECTIVE
56
Of 10,000 compounds that get
tested in the lab, 5 make it to
human trials and 1 makes it to
market.

57. THE PREVENTION PACKAGE
57
 Condoms – male and female
 Condom-compatible lubricant
 Information/education
 Counseling/risk reduction
 HIV testing
 STI testing/treatment
 HEP A and B vaccinations

58.  A PRODUCT APPLIED TOPICALLY IN THE VAGINA OR THE
RECTUM THAT CAN OFFER PROTECTION AGAINST HIV AND,
IDEALLY, OTHER STIs
 IDEALLY WOULD HAVE A CONTRACEPTIVE VERSION, AND
ANOTHER TO ALLOW FOR PREGNANCY – ARV/NON-ARV
 FORMULATED AS A GEL/LUBRICANT, FILM, FIBER, VAGINAL
RING
 A RECTAL MICROBICIDE MIGHT BE DELIVERED VIA
GEL/LUBRICANT, DOUCHE/ENEMA, OR …
 MICROBICIDES ARE STILL IN DEVELOPMENT
 THEY ARE NOT AVAILABLE YET!
58
MICROBICIDES

59. RECTAL GELS
MICROBICIDES
59

60. An act of unprotected anal
intercourse is 10 to 20 times more
likely to result in HIV transmission
compared to an act of
unprotected vaginal intercourse.

62. 62

63. MTN 017
RECTAL GEL
A Phase 2 Randomized Sequence
Open Label Expanded Safety and
Acceptability Study of Oral
Emtricitabine/Tenofovir Disoproxil
Fumarate Tablet and Rectally-Applied
Tenofovir Reduced-Glycerin 1% Gel

64. N = 192
RECTAL GEL
[Sept ’13 – June ‘16 ]
Participants
Gay/MSM,
transgender
women
Study sites
• US (4)
• Thailand (2)
• RSA (1)
• Peru (1)

65. 017 IN BRIEF
Study regimens include:
RECTAL GEL
• Rectal tenofovir gel used daily
• Rectal tenofovir gel used before and after sex
• Truvada tablets taken daily
Each participant will follow all of the study regimens for
eight weeks, with a weeklong break between regimens
when no product will be used
• The order in which participants follow study regimens will be based on
random assignment
All participants receive standard HIV prevention package

66. Product
Sequence
N Period 1
(8 weeks)
Product Break
(1 week)
017 STUDY DESIGN
Period 2
(8 weeks)
Product
Break
(1 week)
Period 3
(8 weeks)
1 31 Daily Truvada
Daily rectal gel
Rectal gel before and
after sex
2 31 Rectal gel before and
after sex Daily Truvada Daily rectal gel
3 31
Daily rectal gel
Rectal gel before and
after sex Daily Truvada
4 31
Daily rectal gel Daily Truvada
Rectal gel before and
after sex
5 31
Daily Truvada
Rectal gel before and
after sex Daily rectal gel
6 31 Rectal gel before and
after sex Daily Rectal gel Daily Truvada
Slide courtesy of Dr. Ross D. Cranston, 017 Principal Investigator
RECTAL GEL

67. 017 ADHERENCE
PK monitoring, “real time” PK
RECTAL GEL
Layered approach to monitoring
•SMS (text messages)
• Product returns
• CASI (computer assisted self interview)

68. RECTAL GEL

69. RECTAL GEL

70. RECTAL GEL

71. RECTAL GEL

72. 72

73. RECTAL GELS
 Combination HIV Antiretroviral Rectal
Microbicide Program (CHARM)
 Phase I
 Maraviroc gel
 Microbicide Trials Network
 Phase I – in development
 Dapivirine gel

74. 74

76. 76

77. VAGINAL GELS AND RINGS
MICROBICIDES
77

78. South Africa -
2 sites in
KwaZulu-Natal
Phase IIB - 889
HIV- women,
18 – 40
Enrolled May
2007 – Jan.
2009
Vaginally
formulated
tenofovir gel
Results July
20, 2010 –
AIDS 2010

79. CAPRISA 008
 Implementation study
underway
 HIV-negative CAPRISA 004
participants
 Effectiveness/sustainability
in rural and urban clinics
 Oct ‘12 – Mar ’15
VOICE [MTN]
 Phase 2B, randomized, double-blind,
placebo-controlled, 5-arm
trial
 5029 women in trial – Uganda,
S. Africa, Zimbabwe
 Studied daily use of following :
 Vaginal tenofovir 1% gel
 Oral tenofovir
 Oral Truvada
 Results announced March 2013
79
VAGINAL GELS

80. 80
VAGINAL GELS

81. VOICE
C, D
Why women didn’t take study product
Asked participants, partners, community members
• Lack of social support
• Hearing that other women were not using
product
• Ambivalence about not knowing if placebo or
active drug
• Concerns about side effects, lack of side effects
• Stigma of using drug used by PLWHIV

82. VAGINAL GELS
Phase III trial of tenofovir gel
BAT24 dosing – hope to confirm
CAPRISA 004
2600 women, age 18-30, South Africa,
10 sites
Oct 2011 ~ late 2014
Results 2015

83. VAGINAL GELS
Courtesy of FACTS 001

84. 84
Courtesy of FACTS 001

85. 85
VAGINAL GELS
Courtesy of FACTS 001

86. 86
VAGINAL GELS
Courtesy of FACTS 001

87. 87
VAGINAL GELS
Courtesy of FACTS 001

88. VAGINAL RINGS
MICROBICIDES
88

89. VAGINAL RINGS
Monthly vaginal ring with Dapivirine
The Ring Study/IPM 023
• Phase III
• 1650 women
• South Africa, Rwanda
• Apr 2012 ~ mid 2015
ASPIRE/MTN 027
• Phase III
• 3500 women
• Malawi, SA, Uganda, Zambia,
Zimbabwe
• July 2012 ~ end 2014
Slide courtesy AVAC
TWO TRIALS

90. WHY AFRICA?
90

91. www.hivresourcetracking.org

92. FILMS AND FIBERS
MICROBICIDES
92

93.  International Partnership for Microbicides
 Early preclinical
 Maraviroc/tenofovir film
 Dapivirine/maraviroc film
 Phase I
 Dapivirine film
93
VAGINAL FILMS

94. 94
VAGINAL NANOFIBERS
PSEUDO TAMPON

95.  Weave maraviroc into water-soluble nano fibers
 200 times thinner than strand of human hair
 After insertion into vagina, fibers can dissolve
and release an effective dose in about 6 min
 Intercourse could further disperse drug
throughout the vagina
95
VAGINAL NANOFIBERS
VIA UNIVERSITY OF WASHINGTON

96. 96

97. 97

98. BREAK TIME
98

99. DOSING
PREP
99

100. Alternative Dosing to Augment
Pre-Exposure Prophylaxis Pill Taking
540 HIV-negative volunteers, randomized to 3 arms
Gay men, transgender women, cisgender women
Bangkok, Cape Town, New York City
Began late 2011, ongoing
100
INTERMITTENT PREP

101. 101
INTERMITTENT PREP
Intervention Préventive de l'Exposition aux Risques avec et pour les
hommes Gays
Action to Prevent Risk Exposure By and For Gay Men
Randomized, placebo controlled, pilot study to assess adherence and
feasibility.
France Jan ‘12, Quebec July ’13
Gay men, Canada (50) and France (300) – haven’t used condoms for
anal w/at least 2 partners in past 6 mos
Controversial study design
AIDS 2014 – good adherence (CASI, pill counts, plasma, hair)

102. 102
INTERMITTENT PREP
Regimen = Two Truvada 2 to 24 hours before sex, one tablet
within 24 hours after sex, and another tablet within 48 hours
after sex.

103. ORAL
PREP
103

104. 104
ORAL MARAVIROC
Phase II safety and tolerability study – June ‘12 – July ‘15
600 HIV-negative individuals – women and gay men
All U.S. sites
Comparing 4 regimens
• Maraviroc
• Maraviroc + Emtricitabine (FTC)
• Maraviroc + Tenofovir (TDF)
• Truvada (TDF +FTC)

105. LONG ACTING INJECTABLES
PREP
105

106. 106
Graphic courtesy AVAC
LONG ACTING INJECTABLES

107. 107
LONG ACTING INJECTABLES

108. 108

109. MALE AND FEMALE (RECEPTIVE)
NEW CONDOMS
109

110. www.hivresourcetracking.org

111. The Woman’s Condom
• Polyurethane with dissolving capsule
applicator
• Held in place by foam shapes
• Trials demonstrate safe, acceptable, and easy
to use, and has comparable functionality to
FC2
• Additional studies, including contraceptive
efficacy, are in process
• Received CE marking
• Commercially available in China and South
Africa
FEMALE CONDOMS

112. • Cupid
 Latex, inner sponge that aids insertion
 Outer ring helps keep it in place during sex
 Available in India, Brazil, Indonesia, The Netherlands, South
Africa, Mozambique, and Kyrgyz Republic
 Pre-qualified by WHO/UNFPA, enabling bulk procurement
 Safe, acceptable, and comparable functionality to FC2
 CE marking
• Cupid 2
 Same construction, thinner sponge
 Under evaluation for functionality
FEMALE CONDOMS

113. • Panty Condom
• Polyethylene sheath pre-lubricated w/
Vaseline
• Limited distribution in Colombia, under
review for WHO pre-qualification
• Phoenurse
• Polyurethane, silicone lubricated
• Insertion tool
• Limited availability in China & Brazil, under
review for WHO pre-qualification
FEMALE CONDOMS

114. FEMALE CONDOMS
• Origami
• Silicone, accordion-like folding
• Assessed acceptability and performance with 20 HIV-negative
hetero San Fran couples

115. ANAL CONDOM
 Origami
BOOTY SPECIFIC
 First condom designed specifically for receptive anal sex
 Silicone
 Fenway conducting Phase 1 safety trials with gay men

116. 116
GATES FOUNDATION CONDOM CHALLENGE

117. 117
GATES FOUNDATION CONDOM CHALLENGE
The common analogy is that wearing a
condom is like taking a shower with a
raincoat on. A redesigned condom that
overcomes inconvenience, fumbling, or
perceived loss of pleasure would be a
powerful weapon in the fight against
poverty.
– Dr. Papa Salif Sow, senior program
officer, Gates Foundation

118. CONCEPTS IN DEVELOPMENT
• Air-Infused Female Condom
• Uses air pressure to insert
• Polyurethane
• Female Pleasure Condom
• Elliptical opening
• Ribbed exterior
• Pleasure focus
• Non-Gender Specific Internal Silicone Condom
• Refining silicone Origami condoms
• Intended for both vaginal and anal
intercourse
118
GATES FOUNDATION CONDOM CHALLENGE

119. COMBINATION PRODUCTS
MULTIPURPOSE
TECHNOLOGIES
(MPTS)
119

120. 120

121. 121
Graphic courtesy AVAC
MPTS

122. MPTS
122
Graphic courtesy AVAC

123. IMPLEMENTATION
123

124. DBS TFV-DP levels at Week 4, by study site
5.4
10.8
27
60
50
40
30
20
10
Miami
DC
SF
60% (557/922) of potentially eligible
participants enrolled, indicating strong
interest in PrEP use
Patients were more likely to enroll if they:
• Had prior PrEP awareness
• Were at higher risk (2-5 or >5 episodes
of anal sex with HIV+ partner in the last
12 months)
98% (n=136) of those with drug levels at
Week 4 had TFV-DP detected
• Most participants (77%) had TFV-DP
level consistent with taking ≥4
doses/week
Interest in FTC/TDF for PrEP and adherence as measured by drug levels
were high in this demonstration research project
43.2
13.6
2 2
18.4
42.9
34.7
0
4 4
40
52
0
BLQ <250 250-550 >550-950 >950
(<2 doses/wk) (2 doses/wk) (4 doses/wk) (daily dosing)
Samples, %
DBS TFV-DP level, in fmol/punch (estimated dosing)
PrEP Demonstration Project
PREP IMPLEMENTATION IN STD CLINICS:
HIGH UPTAKE AND DRUG DETECTION AMONG MSM
48-week, open-label PrEP demonstration project in MSM and transgender women
in San Francisco, Miami and Washington, DC (N=557); Sept 2012 – Jan 2014
Cohen S, et al, CROI 2014; Boston. # 954
IMPLEMENTATION

125. U.S. CITIES INVOLVED IN DEMONSTRATION PROJECTS
San Francisco (2)
Boston (2)
Miami
D.C.
Chicago (2)
Los Angeles (2)
San Diego
Rochester
NYC (2)
Oakland
Birmingham
Orlando
Philadelphia (2)
Memphis
Nashville
New Orleans
Houston(2)
Detroit
Baltimore
Aurora
* NYC = Manhattan, Harlem, Bronx and Brooklyn
Chapel Hill
Jackson
Providence
Newark
Seattle (2)
Cleveland
Atlanta
Dallas
Tampa
Bethesda
Annandale
UPDATED
Demonstration and Implementation projects have a
planned enrollment of approximately 8,000 participants.
125
IMPLEMENTATION

126. SELECTED POST-APPROVAL DEMO/IMPLEMENTATION PROJECTS

127. 127
WE’RE IN THE
HOME STRETCH

128. CHICAGO
IMPLEMENTATION
128

129. 129
SHIPP [SUSTAINABLE HEALTH CENTER
IMPLEMENTATION PREP PILOT]
 June 1. 2014
 Implementation project examining PrEP use in
primary care settings in Chicago, Newark, Houston,
and Philadelphia
 Serves women and men
 Access Grand Boulevard Specialty Clinic
 5401 South Wentworth Avenue
PS-PREP
 Jan 1, 2015
 Randomized clinical trial of
PrEP linkage program by DIS
staff, UC and CDPH
CHICAG0 IMPLEMENTATION

130. 130
PROJECT PREPARE II
CHICAG0 IMPLEMENTATION
 Open label demo project AND safety study of PrEP in
young gay/MSM ages 15-22
 Actively enrolling 300 youth in 13 US sites, Chicago
 Evaluating:
 Safety of PrEP use among young HIV-neg gay/MSM
 Acceptability, patterns of use, adherence
 Risk patterns
 Texting to encourage adherence
 Demographic and/or behavioral difs among youth
 Interested in PrEP study
 Who stays on PrEP

131. 131
CHICAG0 IMPLEMENTATION
HOWARD BROWN HEALTH CENTER
 Evaluating PrEP in community
health center setting
 Collects info on why patient AND
provider are considering PrEP
 Data quality can be monitored by
visit types, provider, and testing
location
 Process enabling improved
communication and tracking of
those interested in PrEP, on PrEP,
discontinuing PrEPages 15-22

132. 132

133. MAPPING PATHWAYS
IMPLEMENTATION
133

134. Published 1 April, 2014
mappingpathways.org

135. What is most striking is
that [the] future is not
driven by the science, it
is driven by communities
and the needs of
implementation.

136. 136
>>> HOW CAN I MAKE THIS
RELEVANT TO THOSE I SERVE?

137. 137

138.  INTERNATIONAL RECTAL MICROBICIDE ADVOCATES
ADVOCACY
 rectalmicrobicides.org
 MAPPING PATHWAYS
 mappingpathways.org
 MY PREP EXPERIENCE
 myprepexperience.org
 CHICAGO FEMALE CONDOM COALITION
 chicagofemalecondom.org
 AVAC – GLOBAL ADVOCACY FOR HIV PREVENTION
 avac.org
 PREP WATCH
 prepwatch.org

139. POST-TEST
LET’S SEE IF WE KNOW A LITTLE MORE
139

140.  ACCESS Grand Boulevard
 Aidsmap
 AVAC – Global Advocacy for HIV Prevention
 CORE Center
 FACTS
 HIV Prevention Trials Network
 HIV & Microbicides Resource Tracking
Working Group
 Howard Brown Health Center
 International Partnership for Microbicides
 Jessica Terlikowski/AFC
 Microbicide Trials Network
 Population Council
 Treatment Action Group
 University of Chicago
140
ACKNOWLEDGMENTS
Thank you

141. THANK YOU
141

142. CONTACT
JPICKETT@AIDSCHICAGO.ORG