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Grassroots AIDS activists fought for and won affordable HIV treatments around the world – but PEPFAR didn’t change governments and pharma

The US PEPFAR initiative has brought HIV medication to millions of people globally. Behind this progress are the activists that pressured politicians and…

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AIDS activists have used protests to demand access to treatment. Jim Watson/AFP via Getty Images

The President’s Emergency Program for AIDS Relief, or PEPFAR, has revolutionized the fight against global AIDS over the last 20 years. In that time, the U.S. program has brought antiretroviral treatment to nearly 19 million people living with HIV, the virus that causes AIDS; prevented mother-to-child transmission of HIV for 2.8 million babies; and brought HIV testing and prevention services to millions of others.

But this program would not be so successful – and might not even exist – without the work of grassroots AIDS activists around the world.

As a historian of social movements, I spent years interviewing AIDS activists, digging through their papers and scanning old websites, group email lists and message boards. These sources showed that, over the course of more than a decade, these activists challenged the status quo to demand – and deliver – HIV treatment to millions of poor people around the world.

Treatment Action Campaign activists in South Africa put pressure on drugmakers and governments for access to HIV medication.

AIDS drugs for Africa

In his 2003 State of the Union address, then-U.S. President George W. Bush announced the creation of PEPFAR when he called for an astounding US$15 billion in funding over five years for the fight against AIDS in Africa and the Caribbean.

His announcement did not come out of nowhere. By that point, AIDS activists had spent years fighting to bring treatments for HIV to low- and middle-income countries hardest hit by the epidemic. My book, “To Make the Wounded Whole,” describes how members of the AIDS Coalition to Unleash Power (ACT UP) Philadelphia linked their own struggles for affordable, quality health care for poor people with AIDS in the U.S. to similar struggles around the world.

This fight began in earnest in the late 1990s when highly effective antiretrovirals to treat HIV became available, giving a new lease on life to those who could access them. But the new drugs were expensive, and activists saw that their high cost would put them out of reach for most who needed them.

Some low- and middle-income countries took their own steps to make life-saving antiretrovirals available. In 1997, South Africa, in the midst of a rapidly growing HIV epidemic, passed the Medicines and Related Substances Act, allowing the government to produce or acquire less-expensive generic versions of the drugs. Meanwhile, domestically produced generics were a cornerstone of Brazil’s program to provide access to free antiretrovirals for people living with HIV/AIDS in the country.

Pharmaceutical companies opposed these efforts, with a representative of the Pharmaceutical Research and Manufacturers Association (PhRMA) claiming that countries that produced generics committed “a form of patent piracy.” So, too, did the Clinton administration, claiming that South Africa and Brazil violated intellectual property agreements under the World Trade Organization. In particular, former Vice President Al Gore, acting as chair of the U.S.-South Africa Binational Commission, and Charlene Barshefsky, the U.S. Trade Representative, pressured their South African counterparts to change the law in 1999.

Activists marching with signs reading 'Europe! Hands off our medicine'
AIDS activists in Nairobi, Kenya, protested against a free trade agreement between the European Union and India that would have phased out generic AIDS drugs. Khalil Senosi/AP Photo

Activists fought back against both the pharmaceutical industry and the policymakers who put intellectual property rules, and the corporate profits they protected, ahead of saving people’s lives. Members of ACT UP Philadelphia, along with others, hounded Gore on the presidential campaign trail, chanting, “Gore is killing Africans – AIDS drugs now,” and occupied Barshefsky’s office in Washington. They also participated in a massive demonstration at the 2000 International AIDS Conference in Durban, South Africa, with thousands of marchers from around the world crying “Phansi, Pfizer, phansi!” (“phansi” is Zulu for “down”) to demand a reduction in the drug company’s AIDS treatment prices.

All of this agitation worked. Clinton curbed his administration’s pressure campaign against South Africa. Thanks in part to the wider availability of generics, the average cost of antiretrovirals fell dramatically. And the 2001 World Trade Organization Ministerial Conference in Doha, Qatar, affirmed that public health and “access to medicines for all” would be paramount in the fight against HIV/AIDS and other epidemics.

Having succeeded in making antiretrovirals more affordable, activists pressed for an international program to purchase and distribute them. According to journalist Emily Bass, external pressure from grassroots activists gave global health advocates within the Bush administration, including National Institute of Allergy and Infectious Diseases Director and chief medical advisor Anthony Fauci, the opportunity to push forward their proposal for a massive effort by the U.S. to treat AIDS in Africa. That proposal quickly evolved into PEPFAR.

John Robert Engole was the first patient to receive HIV treatment under PEPFAR.

Activists continued to shape PEPFAR as the program came together. They advocated for people with AIDS to be treated with generic antiretrovirals, which allowed more people to be treated than would otherwise be possible with patented drugs. And when it came time to renew PEPFAR in 2008, they extracted promises from presidential candidates to reauthorize the program at $50 billion, over three times Bush’s initial pledge.

Today, PEPFAR works in over 50 countries, including in Central and South America, Southeast Asia and the former Soviet Union. Since 2003, the program has injected over $100 billion into the fight against global AIDS, although annual funding levels have been flat for most of that time. Yet despite stagnant funds, PEPFAR has brought treatment to an increasing number of people in need. That it has done so is in no small part thanks to the AIDS activists who fought to make generic antiretrovirals available, allowing the program to treat many more people than would otherwise be possible.

Lessons unlearned

To be sure, the Bush administration had its own reasons to address AIDS in Africa. National security experts at the U.S. State Department had long worried that AIDS would destabilize the continent, as historian Jennifer Brier has shown, and PEPFAR burnished the president’s commitment to “compassionate conservatism” and faith-based social programs.

But by the time of Bush’s announcement, grassroots activists had already spent years arguing in public that treating AIDS in Africa was not only possible but imperative. And their advocacy for low-cost generic antiretrovirals paved the way for global AIDS treatment on a scale that had once been thought impossible.

Protestors holding a black coffin, wearing paper skull masks and signs reading 'I died on an ADAP waiting list' and 'Gilead gouges gov' AIDS dollars'
AIDS protestors called upon pharmaceutical companies to lower drug pricing to affordable levels. Alison Yin/AP Images for AIDS Healthcare Foundation

Unfortunately, U.S. responses to recent viral epidemics have not shown evidence that the nation has learned from the PEPFAR example. The hoarding of COVID-19 vaccines by the U.S. and other wealthy nations shows the same persistent disregard for human life that was evident in attempts to block generic medicines from reaching people who needed them. At the same time, millions of doses of a highly effective vaccine against mpox in the U.S. national vaccine stockpile were allowed to expire while outbreaks of the virus raged in West and Central Africa in 2022. And early 2023 announcements that Pfizer and Moderna may both price their COVID-19 vaccines at well over $100 per dose in the U.S. recalls the exorbitant drug prices that aroused activist fury in the fight against AIDS.

PEPFAR has saved millions of lives, in no small part because activists thought big and fought hard for justice in the U.S. response to global AIDS. Although the program is far from perfect, it serves as a reminder of what is possible when solidarity guides responses to humanity’s biggest challenges, and the power of grassroots organizing in turning principles into policy.

Dan Royles has received funding from the National Endowment for the Humanities and the National Park Service. He is affiliated with the Miami-Dade Democratic Party.

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AI identifies antimalarial drug as possible osteoporosis treatment

Correction (Oct. 17, 2023): The paper’s title has been corrected to “Deep Learning-Predicted Dihydroartemisinin Rescues Osteoporosis by Maintaining…

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17 mins ago

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October 18, 2023

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Correction (Oct. 17, 2023): The paper’s title has been corrected to “Deep Learning-Predicted Dihydroartemisinin Rescues Osteoporosis by Maintaining Mesenchymal Stem Cell Stemness through Activating Histone 3 Lys 9 Acetylation

Credit: Adapted from ACS Central Science, 2023, DOI: 10.1021/acscentsci.3c00794

Correction (Oct. 17, 2023): The paper’s title has been corrected to “Deep Learning-Predicted Dihydroartemisinin Rescues Osteoporosis by Maintaining Mesenchymal Stem Cell Stemness through Activating Histone 3 Lys 9 Acetylation

Artificial intelligence has exploded in popularity and is being harnessed by some scientists to predict which molecules could treat illnesses, or to quickly screen existing medicines for new applications. Researchers reporting in ACS Central Science have used one such deep learning algorithm, and found that dihydroartemisinin (DHA), an antimalarial drug and derivative of a traditional Chinese medicine, could treat osteoporosis as well. The team showed that in mice, DHA effectively reversed osteoporosis-related bone loss.

In healthy people, there is a balance between the osteoblasts that build new bone and osteoclasts that break it down. But when the “demolition crew” becomes overactive, it can result in bone loss and a disease called osteoporosis, which typically affects older adults. Current treatments for osteoporosis primarily focus on slowing the activity of osteoclasts. But osteoblasts — or more specifically, their precursors known as bone marrow mesenchymal stem cells (BMMSCs) — could be the basis for a different approach. During osteoporosis, these multipotent cells tend to turn into fat-creating cells instead, but they could be reprogrammed to help treat the disease. Previously, Zhengwei Xie and colleagues developed a deep learning algorithm that could predict how effectively certain small-molecule drugs reversed changes to gene expression associated with the disease. This time, joined by Yan Liu and Weiran Li, they wanted to use the algorithm to find a new treatment strategy for osteoporosis that focused on BMMSCs.

The team ran the program on a profile of differently expressed genes in newborn and adult mice. One of the top-ranked compounds identified was DHA, a derivative of artemisinin and a key component of malaria treatments. Administering DHA extract for six weeks to mice with induced osteoporosis significantly reduced bone loss in their femurs and nearly completely preserved bone structure. To improve delivery, the team designed a more robust system using injected, DHA-loaded nanoparticles. Bones of mice with osteoporosis that received the treatment were similar to those of the control group, and the treatment showed no evidence of toxicity. In further tests, the team determined that DHA interacted with BMMSCs to maintain their stemness and ultimately produce more osteoblasts. The researchers say that this work demonstrates that DHA is a promising therapeutic agent for osteoporosis.

The authors acknowledge funding from the National Natural Science Foundations of China, the Beijing International Science and Technology Cooperation, the Beijing Natural Science Foundation, Peking University Clinical Medicine Plus X – Young Scholars Project, the Ten-Thousand Talents Program, the Key R & D Plan of Ningxia Hui Autonomous Region, the Innovative Research Team of High-Level Local Universities in Shanghai, the Beijing Nova Program, the China National Postdoctoral Program for Innovative Talents, the China Postdoctoral Science Foundation, and the Peking University Medicine Sailing Program for Young Scholars’ Scientific & Technological Innovation.

The paper’s abstract will be available on Oct. 18 at 8 a.m. Eastern time here: http://pubs.acs.org/doi/abs/10.1021/acscentsci.3c00794

The American Chemical Society (ACS) is a nonprofit organization chartered by the U.S. Congress. ACS’ mission is to advance the broader chemistry enterprise and its practitioners for the benefit of Earth and all its people. The Society is a global leader in promoting excellence in science education and providing access to chemistry-related information and research through its multiple research solutions, peer-reviewed journals, scientific conferences, eBooks and weekly news periodical Chemical & Engineering News. ACS journals are among the most cited, most trusted and most read within the scientific literature; however, ACS itself does not conduct chemical research. As a leader in scientific information solutions, its CAS division partners with global innovators to accelerate breakthroughs by curating, connecting and analyzing the world’s scientific knowledge. ACS’ main offices are in Washington, D.C., and Columbus, Ohio.

To automatically receive news releases from the American Chemical Society, contact newsroom@acs.org.

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Journal

ACS Central Science

DOI

10.1021/acscentsci.3c00794

Article Title

Deep Learning-Predicted Dihydroartemisinin Rescues Osteoporosis by Maintaining Mesenchymal Stem Cell Stemness through Activating Histone 3 Lys 9 Acetylation

Article Publication Date

18-Oct-2023

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International

AI and 10 seconds of voice can screen for diabetes, new study reveals

 Determining whether a person is diabetic could be as easy as having them speak a few sentences into their smartphone, according to a groundbreaking study…

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October 18, 2023

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 Determining whether a person is diabetic could be as easy as having them speak a few sentences into their smartphone, according to a groundbreaking study from Klick Labs that combines voice technology with artificial intelligence in a major step forward in diabetes detection.

Credit: Klick Labs

 Determining whether a person is diabetic could be as easy as having them speak a few sentences into their smartphone, according to a groundbreaking study from Klick Labs that combines voice technology with artificial intelligence in a major step forward in diabetes detection.

The new study, published in Mayo Clinic Proceedings: Digital Health, outlines how scientists used six to 10 seconds of people’s voice, along with basic health data, including age, sex, height, and weight, to create an AI model that can distinguish whether that individual has Type 2 diabetes. The model has 89 percent accuracy for women and 86 percent for men.

For the study, Klick Labs researchers asked 267 people (diagnosed as either non- or Type 2 diabetic) to record a phrase into their smartphone six times daily for two weeks. From more than 18,000 recordings, scientists analyzed 14 acoustic features for differences between non-diabetic and Type 2 diabetic individuals.

“Our research highlights significant vocal variations between individuals with and without Type 2 diabetes and could transform how the medical community screens for diabetes,” said Jaycee Kaufman, first author of the paper and research scientist at Klick Labs. “Current methods of detection can require a lot of time, travel, and cost. Voice technology has the potential to remove these barriers entirely.”

The team at Klick Labs looked at a number of vocal features, like changes in pitch and intensity that can’t be perceived by the human ear. Using signal processing, scientists were able to detect changes in the voice caused by Type 2 diabetes. Surprisingly, those vocal changes manifested in different ways for males and females, Kaufman said.

A Potential New Screening Tool for Undiagnosed Diabetes

Almost one in two, or 240 million adults living with diabetes worldwide are unaware they have the condition and nearly 90 percent of diabetic cases are Type 2 diabetes, according to the International Diabetes Federation. The most frequently used diagnostic tests for prediabetes and Type 2 diabetes include the glycated hemoglobin (A1C), along with the fasting blood glucose (FBG) test and the OGTT–all which include a trip to a healthcare provider for patients.

Yan Fossat, vice president of Klick Labs and principal investigator of this study, said Klick’s non-intrusive and accessible approach offers the potential to screen vast numbers of people and help identify the large percentage of undiagnosed people with Type 2 diabetes.

“Our research underscores the tremendous potential of voice technology in identifying Type 2 diabetes and other health conditions,” Fossat said. “Voice technology could revolutionize healthcare practices as an accessible and affordable digital screening tool.”

Fossat said next steps will be to replicate the study and expand their research using voice as a diagnostic in other areas such as prediabetes, women’s health and hypertension.

This latest discovery is enabled by Klick Labs’ over a decade of expertise and investment in machine learning, data science and artificial intelligence, across several therapeutic areas, including the diabetes space. Their “Homeostasis as a proportional–integral control system” study, published in Nature Digital Medicine in 2020, was also based on mathematical modeling to determine some of the underlying changes in how glucose is regulated. More recently, their “Screening for Impaired Glucose Homeostasis: A Novel Metric of Glycemic Control” study appeared in Mayo Clinic Proceedings: Digital Health.

About Klick Applied Sciences (including Klick Labs)

Klick Applied Sciences’ diverse team of data scientists, engineers, and biological scientists conducts scientific research and develops AI/ML and software solutions as part of the company’s work to support commercial efforts using its proven business, scientific, medical, and technological expertise. Its 2019 Voice Assistants Medical Name Comprehension study laid the scientific foundation for rigorously testing voice assistant consumer devices in a controlled manner.

About Klick Group

The Klick Group of companies–Klick Health (including Klick Katalyst and btwelve), Klick Media Group, Klick Applied Sciences (including Klick Labs), Klick Consulting, and Sensei Labs–is an ecosystem of brilliant talent collectively working to maximize their people’s and clients’ full potential. Established in 1997, Klick has teams across North America, with offices in New York, Philadelphia, Toronto, global hubs in London, São Paulo, and Singapore, and plans to open more offices in Basel, Buenos Aires, Munich, Paris, and Tokyo. Klick has consistently been named a Best Managed Company and Great Place to Work. Over the last two years alone, the company has been recognized with almost 30 Best Workplace awards, including Best Workplaces for Women, Best Workplaces for Inclusion, Most Admired Corporate Cultures, Fast Company’s Best Workplaces for Innovators, FORTUNE’s Best Workplaces in New York, and FORTUNE’s Best Workplaces in Advertising.

Journal

Mayo Clinic Proceedings

DOI

10.1016/j.mcpdig.2023.08.005

Method of Research

Computational simulation/modeling

Subject of Research

People

Article Title

Acoustic Analysis and Prediction of Type 2 Diabetes Mellitus Using Smartphone-Recorded Voice Segments

Article Publication Date

17-Oct-2023

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International

Biden In Israel, Agrees With Netanyahu: Looks Like The “Other Team” Did Hospital Strike

Biden In Israel, Agrees With Netanyahu: Looks Like The "Other Team" Did Hospital Strike

At a moment the whole region threatens to erupt, and…

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18 mins ago

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October 18, 2023

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Biden In Israel, Agrees With Netanyahu: Looks Like The "Other Team" Did Hospital Strike

At a moment the whole region threatens to erupt, and as mass protests have continued across Arab capitals and in many other parts of the world, President Joe Biden arrived in Israel Wednesday pledging unwavering US support for Israel.

Breaking from other allies like France's Macron, who appeared to condemn Israel for the deadly al-Ahli Baptist Hospital bombing, Biden instead during his first meeting with Netanyahu since the crisis began sided with Israel's narrative of events. "Based on what I have seen, it was done by the other team, not you," Biden said.

"But there’s a lot of people out there who are not sure. So we’ve got to overcome a lot of things," he added. The Israelis had the day prior emphasized they had shared their case, including intelligence they say they have, with the Americans as Biden was en route in Air Force One to Tel Aviv.

AFP via Getty Images

Likely this was enough for now to satisfy the Israelis, who are under growing international pressure given the massive death toll of at least 200-300 Gazans at the hospital, many of them women and children; however, the "other team" reference is somewhat awkward a response - as it doesn't name Palestinian Islamic Jihad (PIJ) or Hamas.

Later in the day, in a meeting with Netanyahu which also included members of his war cabinet in Tel Aviv, Biden as expected pledged that "We will continue to have Israel's back as you work to defend your people."

"We’ll continue to work with you and partners across the region to prevent more tragedy to innocent civilians," said, and described the Oct.7 Hamas cross-border raid as "brutal, inhuman, almost beyond belief."

Netanyahu then spoke of "this terrible, double-war crime against humanity" — in reference Israel's claims that Gaza's militant factions killed the hundreds of Palestinians at the hospital. Israel's version of events is that an errant missile fired by the PIJ faction struck the hospital.

"While Israel seeks to minimize civilian casualties, Hamas seeks to maximize civilian casualties," Netanyahu said. "Hamas wants to kill as many Israelis as possible and has no regard whatsoever to Palestinian lives – every day they perpetrate a double war crime, targeting our civilians while hiding behind their civilians, embedding themselves in the civilian population and using them as human shields."

The Israel Defense Forces (IDF) has released what it says is evidence, in the form of intercepted communications, that it wasn't Israel behind the attack:

"We saw the cost of this terrible war crime yesterday, when a rocket fired by Palestinian terrorists misfired and landed on a Palestinian hospital," Netanayahu continued in his meeting with Biden. "The entire world was rightfully outraged – but this outrage should be directed not at Israel, but at the terrorists. As we proceed in this war, Israel will do everything it can to keep civilians out of harm's way."

Netanyahu further said "the civilized world must unite to defeat Hamas" and that "we will defeat Hamas and remove this terrible threat from our lives."

Tyler Durden Wed, 10/18/2023 - 08:25

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