A Shoulder to CROI On
Brian Minalga, HANC Deputy Director
March 9 - 12, 2025, San Francisco, CA
I should state upfront that I don’t just work at a cancer center; I am a Cancer (the astrological kind). We Cancers, represented by the crab symbol, notoriously carry a protective shell over a capacity for emotion that is unparalleled in the zodiac. Sensitive, intuitive, and imbued with the quintessential feminine energy of the Moon, we are known to indulge in a good cry. This year’s CROI coincided with a Waxing Gibbous moon, culminating in a total lunar eclipse Blood Moon. In other words, there were tears galore at CROI 2025, and I cried my fair share. I can’t cover it all, but here’s a Cancer’s recap of what went down in San Francisco.
Let’s start with the first major applause-winning quote from the opening plenary: “We condemn the censoring of science.” These six words from CROI Conference Chair, Diane Havlir, let the audience know exactly what kind of CROI we were in for. Up until that point, we weren’t sure. I knew that federal employees who had planned to attend would be absent pursuant to federal travel bans. I had seen articles about the censorship of words like “transgender” from the conference. And I knew from my own experience that many of my colleagues were frightened to speak out and stand their ground against the virulent outbreak of anti-science hostilities. But there were the words I had been waiting for—that so many of us had been waiting for: We condemn the censoring of science. How the audience cheered! The stage had been set.
I was not prepared for the next person to take the stage: writer and activist, Rebecca Denison. She had technical difficulties, she stumbled here and there, and she went about 15 minutes over the allotted time. She was brilliant. Rebecca’s story—and the way she delivered it—spoke to every imperfect person in the room. Rebecca Denison is human. She centered humanity in her address to the CROI community—her own humanity as well as that of every person living with HIV, every doctor, every transgender person, every researcher, every person who uses drugs, every study participant, every undocumented person…she reminded all of us of the centrality of people to the work that we do. After all, the H in HIV stands for Human. I won’t do injustice to her speech by attempting to summarize it; please enjoy it for yourself. (Maybe grab a tissue first).
After a standing ovation for Rebecca Denison, I was sure I was sure my tear ducts would get a break. But then Dr. Adeeba Kamarulzaman took the stage to deliver the N’Galy-Mann Lecture, which she titled, “When Science Alone is Not Enough: The Intersection of Drug Use, Public Health, and Policy.” Dr. Kamarulzaman’s last name means, “Moon of the era.” As the Moon pulls the tides of the seas, Dr. Kamarulzaman’s emotional speech drew tears from the audience. She showed an image of her research team in Malaysia wearing masks in an outdoor area, but she was quick to note that the image was taken pre-COVID. With emotions raking her voice, she told us that the masks were to help cover the overwhelming stench of garbage in the area, which was home to countless people who had been outcast for their addiction to drugs. Once again, humanity was centered in the opening plenary of CROI 2025, as Dr. Kamarulzaman walked us through her incredible research that has helped to change harmful policies and lower HIV incidence among people who use drugs.
Before I cover my favorite moment from the conference, let’s talk science updates that caught my eye:
· Dr. Steve Shoptaw presented preliminary findings from HPTN 094, one of the few HIV clinical trials conducted to date that was designed specifically for people who inject drugs. Findings showed 70% reduction of all-cause mortality in the intervention arm, which Dr. Shoptaw noted was not a statistically significant finding, but a significant finding in the purest sense of the word.
· A new formulation of Lenacapavir for HIV prevention holds promise for a once-yearly PrEP shot.
· Lenacapavir is also being combined with broadly-neutralizing antibodies to expand options for long-acting treatment for people living with HIV.
· We’ve heard a lot about Lenacapavir’s 100% efficacy at preventing HIV for cisgender women in the PURPOSE 1 study, but new information presented at CROI suggests that F/TAF, also known as Descovy, is a viable option for oral PrEP for cis women. This oral PrEP option is currently limited to people assigned male at birth due to the exclusion of people assigned female at birth from prior studies.
· I’m now losing count of the number of people cured of HIV, which is awesome. Two new possible cures were reported at CROI.
"Let’s also normalize crying at conferences. This was only my second CROI, but I’ve always heard about its reputation for being exclusive and guarded. This year’s CROI felt more like an exhale."
Brian Minalga, HANC Deputy Director
Finally, let’s talk about the session chair who is probably looking into ways to ban me from future meetings. Dr. Tonia Poteat chaired a session titled, “Meeting the Treatment and Prevention Needs of Transgender Women.” Dr. Poteat has supported me and my community in priceless ways for many years. In this session, she uplifted the work of three researchers working with trans women in different regions of Brazil and France. On my way to the session, I passed a gorgeous flower shop on Howard Street in San Francisco. You know that phrase about “giving people their flowers”? Well, I did just that…by going to the session microphone and asking Dr. Poteat to accept some purple roses as a small token of gratitude from the community. So many conference goers approached me later and thanked me for giving Dr. Poteat her flowers, because she had also made a difference in their careers, lives, and communities. As for Dr. Poteat herself, well…let’s just say the limelight isn’t everyone’s comfort zone. But I firmly believe that the way we move forward in the HIV movement is by uplifting each other. I’ve been preaching this for a while now: we need to be more united as a field, even through disagreements. We should always be lifting each other up—never tearing each other down (that territory is well covered already). Cancel culture is over—let’s normalize expressing our gratitude for one another, taking pride in the success of others, and giving each other our flowers while we’re still around to smell them.
Let’s also normalize crying at conferences. This was only my second CROI, but I’ve always heard about its reputation for being exclusive and guarded. This year’s CROI felt more like an exhale. While so much of our future is threatened, perhaps we are beginning to unite around the work that means so much to all of us, and to see each other in our shared humanity. If you haven’t had a chance to let it out yet, find yourself a good Cancer’s shoulder, and have a good cr(oi)y.
Photos from CROI 2025