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40 years on, HIV/AIDS is still spreading despite medical advancement

President Joe Biden recognized the 40th anniversary of the first documented cases of HIV/AIDS on Saturday, acknowledging the more than 32 millions lives lost to the virus and the more than 39 million people across the globe living with it today. Dr. Chris Beyrer, professor at Johns Hopkins Bloomberg School of Public Health, who has been on the frontlines of COVID-19 and HIV/AIDS joins to discuss the similarities and lessons from the two health crises.

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  • Hari Sreenivasan:

    It's been 40 years since the Centers for Disease Control and Prevention published case reports on five men who had contracted an unusual lung infection. It was the first report documenting what would become known as AIDS and the start of a decades long battle against HIV. President Biden recognized the fortieth year of the epidemic in a statement today, acknowledging the more than 32 million lives lost to AIDS related illnesses and the more than 38 million globally living with HIV today.

    I spoke with Dr. Chris Beyrer, professor at Johns Hopkins Bloomberg School of Public Health, who has been on the front lines of both HIV and COVID.

  • Chris Beyrer:

    When HIV was first discovered, of course, in that June 5th, 1981 report from the CDC, people often don't remember that it took 15 years before we had effective antiviral therapy. It was 1996 and those were just incredibly tough years when so many people lost their lives. Fast forward to COVID. You know, the the sequence was put online and early January of 2020. I got involved in the COVID vaccine trials in April. And, you know, here we are less than two years later, we have three effective vaccines with emergency use authorization. We're seeing our way forward out of this.

    HIV, we've been at it for 40 years. We still don't have a vaccine. We don't have a cure. It is, of course, now a completely different disease because we have effective therapy and it's manageable. Life expectancy has gone from when I was a medical student, it was six months to now it's seventy two years. So that's just a huge change. We've gotten it down to one pill once a day for most patients, but nevertheless, we're still in the HIV AIDS pandemic and there are still parts of the world where where the virus is in expansion mode, Eastern Europe and Central Asia, the Middle East and North Africa. And in our own country, you know, we have still have an ongoing epidemic that is now very concentrated in the south and southeast among racial and ethnic minorities, particularly African-Americans, Latin Americans and in sexual and gender minorities. Two thirds of our infections are in are in gay and bisexual men, including primarily men of color, the most affected groups.

  • Hari Sreenivasan:

    That is stunning that there are still parts of the world where HIV is on the rise, which also helps people see that here we are 40 years later and there are still significant health disparities and access disparities when it comes to any of these three wonderful vaccines that we have available. They're not available to everyone by a long shot.

  • Chris Beyrer:

    They're not available to the great majority of humanity, not just everyone. You know, this this also is similar to the period in '96 when we finally had triple therapy was absolutely amazing. We called it the Lazarus effect. People rose up off their deathbeds, went back to work and went back to school, to parenting. But that period then followed where we just didn't have access in most of the world and certainly not in Africa and Asia, which were the most affected regions. And it wasn't until the PEPFAR program, it wasn't until the presidency of George Bush 2003, which was, you know, something like seven years, eight years later, that we finally started to see global access to antivirals.

    We can't wait that long with COVID this virus is mutating quickly. It's spreading very quickly. As I'm sure you know, we're actually at the worst point globally. Asia right now, there are many countries in Asia, Vietnam, Thailand, Cambodia. They're having their first major surges right now, having been spared in the early years. And the variants that are emerging are really of concern. Of course, that is part of what is ravaging India right now.

  • Hari Sreenivasan:

    Do you see are you optimistic about the technologies and how these vaccines were developed, the kind of information sharing that happened, the speed at which these vaccines were developed? Are you optimistic that any of that can be transferred in the fight against HIV?

  • Chris Beyrer:

    Yeah, absolutely. So, you know, the investments that we have made in the last 10, 15 years in biotech have really paid off. So there has been optimism in the vaccine field about messenger RNA technologies for some years, and they've been used for some other emerging infections like Ebola in Africa. But we've never really gone to scale. We've never gotten anything to the point where we had an approved vaccine. Messenger RNAs are here to stay. They're going to have application in many other diseases and cancer potentially. And remarkably enough, there's already a candidate HIV vaccine in early testing based on this messenger RNA technology. That's the technology in the Pfizer and in the Moderna vaccines. And that is really incredibly exciting and encouraging. So so I think I think that's something we all take heart in. It's also true that that the HIV research infrastructure, the clinical trials, infrastructure that we've built in this country was used for the covid vaccine trials, and that proved to be an incredibly important time saving investment. So the American taxpayers really have earned this vaccine and supported this research effort for many years.

  • Hari Sreenivasan:

    If you could put this in personal terms for us, I mean, even though you were on the front lines helping with the Moderna vaccine here, you still lost colleagues and friends in this bizarre way. Not too different from what happened in HIV. I mean, I would imagine in the HIV instance, it was people who were in your social circles, but here, fellow academics, fellow health care workers in this COVID fight.

  • Chris Beyrer:

    Yeah, yeah. Well, I lost my first partner to HIV before there was any treatment. He was a wonderful man who died at 31 of Kaposi's sarcoma, which was a very untreatable at the time, pulmonary. And I was a resident at Johns Hopkins when he passed. So, yeah, intensely personal to me. Now, in the last last few months, we've lost I lost two close colleagues who were leading HIV docs, leading infectious disease people in Zimbabwe who were treating covid patients and of course, did not have access to the vaccines. So that is the reality.

    You know that more than a thousand physicians already are thought to have died in India, countries where, you know, these people are few and far between compared to to wealthier countries. And of course, every loss is a human loss. But the losses of those those providers, of course, has implications for everybody else as well. So, yeah, it's it's it's I think for many that sense now that the pandemic is lifting here and it is still ongoing in so many other countries, the urgency that we feel that we have got to do better with global COVID vaccine access. And I would just add that that PEPFAR infrastructure that that we owe to George Bush in the Congress who have supported it and the past four presidential administrations, including the Biden administration, that infrastructure can be leveraged in Africa and Asia for COVID vaccine immunization. And I think it really should be. I think that that's really important. And we have people, we've got nurses, we've got outreach workers, we've got drivers about all kinds of folks who work for that program, delivering HIV treatments and prevention. And they could be working on COVID as well. So I think that's that's something that I hope we're going to see soon.

  • Hari Sreenivasan:

    Did the loss of your partner at that time change how you thought about medicine? I mean, you probably were becoming a doctor at the time.

  • Chris Beyrer:

    Yeah, yeah, yeah. I was just finishing my my training and certainly did. I mean, I reached a point where I was taking care of AIDS patients in the clinic and my partner was gravely ill at home and our friends and our circle was it was very overwhelming. And at the time it seemed that really we needed to do more research on prevention. That seemed the best option and also on vaccines. And that's when I got involved in the HIV vaccine effort.

    My first job when I finished my training was setting up the HIV vaccine trials program for Johns Hopkins and the NIH in Thailand. I moved out to Thailand, spent five years there working on vaccines. And and that, I think, was a way to really respond and have some hope and try and be proactive and and work on another aspect of the epidemic. It was going to be a long way before we had treatment. I started that work in '92 and we didn't have therapy really in Thailand until 2001. It was a long, long haul.

  • Hari Sreenivasan:

    So what do we do to try to reach those populations that have still been marginalized from access to basic medicine like vaccines that are still here in the United States today?

  • Chris Beyrer:

    Yeah, yeah. Well, I think what you're going to see is we have learned painfully with COVID all over again how quickly the health disparities emerged, how little we've invested so much more in our biomedical research infrastructure, which delivered these vaccines than we have in our public health infrastructure, which is really meant to implement them and provide them. And I think the Biden administration is committed to reinvigorating those basics of public health. Public health departments and states and municipalities have been underfunded for twenty years. So that that is definitely going to have to change.

    We also have to invest in scientific literacy. When you look at where vaccine uptake and use in the states varies, it's it's significantly higher in the Northeast than it is, for example, in the Deep South, the state that's doing the worst with with vaccine coverage is Mississippi. And there are reasons for that. And and certainly, you know, we still haven't extended the health care franchise to all Americans. We still have so many states that that did not agree to expand Medicaid through the Affordable Care Act. That means there are still millions of Americans who are either underinsured or uninsured. And most of those people fit into the working poor category. They don't have health insurance through work and they're not low enough income to qualify for Medicaid. We have to fix that. We can't be in a country where where we have this reality that we haven't agreed to extend health care access to to everyone in this country. I think that that's very fundamental going forward.

  • Hari Sreenivasan:

    Dr. Chris Beyrer, professor of epidemiology at Johns Hopkins Bloomberg School of Public Health, thanks so much.

  • Chris Beyrer:

    Thank you. It's been a pleasure being with you.

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