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tv   Experts Discuss Latest HIV AIDS Research  CSPAN  July 30, 2021 10:04am-11:08am EDT

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fully vaccinated you no longer need to wear a mask. [indiscernible] reporter: in may, it sounded like getting vaccinated was losing a mask. president biden: that was true at the time. they're getting vaccinated may make a difference. what happened was a new variant came along. they didn't get vaccinated. >> i'm j. stephen morrison where i head up csis's work on global health. this events is -- event is sponsored jointly with the kaiser family foundation, a close partner over many, many years. my co-host is jennifer kates, also a close friend, who is the
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senior vice president at kaiser foundation. we've been in the habit for two decades of jointly organizing these events. we have with us in person this morning two good friends and noted h.i.v. experts, chris beyrer and maureen goodenow. chris is professor of epidemiology at johns hopkins bloomberg school of public health and president of the international aides society. maureen is associate director for aides research at the national institutes of health and director of the n.i.h. office of aides research. we have coming in remotely adeeba kamarulzaman, president of the international aides society. welcome, adeeba. she's a former dean of the faculty of medicine and is a professor of medicine and infectious diseases at the university of malaya in kuala
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lumpur. thank you, adeeba. delighted to have you here today. adeeba: thank you for having me. stephen: we will come in with some questions and we're delighted to welcome them. special thanks to our colleagues at the global health policy center, particularly mckenzie, noel, who has come to help us today. special thanks to our csis production team, graham, emma, mary, denish, and we're delighted that c-span can join us today to broadcast this event. we have only one hour. a lot of ground to cover. we -- i will offer a few additional remarks on this moment that we find ourselves in. jennifer will offer some welcoming remarks. and then we will hear quick opening remarks, beginning with adeeba, maureen and chris, and
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then we'll have a conversation that follows that. in terms of where we are right now, this moment, this conversation occurs in a moment of a major transition in the covid-19 pandemic. there's no avoiding talking about that. i'm sure we will. we're at the 18-month mark, and it's a moment of accelerating change. it's an existential moment. we saw that last night in president biden's empassioned speech about vaccinations. we saw that by major changes in c.d.c. masking. we saw it last night in the release of the c.d.c. slide deck on the delta variant. we know now we are facing a virus in the delta variant that is of new levels of danger, destructive power, and perniciousness. it's winning in many parts of the world. we have entered a long war.
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this is not one that is going to be short. and it's a painful race. it's a three-continental sweep we are seeing today in terms of the surge hitting now surging in africa, but extending into southeast asia, south asia, and across latin america. obviously here in the united states, we've had major gains in vaccine coverage, but we are struggling. we are at a moment of fear and uncertainty. what are we seeing in much of the world, much of low and middle-income countries? we're seeing gross inequity in terms of access -- affordable access to vaccines and to critical input, oxygen. we're seeing critical shortages in the health workforce. there's enormous uncertainty surrounded what are the gains achieved through vaccines and there's disproportionate impacts on key populations, on women and girls, and the health impacts. we'll hear more about this today
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in terms of the disproportionate impacts of people living with h.i.v. we know that many countries have acute lack of readiness in terms of financing and delivery mechanisms. as we move towards greater abundance of vaccines, there's this question of how are these countries going to manage that. we're seeing rising instability. as a cascade of the pandemic, of humanitarian emergencies, fiscal insolvency, and risk of famine and violent instability. we're seeing this in south africa, lebanon, myanmar, haiti, cuba, just to name a few of the most notable cases. this is a tough world we're in right now to be talking about the achievement -- sustaining the achievements of h.i.v. along with other global health gains. we'll talk today about trying to answer some of the uncertainties. how much impact can covid-19 having upon existing h.i.v. programs?
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how much damage, how lasting, how many resilience? we know prevention has -- prevention services have suffered. diversion of staff. lab resources, finances. we know there's exhaustion in many places. we know there is a risk of regression, a risk of reignition of pandemics in h.i.v., t.b. elsewhere. we know there's uncertainty right now and a growing debate on where does h.i.v. fit in this new world, a world in which we have an ongoing endemic coronavirus pandemic. the geopolitics surrounded this have not been very promising. we had a complete absence of high-level diplomacy in the first year of this epidemic in 2020. we had some progress at the g-7, but it was pretty disappointing overall in terms of the mobilization. with that uncertainty is uncertainty where will the solutions come from and who will
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lead. right now, the solutions that are coming forward, covax and others, are quite promising, but they fall short of the scale what's required. and they put at risk, i believe, h.i.v. achievements and the ability to sustain progress as we move forward. so thank you, all, for joining us. i'll turn to my close friend and ally here this morning, jennifer kates, to kick things off. jennifer. jennifer: thanks, stephen. hi, everyone. great to build on our long tradition of collaborating on the aides conference and i want to -- aids conference and i want to thank adeeba. i'm also part of the i.a.f. governing council. i'm proud of the team under adeeba's leadership. we're pivoting quickly to create virtual platforms to allow scientists and community and
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researchers to keep talking about h.i.v. and connecting and moving this forward despite the obstacles we face. steve talked about the larger uncertain and dangerous situation we find ourselves in. i want to continue from that vantagepoint and focus on four themes which has bearing on the h.i.v. response and outlook. the first is the economic outlook for countries. second, funding for h.i.v. is on shaky ground. the third, the last year and a half have shown us how important the prime is i of science is. world has transferred to h.i.v. in terms of commitment. and then four, it's not just science. it never is. it's also human behavior and social determinans. so on the first, the economic outlook, i just wanted to highlight two recent reports that came out in the last few days that i think just tell us from their main messages where we are, how we have to think about this. the first is from the i.m.f. and updated world economic outlook
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released just a few days ago. quote, vaccines have emerged as a principal faultline which the global recovery splits into two blocks. those that can look forward to normalization of activity further this year. almost all advanced economies. and those that will still face resurgent infections and rising covid death tolls. the recovery is not assured when infections are very low so long as the disease goes. another, quote, the path of the economy depends on the course of the virus. progress and vaccinations will likely continue to reduce the effects of the public health crisis on the economy but risks to the economic outlook. and our research, we found current rates of vaccine administration throughout the world with the current level of vaccines provided to low and middle-income countries,
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coverage in low-income countries will only be about 5% in a year from now. so that is where we are. second point, government funding for h.i.v. is on shaky ground. we released our new report in conjunction with a meeting and found a little bit of glimmer, what sounds like good news, increase in donor disbursements of h.i.v. in 2020 but this was entirely due to the payout of the u.s. from prior year money. all donor governments seem to retrieve on their bilateral disbursements. they have cut back other than the u.s. and recovery still remains below prepandemic projections, so the environment is fluid. also, our data in this report reflects prior year political decisions and do not capture the impact of covid-19 on budget decision-making by donors. finally on this point, depending upon the future impact of covid in low and middle income countries, it's possible their health needs and economic crisis
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will grow, therefore, needing more, not less, from donor governments on h.i.v. and all else. emergency funding has been provided, but i think it's an open question to whether it's enough. third point on the primacy of science. the last year and up until today and yesterday, we see every day how important science is to getting us through this. it's demonstrated that through the world, i think, whether everyone has listened, it's not necessarily has happened but at least demonstrated. something we've known in h.i.v. always. the critical role of science. will this bolster and reinforce the h.i.v. scientific enterprise or deplete it as h.i.v. researchers move to address covid-19? it may dry up. finally, it's not just science. also, it's human behavior and social determinance which we've known about h.i.v. from the beginning. at least as important as science is, it's human behavior.
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this is the x factor. we cannot ignore this when we are talking about an infectious like h.i.v. or covid-19. and now with covid, despite having some of the most effective vaccines for any, we see human behavior, choices, the complexities of people's lives are determining the course of this pandemic. in some cases more than highly effective vaccines. and added to that is the disinformation, misinformation, and some erosion in the confidence of science that we're all living in. so the real backdrop i think we have to consider the discussion about h.i.v. i want to stop here, turn it back to steve and look forward to hearing everybody's thoughts. steve soen: -- stephen: thank you. adeeba, it's great to have you with us. we read over -- we assembled some notes from the summarizing some of the sessions of the conference and i was really struck by how many eloquent
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interventions we made over the course of many of these different events. i was also really impressed that chancellor merkel came, minister spahn on the german side. we had swammi. it was quite the outpouring of support coming from some of these key personalities and key institutions. congratulations on that. congratulations to you and to the team. so over to you to share with us your sort of top line reflections on what came out of the conference. adeeba: thank you very much, steve and jen, and everyone for inviting me. it's evening time here. session. thank you for your confidence on how well the i.a.s. conference.
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it's a credit to the i.a.s. team and the organizing committee. i'm getting feedback. is that ok on your side? is it ok on your side? stephen: it's good. adeeba: ok. ok. and proud to have been able to provide a rerich scientific concontent for the -- scientific content for the barriers trying to arrange a conference virtually. but i'm glad many people came. the scientific content and the platform is easier at this time. so i'll speak to a couple of themes. maureen will be touching on the h.i.v. cure.
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i thought one of the themes that came out, the [indiscernible] i think it's important we program to refocus on a more holistic management of patients because there were several presentations that focused on the issue of aging and h.i.v. and the problem it would bring into patients in both high and low and middle-income countries.
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there was a nice presentation from joe that looked at more than 20,000 patients in a retrospective study of a very large database that looked at the co-morbidity and what -- comparing to people living in south asia and the conditions that's -- people living with h.i.v. across, you know, different age groups and much more prevalent in women [indiscernible] it was more pronounced among asian individuals. so all of this will naturally add to the burden of managing people living with h.i.v. and how it will play out in the
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post-covid world. as jen touched on, reduction in finances and economic impact that covid has had on countries, co-morbidity increasing the health dollars -- will put a certain strain on health systems. the other thing that came out, i think, in terms of h.i.v. aging [indiscernible] the epidemiology and underlying public changes [indiscernible] across the nation and the role of [indiscernible]. once again, the accelerated raging and increase in
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[indiscernible] that occurs will naturally acts as a burden in the low and middle-income countries. more than 20% of patients living with h.i.v. now are over the age of 50. [indiscernible] so all these things will lead to [indiscernible] look at how we
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can better monitor [indiscernible] looking at health [indiscernible] as well as [indiscernible] [inaudible] i hope moving forward we can continue to have discussion of the research, on the importance of, you know, managing h.i.v. [indiscernible] along those lines, individualized care [indiscernible] my mentor,
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jenny. wonderful plenary presentation on the changing paradigm of therapy [indiscernible] a previous three-drug combination. but as pointed out, i think certainly in the two-drug regiment in pregnancy, in test and treat strategy, particularly in low and middle-income countries where the prevalence of hepatitis may be higher,
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areas that might be of greater concern of increased resistance as well as t.b. i guess one of the highlights in terms of therapy [indiscernible] combination, drugs such as [indiscernible] there was a presentation on patients as well as capella, the study on multidrug systems [indiscernible] so i think what
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2021 brought hopefully is more confirmation that there are medications that can hopefully improve the quality of life in patients who can be given. obviously, there needs to be more studies of the drugs [indiscernible] more
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importantly, in line with the goal should be in terms of providing care, patients will have a choice -- that we can provide better. a three-drug regimen. or a combination. i share jen's concern in terms of what the covid-19 pandemic will do not only to h.i.v. care but h.i.v. research. to that end the governing
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council will be convening [indiscernible] the chairman came up with the idea. she is like me. she is an optimistic person. we want to tech nationalize -- technicalize -- i don't know if it's the right word -- [indiscernible] how can we use the covid response to reinvigorate the h.i.v. research and effort [indiscernible] in the next 12 to 24 months. so with that, thank you very much. stephen: thank you so much, adeeba. and you'll stay with us.
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we'll come back to you during the course of this conversation. i'm going to turn to maureen goodenow now to after her quick thoughts on what transpired at the conference. maureen, thank you. maureen: thanks, steve. thanks, jen. nice to see you, adeeba. chris and some of the folks in the audience. it's wonderful to be here. i want to talk about three quick things. one is about the conference itself. two, adeeba mentioned, some of the science related to a cure. third, how do we work in this environment. so i think the most amazing thing, really, is that i.a.s. science 2021 took place, not only did it take place but it was an amazing success. it was a technologically success and a scientific success. really, this reflects the tremendous job that adeeba and
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all of the staff and colleagues contributed to the event. i was struck by hearing some initial analysis that despite the fact that it was totally virtual, we had more attendees than at the in-person meeting. and there were more junior investigators and scholarships because the costs were reduced because they weren't traveling. i think that is a testimony to the resiliency of the scientific community in this area. we should be celebrating this. i think it's a testimony, h.i.v. and the persistence of covid, the extent to which the h.i.v. field pivoted expertise to develop a safe and effective vaccine. so then next step is what we discussed at the meeting. i was struck by the significant component of the agenda that was
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related to cure and it was really across the sort of pipeline of the cure, if you will, because it started with consideration in reservoirs. continued discussions and discoveries in how to maintain long-term viral suppression, and how can all of these events be used to develop and expand the opportunities for developing cure strategies. you know, understanding viral replications, the continued discovery how the virus interacts with the cells is amazing. i don't know if you saw some of the images of virus actually working its way through the interior of the cell and as a vy rolgs, i find this --
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virologist, i find this amazing. we can look and identify more targets that can be used for developing drugs. and the whole new strategy, the whole new theory of drugs that are based on disruption of viral assembly because it integrates into and disrupts the formation is a whole new class of drugs and it's really, really exciting from that perspective. i think cure itself is maturing. there's a lot of strategic planning going on in terms of target product profiles with partnerships that have been developed and continue for discovery. cure strategies i think are -- we're in place and really set up with the covid partnerships that set up quickly in order to develop a vaccine.
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so that -- and i think the other piece of this, too, is that we need to continue to understand the vulnerabilities of the virus and how can we avoid development of drug resistance. there were some presentations on that. i think it's an important point that needs to be kept on the horizon or on the table, actually. so i think the continued challenges of the policies, however, that promote an environment, stigma, discrimination, are a real barrier and present real challenges to the research enterprise. i think one of the real advantages of the i.a.s. science 2021 and that whole type of conference is really having the basic science integrated with the clinical, the translational, and implementation, as well, and with the policy pieces. you can sort of see the whole
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picture. it's a very exciting environment to be in. i know from some of the junior investigators that were there, to see where they fit into this environment is a really important part of this meeting. it's fantastic. so quickly, then, looking forward and how the major question of discovery in the future and how do we sustain are enterprise, how can we rebuild it and how do we pivot it in this environment, because i think the fierce persistence of new infection -- one of your c.s.i. publications is fierce persistence of new infections is true not only for covid but also for h.i.v. we're 40 years into the pandemic. there's been a remarkable return on the investment over these years. but i think we can really take advantage of this time to
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critically evaluate the portfolio, right size, adjust, and pivot and make resources available for next steps. stephen: thanks, maureen. chris. chris beyrer. chris: that was a perfect segue, maureen. because of fierce persistence of new infections, really the problem of h.i.v. incidents, is exactly what the prevention science part of the conference is trying to address. and i think we all have understood that there was a tremendous effort on the part of just countless providers, clinicians, pepfar, national governments to ensure that in the covid pandemic there were not treatment interruptions. everybody understood the centrality of trying to keep people on treatment. but many, many health care that you would put in the category of elective, like, for example, do i need an h.i.v. test today?
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is it worth going to the clinic and risking exposure to covid? or should i refill that prescription? these really, i think, were more profoundly effective than the treatment area. so we're going to be analyzing for a very long time the impact of covid-19 on that aspect of the h.i.v. pandemic. but we should be clear based on the 2019 data, and everybody will remember that 2020 was supposed to be the year that we were going to achieve all these targets of the last target. we already knew and we were publishing on this and many others did that in 2018 and 2019, we were not going to make those 2020 targets in reduction of new infection. that incidents was a remaining problem. now, u.n.a. report, of course, they put those graciously out
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during the time of our conference so people can look at, made clear we are now seeing the key populations, the most vulnerable, the most likely to be excluded from prevention services accounts for the majority of infections. that, again, was true in 2019 and there's no reason to think it isn't even more true in 2020. so i think what that says to us is that this really is the challenge ahead of us. the exciting thing from the science, which i'll get into in a moment, is that we are in an era of expanding choice, of expanding potency. finally, of some uptick and good news about adherence and persistence on prep including, among women and girls in sub-saharan africa. we want to highlight those positive findings. we're really coming into the era of choice. but our challenge is going to be delivery and uptick and doing
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differentiated prevention that actually reaches the people who need it most. in ways that who work with their lives and which they're willing to use and that really is going to be an enormous challenge. it would have been anyway, but in the era of covid and when all of the countries that share the unfortunate reality of high h.i.v. burdens and high covid burdens and low covid vaccine access, this is an enormously challenging period for governments and ministries and programs to keep the eye on h.i.v. prevention. as i said, we're doing wonderfully with treatment. but keeping the eye on h.i.v. prevention in the middle of this context is very challenging. so what is the good news? the reed study which looked at vaginal ring in african women and girls showed adherence, 50%,
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and that's way better than some of the trials of some of these products. and ongoing persistence. so women and girls appeared to be willing after starting and adhering to persist on these agents much more with higher tolerance and higher acceptability. and, of course, again, the choice. do you want oral prep or would you have a ring? it starts to really make a difference for people. we have good news from gems. gems was a very large study that was joined by pepfar, usaid, over 100,000 people followed in prep programs. and the question that they were really looking at and interested in is, among people on prep -- and these are real-world settings, kenya, south africa -- how much drug resistance are we seeing in people who acquire
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h.i.v. while on these prep programs? because that, of course, is an existential threat. maureen mentioned anti-viral resistance really is a challenge. it turned out, first of all, there were not that many infections. the infection rate overall is about .2%. that's amazing. that is amazing. these are places where the incidents in people not using preventive measures and not accessing prep is generally around 2% or higher. so that is a log decline. that in and of itself is important. but most of the drug resistance they did find did turn out to be from the infected partners who transmitted to somebody. it was not primary prep resistance. that's not what was emerging so that also is very good news. and it, again, appears to be largely people who acquired h.i.v. were not adhering to
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prep. we've known that for a long time. there was important data on kenyan providers and messaging around prep and treatment as prevention. so it turns out that there's a whole global movement of you equals you. undetectable equals untransmissable. the concerns that emerged were concerns about viral rebound, about increasing medical mistrust, and also about the concern that partners might be blamed if they had a viral breakthrough and transmitted to their loved one. other data from kenya that also were encouraging were about the use of community pharmacies. so trying to demedicalize prep and decentralize it, get it out to community pharmacies and that turned out to be both feasible and highly acceptable. so that is really good news. more real-world data on the challenge of prep and the likelihood of increasing
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sexually transmitted infections. so this was a big study from m.s.n. in the u.k. about 180,000 prep users and a very high rate of s.t.i.'s in some of them, but it turned out about a quarter of the men accounted for 80% of all infections. and most of those men had repeated f.t.i. what it really looks like is there a small group of people who are at high risk. when they looked at what the characteristics of those men were, they're younger and they had african, caribbean, black ancestry. so marginalized younger folks. not dissimilar at all to what we see in the u.s. and telling us, really, that prep works. that it has to go along with support and other kind of programmatic support.
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self-testing in sub-saharan africa. w.h.o. study from nine countries, very low awareness and only 2% of adults reported ever having an h.i.v. self-test. that's got a lot of potential, particularly in the covid area, where we want to keep people out of clinics where they might encounter covid but very low uptick from now. good news on s.t.i. self-testing and self-screening. in this case from the tangerine clinic in bangkok. they compared physician s.t.i. screening or provider s.t.i. screening with self-screening among transgender women, including women with neovaginal self-screening, for those that had vaginolasty. -- vaginoplasty. there was more data from others.
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you talked about long acting cabotegravir. it's a prevention tool. there were in the oa-4 trial, this was the head-to-head comparison. double dummy, double placebo trial. there were 40 infections overall in that trial. only four in cab-la. 36 in the f.t.c. arm. so cab-la showing more efficacy. what's really important, mark from hopkins looked at the viruses in those 40 folks who converted. it turns out in the skrfshgs ab
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arm, three of the zero converters were those not getting cabin jekss -- cab injections. and the one that did had acquired h.i.v. acutely before the trial happened. that underscores why we need to do high-quality screening before we start people on this. essentially, nobody got infected who was using it. that turned out to be true with the 36 people who acquired h.i.v. who are on f.t.c. and so that's encouraging. the efficacy was high. this raises an issue that lynn brought up and others brought up. that is our prevention tools right now are reaching such high levels of efficacy and we have so many choices and presuming that cab-la will be improved, which we think it will be
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relatively soon, perhaps this year, we're going to not be able to do placebo trials in the old way. and the control condition is going to have such low incidents that we really are going to be in a challenging place for prevention studies going forward. and that is really going to be an issue for the vaccine trials for primary prevention. so there's a lot of work going on developing counterfactual modeled incidents designs, looking at community incidents, looking at, for example, the rate of infection that you identify, acute infection in people screened for these trials and using that as the incidents measure. and in the past, the f.d.a. and others have been very reluctant to go down this road, but the recognition, i think, now is there isn't any choice. the next generation of trials are going to look very different. so i will just summarize by saying that what people really, if you look across the
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prevention and implementation signs, what people wanted was for our prevention efforts to be simplified, to be differentiated and patient-centered, to be demedicalized, and to be integrated with other services. and i think that really for me is the path forward. we have many more tools. we have to figure out who wants them, how to get them to them, who gets what and new designs of the next generation of products to reduce incidents. stephen: thanks, chris. jen's going to lead off one quick round of conversation among us and i'll encourage those in our audience -- we have a number of notable experts in the audience to come forward. there's a mic over here and pose some questions so we can have some exchange with the audience in the balance of time. we have about 15 minutes. and then we'll wrap. jen and i will wrap up to close things. over to you, jen.
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jen: one common theme that adeeba talked about was choice. that was a theme i heard at the conference. it's great. adeeba, this is not a scientific question. because we don't have a lot of time. can you talk a little bit more or highlight looking ahead to aids 2022, people listening, where we're headed and what we can look forward to for aids 2022? adeeba: thanks, jen. building on the conversation from i.a.s. 2021. some of the themes experts mentioned. [indiscernible] research.
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hope to hear more. [indiscernible] the clinical trial. the bigger aids conference we'll hear more around discrimination. [indiscernible] stephen: in your
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planning for montreal next summer, it's a hybrid, what's your -- what's your thinking in terms of the likely in-person participation? what's that likely to look like? adeeba: as maureen said, [indiscernible]
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[indiscernible] so the idea for the conference, you know, knowing that [indiscernible]
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stephen: thank you. thank you. greg with us. greg, would you just introduce yourself and give us your question? greg: sure. director of public policy at amfar. thank you for a wonderful discussion and information on what took place for i.a.s. 2021. one thing i didn't hear was h.i.v.-covid co-infection. we might have a health divide in terms of transmissibility of covid among people living with h.i.v. given some of the data that jen gave in terms of low-income countries and next year only 5% of individuals in low-income countries might expect to have access to covid vaccines, what exactly does this mean for people living with h.i.v. moving forward as we move towards different strains of covid in terms of not only controlling
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the virus but also getting to the goals we always aspire to get to by 2030? stephen: chris, do you want to jump in on that? chris: it's such an important question. as you know, and i'm sure greg knows the studies have been mixed. there's quite a lot of information that we still really need to understand, in the members meeting, there was a beautiful talk summarizing all of the available data. his sort of takeaway there really is an effect of h.i.v. on the likelihood of having worse covid outcomes, hospitalizations and death. and there's big debate what we should control and what we shouldn't. it comes out to be about sort of in the 10% increase likelihood range. it's not a huge difference, but it appears it's a real difference. what that means and what i think all of us came away from, it's
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extremely important that people living with h.i.v. be prioritized for immunization. that is very important. and that people, particularly who have immunocompromise with their h.i.v. infection who are not suppressed or who have other risk factors which differ in, for example, sub-saharan africa, they are much more likely to have a history of t.b., that those folks need to be prioritized for immunization. ideally with high efficacy vaccines, with mrna vaccines and with j&j. there is a big debate with people who are immunocompromised should be boosted. folks living with h.i.v. would fit into that category. stephen: maureen and adeeba, did you have thoughts? maureen? adeeba: i did.
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i think we use the platform to kind of call out for the scientific community to do more -- to really reinvigorate just as we did at previous aids conferences for anti-viral therapy. i truly do think, particularly with the variant that's raging around the world, experiencing that in malaysia. for asia, we're doing quite well in terms of vaccination. but still we're not able to catch up in many states around malaysia because of vaccine supply and number of infections
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and deaths skyrocketing. so perhaps as the -- what the h.i.v. community is so well-known for, perhaps we need to make it stronger for vaccination across the world. maureen: i think one of the advantages of the mrna approach you can tweak this with a lot more ease than the traditional vaccine platform. i think to that extent, we have some advantages and i think some are already being developed. stephen: another question from matt. matt, introduce yourself, please, and your question. matt: matt kavanaugh from georgetown university. department of international health. i wonder if you could talk a little bit about kind of access thinking about the long-acting injectables? this is really remarkable science that's coming both on the prevention side and on the treatment side. it's just so good to see.
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i wonder what came out of the conference related to who's likely to benefit most. one of the things that we need to be moving toward planning for how do we get these to the communities, where it will make a big impact on it? thanks. stephen: adeeba. adeeba: so matthew, what i saw mostly -- [indiscernible] long acting as prep for key populations. i think we had the results from -- i'm blanking now. that looks at gender and transgendered in south africa --
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but the -- there was nothing specific, i think, in i.a.s. 2021 looking at key populations that i can remember. and i still think there are certain designs of the long acting -- both the oral and the injectable that, for instance, for people who take drugs. [indiscernible] certainly from previous experiences, it's going to take a long time for the pricing of these drugs make it affordable for low and middle-income countries. chris: yeah, i think it's an important question. the oa-4 data on the converters is very compelling data that cab-la injectable is clearly far
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superior for women and girls. and for many, you know, those were, of course, all women and girls in sub-saharan africa, they fit into a key population for many reasons. so that's very encouraging. the oa-3, which was america's trial, which was m.s.n. and trans women also showed superiority. it was very clear superiority. that analyses of those viruses i don't know is out yet. we haven't had a chance to look at that yet. but there's no question, i think, that people are thinking about these as potentially very important for adolescents, and adolescent key populations that are at risk and sex workers, women and girls at risk. so i think -- i think there is
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some differentiation happening there already. also with data on merck's new drug is unique, different mechanism reverse inhibitor. a novel mechanism that a very small dose essentially blocks the replication for a month. it's a really remarkable drug. . it may be long acting and an implant. the once a month pill is the size of a baby aspirin to give you a feel. there are small molecules are really coming. they are impressive. stephen: we are getting to the end of our hour. here's what i propose we do. aim going to offer a very quick set of remarks, impressions, ask jen to do the same.
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we'll come back to our three speakers with just a very quick answer to the question of what gives you hope and confidence and optimism in this period of crisis. prepare yourselves. adeeba, you'll get the last word today. some quick impressions. one, this is a very strong community, this scientific community is a very strong community. it's showing remarkable resilience. i hope it will use its voice in the coming period to bring about -- to really draw attention to the r&d enterprises endangered and in risk, population served and services at risk, and we see here in the united states zekea put together a letter, 60 health providers around vaccinations, which had huge impact. i think there is a role for -- using that voice, they strategicically, of this very strong community. i'm struck how much u.s.
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dependence has grown. it continues to grow. and the essential leadership that the u.s. plays and we have a gap at the moment and we need to correct for that gap. and we are in final point, we are in an era of anti-science. we are trying to conduct science in an anti-science era of dismfings and falsehoods and facts. upon the scientific enterprise. it's endangering trust and confidence among the people that we serve. i think that has to be a top-line priority looking ahead and i hope to learn and see more. i know you addressed this in the course of the meetings and i hope we'll see -- focus on all these issues as we head towards montreal. thank you. jen? jen: very quickly. i started one of the points i made was that -- it's not the science we need to think about people's experience and the choices -- the things they choose to do and things they
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don't have choice about. to pick up on that comment, it's also not just science, we have to think about how we get science to people in the future. we have to be planning about it right now. it's not just how their lives are constrained or conscripted now. it's in the future. because there is so much time, i'm going to yield the rest of my time to everybody else and hear your thoughts. stephen: maureen, go to you for what gives you strength, optimism, confidence looking ahead. then chris and adeeba closes. maureen: three points quickly. one is optimism. we have two big vaccine trials that we'll be reading out over the next year, year and a half. secondly, the amazing choice that is we have. interesting things we have to increase our investment in implementation science and figuring out what people want in different settings. even different stages of their lives. then thirdly, you mentioned the
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research community is resilient , it's not a lot of optimism, i'm concerned about the fragile infrastructure and funding. and getting across how research investment is an investment and it's not a cost. how are we going to continue the investment in the research justice department prize and get recovery to the level that we can continue the good work. stephen: chris. chris: i have hope because there is always science. and science, even if this very anti-science time is extraordinary. it's unbelievable record time. i think one of the things that's going to happen for the h.i.v. movement is we are going to be increasingly informed by the success of this vaccine movement on covid on many levels and hopefully that is going to help us get out of
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this place where the mistrust in science is such a challenge. i just want to say one other thing, i neglected at the beginning to thank maureen and the n.i.h. for their sustained and continued engagement in the conferences. we greatly appreciate it. stephen: adeeba, we are so grateful you have been with us for this hour. it's just terrific. so valuable. offer your closing thoughts, please. adeeba: thanks very much, steve. optimism and strength i think the investment it that the u.s. and the global science community has put into hiv-aids, as we know, before covid as well. i think moving forward that long-standing investment will
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continue to do us well. we saw many, many good science being presented at the conference, and i remain optimistic that good science will continue. even if there will probably be some setbacks in terms of funding. the energy that was transmitted , i thirks even virtually for many presenters, particularly young researchers continue to have much higher -- so i remain optimistic. like i said hope to be at the meeting to see how the advances that happened last 18 months
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with covid science and research we can incorporate that to reinvigorate h.i.v. research as well. stephen: thank you, adeeba. thank you, chris and maureen. thanks to jen and keyser family foundation for partnering with us. thanks to everyone who has joined us remotely and in person. to all of the c.s.i. who put this rather complicated event together. those of you who are here in person, we'll have a reception with an early lunch. please do join us right out on the patio. we are adjourned. [captions copyright national cable satellite corp. 2021] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. visit] >> live coverage continues here on c-span. health and human services assistant secretary for health, drft rachel lavine, at this event hosted by "the washington post." we join it in progress.


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