Reasons for Concern, But Also Hope, in Global Fight to End HIV
Waning international funding and social factors have slowed progress on reducing new HIV infections, but panelists at a DGHI event express optimism about new treatments.
Watch the Sept. 17 Think Global event above.
By Alicia Banks
September 20, 2024
Over the past 40 years, the effort against HIV/AIDS has achieved remarkable progress, turning a disease that was nearly always fatal into one that can be managed with treatment and prevention. Despite those strides, more than 1.3 million people are infected with HIV each year, and meeting the United Nations’ ambitious goals to end AIDS by 2030 appears out of reach
“There’s a concern the enthusiasm, donor support and engagement on HIV/AIDS is threatened,” Chris Beyrer, M.D., director of the Duke Global Health Institute, said during a Think Global panel discussion on Sept. 17. “The epidemic isn’t over.”
The event, titled “The Fight to End HIV: Are We Losing Momentum?.”, explored the challenges to continuing to bring down the number of HIV cases globally, including access to HIV prevention and treatment and the high rates of patients abandoning treatment routines that can suppress HIV loads. Beyrer, an HIV researcher who moderated the event, noted declining international funding for HIV prevention efforts and new laws in many countries that marginalize sexual and gender identities who may be at high risk of HIV infection. Panelists pointed to the uncertain future of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), which last year was reauthorized by Congress for only a single year and may face political challenges again, as one factor that could slow global efforts.
But speakers at the event also discussed the excitement over potential new HIV treatments such as lenacapavir, a drug developed by Gilead Sciences that has been shown to be highly effective at preventing HIV in two clinical trials in Africa. The drug, which can provide protection for six months with a single injection, offers significant advantages for patients in low-income countries, if it can be provided affordably, the panelists noted.
“We have the innovation, but we have to get the implementation right, focusing on structural barriers, policies, income and gender inequality,” said Jirair Ratevosian, Dr.P.H., the Hock Fellow at DGHI and former senior advisor to PEPFAR. “Progress is to be celebrated, but the next frontier will be the hardest.”
Watch the full discussion above, or scroll for highlights.
“It’s not acceptable that adolescents, young women and those becoming pregnant aren’t getting the care they need. We have to get meds to the people who need them.”
Dorothy Dow, M.D. — DGHI Associate Professor of Pediatrics and Global Health
ABOUT THE SPEAKERS
Chris Beyrer (moderator) is director of the Duke Global Health Institute and an internationally recognized epidemiologist, he’s worked on the front lines of HIV/AIDS and the COVID-19 treatment and research. His expertise has led to current roles as an advisor to PEPFAR, the World Health Organization and the Physicians for Human Rights.
Dorothy Dow, MD, is a physician-scientist whose research focuses on the prevention and treatment of HIV in pediatric populations that include prevention of mother-to-child transmission, adolescents and young adult populations. Dow co-developed Sauti ya Vijana (SYV-The Voice of Youth), a peer-led, group based mental health intervention for youth living with HIV in Tanzania.
Jirair Ratevosian, DrPH, is the inaugural Hock Fellow at DGHI, a postdoctoral position focused on HIV policy and research. He is a senior global health security and development leader with more than 20 years of experience in public service, non-profit, private sector and diplomacy. He previously served as the acting chief of staff to the U.S. Global AIDS Coordinator John Nkengasong from 2022 to 2023. .
Emily Gibbons, MPP, is the senior director of international government affairs and policy at Gilead Sciences with more than 20 years of experience in global health policymaking in the U.S. government and the private sector. As a strategic professional, her expertise centers on areas such as public health, pharmaceuticals, public affairs and NGOs.
HIGHLIGHTS
Roadblocks in HIV care
“Laws and policies continue to lead to HIV vulnerability for people who have sex with men, sex workers and transgender people. Many countries still criminalize these populations [such as] the Ugandan parliament that outlawed same sex relationships. If you’re a gay man in Kampala, you’re not going to a health center because you’re scared to talk about your sexuality and to get healthcare service. These laws [even our U.S. Supreme Court] make it complicated around the world when it comes to LGBTQ+ and women with access to healthcare.”
Jirair Ratevosian
“Although we have few infections in the U.S., it’s still a shame we have any at all. I took care of an infant at Duke that was infected about a year and a half ago, and it shows the cracks in the system. We’re not done. It’s not acceptable that adolescents, young women and those becoming pregnant aren’t getting the care they need. We have to get meds to the people who need them, and that’s everyone, but the adolescent and young adult population are key to getting this under control.”
Dorothy Dow
“The Achilles heel is that starting on PrEP and using it are two radically different things. We’ve seen this with women and girls as some don’t stay on it for longer than a month. By the end of the year, less than 10 percent are still on it. You have to be on it through your risk period in life for it to make a difference.”
Chris Beyrer
How mental health fits into HIV/AIDS care
"There’s plenty of evidence to show improving mental health can and will lead to improved HIV adherence and viral suppression. As the motto goes, ‘There is no health without mental health,’ and there’s data that brings this perspective to HIV.”
Dorothy Dow
Why implementation matters
“I think back to when I was at PEPFAR and oral PrEP rolled out. People were nervous and unfortunately, oral PrEP was marketed to sex workers and people with high risk, causing it to be stigmatizing. That impacted – for years to come – uptake. Now, oral PrEP is affordable, but adherence is really low. We got that wrong, and it’s important to get implementation right.”
Emily Gibbons
At Gilead, we’re not a ‘one size fits all,’ and people take PrEP at different cycles of their life. We’ve thought about the best way to reach people, and we know some people want to go to a place that fits their life and needs. Our plan is to be where we can be valued with this innovation [of long-acting injectables], where we can have access and finding the next partnership with that implementation.”
Emily Gibbons
Incorporating widespread licensing, and inclusion in innovations
“Gilead has built an expertise with licensing and regional diversification to not be in a scenario where people can’t benefit. There was a time when India had an export ban [during COVID-19], and that was challenging for pharmaceutical companies who worked there. We have a focus to have enough generic companies that will drive the price down and create competition, but to not disincentivize them. Gilead tries to find the sweet spot with generic companies who have longstanding relationships with the WHO, meet quality standards and expectations.”
