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.

​In this episode, CSIS Senior Associate Jeffrey L. Sturchio speaks with Kathleen McManus, Assistant Professor of Medicine in the Division of Infectious Diseases and International Health at the University of Virginia Medical School, about what still needs to be done to achieve the ambitious goal of ending the HIV/AIDS epidemic in the United States. Professor McManus discusses how inequalities are driving HIV transmission and how they still affect vulnerable populations disproportionately, drawing on her experiences treating HIV patients in the Ryan White clinic at the University of Virginia. She also explores how the complicated and bewildering patchwork system of uneven coverage and access to HIV prevention and treatment services in the US healthcare system presents barriers to care and treatment for key populations at risk of HIV infection. The podcast concludes with Professor McManus’s reflections on what needs to be done at the state and local levels to translate the policy prescriptions of the US National HIV/AIDS strategy into service delivery programs that leave no one behind.

In this episode, CSIS Senior Associate Jeffrey L. Sturchio talks with Chris Beyrer, Desmond M. Tutu Professor of Public Health and Human Rights of the Johns Hopkins Bloomberg School of Public Health, about issues at the intersection of the HIV/AIDS and Covid-19 pandemics – and the prospects for an integrated and sustained global response. Professor Beyrer explores why people living with HIV/AIDS are at greater risk of being infected with Covid-19, and the impact this new virus has had on disparities in HIV/AIDS care for different key populations – including people who are incarcerated, refugees and migrants, and adolescent girls and young women. He also discusses how the global research infrastructure and networks for HIV/AIDS pivoted to conducting clinical trials for Covid-19 therapeutics and vaccines. The podcast concludes with a discussion of the steps needed to ensure a more integrated response to both Covid-19 and HIV/AIDS with a focus on solidarity and equity for improved global health security in the long run.

In this episode, CSIS Senior Associate Jeffrey L. Sturchio speaks with author Emily Bass about her new book, To End a Plague, which chronicles the transnational activism, legislative deal-making, and unprecedented political leadership that led to President George W. Bush’s 2003 announcement of the U. S. President’s Emergency Program for AIDS Relief (PEPFAR). With more than $85 billion invested, 18.2 million men, women, and children treated with antiretroviral therapy, and more than 50 million people provided HIV prevention services in recent years, it is also the largest commitment in history by any nation to address a single disease. In this conversation, Bass reflects on what drew her to this complex and compelling story, on the key factors in PEPFAR’s origins and evolution, on the reasons for the program’s improbable and long-standing bipartisan support, and on the crucial contributions of people living with HIV/AIDS and their allies and advocates in shaping the program’s priorities. She also comments on the role of the private sector and on lessons to be learned from PEPFAR in the present moment, when the world continues to grapple with the Covid-19 pandemic.

In this episode, Katherine E. Bliss speaks with Agnes Ronan, Head of Programmes and Knowledge at Paediatric Adolescent Treatment Africa (PATA), based in Cape Town, South Africa. Agnes shares how PATA has adapted its work and how she’s seen service delivery change during the COVID-19 pandemic. She unpacks how stress, disruption, and exhaustion will have long-term impacts on caregivers, children and families, and health workers, and why psychosocial interventions will be a critical element in recovering from the pandemic and reinforcing efforts to make progress against pediatric HIV. Agnes also reflects on the importance of fighting the double burden of stigma, engaging young people to ensure their voices are heard by decision-makers, and prioritizing the needs of children and their caregivers in new global strategies to address HIV/AIDS.

Her Excellency Mrs. Monica Geingos, First Lady of the Republic of Namibia, has been an outspoken champion for women and girls and gender equality in Namibia and globally. In this episode, Janet Fleischman, senior associate with the Global Health Policy Center at CSIS, speaks with Mrs. Geingos about why Covid-19’s disproportionate impact on women and girls should push countries and donors to prioritize them in policy and funding, why the world keeps making the same mistakes in responding to pandemics and global health security, why multi-sectoral initiatives like PEPFAR’s DREAMS are so critical, and why she tells girls and young women not to aspire to become first ladies – but to be politically and economically empowered.

Students around the world are struggling to return to school in the midst of the Covid-19 crisis, but these challenges are especially acute for vulnerable adolescent girls and young women in low income countries, where Covid-19 has magnified the barriers they already faced in getting an education, including HIV, economic hardship, gender-based violence, early marriage, and unintended pregnancy. In this episode, we’re looking at why education for girls, especially secondary education, is so critical for girls’ health and development, and how Covid-19 threatens their ability to go back to school. Janet Fleischman speaks with Dr. Kakenya Ntaiya, a Kenyan educator and founder of Kakenya’s Dream, which educates and empowers girls and works to end harmful traditional practices, like female genital cutting/mutilation and child marriage. Kakenya describes the impact of Covid-19 on the school for girls that she founded in Kenya, and how the school responded. Janet then takes us to western Kenya, where she speaks to Linda Achieng Orodo, a 19-year-old secondary school student, who participates in the PEPFAR-led DREAMS program. Like many girls in her community, Linda faced many challenges in returning to school after the Covid lockdown, and she gives us a glimpse of why secondary school is so critical for girls in Kenya.

Even before the onset of the Covid-19 pandemic, preventive services, diagnostics, and treatments for pediatric HIV lagged far behind the comparable tools for adult populations. Recognizing that progress had stalled, in 2017 the Vatican convened leaders from pharmaceutical companies, regulatory agencies, research institutions, and community organizations to align interests and identify new areas for collaboration. This series of discussions gave rise to the Rome Action Plan, a rights-based partnership that has served as an accountability mechanism to generate higher-quality services for children living with HIV globally. In this episode of AIDS2021, Katherine E. Bliss speaks to Chip Lyons, President and CEO of the Elizabeth Glaser Pediatric AIDS Foundation; and Monsignor Robert Vitillo, Attaché at the Permanent Observer Mission of the Holy See to the UN in Geneva and Secretary General of the International Catholic Migration Commission to discuss the how the commitments made under the Rome Action Plan have advanced progress for children living with HIV and how that partnership model can be adapted for the Covid-19 crisis and used to drive innovation in the years to come.

Economic empowerment is a critical pathway to preventing HIV in adolescent girls and young women (AGYW), and an increasing focus of PEPFAR’s DREAMS program (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe). This episode takes us to western Kenya, where new HIV infections among AGYW are among the highest in the country, fueled by social and economic factors. Janet Fleischman brings us three perspectives about the importance, impact, and challenges of reaching vulnerable young women with economic strengthening activities and why these approaches can improve HIV outcomes. First we speak to Daniel Oluoch-Madiang, the DREAMS coordinator for PATH in Kenya. We then hear from one of the young women participating in DREAMS, Valary Atieno, about how she’s translated the financial support she received from DREAMS into chickens that help her to be independent and avoid risky behaviors. We also hear from one of the DREAMS mentors, Veronica Chesongok Owiti. Their on-the-ground perspectives elevate our understanding about why economic support is so central to HIV prevention for this population. You can see a photo of Valary with her daughter and her chickens here.

In recent years Kenya has experienced notable successes in reducing mother-to-child transmission of HIV and initiating children living with HIV on antiretroviral treatment, but progress in scaling up newer point of care testing approaches and maintaining children on treatment regimens has been slower. Since March of 2020, when the first Covid-19 cases in Kenya were reported, quarantine measures, the diversion of health resources to outbreak response, and supply chain disruptions have exacerbated existing challenges but also provide opportunities for innovations and improved service delivery for children. In this episode of AIDS 2021, Katherine E. Bliss speaks with Dr. Catherine Ngugi, Head of the National AIDS and STI Control Program in Kenya, on how health care providers are finding ways to continue community engagement and ensure the rollout of new technologies, despite a constrained emergency environment.

In this episode of AIDS 2021, we discuss pre-exposure prophylaxis — PrEP — a critical HIV prevention tool for adolescent girls and young women (AGYW) in countries with high HIV burdens. Janet Fleischman speaks with Mitchell Warren, the executive director of AVAC, and two women working with Wits Reproductive Health and HIV Institute in South Africa – Khanyi Kwatsha, a 26-year-old PrEP ambassador, and Elmari Briedenhann, a senior project manager. They discuss the importance of PrEP for AGYW and highlight innovative approaches to better reach this group and to address the inherent challenges of meeting the needs of this population.