A GLOBAL pledge to end the AIDS pandemic as a public health threat by 2030 could hang in the balance, partly due to US politics.
Renowned Aids scientist Professor Quarraisha Abdool Karim says the world is definitely “off track” as the latest figures show there were 1.3 million new HIV infections in 2023, and about 600 000 deaths, while nearly 40 million people are living with HIV but only 30 million are on ARV treatments.
However, she believes that the PURPOSE 1 trial undertaken in Uganda and South Africa could be a game-changer, because it demonstrated that a six-monthly injection offered 100% protection to young women who participated in the trial.
“If we can give them two injections a year, it could potentially not just benefit young women to reach age 25 and be HIV-free, but it could also alter our current epidemic trajectories on the continent.”
However, she warned that the real impact of (the) the power of science happens when it is implemented and reaches those whose lives will benefit most from it.
According to Abdool Karrim there were several steps that needed to be taken before the drug reached its intended market.
“And I think this is where the crunch comes in because we're in a very complex geopolitical context. And for example, there's PEPFAR and the Global Fund, important bodies for introducing new technologies. And right now with the Trump administration, there's a lot of uncertainty about the future of PEPFAR. And while it would appear that treatment and interventions to reduce mother-to-child transmission will continue, the role of South Africa in that and whether South Africa will be included is all is unclear at this point.
“But I think it also is an opportunity for us as South Africans, us as Africans, to be thinking more creatively, to be touching on other resources we may have, to see once this product is licensed, how can we ensure scale-up?
Abdool Karrim said that the six-monthly injection of Lenacapavir for the first time offered an opportunity to get to that point where prevention was priority.
According to the scientist there were misperceptions among political leaders and donors and decision-makers that the world had turned the tide on the pandemic. Young women and adolescents (16-24) still bear the brunt of the disease. “We are still seeing a disproportionate burden of infection in young women because men over 25 don't know their HIV status. And so are not on treatment, and that's an ongoing source of infection in young women. We have more PrEP options, but not all of them are widely available.”
She said because of that age-disparate sex and the need for women-initiated technologies that enable and empower women to protect themselves, the PrEP (pre-exposure prophylaxis) has been an important breakthrough. In addition with antiretroviral treatment access and more people being on treatment and virally suppressed, the combination of things have been contributing to reducing transmission rates in young women, but it still remains a challenge.”
“At this point in time, we have the daily oral tenofovir, but adherence and uptake is not high enough to make a difference. And I believe that the six-monthly injectable could be a real game-changer for young women in sub-Saharan Africa.”
The Independent on Saturday spoke to Abdool Karim yesterday after the announcement that she had been honoured for her exceptional contributions to health sciences by the South African Medical Research Council (MRC). Abdool Karim, the Pro Vice-Chancellor at UKZN’s College of Health Sciences received the MRC’s Platinum Lifetime Scientific Achievement Award for her exceptional contributions to health sciences.
While the pre-eminent infectious diseases epidemiologist has received more than 40 prestigious awards throughout her career, this one was particularly special because she started her research in HIV at the MRC about 37 years ago.
“We don't do the research for the awards but quite often you get recognition all over the world and your family is the last to recognise you. So in an odd way, when you get the family recognition, it's a bit of a cherry on the top and it is special. I started off my research career with MRC and to get this award from family, so to speak, is quite an honour and privilege.”
“Given the many challenges that we're facing, to be able to show that South African science meets high global standards is an important acknowledgement and recognition of this type of capacity that we have within the continent.”
“We have many unique challenges and if scientists in Africa don't address them and don't lead the charge in addressing them, then we're going to be waiting a long time for solutions.
Abdool Karim’s research on HIV transmission among young women has influenced global HIV prevention strategies, including UNAIDS’ "Life Cycle Approach to HIV" and PEPFAR’s DREAMS initiative.
She said that biomedical research was a slow process and that scientists meet failure more often than success.
“In the case of adolescent girls and young women, we certainly have come a long way in terms of developing women-initiated technologies and the concept of pre-exposure of prophylaxis was a very important milestone.”
She said scientists had “expanded the toolbox” but the world still needed a vaccine and a cure to end AIDS and eradicate HIV.
“And that needs to be an ongoing investment that we have. But we do have tools to accomplish that 2030 goal of ending AIDS as a public health threat. And I think the key game-changer in this, in addition to ARV treatment, is a six-monthly Lenacappa injectable to prevent infection.”
“We've come a long way, lots of investments, a lot of knowledge, but we can't drop the ball now. Because what we'll do is reverse all these gains that we've made.”
She said infectious diseases don't recognize geographical boundaries and borders, they spread and become a threat for the entire global community.