AIDS' Existential Moment

In this episode, CSIS Senior Associate Jeffrey L. Sturchio speaks with Matt Kavanagh, Deputy Executive Director for Policy, Advocacy, and Knowledge at UNAIDS, where he is responsible for the organization’s work to advance policy, law and political change to end the AIDS pandemic. Matt begins by noting some of the recent advances in the science of HIV prevention and treatment (such as new tools for long-acting HIV prophylaxis), which are causes for optimism in the global response to the HIV pandemic. At the same time, there are worrying trends in new HIV infections due in part to the impact of COVID-19 and economic crises on country investments in HIV programs. Despite these challenges, some countries are still making encouraging progress in fighting HIV/AIDS. As Kavanagh observes, “science doesn’t implement itself,” and we need to look to politics and the enabling policy environment to understand why some countries are doing better than others at addressing HIV/AIDS. Countries as diverse as Botswana, Nigeria, and Thailand have responded effectively: by comparing their approaches, we find that a combination of political leadership, partnerships, community engagement, structural interventions, and changes in law and policy help to explain their success.  Another important factor in understanding success in addressing HIV/AIDS is the role of vibrant civil society and strong community response to the epidemic. Matt also discusses the importance of ending inequalities to end the AIDS epidemic: we need to know where the gaps in coverage are – by geography, income level, or key populations – and tailor interventions that work to close the gaps.  Matt concludes by calling for more investment in global public goods, not only to sustain the AIDS response, but also to be better prepared for future global pandemics.    Matthew M. Kavanagh has worked internationally for more than 20 years at the intersection of global health, politics and law and comes to UNAIDS on secondment from Georgetown University, where he holds faculty appointments in international health and law and is a director at the O’Neill Institute for National & Global Health Law.

In this crossover episode with Pandemic Planet, recorded during the International AIDS Conference in Montreal, Canada, on July 30th, Jeff Sturchio speaks with Dr. Mark Feinberg, president and CEO of the International AIDS Vaccine Initiative (IAVI).  In this interview, Dr. Feinberg addresses the continued progress in HIV prevention and treatment seen in recent years and outlines the challenges still faced in translating this progress into meaningful impact on the lives of people affected by HIV/AIDs. Turning the tide against HIV will require a decline in new infections, which highlights the need for an effective HIV vaccine. Dr. Feinberg discusses the exciting and fascinating progress being made in research on broadly neutralizing antibodies and how the lessons learned from failed vaccine efficacy trials have informed new approaches that have considerable promise for enhancing understanding of how to design effective HIV vaccines. He also explains clearly and compellingly some of the basic biology that makes HIV such a wily and difficult adversary due to its genetic diversity compared to such other pathogens as Ebola and SARS-COV-2. New tools in such areas as mRNA delivery and computational biology are being brought to bear in the search for an HIV vaccine. Dr. Feinberg concludes by expressing his hope that the scientific challenges of HIV will continue to attract the next generation of creative young scientists.  Mark Feinberg leads a global team at IAVI working to advance the development of vaccines and other biomedical innovations to protect against infection with HIV, TB, and other infectious diseases that have a disproportionate impact on low-income countries. Prior to joining IAVI in late 2015, Feinberg served as chief public health and science officer with Merck Vaccines. Dr. Feinberg holds an M.D. and a Ph.D. from Stanford University, and a B.A. degree from the University of Pennsylvania.

In this crossover episode with Pandemic Planet, recorded during the International AIDS Conference in Montreal, Canada, on July 30th, Jeff Sturchio speaks with Solange Baptiste, Executive Director of the International Treatment Preparedness Coalition (ITPC). This is one in a series of podcasts in which we explore what needs to be done to end the AIDS pandemic, both globally and domestically.     In this wide-ranging interview, Ms. Baptiste addresses the issues that are still creating barriers to equitable access to HIV treatment around the world. She contrasts the excitement at new developments like long-acting prevention tools with the persistent challenge of inequities in HIV care and treatment, especially in middle-income countries. She speaks eloquently of access as a human right and the importance of educating and empowering affected communities to take the lead in creating new solutions. Ms. Baptiste makes a strong case that the world won’t achieve access for all unless we tackle structural barriers and power imbalances – and redesign systems to address the needs of people living with or at risk of HIV infection.      Solange Baptiste assumed her current role as Executive Director of ITPC in 2016. She leads community activists and allies across the globe to deliver ITPC’s mission to enable people in need to gain access to optimal and affordable HIV treatment through treatment education, demand creation, community-based monitoring, and interventions to make medicines more affordable. She earned her Bachelor of Science in Biology from Tuskegee University and her Master of Science in Population and International Health from the Harvard School of Public Health. Solange is committed to ensuring that the voice of affected communities contributes to and influences the decisions and policies that affect their lives.

In this crossover episode with Pandemic Planet, recorded during the International AIDS Conference in Montreal, Katherine speaks with Phelister Abdalla, of KESWA, the Kenya Sex Work Association, and Ruth Morgan Thomas, of the Global Network of Sex Work Projects (NSPW), about the intersection of sex work, HIV/AIDS, and the Covid-19 pandemic. Phelister and Ruth argue that sex workers’ livelihoods have been uniquely disrupted by recurring curfews and lockdowns, noting that this often-stigmatized community has not benefitted from the social protection programs many countries established to support workers in the formal sector from loss of jobs or income during the early phases of the pandemic. They highlight how sex workers have instead been at the forefront of community-led initiatives that deliver antiretroviral medications, food, and other essential health commodities to each other, and consider how the integration of HIV/AIDS response into pandemic preparedness and response may affect sex workers and the community people living with HIV. Over the years and across many international AIDS conferences, sex workers have fought for their experiences to be taken into account and for their voices to be heard within the meetings’ focus on policy and research agendas. Phelister Abdalla is the National Coordinator of the Kenya Sex Workers Alliance (KESWA) and the President of the Global Network of Sex Work Projects (NSPW), based in Nairobi. She is a single mother of three, and an active sex worker living with HIV for the last 11 years. Ruth Morgan Thomas is the Global Coordinator, Global Network of Sex Work Projects (NSPW). She has been involved in the sex industry for more than 30 years, including as a sex worker, an academic researcher at Edinburgh University, and a sex workers’ rights advocate.

In this crossover episode with Pandemic Planet, recorded during the International AIDS Conference in Montreal, Canada, on July 31st, Jeff Sturchio speaks with Professor Alan Whiteside, Centre for International Governance Innovation Chair emeritus in Global Health Policy at the Balsillie School of International Affairs.     Professor Whiteside begins with a discussion of new treatments and prevention tools for HIV/AIDS that offer the opportunity for those who have access to enjoy longer and healthier lives. But there are still barriers and challenges related to the social determinants of health that lead to persistent inequalities and make it difficult for some population groups (especially African women) to benefit. He calls for a focus on the “real issues that real people face” and for understanding the ways that power relationships and marginalization affect the health of people living with and at risk of HIV infection. He also discusses the interactions of the HIV and Covid-19 epidemics in recent years and the additional strains this has placed on health systems and the economics of the global HIV response. Professor Whiteside concludes with observations on the need for leadership and the power of communities in fashioning sustained responses to the impact of HIV/AIDS.     Born in Kenya but raised in Swaziland (now Eswatini), Alan Whiteside is an internationally recognized academic and AIDS researcher. He was the founding executive director of the Health Economics and HIV/AIDS Research Division at the University of KwaZulu-Natal and is also professor emeritus in the Wilfrid Laurier University School of International Policy and Governance in Waterloo, Ontario and editor-in-chief of the African Journal of AIDS Research. His most recent book is HIV & AIDS: A Very Short Introduction, second edition (Oxford University Press 2016).

In this crossover episode with Pandemic Planet, recorded during the International AIDS Conference in Montreal, Katherine speaks with Dr. Adeeba Kamarulzaman, immediate past president of IAS and the International Co-Chair of AIDS 2022, about the themes of this year’s conference, “Re-engage and follow the science.” Four years since the last International AIDS Conference took place in Amsterdam, Adeeba discusses the importance of bringing the HIV research, advocacy, and policy communities back together in a hybrid in person/virtual setting to rejuvenate the fight to end the AIDS pandemic. Katherine and Adeeba discuss the exciting new scientific breakthroughs announced at the conference, technical innovations during Covid-19 that that can be successfully applied to HIV programs, and the uncertain future of funding for global HIV/AIDS activities in a period when conflict, food insecurity, climate change, and pandemic preparedness efforts require increased financial investments, as well.    Dr. Adeeba Kamarulzaman is former Dean of the Faculty of Medicine and Professor of Medicine and Infectious Diseases at the University of Malaya in Kuala Lumpur, Malaysia.

In this crossover episode with Pandemic Planet, recorded during the International AIDS Conference in Montreal, Canada, on July 31st, Jeff Sturchio speaks with Dr. Michel Kazatchkine, Professor of Medicine at the Universite Rene Descartes in Paris, Special Advisor to UNAIDS for Eastern Europe and Central Asia, and a Senior Fellow with the Global Health Centre of the Graduate Institute of International and Development Studies in Geneva.  Professor Kazatachkine reviews the interactions of structural determinants of health, stigma and discrimination, and punitive laws that affect people living with HIV and at-risk populations throughout Eastern Europe and Central Asia. He also discusses the remarkable resilience of people in Ukraine in response to the Russian invasion and outlines the health impacts of reconstruction both in Ukraine and among migrant and refugee populations in surrounding countries. Professor Kazatchkine reminds us that health and human rights involve political choices – and also offer political opportunities. If we hope to achieve an end to AIDS as a public health problem by 2030, we need to work with key populations and communities to deliver solutions that they need. Finally, Jeff and Michel discuss the prospects for long-term financing of the HIV response. We need to think differently about how to sustain programs in a multipolar world, particularly to address the needs of middle-income countries.    Professor Michel Kazatchkine has dedicated more than 30 years to fighting AIDS and promoting global health as a physician, research, advocate,policmake, diplomat, and administrator. Among his many other roles, he has directed the French National Ressearch Agency (ANRS), the world’s second largest AIDS research programs; served as France’s global ambassador for HIV/AID and transmissible diseases; led the Global Fund to Fight AIDS, TB, and Malaria; and served as the UN Secretary General’s Special Envoy on HIV/AIDS in Eastern Europe and Central Asia.

In this crossover episode with Pandemic Planet, recorded during the International AIDS Conference in Montreal, Katherine Bliss speaks with Eamonn Murphy, Deputy Executive Director of Programmes at UNAIDS, the Joint UN Program on HIV and AIDS, about the agency’s latest report, “In Danger.” Sounding the alarm regarding faltering progress in HIV prevention and treatment over the course of the pandemic, the report calls for greater attention to implementing legal protections for vulnerable populations and highlights the particular challenges girls and young women have faced in preventing infections and accessing testing and treatment. Katherine and Eamonn also discuss the lessons that can be learned from countries that have managed to make progress despite pandemic-related challenges, and what opportunities the greater uptake of self-testing and use of digital communications technologies during the pandemic may mean for HIV services. Eamonn Murphy, Deputy Executive Director of Programmes, leads UNAIDS’ efforts in promoting an expanded and integrated United Nations system response to HIV at the country, regional, and global levels. Previously he was Regional Director for Asia and the Pacific, where he supported countries across the region in achieving the goals outlined in the United Nations Political Declaration on Ending AIDS as well as the Global AIDS Strategy.

Yana Panfilova, a 24-year-old Ukrainian woman born with HIV, fled Kyiv shortly after Russia’s invasion and is currently based in Berlin with her mother, grandmother, and cat. Eight years ago, she helped found Teenergizer, an organization supported by UNAIDS that seeks to end discrimination against youth in Ukraine living with HIV. Over time, its scope widened to include other youth groups, and its services expanded into mental health counseling and sexual health training. Affiliates arose across Eastern Europe and Central Asia. In the face of Covid-19 and, most recently, the Russian invasion of Ukraine, Teenergizer greatly enlarged its network in Ukraine from 20 to over 120 counselors. Using her experience living with HIV, Panfilova has reached more than 5 million teens living with HIV and those facing other forms of discrimination, providing them with the support she wished she had as an adolescent.

In this episode, CSIS Senior Associate Jeffrey L. Sturchio speaks with Gregorio (Greg) Millett, vice president at amfAR, the Foundation for AIDS Research, and the director of amfAR’s Public Policy Office, about whether we’re doing enough to underserved populations in the fight against HIV/AIDS.  Greg begins with a review of the state of the HIV/AIDS epidemic in the United States, looking at how health disparities are reflected in the patterns of infection, care, and treatment when the data are viewed through the lenses of race, ethnicity, gender, age, and geography.  He also addresses such questions as what are the key sources of risk and vulnerability that make it challenging to achieve the Ending the HIV Epidemic (EHE) goals? How has COVID-19 affected the domestic HIV epidemic? How do factors like housing instability, poverty, food insecurity, racism, stigma, and discrimination lead to disparities in access to HIV care and treatment for key populations? Why have there been lags in access to and uptake of new tools for pre-exposure prophylaxis (PrEP)? Greg also discusses parallels and differences between response to the HIV pandemic globally and domestically, as well as the implications of the situation in Ukraine for people living with HIV who are forced to leave home. The podcast concludes with his reflections on causes for optimism and hope in the continuing fight to end HIV/AIDS.