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CAPT MARY GLENSHAW: Welcome to
the NIH World AIDS

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Day 2024 Event: Progress,
Innovation, and Impact

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in HIV Research. My name is Mary
Glenshaw, the

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Acting Deputy Director in the
NIH Office of AIDS

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Research, or OAR, and the emcee
for today’s event.

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On behalf of OAR and the broader
NIH community,

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thank you for joining us today.
We greatly

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appreciate our speakers for
sharing your time

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and insights as we continue a
busy week here in

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the nation’s capital to
commemorate the 2024 World

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AIDS Day observance. Let’s get
started with some

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logistics. This session is open
to the general

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public and being recorded for
on-demand viewing.

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The panel discussion will be
followed by a live

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question and answer, or Q&A
session. We invite

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all audience members to submit
questions using

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the Q&A feature in Zoom. The Q&A
icon appears in

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the toolbar directly beneath
your video display.

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Click on it to submit your
question for the

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panel. You can see on the slide
exactly how

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this should appear. So, let’s
get started. We

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are so grateful to bring
together an esteemed

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group of speakers for
today…today’s discussion on

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progress, innovation, and impact
in HIV research.

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The panel will be moderated by
Mr. Francisco

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Ruiz, the Director of White
House…the White

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House Office of National AIDS
Policy, and Dr.

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Geri Donenberg, the Associate
Director for

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AIDS Research and Director of
OAR at the National

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Institutes of Health. It is my
pleasure to first

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introduce Dr. Donenberg. Dr.
Donenberg joined NIH

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in October this year, bringing
more than 25 years

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of domestic and international
research experience

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across the HIV continuum, with
an emphasis on

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health equity and global impact.
Working in close

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collaboration with NIH
institutes and centers, she

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now leads OAR in coordinating
the NIH HIV program

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to achieve pandemic control
through the prevention

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and…of transmission and
improvement of health.

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Dr. Donenberg, welcome. The
floor is yours.

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DR. GERI DONENBERG: Thank you. I
am very excited

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to be here, and I am thrilled to
be part of

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the effort right now at the NIH
to make HIV a

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non-health threat worldwide. As
was mentioned,

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I have spent 25 years in
academia at the

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University of Illinois, Chicago,
running

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many studies funded by the
National Institutes

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of Health to involve…involving
young people whose

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behavior and psychological
distress put them at

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risk for acquiring HIV, as well
as studies that

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improve mental health and/or
adherence among

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youth with HIV. And, to my great
fortune,

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with terrific colleagues, I’ve
been able to lead a

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number of studies in sub-Saharan
Africa to prevent

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HIV and improve quality of life.
I was trained

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as a clinical psychologist, so
you’ll see that

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most of my work has this as
mental health as an

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underlying theme. But most
recently I was…I added

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implementation science to my
behavioral and social

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science expertise. And I’ve also
had a lifelong

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commitment to an action toward
mentoring early

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stage investigators. So, at this
point in the

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epidemic, I couldn’t be more
excited to be joining

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this effort to go the last mile.
We have so many

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tools now in the HIV prevention
and treatment

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toolbox, and we just need to get
them to the

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people who need them the most.
And that involves

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ensuring equal access to these
innovations,

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and implementation science is
precisely the type

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of research we need to ensure
equity in reach,

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adoption, uptake, and
sustainability. So, like my

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colleague said, I want to
sincerely thank you for

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joining us on this important day
and my fellow

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speakers, NIH partners, as well
as the O…OAR

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staff who are helping to
celebrate everything

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we have accomplished. For those
of you who

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might be a little less familiar
with the Office

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of AIDS Research at NIH, we were
created in 1988

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by a congress…congressional
mandate

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to oversee, coordinate, and
manage

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the NIH…HIV research portfolio.
So, our role

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is to really convene, catalyze,
coordinate,

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and communicate HIV-related
research with our

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diverse partners across the
research ecosystem,

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and that would include the rest
of NIH, HHS,

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other government agencies,
academia, community,

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and nongovernmental
organizations. And of course,

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we strive to make sure that the
research funding

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is directed at the
highest-priority areas and

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addresses the most current and
emerging gaps. So,

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as we take…help and lead this
office, we also

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help coordinate the annual NIH
World AIDS Day

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observance, including this
event. And World AIDS

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Day was established to unite all
of us in our

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efforts to end…to end the
pandemic, to make HIV

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a non-health threat, to support
people with HIV,

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and to honor and remember those
who we’ve lost to

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AIDS. We have made stunning
successes in this…in

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this struggle. We have
transformational research

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that has turned HIV and AIDS
from a certain

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death sentence into a chronic
illness, and we are

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extremely proud. And then recent
discoveries are

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changing how we actually address
HIV prevention

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and treatment, including a new
medication that

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prevents HIV transmission and
the development

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of novel strategies to encourage
HIV testing

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and treatment. So, thanks to
these innovations

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and those in service delivery,
we are trying

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to identify creative ways to
ensure equitable

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access to these interventions,
particularly

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those who are disproportionately
impacted by

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HIV. And yet, we know that
many…structural and

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social factors continue to
impede access, reach,

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and adoption of these effective
prevention and

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treatment strategies. So, this
year’s event

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call…we’ve titled Progress,
Innovation, and

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Impact in HIV Research. And it’s
to celebrate the

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breakthroughs that we’ve seen
while simultaneously

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calling attention to the
considerable work that

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remains to ensure that all of
the progress we have

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achieved reaches the communities
and the people

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most in need across the U.S. and
around the world.

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Today’s event will highlight
recent progress,

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including the development of
novel strategies

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to encourage prevention,
testing, and treatment.

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It will articulate the
importance of sustained

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investment in HIV research that
is in direct

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response to the needs of
communities. And, today

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we’ll emphasize proven and
potential opportunities

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to get interventions to those
who need them to

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improve health and achieve
health equity. So, I

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thank you again for being here,
and I’m going to

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turn the event over to Captain
Mary Glenshaw

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to introduce my co-moderator,
Francisco Ruiz.

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CAPT MARY GLENSHAW: Thank you,
Geri. I’ll now

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introduce, as Geri said, our
co-moderator for

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today’s discussion. We are
delighted to be joined

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by Mr. Francisco Ruiz, the
director of the White

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House Office of National AIDS
Policy. Mr. Ruiz

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is a true groundbreaker. As the
first openly

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HIV-positive Latine in this
role, he has brought

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a fresh perspective to lead the
federal HIV

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response. During his tenure, he
has intentionally

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centered populations most
impacted by HIV,

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including Black, brown, and
queer communities.

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As we commemorate World AIDS Day
this week,

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the AIDS quilt is displayed for
the first

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time on the south lawn of the
White House,

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and the administration will soon
release the

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first national HIV/AIDS strategy
progress

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report. Francisco, thank you for
your leadership,

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and thank you for being with us
today. Welcome.

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MR. FRANCISCO RUIZ: Good
morning, buenos días.

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Thank you, Captain Glenshaw, for
the invitation

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to join you and our esteemed
panelists today for

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this timely NIH webinar. As we
gather here today,

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we’re reminded of the essential
role that research

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plays within the broader federal
response to HIV.

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This webinar serves an
opportunity not only to

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reflect on the achievements, but
also to chart

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the course forward as we update
the national HIV

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strategy. Our discussions today
are framed by the

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remarkable progress we’ve seen
across the United

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States, fueled by the relentless
innovation and

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impactful research. Since the
inception of

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the national HIV strategy, we
have witnessed

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significant strides in reducing
HIV incidence,

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improving treatment outcomes,
and expanding access

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to prevention tools like PrEP.
For instance,

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HIV incidence among Americans
aged 13 and

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older decreased by 12 percent
from 2018 to 2022.

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Notably, incidence among young
people aged 13 to

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24 saw a dramatic 30 percent
decrease. While we

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celebrate these milestones, we
are also reminded

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of the disparities that persist,
particularly

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among Black and Hispanic,
signaling there are

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efforts that we must continue to
intensify to make

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sure that everyone has access to
these resources

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and this in…innovation. The role
of research in

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our national HIV strategy is
paramount. It is

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not just about creating
knowledge but ensuring

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that this knowledge translates
into practice.

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Implementation science plays a
critical role

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here, bridging gap between
research outcomes and

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community needs. It ensures that
our scientific

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advancements support and do not
[inaudible] the

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lived experiences of those
affected by HIV. As we

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proceed today on today’s
webinar, let’s keep in

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mind that each statistic we
discuss represents

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individual lives—lives that are
being improved

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through research, policy, and
collective action.

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Together with our contributions,
we continue to

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advance the goals of the
national HIV strategy,

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ensuring our scientific
endeavors translate

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into tangible benefits for all
affected by HIV.

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So, thank you for your
dedication and for your

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participation today. Let’s
continue to push the

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boundaries of what is possible
in HIV research,

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implementation, and policy. So,
with that, I…I

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pass it back. I believe I am now
introducing the

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panelists. I…you know, we’re
really excited to

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have our four…four panelists
today, Dr. Latesha

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Elopre, who is the Associate
Professor Division

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of Infectious Disease at The
University of Alabama

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in Birmingham. We have Dr. Eric
Freed, Senior

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Investigator of HIV Dynamics
Replication Programs

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at the National Cancer Institute
at NIH; Dr.

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Jeanne Marrazzo, Director of
National Institutes

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of Allergy and Infectious
Diseases, as in…at

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NIH; and Dr. LaRon Nelson,
Independent Foundation

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Professor of Nursing, Yale
School of Nursing.

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And with that, I pass it back to
Dr. Donenberg.

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DR. GERI DONENBERG: Wonderful.
So, for

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our first topic, we want to
celebrate our

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advances and decades of…of
investment that have

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led to incredible progress. In
my own research,

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I’ve been pleased to be able to
see the power of

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mother-daughter relationships
and communication

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that prevented sexually
transmitted infections

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in young women 1 year after a
social behavioral

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intervention. And even more than
the data, we

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see that mothers and daughters
have shared with

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us how important it was to learn
to communicate

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with one another and how that’s
transformed their

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relationship and their
ability…feeling equipped

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to talk about PrEP and how to
use condoms. So,

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I’d like to start with you, Dr.
Marrazzo.

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Over the past 40 years, as you
know, we’ve

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seen incredible…incredible
progress. What would

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you say are some of the recent
advances in HIV,

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and how might implementation
science help

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to ensure that they are…are
available and

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reach the people who most need 
them? You are on mute.

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Apologies.

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DR. JEANNE MARRAZZO: No, my
apologies.

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Can you hear me okay now? Sorry.

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DR. GERI DONENBERG: Perfect.

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DR. JEANNE MARRAZZO: So, thank
you for the

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question. Thank you for the
opportunity to

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00:13:06,753 --> 00:13:08,939
participate. And a warm welcome
to you in your

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00:13:08,939 --> 00:13:11,357
new leadership role. It’s great
to have you here,

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00:13:11,357 --> 00:13:13,526
and I really look forward to
working with you to

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00:13:13,526 --> 00:13:15,828
address some of the things you
brought up in your

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00:13:15,828 --> 00:13:19,926
opening remarks. You know,
it’s…it’s a little bit

245
00:13:19,926 --> 00:13:24,270
tough to choose what is most
exciting about recent

246
00:13:24,270 --> 00:13:27,723
discoveries because we have had
a pretty bountiful

247
00:13:27,723 --> 00:13:31,244
last year, let alone last few
years. But I’ll try

248
00:13:31,244 --> 00:13:34,477
to kind of highlight some of my
favorites from

249
00:13:34,477 --> 00:13:37,917
the past year. And I do think
it’s important to

250
00:13:37,917 --> 00:13:40,845
your point that not only have we
made advances in

251
00:13:40,845 --> 00:13:43,890
the biomedical sciences, but we
have learned more

252
00:13:43,890 --> 00:13:46,415
about how to safely and
effectively get these

253
00:13:46,415 --> 00:13:48,995
products to people where they
live and where

254
00:13:48,995 --> 00:13:51,722
they really need these
interventions. So, let

255
00:13:51,722 --> 00:13:54,567
me just go through a few of the
interventions

256
00:13:54,567 --> 00:13:56,969
that I think are really
exciting. First of all,

257
00:13:56,969 --> 00:13:59,472
there was a landmark clinical
study most of you

258
00:13:59,472 --> 00:14:02,238
may be familiar with, reporting
that multiple

259
00:14:02,238 --> 00:14:04,944
children who acquired HIV before
birth and

260
00:14:04,944 --> 00:14:08,163
started antiretroviral therapy
in the first few

261
00:14:08,163 --> 00:14:11,584
days of life remained free of
detectable HIV for

262
00:14:11,584 --> 00:14:14,145
more than 1 year after their
treatment was paused.

263
00:14:14,145 --> 00:14:16,656
And this is really terrific
because it provides

264
00:14:16,656 --> 00:14:18,992
a concept for further study with
more advanced

265
00:14:18,992 --> 00:14:21,427
therapeutics and can also give
us some answers

266
00:14:21,427 --> 00:14:24,206
about how we might be able to
communicate and

267
00:14:24,206 --> 00:14:27,166
prevent [inaudible] of long-term
HIV infection

268
00:14:27,166 --> 00:14:29,538
in the body. That’s a big one.
The other one that

269
00:14:29,538 --> 00:14:32,004
has gotten a lot of press just
in the last couple

270
00:14:32,004 --> 00:14:35,492
of weeks is a multicenter
observational study that

271
00:14:35,492 --> 00:14:38,911
found that kidney
transplantation from deceased

272
00:14:38,911 --> 00:14:41,998
donors with HIV to recipients
with HIV was safe

273
00:14:41,998 --> 00:14:45,084
and comparable to kidney
transplantation from

274
00:14:45,084 --> 00:14:47,620
donors without HIV. This is
really critical.

275
00:14:47,620 --> 00:14:50,156
Organs are in very short supply.
And this,

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00:14:50,156 --> 00:14:52,749
I think you know, has directly
informed some

277
00:14:52,749 --> 00:14:55,228
recent guidelines coming out of
HHS. So,

278
00:14:55,228 --> 00:14:58,512
really, really important work.
The findings, in

279
00:14:58,512 --> 00:15:02,001
fact, were pivotal in enabling
the Department of

280
00:15:02,001 --> 00:15:04,500
Health and Human Services rule
change to expand

281
00:15:04,500 --> 00:15:07,206
access to kidney and liver
transplants for people

282
00:15:07,206 --> 00:15:09,997
living with HIV by removing the
requirements

283
00:15:09,997 --> 00:15:12,912
that had previously made it very
challenging

284
00:15:12,912 --> 00:15:16,423
to get transplants to those
folks. Another area

285
00:15:16,423 --> 00:15:20,153
my own interest in…in…in the
past in particular,

286
00:15:20,153 --> 00:15:24,356
is the evidence based on
pre-exposure prophylaxis,

287
00:15:24,356 --> 00:15:28,394
or PrEP. So, we have advanced
our work on PrEP

288
00:15:28,394 --> 00:15:31,206
in the context of reproductive
health in several

289
00:15:31,206 --> 00:15:34,133
ways, against getting to this
concept of getting

290
00:15:34,133 --> 00:15:36,470
people what they need, where
they need it, when

291
00:15:36,470 --> 00:15:38,905
they want it, right?
Reproductive health being,

292
00:15:38,905 --> 00:15:41,427
of course, a huge focus for many
women who

293
00:15:41,427 --> 00:15:44,477
remain at high risk for HIV.
Several studies have

294
00:15:44,477 --> 00:15:47,777
reported additional data
reinforcing the safety

295
00:15:47,777 --> 00:15:51,284
of the oral…of oral vaginal ring
and long-acting

296
00:15:51,284 --> 00:15:54,003
injectable PrEP formulations in
pregnancy. And, in

297
00:15:54,003 --> 00:15:56,722
fact, we recently shared a new
analysis from one

298
00:15:56,722 --> 00:16:00,208
of the efficacy studies of
long-acting injectable

299
00:16:00,208 --> 00:16:03,763
cabotegravir PrEP that found
that CAB-LA did not

300
00:16:03,763 --> 00:16:06,984
interact with long-acting
reversible contraceptive

301
00:16:06,984 --> 00:16:10,269
drugs. So really good news for
people who want to

302
00:16:10,269 --> 00:16:13,364
address unintended pregnancy, as
well as

303
00:16:13,364 --> 00:16:16,609
HIV. I think that Dr. Freed will
discuss

304
00:16:16,609 --> 00:16:18,730
this in more detail, but I’d be
remiss if I

305
00:16:18,730 --> 00:16:20,947
didn’t mention the
ground-breaking findings

306
00:16:20,947 --> 00:16:23,935
on injectable lenacapavir, which
was found to

307
00:16:23,935 --> 00:16:27,053
be safe and effective as twice
yearly PrEP in

308
00:16:27,053 --> 00:16:29,198
two large international trials
just this past

309
00:16:29,198 --> 00:16:31,624
week, published in New England
Journal by Colleen

310
00:16:31,624 --> 00:16:34,804
Kelley, and colleagues looking
at this in men

311
00:16:34,804 --> 00:16:38,331
who have sex with men and
transgender women, and

312
00:16:38,331 --> 00:16:41,635
previously in cisgender women.
So, really amazing.

313
00:16:41,635 --> 00:16:45,004
And I would remind you that this
was a tremendous

314
00:16:45,004 --> 00:16:47,772
achievement for the HIV
response, but it was

315
00:16:47,772 --> 00:16:50,910
also possible because of
foundational scientific

316
00:16:50,910 --> 00:16:53,657
discoveries from NIH-supported
investigators

317
00:16:53,657 --> 00:16:56,282
in partnership with industry
scientists,

318
00:16:56,282 --> 00:16:59,057
so getting back to some of
Francisco’s comments

319
00:16:59,057 --> 00:17:02,121
about how important it is to
continue to recognize

320
00:17:02,121 --> 00:17:05,371
the role of basic science in
research and also

321
00:17:05,371 --> 00:17:08,828
working closely with our
industry partners. So,

322
00:17:08,828 --> 00:17:11,057
there…these are all really big
advances, but

323
00:17:11,057 --> 00:17:13,633
more than 40 years into the
pandemic, as you have

324
00:17:13,633 --> 00:17:16,581
pointed out, we know how
important and challenging

325
00:17:16,581 --> 00:17:19,472
it is to translate these
scientific advances to

326
00:17:19,472 --> 00:17:23,075
equitable implementation and
access at scale.

327
00:17:23,075 --> 00:17:26,913
So, I want to remind people that
NIH’s mission

328
00:17:26,913 --> 00:17:29,268
is—in supporting HIV science—as
you have said, is

329
00:17:29,268 --> 00:17:31,717
to improve the health-related
quality of people’s

330
00:17:31,717 --> 00:17:35,637
lives, whether their goals
are…are to achieve and

331
00:17:35,637 --> 00:17:39,792
maintain viral suppression and
prevent HIV-related

332
00:17:39,792 --> 00:17:42,806
complications, learn their HIV
status, or use an

333
00:17:42,806 --> 00:17:46,065
HIV-prevention method tailored
to their needs. So,

334
00:17:46,065 --> 00:17:48,548
I think these options need to be
safe, they

335
00:17:48,548 --> 00:17:51,370
need to be effective, they need
to be discreet,

336
00:17:51,370 --> 00:17:54,300
and they need to be accessible.
So, to that end,

337
00:17:54,300 --> 00:17:57,410
we’re currently supporting
implementation science

338
00:17:57,410 --> 00:17:59,935
through Ending the HIV Epidemic
in the United

339
00:17:59,935 --> 00:18:02,515
States Initiative, in
collaboration with our

340
00:18:02,515 --> 00:18:05,687
federal partners. We’ve
supported these projects

341
00:18:05,687 --> 00:18:08,988
with the National Institute of
Mental Health, in

342
00:18:08,988 --> 00:18:12,192
particular, to answer some of
the implementation

343
00:18:12,192 --> 00:18:15,528
science questions in order to
increase uptake of

344
00:18:15,528 --> 00:18:18,238
these tools. We’re also in the
middle of a

345
00:18:18,238 --> 00:18:21,200
consultative process to set a
vision for the

346
00:18:21,200 --> 00:18:24,547
future of NIAID’s HIV clinical
trials networks,

347
00:18:24,547 --> 00:18:28,174
including the role that
NIH-funded implementation

348
00:18:28,174 --> 00:18:31,676
science is going to need to play
as we understand

349
00:18:31,676 --> 00:18:35,247
how to reduce some of these
persistent barriers.

350
00:18:35,247 --> 00:18:38,684
And just a reminder, we’re still
inviting comments

351
00:18:38,684 --> 00:18:42,188
on that plan for future funding.
More information

352
00:18:42,188 --> 00:18:45,770
is available at our NIAID HIV
enterprise webpage.

353
00:18:45,770 --> 00:18:49,495
And then the last thing I’ll
just mention is that

354
00:18:49,495 --> 00:18:52,395
in addition to applying classic
implementation

355
00:18:52,395 --> 00:18:55,234
science, we need to ensure we
begin product

356
00:18:55,234 --> 00:18:57,896
research and development with
the end user in

357
00:18:57,896 --> 00:19:00,673
mind. By that I mean that we
need to plan for

358
00:19:00,673 --> 00:19:03,556
impact by mapping clear pathways
to rapid

359
00:19:03,556 --> 00:19:06,645
regulatory decisions, scalable
production,

360
00:19:06,645 --> 00:19:09,615
and fair pricing before the
start of any efficacy

361
00:19:09,615 --> 00:19:12,585
study. So, I’ll pause there and
look forward to

362
00:19:12,585 --> 00:19:15,171
the reflections of my fellow
panelists, and

363
00:19:15,171 --> 00:19:17,757
thanks a lot for giving me the
opportunity.

364
00:19:17,757 --> 00:19:19,191
DR. GERI DONENBERG: Thank you,
Dr. Marrazzo,  

365
00:19:19,191 --> 00:19:21,777
very enlightening. I would like
to

366
00:19:21,777 --> 00:19:24,363
invite the other speakers if
you

367
00:19:24,363 --> 00:19:28,531
have other comments of new
innovations

368
00:19:28,531 --> 00:19:32,805
or recent advances you’d like to
share.

369
00:19:32,805 --> 00:19:35,232
DR. LARON NELSON: Thank you, Dr.
Marrazzo, for

370
00:19:35,232 --> 00:19:37,710
those comments. And thank you
also, Geri. I…I

371
00:19:37,710 --> 00:19:41,463
guess I would say I’ve also been
struck by the,

372
00:19:41,463 --> 00:19:45,451
the pace of advancements and the
discovery side,

373
00:19:45,451 --> 00:19:47,812
particularly, you know, if we
think about PrEP

374
00:19:47,812 --> 00:19:50,122
moving so quickly from the first
oral daily

375
00:19:50,122 --> 00:19:54,359
option to now the potential of a
licensed twice a

376
00:19:54,359 --> 00:19:58,764
year [laughs] injectable is…is
extraordinary. But

377
00:19:58,764 --> 00:20:02,867
I think for me, the…the most
exciting thing about

378
00:20:02,867 --> 00:20:06,806
the progress is this…this
willingness now to,

379
00:20:06,806 --> 00:20:10,500
I think, address the complex
drivers of the

380
00:20:10,500 --> 00:20:14,447
epidemic in ways that just
seemed impossible

381
00:20:14,447 --> 00:20:17,336
that…that we wouldn’t consider.
You know, when,

382
00:20:17,336 --> 00:20:20,286
when I was starting out, the
focus was only on

383
00:20:20,286 --> 00:20:23,424
behavioral interventions and
vaccines, you know.

384
00:20:23,424 --> 00:20:26,625
But that was it. Because it
was…we had to focus

385
00:20:26,625 --> 00:20:29,527
on what we…what we said was
modifiable. What are

386
00:20:29,527 --> 00:20:32,665
the things that you could
change? And you couldn’t

387
00:20:32,665 --> 00:20:35,722
focus on structural factors
because you couldn’t

388
00:20:35,722 --> 00:20:38,904
change them. Those weren’t
modifiable. But those

389
00:20:38,904 --> 00:20:41,938
were the things that we have to
change. [laughs]

390
00:20:41,938 --> 00:20:44,910
And so, you know, for
the…the…there wasn’t an

391
00:20:44,910 --> 00:20:47,503
appreciation that system-level
barriers and

392
00:20:47,503 --> 00:20:50,449
inefficiencies were, I think, in
the legitimate

393
00:20:50,449 --> 00:20:53,468
scope of scientific endeavor,
especially in

394
00:20:53,468 --> 00:20:56,555
infectious diseases. And now
that seems to

395
00:20:56,555 --> 00:20:59,457
be changing. [laughs] And that’s
exciting for me

396
00:20:59,457 --> 00:21:02,595
because for the last, you know,
the better part of

397
00:21:02,595 --> 00:21:05,602
20 years, I’ve just been mad all
the time [laughs]

398
00:21:05,602 --> 00:21:08,667
because we haven’t been doing
this. And I…I agree

399
00:21:08,667 --> 00:21:11,385
with you, Dr. Donenberg, it does
feel like this

400
00:21:11,385 --> 00:21:14,273
is…we’ve reached that last
mile…last mile to go.

401
00:21:14,273 --> 00:21:17,193
And I think now more than ever,
it seems that…that

402
00:21:17,193 --> 00:21:20,112
this is a shot. We got a shot to
really do this.

403
00:21:20,112 --> 00:21:22,965
So, I’m excited about the
progress that we’ve

404
00:21:22,965 --> 00:21:25,818
made and…and things that are
looking forward.

405
00:21:25,818 --> 00:21:29,639
DR. GERI DONENBERG: Thank you,
Dr. Nelson.

406
00:21:29,639 --> 00:21:33,726
Anyone else like to share? All
right, well,

407
00:21:33,726 --> 00:21:36,755
maybe it sounds like we have a
number of

408
00:21:36,755 --> 00:21:39,932
innovations that we have to be
proud of,

409
00:21:39,932 --> 00:21:42,771
and we’re finally getting to
some of

410
00:21:42,771 --> 00:21:46,071
the more…oh, was there someone
else? Oh,

411
00:21:46,071 --> 00:21:48,557
sorry. And that we’re finally
getting to some

412
00:21:48,557 --> 00:21:51,043
of the more underlying, maybe
difficult and

413
00:21:51,043 --> 00:21:54,742
complex factors that are driving
transmission,

414
00:21:54,742 --> 00:21:58,284
driving prevention and
treatment, and that

415
00:21:59,051 --> 00:22:01,562
we’re moving in the right
direction to get

416
00:22:01,562 --> 00:22:04,190
to that last mile. So, I’m going
to pivot,

417
00:22:04,190 --> 00:22:08,956
and I’m going to hand over to
Dr. Francisco Ruiz,

418
00:22:08,956 --> 00:22:13,532
who will lead us in a discussion
on innovation.

419
00:22:13,532 --> 00:22:15,496
MR. FRANCISCO RUIZ: Awesome.
Great. Thank you. Now

420
00:22:15,496 --> 00:22:17,536
let’s focus on the critical role
of innovation and

421
00:22:17,536 --> 00:22:20,242
really sort of talk about the
whole of government,

422
00:22:20,242 --> 00:22:22,841
whole of society approach…to
combating HIV. We

423
00:22:22,841 --> 00:22:25,831
know the whole of society really
includes…sort

424
00:22:25,831 --> 00:22:28,948
of underscores the importance of
collaboration

425
00:22:28,948 --> 00:22:31,147
and coordination across various
folks—and so,

426
00:22:31,147 --> 00:22:33,586
that’s government, that’s health
care providers,

427
00:22:33,586 --> 00:22:36,384
community-based organizations,
people with HIV,

428
00:22:36,384 --> 00:22:39,124
and researchers—to make sure
that we achieve

429
00:22:39,124 --> 00:22:41,768
equitable health outcomes. And
so, the first

430
00:22:41,768 --> 00:22:44,530
question that I have here in
this regard is,

431
00:22:44,530 --> 00:22:47,565
what is the role of innovation
in sustaining

432
00:22:47,565 --> 00:22:50,736
and accelerating—again, going
with our theme

433
00:22:50,736 --> 00:22:53,592
for World Day’s Day—sustaining
and accelerating

434
00:22:53,592 --> 00:22:56,508
research progress to reach
communities most in

435
00:22:56,508 --> 00:22:59,644
need? What have…where have we
seen innovative

436
00:22:59,644 --> 00:23:02,915
approaches helping achieve
tangible gains for

437
00:23:02,915 --> 00:23:07,073
our communities? And so, I
invite maybe Dr.…Dr.

438
00:23:07,073 --> 00:23:11,490
Eric Freed, if you want to start
the conversation.

439
00:23:11,490 --> 00:23:14,576
DR. ERIC FREED: Yes. certainly.
Thank you Dr.

440
00:23:14,576 --> 00:23:17,796
Donenberg for putting in OAR for
putting this

441
00:23:17,796 --> 00:23:20,659
together, inviting me to
participate. So, I think

442
00:23:20,659 --> 00:23:23,636
it’s very important to keep in
mind that although

443
00:23:23,636 --> 00:23:26,688
we have made tremendous progress
in the last

444
00:23:26,688 --> 00:23:29,875
40 years in developing drugs
that combat HIV

445
00:23:29,875 --> 00:23:33,779
infection, we still have no
vaccine and no cure.

446
00:23:33,779 --> 00:23:37,683
So, we are really…you know,
our…our ability to

447
00:23:37,683 --> 00:23:41,923
treat HIV infection is based on
the really highly

448
00:23:41,923 --> 00:23:45,824
efficacious drugs that have been
developed.

449
00:23:45,824 --> 00:23:49,483
However, I think I really want
to stress that we

450
00:23:49,483 --> 00:23:53,365
need to continue innovation and
basic research to

451
00:23:53,365 --> 00:23:56,928
develop new drugs because
resistance to the

452
00:23:56,928 --> 00:24:00,572
current drugs are…is increasing
in…in many

453
00:24:00,572 --> 00:24:03,850
parts of the world. So, Dr.
Marrazzo alluded

454
00:24:03,850 --> 00:24:07,346
to lenacapavir, which is really
a…an exciting

455
00:24:07,346 --> 00:24:10,614
innovation that’s come out of
partnerships

456
00:24:10,614 --> 00:24:14,186
between basic research and…and
industry work

457
00:24:14,186 --> 00:24:19,160
at the NIH extramural community
and…and companies.

458
00:24:19,160 --> 00:24:24,330
And just to…to contextualize
this, we have learned

459
00:24:24,330 --> 00:24:28,010
a tremendous amount about a part
of the virus

460
00:24:28,010 --> 00:24:31,770
particle known as the capsid. So
this is a…a

461
00:24:31,770 --> 00:24:36,214
proteinase shell that surrounds
the viral core

462
00:24:36,214 --> 00:24:40,846
in the virus particle. And a
signature feature

463
00:24:40,846 --> 00:24:44,127
of lentiviruses like HIV-1 is
their ability to

464
00:24:44,127 --> 00:24:47,686
infect nondividing cells—and
this has been known

465
00:24:47,686 --> 00:24:51,631
for decades—so we know that the
incoming viral

466
00:24:51,631 --> 00:24:55,828
complex has to cross an intact
nuclear envelope

467
00:24:55,828 --> 00:24:58,975
in order to productively infect
the cell. And

468
00:24:58,975 --> 00:25:02,601
we’ve also known, again, that
this capsid protein,

469
00:25:02,601 --> 00:25:05,586
or CA protein, forms the outer
shell of the

470
00:25:05,586 --> 00:25:08,774
viral core, but really, only
recently has it

471
00:25:08,774 --> 00:25:12,879
become clear how important the
capsid is in early

472
00:25:12,879 --> 00:25:17,149
events in the virus replication
cycle. The capsid

473
00:25:17,149 --> 00:25:20,289
interacts with host factors both
during nuclear

474
00:25:20,289 --> 00:25:23,756
import and also as it crosses
the nuclear envelope

475
00:25:23,756 --> 00:25:27,221
and into the nucleus. This is
work from…from a

476
00:25:27,221 --> 00:25:31,130
number of labs. So, this work,
this basic science,

477
00:25:31,130 --> 00:25:34,133
has really revealed that the
capsid is a key

478
00:25:34,133 --> 00:25:37,469
fundamental part of the virus
replication cycle

479
00:25:37,469 --> 00:25:42,096
and is therefore a viable target
for developing

480
00:25:42,096 --> 00:25:47,012
antiretrovirals. There was a
prototypical capsid

481
00:25:47,012 --> 00:25:50,070
inhibitor known as PF74
developed by Pfizer that

482
00:25:50,070 --> 00:25:53,252
was really helpful in uncovering
many of the key

483
00:25:53,252 --> 00:25:56,238
aspects that I just alluded to.
But more recently,

484
00:25:56,238 --> 00:25:59,224
work from Gilead led to the
discovery—along with

485
00:25:59,224 --> 00:26:02,174
academic partners—led to the
discovery of

486
00:26:02,174 --> 00:26:05,264
GS-6207, or lenacapavir, which
has really

487
00:26:05,264 --> 00:26:09,668
shown remarkable efficacy not
only in treatment,

488
00:26:09,668 --> 00:26:14,072
but I think even more
importantly as PrEP. And

489
00:26:14,072 --> 00:26:17,746
two papers published in
[inaudible] Medicine

490
00:26:17,746 --> 00:26:21,747
showed really stunning success
in…in PrEP. And

491
00:26:21,747 --> 00:26:25,434
the…the …the chemical properties
of lenacapavir

492
00:26:25,434 --> 00:26:29,121
allow it to be administered as a
twice-yearly

493
00:26:29,121 --> 00:26:32,135
injection. So, this really
removes many of

494
00:26:32,135 --> 00:26:35,360
the barriers to former or
current…currently

495
00:26:35,360 --> 00:26:40,082
used PrEP modalities in which
oral pills need to

496
00:26:40,082 --> 00:26:44,803
be taken in…in many cases daily.
So, I…I think

497
00:26:44,803 --> 00:26:47,958
this all really stresses the
need for continued

498
00:26:47,958 --> 00:26:51,310
basic research to uncover
fundamental aspects of

499
00:26:51,310 --> 00:26:54,780
the replication cycle that can
then lead to

500
00:26:54,780 --> 00:26:58,250
novel targets for antiretroviral
therapies.

501
00:26:58,250 --> 00:27:00,853
MR. FRANCISCO RUIZ: Thank you 
for that. Anyone else from the  

502
00:27:00,853 --> 00:27:08,727
panel want to sort of speak to
that? Welcome.

503
00:27:08,727 --> 00:27:10,107
DR. LATESHA ELOPRE: Thank you so
much

504
00:27:10,107 --> 00:27:11,597
for having me. And I just want
to add,

505
00:27:11,597 --> 00:27:14,703
I think it’s a…amazing time
right now with regards

506
00:27:14,703 --> 00:27:17,870
to all of the innovations that
have been recently

507
00:27:17,870 --> 00:27:20,724
published for long-acting
modalities in regards

508
00:27:20,724 --> 00:27:23,876
to people who are living with
HIV, but also people

509
00:27:23,876 --> 00:27:25,945
who potentially could be
diagnosed with HIV in

510
00:27:25,945 --> 00:27:28,146
the future. I think it opens a
lot of doorways,

511
00:27:28,847 --> 00:27:31,590
but speaking and tapping into
what Dr. Nelson said

512
00:27:31,590 --> 00:27:34,386
earlier in regards to having
these human-centered

513
00:27:34,386 --> 00:27:36,337
approaches that are really
challenging and

514
00:27:36,337 --> 00:27:38,423
pushing against the structural
barriers and

515
00:27:38,423 --> 00:27:40,455
the interpersonal and
policy-level barriers that

516
00:27:40,455 --> 00:27:42,528
people face when they’re trying
to access these

517
00:27:42,528 --> 00:27:45,100
innovations, I think also is
something that has

518
00:27:45,100 --> 00:27:47,833
been really groundbreaking in
regards to science

519
00:27:47,833 --> 00:27:51,124
in this point in time.
Implementation science

520
00:27:51,124 --> 00:27:54,773
has moved. I think this idea
that you have these

521
00:27:54,773 --> 00:27:57,064
sometimes 100 percent effective
interventions that

522
00:27:57,064 --> 00:27:59,444
aren’t really reaching and
having that efficacy in

523
00:27:59,444 --> 00:28:02,168
all populations and trying to
uncover why. So,

524
00:28:02,168 --> 00:28:04,950
I’ve been excited about that in
my own state,

525
00:28:04,950 --> 00:28:06,921
which is a non-Medicaid
expansion state.

526
00:28:06,921 --> 00:28:08,987
I’ve also been really excited
around the

527
00:28:08,987 --> 00:28:11,962
idea in resource-limited
settings. How can you

528
00:28:11,962 --> 00:28:15,127
capitalize on precision public
health and large

529
00:28:15,127 --> 00:28:17,542
data sets to make sure that
you’re really pushing

530
00:28:17,542 --> 00:28:19,765
resources to where they’re
needed the most?

531
00:28:19,765 --> 00:28:22,549
Targeting communities that are
recently having

532
00:28:22,549 --> 00:28:25,571
outbreaks or having uncontrolled
viral loads and

533
00:28:25,571 --> 00:28:28,444
trying to, again, using those
human-centered

534
00:28:28,444 --> 00:28:31,510
approaches, address why that’s
occurring. So,

535
00:28:31,510 --> 00:28:36,273
I think marrying the two is
probably the

536
00:28:36,273 --> 00:28:41,153
way forward to getting to that
last mile.

537
00:28:41,153 --> 00:28:43,036
MR. FRANCISCO RUIZ: Dr. Nelson,
anything

538
00:28:43,036 --> 00:28:45,057
you want to add to that now that
you spoke?

539
00:28:45,057 --> 00:28:47,104
DR. LARON NELSON: Yeah, I think
for me, I was…I

540
00:28:47,104 --> 00:28:49,194
was struck with Dr. Freed
mentioned at the top

541
00:28:49,194 --> 00:28:53,416
of his comment about vaccines.
I…I think that, you

542
00:28:53,416 --> 00:28:57,803
know, we do…we do well to
celebrate all the events

543
00:28:57,803 --> 00:29:00,661
that we’ve had, but we do…we
don’t have a vaccine.

544
00:29:00,661 --> 00:29:03,575
And so, I don’t think we have
everything we need.

545
00:29:03,575 --> 00:29:06,878
[laughs] There could be more.
And I…I really

546
00:29:06,878 --> 00:29:10,549
think that vaccines have gotten
sort of wrapped

547
00:29:10,549 --> 00:29:12,910
up in controversy for other
things, which…which

548
00:29:12,910 --> 00:29:15,320
could have an impact on how we
continue to try

549
00:29:15,320 --> 00:29:18,084
to accelerate advances in HIV
vaccine production.

550
00:29:18,084 --> 00:29:20,959
But I think that’s…that is
important. And I think

551
00:29:20,959 --> 00:29:23,260
a lot of what I’ve learned, how
I’ve learned

552
00:29:23,260 --> 00:29:25,664
how to innovate in…in the field
where I work

553
00:29:25,664 --> 00:29:28,599
in specifically, has been from
learning from

554
00:29:28,599 --> 00:29:31,470
and in some ways being mentored
by people

555
00:29:31,470 --> 00:29:33,849
who’ve really been leading the
charge on trying to

556
00:29:33,849 --> 00:29:36,274
find the vaccine. And I think
staying determined,

557
00:29:36,274 --> 00:29:38,323
learning from failures, and
finding ways to

558
00:29:38,323 --> 00:29:40,512
continue to innovate is
something that we…we

559
00:29:40,512 --> 00:29:43,131
still have to do in hopes that
we will

560
00:29:43,131 --> 00:29:45,884
get one one day. And even if we
don’t,

561
00:29:45,884 --> 00:29:49,614
we’re…we’re blessed that we have
so many other ops

562
00:29:49,614 --> 00:29:53,125
that can help us make progress
in the meantime.

563
00:29:53,125 --> 00:29:54,393
MR. FRANCISCO RUIZ: Thank you. I
think

564
00:29:54,393 --> 00:29:55,694
that’s super helpful. I think
the…the

565
00:29:55,694 --> 00:29:57,819
main takeaways that I got from
this is,

566
00:29:57,819 --> 00:29:59,998
sort of, we’ve made progress,
so, yes,

567
00:29:59,998 --> 00:30:02,260
check. But there’s still more
work to be done,

568
00:30:02,260 --> 00:30:04,569
right? I think there’s some
conversations. We

569
00:30:04,569 --> 00:30:06,869
talked about the basic science
piece. You know,

570
00:30:06,869 --> 00:30:09,408
we don’t have the cure, we don’t
have the vaccine,

571
00:30:09,408 --> 00:30:11,875
and that’s something that we
still need to sort

572
00:30:11,875 --> 00:30:14,446
of think through. And we must
capitalize on the

573
00:30:14,446 --> 00:30:16,541
progress, right? We talked about
intentional

574
00:30:16,541 --> 00:30:18,684
human-centered approaches,
making sure that

575
00:30:18,684 --> 00:30:20,752
we’re sort of making sure
everyone access…has

576
00:30:20,752 --> 00:30:22,954
access…to the science and…and
innovations that

577
00:30:22,954 --> 00:30:25,469
we’re developing. And the last
piece that I

578
00:30:25,469 --> 00:30:28,326
heard is really making sure that
we disentangle

579
00:30:28,326 --> 00:30:30,629
the important work that we’re
doing as public

580
00:30:30,629 --> 00:30:33,031
health and…and researchers from
the politics,

581
00:30:33,031 --> 00:30:35,538
and making sure that we address
some of

582
00:30:35,538 --> 00:30:38,170
the barriers that we may see in
various

583
00:30:38,170 --> 00:30:41,409
jurisdictions and making sure
that folks are sort

584
00:30:41,409 --> 00:30:44,843
of being able to appreciate the
science as science

585
00:30:44,843 --> 00:30:47,946
and disentangling it from some
of the politics

586
00:30:47,946 --> 00:30:51,049
that we may have be seeing as of
recent. So,

587
00:30:51,049 --> 00:30:53,903
thank you for the discussion.
I’m going to

588
00:30:53,903 --> 00:30:57,022
pass it back over to Dr.
Donenberg. Thank you.

589
00:30:57,022 --> 00:31:01,256
DR. GERI DONENBERG: Thank you.
So, this is, sort

590
00:31:01,256 --> 00:31:05,664
of, the final part for our panel
discussion. And

591
00:31:05,664 --> 00:31:09,307
the question that we would like
to discuss

592
00:31:09,307 --> 00:31:13,205
is, sort of, the future of HIV
research and

593
00:31:13,205 --> 00:31:15,134
the additional work that needs
to be done.

594
00:31:15,134 --> 00:31:17,109
So, we’ve been talking about
that quite a

595
00:31:17,109 --> 00:31:20,854
bit. We’ve been reflecting as a
panel on the

596
00:31:20,854 --> 00:31:25,016
advances and in some of the ways
that the…maybe

597
00:31:25,016 --> 00:31:28,180
some of the
barriers—particularly maybe some

598
00:31:28,180 --> 00:31:30,771
of 
the individual, interpersonal,

599
00:31:30,771 --> 00:31:31,990
organizational,

600
00:31:31,990 --> 00:31:36,113
and structural factors—that are
going to impact

601
00:31:36,113 --> 00:31:40,665
or that do impact, whether we
have these effective

602
00:31:40,665 --> 00:31:43,329
strategies are ultimately going
to reach the

603
00:31:43,329 --> 00:31:46,171
populations most in need, the
context most in

604
00:31:46,171 --> 00:31:49,225
need, low, sort of, more
resource-constrained

605
00:31:49,225 --> 00:31:52,477
settings and so forth. And so,
we want to make

606
00:31:52,477 --> 00:31:56,622
sure in that way that our
interventions that are

607
00:31:56,622 --> 00:32:00,852
effective are feasible,
acceptable, appropriate

608
00:32:00,852 --> 00:32:03,839
for the context, for the
culture. Otherwise,

609
00:32:03,839 --> 00:32:06,892
we know they won’t really be
sustained over

610
00:32:06,892 --> 00:32:10,147
time. And so, this is where I
think all of us are

611
00:32:10,147 --> 00:32:13,598
recognizing that implementation
science can really

612
00:32:13,598 --> 00:32:18,320
take us to that final…that mile.
So, the question

613
00:32:18,320 --> 00:32:23,041
for the panel is, what could
future investments

614
00:32:23,041 --> 00:32:27,545
support across the entire
research continuum—so

615
00:32:27,545 --> 00:32:32,517
basic science, clinical
interventions, behavioral,

616
00:32:32,517 --> 00:32:35,060
social science, even
implementation

617
00:32:35,060 --> 00:32:37,956
science—that can drive greater
impact,

618
00:32:37,956 --> 00:32:43,512
increase health equity, and
achieve epidemic

619
00:32:43,512 --> 00:32:49,067
control? And maybe we start with
Dr. Elopre?

620
00:32:49,067 --> 00:32:51,788
DR. LATESHA ELOPRE: Thank you.
I

621
00:32:51,788 --> 00:32:54,840
think that’s a wonderful
question,

622
00:32:54,840 --> 00:32:57,988
and I think that is maybe the
entire point of

623
00:32:57,988 --> 00:33:01,479
the panel. Honestly, I think a
lot of this needs

624
00:33:01,479 --> 00:33:04,454
to move towards addressing
syndemics that are

625
00:33:04,454 --> 00:33:07,752
affecting populations in
greatest need. I agree,

626
00:33:07,752 --> 00:33:09,353
again, with Dr. Nelson when he
said that there

627
00:33:09,353 --> 00:33:11,056
was a lot of frustration when
you first started

628
00:33:11,056 --> 00:33:12,927
and you were taking care of
patients, or

629
00:33:12,927 --> 00:33:15,026
you’re taking care of clients,
and you felt

630
00:33:15,026 --> 00:33:17,394
like you were solely focused on
one aspect of

631
00:33:17,394 --> 00:33:19,865
their health and not their whole
being. What,

632
00:33:19,865 --> 00:33:23,817
as a person in a rural state
that doesn’t have

633
00:33:23,817 --> 00:33:28,106
access to food, to housing, to
clean water…where

634
00:33:28,106 --> 00:33:30,723
does HIV fit in that picture?
And I think that in

635
00:33:30,723 --> 00:33:33,445
order for us to really see gains
in the epidemic,

636
00:33:33,445 --> 00:33:36,094
we’re going to have to, I think,
disentangle some

637
00:33:36,094 --> 00:33:38,850
of that and try to understand
from a whole person

638
00:33:38,850 --> 00:33:41,021
standpoint, how can we improve
the overall health

639
00:33:41,021 --> 00:33:43,321
and wellbeing of the people who
are being impacted

640
00:33:43,321 --> 00:33:46,756
the most. So, I…I do think using
implementation

641
00:33:46,756 --> 00:33:49,761
science, using precision public
health,

642
00:33:49,761 --> 00:33:51,787
I think all will help with all
of that.

643
00:33:51,787 --> 00:33:53,965
But honestly, focusing on
syndemics that

644
00:33:53,965 --> 00:33:56,835
are affecting populations in
greatest need

645
00:33:56,835 --> 00:33:59,771
will probably move the needle
the greatest.

646
00:33:59,771 --> 00:34:02,096
DR. GERI DONENBERG: Thank you.
Anyone

647
00:34:02,096 --> 00:34:04,175
else? Yeah, go ahead, Dr.
Nelson.

648
00:34:04,175 --> 00:34:05,842
DR. LARON NELSON: Yeah, I’ll add
to that.

649
00:34:05,842 --> 00:34:07,746
Thank you for that question. I
appreciate Dr.

650
00:34:07,746 --> 00:34:11,885
Elopre’s…those comments. You
know, I think, to add

651
00:34:11,885 --> 00:34:16,187
to that, the biggest challenge
from what I’ve seen

652
00:34:16,187 --> 00:34:19,338
in achieving these
implementation of innovations

653
00:34:19,338 --> 00:34:22,360
just is really finding out a way
to make the

654
00:34:22,360 --> 00:34:25,275
economics work. I mean,
when…even places that

655
00:34:25,275 --> 00:34:28,633
we’ve gone through, I’m leading
a study with Chris

656
00:34:28,633 --> 00:34:32,454
Beyrer called HPTN 096 in…in
four communities in

657
00:34:32,454 --> 00:34:36,274
the South. And every place that
we’ve gone to,

658
00:34:36,274 --> 00:34:39,937
we…we talk to them about oral
PrEP, are they

659
00:34:39,937 --> 00:34:43,682
prescribing it? And the current
injectable,

660
00:34:43,682 --> 00:34:46,024
thinking about what if a
twice-yearly injectable

661
00:34:46,024 --> 00:34:48,320
comes through? And they all are
worried about

662
00:34:48,320 --> 00:34:50,033
how are we’re going to pay for
this? How are we

663
00:34:50,033 --> 00:34:51,890
going to make this work [laughs]
in our practice,

664
00:34:51,890 --> 00:34:54,092
right? It’s…it is about
implementation science,

665
00:34:54,092 --> 00:34:56,294
but they’re not questioning
whether or not it

666
00:34:56,294 --> 00:34:58,599
works [laughs] or whether or not
it’ll

667
00:34:58,599 --> 00:35:01,199
benefit. They’re questioning how
are they

668
00:35:01,199 --> 00:35:03,861
going to implement this evidence
into their

669
00:35:03,861 --> 00:35:06,705
practice in a way that they can
afford. Many

670
00:35:06,705 --> 00:35:10,058
of these practices are business
owners. I mean,

671
00:35:10,058 --> 00:35:13,411
it…you might not think about a
physician as a

672
00:35:13,411 --> 00:35:15,176
business owner, [laughs] but if
they’re running

673
00:35:15,176 --> 00:35:17,015
their private practice, they are
thinking about

674
00:35:17,015 --> 00:35:19,851
it as if they’re running a
business and they

675
00:35:19,851 --> 00:35:22,687
got to pay the admin staff and
the nurses,

676
00:35:22,687 --> 00:35:24,644
and they got to have all these
things. And

677
00:35:24,644 --> 00:35:26,691
they have to make decisions
about what can

678
00:35:26,691 --> 00:35:29,815
they implement that allows them
to give the kind

679
00:35:29,815 --> 00:35:33,131
of care they want to provide and
still be able to

680
00:35:33,131 --> 00:35:36,088
pay their bills. Maybe I’m
oversimplifying it,

681
00:35:36,088 --> 00:35:39,170
but…but I think thinking about
how to make the

682
00:35:39,170 --> 00:35:42,869
economics work is going to be
key, which I also

683
00:35:42,869 --> 00:35:46,645
think means working with
partners differently.

684
00:35:46,645 --> 00:35:50,524
Like the…that the…I don’t know
what…what I would

685
00:35:50,524 --> 00:35:54,719
say it. The pharmaceutical
companies—we can’t just

686
00:35:54,719 --> 00:35:57,327
sort of look at them as the
suppliers [laughs]

687
00:35:57,327 --> 00:35:59,991
right? They have to be partners.
Dr. Marrazzo

688
00:35:59,991 --> 00:36:02,082
talked about thinking about
pricing strategies

689
00:36:02,082 --> 00:36:04,396
now while you’re doing the
efficacy trials. Like,

690
00:36:04,396 --> 00:36:06,987
“Yes, the time to think about it
is now.” And

691
00:36:06,987 --> 00:36:09,634
that might seem odd, but that’s
what we have

692
00:36:09,634 --> 00:36:12,126
to do if we’re going to get to a
point where

693
00:36:12,126 --> 00:36:14,839
this…this product is licensed
and whether it’s

694
00:36:14,839 --> 00:36:17,003
going to actually do anything.
Because if nobody

695
00:36:17,003 --> 00:36:19,344
can afford to use it…and I’m not
talking about the

696
00:36:19,344 --> 00:36:21,338
end users affording to use it.
I’m talking about

697
00:36:21,338 --> 00:36:23,415
can practitioners [laughs]
afford to incorporate

698
00:36:23,415 --> 00:36:26,410
this into their work? It’s going
to make a big

699
00:36:26,410 --> 00:36:29,788
difference or…or not. I think
insurance companies,

700
00:36:29,788 --> 00:36:32,826
we have to think about them as
more than payers,

701
00:36:32,826 --> 00:36:35,927
although that’s their primary
function. But are

702
00:36:35,927 --> 00:36:38,937
there ways to incorporate them
into our research?

703
00:36:38,937 --> 00:36:41,766
Can they, can they experiment
with different

704
00:36:41,766 --> 00:36:44,483
policy pricing strategies or
reimbursement

705
00:36:44,483 --> 00:36:47,705
strategies that optimize access
to the different

706
00:36:47,705 --> 00:36:50,733
types of medications, whether
treatment or PrEP?

707
00:36:50,733 --> 00:36:53,945
Do the reimbursement schemes
encourage physicians

708
00:36:53,945 --> 00:36:56,770
and nurse practitioners to
prescribe and to follow

709
00:36:56,770 --> 00:36:59,484
up and [laughs] to make sure
they retain them?

710
00:36:59,484 --> 00:37:02,931
If it…if it doesn’t…if there’s
not a financial

711
00:37:02,931 --> 00:37:06,524
incentive…let me say I’m a nurse
practitioner,

712
00:37:06,524 --> 00:37:08,916
okay? But if there’s not a
financial incentive

713
00:37:08,916 --> 00:37:11,563
to do a bunch of things—we
already got a bunch of

714
00:37:11,563 --> 00:37:14,219
things to do—it ain’t going to
get done. [laughs]

715
00:37:14,219 --> 00:37:17,035
That’s just kind of how the
economics of it works.

716
00:37:17,035 --> 00:37:19,632
But I…but I think we don’t have
to leave that to

717
00:37:19,632 --> 00:37:22,440
chance. I think if we know that
these systems work

718
00:37:22,440 --> 00:37:25,304
that way and we…[laughs] we know
that people’s

719
00:37:25,304 --> 00:37:28,046
behaviors sort of inclined to be
that way,

720
00:37:28,046 --> 00:37:30,966
we can create incentives with
economic ones,

721
00:37:30,966 --> 00:37:33,952
financial ones to make this work
to…to make

722
00:37:33,952 --> 00:37:36,344
the research make a difference.
And…and again,

723
00:37:36,344 --> 00:37:38,890
I think that’s the point of some
of this panel,

724
00:37:38,890 --> 00:37:41,122
is to talk about implementation
science is that

725
00:37:41,122 --> 00:37:43,495
we need to make the research
have an impact. And

726
00:37:43,495 --> 00:37:46,590
I think there are other ways
that I haven’t

727
00:37:46,590 --> 00:37:49,968
seen, that we’ve tinkered with
quite yet. And

728
00:37:49,968 --> 00:37:52,147
I’m…I’m curious about those
things. But I think

729
00:37:52,147 --> 00:37:54,372
the economics and the financial
sort of levers

730
00:37:54,372 --> 00:37:57,559
are ways we can really think
about, can we push

731
00:37:57,559 --> 00:38:00,945
this further down the line
towards that last mile?

732
00:38:00,945 --> 00:38:02,408
DR. GERI DONENBERG: Thank you.
I

733
00:38:02,408 --> 00:38:03,915
actually really…that
resonates,

734
00:38:03,915 --> 00:38:06,611
I think, a lot with folks
probably listening

735
00:38:06,611 --> 00:38:09,487
in, as well as me. And I think
that’s…exactly

736
00:38:10,288 --> 00:38:14,006
where implementation science
research belongs:

737
00:38:14,006 --> 00:38:17,962
understanding the system-level
factors that are

738
00:38:17,962 --> 00:38:20,565
going to impact uptake or
adoption of these

739
00:38:20,565 --> 00:38:23,168
strategies, right? The strategy
would be,

740
00:38:23,168 --> 00:38:25,405
let’s say, injectable PrEP.
Well, what

741
00:38:25,405 --> 00:38:27,872
are the factors that are going
to impact

742
00:38:27,872 --> 00:38:30,084
whether the system, or the
physician, or the

743
00:38:30,084 --> 00:38:32,443
nurse practitioner can pick it
up? And you’re

744
00:38:32,443 --> 00:38:35,548
naming economics, which of
course is critical.

745
00:38:35,548 --> 00:38:38,917
And I would add, not just do we
need incentives,

746
00:38:38,917 --> 00:38:41,692
we need to make sure there are
no disincentives

747
00:38:41,692 --> 00:38:44,756
also. And I think that’s a
critical issue, because

748
00:38:44,756 --> 00:38:47,404
if there are disincentives to do
it, we’re…we’re

749
00:38:47,404 --> 00:38:50,161
climbing an uphill battle that
we’re going…we’re

750
00:38:50,161 --> 00:38:53,501
never going to reach the top.
So, I think that’s

751
00:38:53,501 --> 00:38:56,568
really important. And I…I
appreciate those

752
00:38:56,568 --> 00:38:59,618
comments because I think when we
talk about where

753
00:38:59,618 --> 00:39:02,607
can the research go, right,
where can the most

754
00:39:02,607 --> 00:39:06,115
impactful research go, it’s to
maybe step away

755
00:39:06,115 --> 00:39:09,848
from the individual person and
to start looking

756
00:39:09,848 --> 00:39:13,077
at the broader systemic factors.
And…and yes,

757
00:39:13,077 --> 00:39:16,588
I think syndemics is critical,
but you can also

758
00:39:16,588 --> 00:39:20,050
start to think of…a little bit
about, you know,

759
00:39:20,050 --> 00:39:23,728
the health care system, the, you
know, Medicare,

760
00:39:23,728 --> 00:39:27,222
insurance, all these things that
we know. And

761
00:39:27,222 --> 00:39:30,868
how do we study those to
understand and drive

762
00:39:30,868 --> 00:39:35,189
impact in the next…next stage of
this research?

763
00:39:35,189 --> 00:39:39,510
Other folks who might want to
weigh in on this?

764
00:39:39,510 --> 00:39:41,568
DR. JEANNE MARRAZZO: Sure,
I’ll…I’ll weigh in

765
00:39:41,568 --> 00:39:43,715
because, of course, with NIAID,
our job is to

766
00:39:43,715 --> 00:39:46,075
look at the data and then think
about what the

767
00:39:46,075 --> 00:39:48,486
scientific priorities from our
standpoint are

768
00:39:48,486 --> 00:39:51,539
going to be. I…I…I…I hear what
you’re saying, but

769
00:39:51,539 --> 00:39:54,592
I think we can’t step away from
in…the research

770
00:39:54,592 --> 00:39:57,003
at the level of the individual,
because at some

771
00:39:57,003 --> 00:39:59,664
level, you know, we aren’t all
the same. There are

772
00:39:59,664 --> 00:40:01,778
systems, but there are some
people who are going

773
00:40:01,778 --> 00:40:03,935
to be different immunologically,
virologically,

774
00:40:03,935 --> 00:40:06,662
and behaviorally, and…and
there’s so many

775
00:40:06,662 --> 00:40:09,908
complexities there. So, I think
it’s…it’s great

776
00:40:09,908 --> 00:40:12,434
that we have a focus on the
entire spectrum. And

777
00:40:12,434 --> 00:40:15,013
that’s what’s the beauty of this
panel, because

778
00:40:15,013 --> 00:40:18,147
we really are…are thinking, I
think from…from

779
00:40:18,147 --> 00:40:21,486
…from the individual all the way
up. You know,

780
00:40:21,486 --> 00:40:24,423
I think if you look at the last
UNAIDS report

781
00:40:24,423 --> 00:40:27,425
it was very exciting, but it was
also really

782
00:40:27,425 --> 00:40:31,041
humbling. So, for the first time
we saw in 2023

783
00:40:31,041 --> 00:40:34,732
that more people were newly
diagnosed with HIV

784
00:40:34,732 --> 00:40:38,086
outside of sub-Saharan Africa
than in sub-Saharan

785
00:40:38,086 --> 00:40:41,439
Africa. And that means that in
the Middle East,

786
00:40:41,439 --> 00:40:43,952
in North Africa, Eastern Europe,
Central

787
00:40:43,952 --> 00:40:46,711
Asia, Latin America, we are not
seeing the

788
00:40:46,711 --> 00:40:50,048
kind of response that we need.
Why? Because we’ve

789
00:40:50,048 --> 00:40:53,584
invested really well in
sub-Saharan Africa, right?

790
00:40:53,584 --> 00:40:56,387
Between PEPFAR and a lot of the
work that you’ve

791
00:40:56,387 --> 00:40:59,190
mentioned, Geri, and many of us
have done. So,

792
00:40:59,190 --> 00:41:02,494
I think we need to think very
carefully about how

793
00:41:02,494 --> 00:41:05,997
we scale prevention efforts to
everybody who needs

794
00:41:05,997 --> 00:41:09,629
them, and to really point out
what the benefit

795
00:41:09,629 --> 00:41:13,571
is when we do that. So,
continuing to review our

796
00:41:13,571 --> 00:41:17,126
priorities, knowing what the
emerging epidemiology

797
00:41:17,126 --> 00:41:20,611
and the biology are is really,
really critical.

798
00:41:20,611 --> 00:41:23,208
The other thing I think about
the UNAIDS report

799
00:41:23,208 --> 00:41:25,750
and that I talk about a lot is
that I really

800
00:41:25,750 --> 00:41:28,476
think we need durable individual
immunity, and the

801
00:41:28,476 --> 00:41:31,255
only way we’re going to get that
is by a vaccine.

802
00:41:31,255 --> 00:41:34,108
Health care systems are often
threatened, they’re

803
00:41:34,108 --> 00:41:36,961
often fragmented. Health care
workers sometimes

804
00:41:36,961 --> 00:41:39,918
are threatened and under, you
know, under duress,

805
00:41:39,918 --> 00:41:42,934
whether it’s economic duress
or…or other duress.

806
00:41:42,934 --> 00:41:45,797
So, we need intact systems to
deliver the kinds of

807
00:41:45,797 --> 00:41:48,773
things that we’re talking about,
like long-acting,

808
00:41:48,773 --> 00:41:51,437
you know, chemoprophylaxis for
example. It’s

809
00:41:51,437 --> 00:41:54,278
not that a vaccine would be a
panacea, but it

810
00:41:54,278 --> 00:41:56,637
would at least get us more to
the point where

811
00:41:56,637 --> 00:41:59,150
you can actually give everybody
the individual

812
00:41:59,150 --> 00:42:01,519
protection that you need, and
ideally, that would

813
00:42:01,519 --> 00:42:03,888
be lifelong. That’s our goal.
So, that’s really

814
00:42:03,888 --> 00:42:06,497
been a pillar of our scientific
mission, I think

815
00:42:06,497 --> 00:42:09,160
as…as everybody knows. And some
of the exciting

816
00:42:09,160 --> 00:42:11,630
things in the past year that I
didn’t really

817
00:42:11,630 --> 00:42:14,265
talk about include some of the
groundbreaking

818
00:42:14,265 --> 00:42:17,392
technology that has allowed us
to target the

819
00:42:17,392 --> 00:42:21,005
germline cells in the bone
marrow, in particular,

820
00:42:21,005 --> 00:42:24,689
that are letting us teach the
immune system how to

821
00:42:24,689 --> 00:42:28,446
develop HIV-specific immunity
that could actually

822
00:42:28,446 --> 00:42:31,034
get us the kind of response that
we so far have

823
00:42:31,034 --> 00:42:33,785
not been able to get from any of
the HIV vaccine

824
00:42:33,785 --> 00:42:36,494
candidates. So, the whole field,
I think, is

825
00:42:36,494 --> 00:42:39,323
really getting very exciting.
And my…I guess

826
00:42:39,323 --> 00:42:41,544
a little bit of my fear is that
with all the

827
00:42:41,544 --> 00:42:43,961
excitement around long-acting,
you know, PrEP,

828
00:42:43,961 --> 00:42:47,147
which I am beyond excited about,
that we can’t

829
00:42:47,147 --> 00:42:50,468
forget that we…we just can’t
take our foot off

830
00:42:50,468 --> 00:42:52,692
the gas when it comes to
understanding,

831
00:42:52,692 --> 00:42:54,972
you know, how we can get to a
vaccine,

832
00:42:54,972 --> 00:42:57,535
especially with some of the
pivotal findings in

833
00:42:57,535 --> 00:43:00,311
the last year. Last thing I’ll
say, too, is that,

834
00:43:00,311 --> 00:43:02,130
you know, I mentioned some of
the countries

835
00:43:02,130 --> 00:43:03,948
outside sub-Saharan Africa that
are being

836
00:43:03,948 --> 00:43:06,968
effective. Again, having worked
with Latesha in…in

837
00:43:06,968 --> 00:43:09,987
Birmingham and recognizing the
challenges in the

838
00:43:09,987 --> 00:43:12,774
South, even the PrEP that we
have, uptake

839
00:43:12,774 --> 00:43:15,760
is incredibly uneven.
Perceptions, stigma,

840
00:43:15,760 --> 00:43:19,363
all of those things are really,
really difficult

841
00:43:19,363 --> 00:43:22,967
to overcome to get people to use
what we have,

842
00:43:22,967 --> 00:43:25,386
and maybe will be difficult to
get people to use

843
00:43:25,386 --> 00:43:27,805
what we employ. So, we don’t
know that there’s

844
00:43:27,805 --> 00:43:29,986
going to be a magic shot that’s
going to work

845
00:43:29,986 --> 00:43:32,310
for these populations. So, I do
think that our

846
00:43:32,310 --> 00:43:35,142
investments, you know, do need
to help resolve

847
00:43:35,142 --> 00:43:38,216
not just the biomedical, but
also the structural

848
00:43:38,216 --> 00:43:42,064
factors and some of the
socio-behavioral factors

849
00:43:42,064 --> 00:43:45,990
that you…that you mentioned. So,
I’ll stop there.

850
00:43:45,990 --> 00:43:48,523
DR. GERI DONENBERG: Thank you.
Dr. Freed,

851
00:43:48,523 --> 00:43:50,695
it looks like you went off mute
to…

852
00:43:50,695 --> 00:43:52,807
DR. ERIC FREED: Yeah, I…I…this
is really…really

853
00:43:52,807 --> 00:43:54,832
a…just a question for my
colleagues who are

854
00:43:54,832 --> 00:43:57,454
involved in implementation,
particularly

855
00:43:57,454 --> 00:44:00,204
in the South. What is the
thinking about

856
00:44:00,905 --> 00:44:04,153
the use of…of long-acting
injectable PrEP

857
00:44:04,153 --> 00:44:07,478
versus oral daily PrEP? Oral
daily PrEP,

858
00:44:07,478 --> 00:44:10,345
as Dr. Marrazzo just pointed
out, is not being

859
00:44:10,345 --> 00:44:13,518
used. The uptake’s, you know, 30
percent or so or

860
00:44:13,518 --> 00:44:17,400
less. What is the thinking, sort
of, on the ground

861
00:44:17,400 --> 00:44:21,359
about the extent to which
injectable PrEP’s going

862
00:44:21,359 --> 00:44:24,223
to be game-changing,
particularly, you know, twice

863
00:44:24,223 --> 00:44:27,031
yearly or something infrequent
along those lines?

864
00:44:27,031 --> 00:44:30,801
DR. LATESHA ELOPRE:  

865
00:44:30,801 --> 00:44:33,371
So, I think it’s amazing that
we’ve, again,

866
00:44:33,371 --> 00:44:36,174
moved into this space where we
can talk about

867
00:44:36,174 --> 00:44:38,910
long-acting in really a
meaningful way. And when

868
00:44:38,910 --> 00:44:41,646
studies have been done that have
really tapped

869
00:44:41,646 --> 00:44:43,910
into the voices, I think, of
southern communities

870
00:44:43,910 --> 00:44:46,083
and of brown and Black
communities, there has

871
00:44:46,083 --> 00:44:48,394
been interest in long-acting. I
think some of

872
00:44:48,394 --> 00:44:50,855
the studies have varied on
whether they want a

873
00:44:50,855 --> 00:44:53,341
long-acting oral or a
long-acting injectable, but

874
00:44:53,341 --> 00:44:55,927
there’s interest. From a
structural standpoint, a

875
00:44:55,927 --> 00:44:58,735
system level standpoint, talking
to clinics—which

876
00:44:58,735 --> 00:45:01,599
I think is where this is all
going, going out of

877
00:45:01,599 --> 00:45:05,012
a specialized ID setting and
going into primary

878
00:45:05,012 --> 00:45:08,639
care providing provision, going
into gynecologic

879
00:45:08,639 --> 00:45:11,792
provision—there is resistance to
implementation

880
00:45:11,792 --> 00:45:14,879
of long-acting modalities. And I
think it is

881
00:45:14,879 --> 00:45:17,156
because of the structural
barriers that we’ve

882
00:45:17,156 --> 00:45:19,483
just identified and how you can
meaningfully

883
00:45:19,483 --> 00:45:23,225
get that type of modality into
the hands of

884
00:45:23,225 --> 00:45:27,391
your patients while not
interrupting workflow,

885
00:45:27,391 --> 00:45:30,491
not having to stress an already
stressed,

886
00:45:30,491 --> 00:45:33,664
under-resourced system that
doesn’t have

887
00:45:33,664 --> 00:45:36,684
the workforce to support it. So,
I think that

888
00:45:36,684 --> 00:45:39,704
is the major concern. And I…I do
sometimes,

889
00:45:39,704 --> 00:45:42,398
living in this setting, want to
continue to

890
00:45:42,398 --> 00:45:45,643
challenge that, and push that,
and see how you can

891
00:45:45,643 --> 00:45:49,580
leverage what you already have
to move the needle

892
00:45:49,580 --> 00:45:53,517
in that way. But it can be…it
can be challenging.

893
00:45:53,517 --> 00:45:56,945
DR. LARON NELSON: Let me…That’s
a very serious

894
00:45:56,945 --> 00:46:00,591
question you asked, Dr. Freed. I
agree with Dr.

895
00:46:00,591 --> 00:46:04,911
Elopre’s responses. I…I want to
point to something

896
00:46:04,911 --> 00:46:09,400
that Mr. Ruiz said earlier. He
talked about what a

897
00:46:09,400 --> 00:46:13,037
whole-government approach might
look like. I think

898
00:46:13,037 --> 00:46:16,674
people in general welcome the
idea [laughs] of a

899
00:46:16,674 --> 00:46:20,207
PrEP option that is has…has less
frequent dosing,

900
00:46:20,207 --> 00:46:23,881
but how they do it, without
trading an awful lot,

901
00:46:23,881 --> 00:46:26,164
is a different story, and it’s
because of

902
00:46:26,164 --> 00:46:28,719
some of these structural
barriers. But I was

903
00:46:30,488 --> 00:46:34,888
in a conversation recently with
Dr.—Mr. Ruiz—will

904
00:46:34,888 --> 00:46:39,463
notice with…on the NIH funded
study, talking with

905
00:46:39,463 --> 00:46:42,664
CDC about some structural issues
we’re hearing

906
00:46:42,664 --> 00:46:46,137
from providers who are thinking
about injectable

907
00:46:46,137 --> 00:46:48,964
cabotegravir, and how hard that
is and why it’s

908
00:46:48,964 --> 00:46:51,909
not happening, and then talking
with Center for

909
00:46:51,909 --> 00:46:55,351
Medicare & Medicaid Services.
So…but it…it made

910
00:46:55,351 --> 00:46:58,649
me realize, it takes…it does
sort of take a

911
00:46:58,649 --> 00:47:01,430
coordinated government alignment
[laughs] to make

912
00:47:01,430 --> 00:47:04,321
it happen. And I wasn’t having
conversation about

913
00:47:04,321 --> 00:47:06,386
something I came up with. This
was something that

914
00:47:06,386 --> 00:47:08,492
physicians, and nurses, and
social workers would

915
00:47:08,492 --> 00:47:10,622
just…we had meetings with them,
they would say,

916
00:47:10,622 --> 00:47:12,930
“Here’s the issue.” But somehow
it wasn’t getting

917
00:47:12,930 --> 00:47:15,703
to all the right people at the
right time. So,

918
00:47:15,703 --> 00:47:18,536
the issue was about how to
support, you know,

919
00:47:18,536 --> 00:47:19,985
in a researcher role—because
people would

920
00:47:19,985 --> 00:47:21,572
sometimes tell you stuff they
wouldn’t tell

921
00:47:21,572 --> 00:47:24,591
their project officer or
whatever—but it was

922
00:47:24,591 --> 00:47:27,878
like, do…is a responsibility we
have if we can

923
00:47:27,878 --> 00:47:30,810
understand where some of these
barriers to…to get

924
00:47:30,810 --> 00:47:33,918
it to the folks who would know
what to do in their

925
00:47:33,918 --> 00:47:35,966
own little realm, but how to get
them to, sort of,

926
00:47:35,966 --> 00:47:38,055
think about it together [laughs]
so that this is,

927
00:47:38,055 --> 00:47:40,024
sort of, a synchronized,
coordinated response

928
00:47:40,024 --> 00:47:42,293
that could address some of these
issues? Because I

929
00:47:42,293 --> 00:47:45,229
think if we make it easier to
implement something

930
00:47:45,229 --> 00:47:48,165
like twice annual injectable
PrEP, people would

931
00:47:48,165 --> 00:47:50,341
do it. [laughs] But it…it can’t
be, to Dr.

932
00:47:50,341 --> 00:47:52,770
Donenberg’s point, disincentives
to doing it.

933
00:47:52,770 --> 00:47:55,594
We have to minimize the number
of disincentives.

934
00:47:55,594 --> 00:47:58,476
And I think people are very keen
on identifying

935
00:47:58,476 --> 00:48:01,092
what’s going to…what the
disincentives are. They

936
00:48:01,092 --> 00:48:03,814
can see those very clearly,
[laughs] even though

937
00:48:03,814 --> 00:48:06,519
sometimes we don’t see them. But
I think there

938
00:48:06,519 --> 00:48:09,453
are solutions, and I think
this…this…I’m saying,

939
00:48:09,453 --> 00:48:11,821
“whole-government approach,”
because I’m using

940
00:48:11,821 --> 00:48:14,492
Mr. Ruiz’s comments, but I think
the more and more

941
00:48:14,492 --> 00:48:17,020
that we can align…align these
sort of priorities

942
00:48:17,020 --> 00:48:19,497
and these different
organizations to all have

943
00:48:19,497 --> 00:48:22,334
different responsibilities, but
that don’t

944
00:48:22,334 --> 00:48:25,436
always…they don’t always match
up at the…the

945
00:48:25,436 --> 00:48:28,609
right time. So, that’s my…my
thought on that. Oh,

946
00:48:28,609 --> 00:48:31,909
let me say one more thing that’s
related to that,

947
00:48:31,909 --> 00:48:36,303
which is, I…I think that, sort
of, my lesson from

948
00:48:36,303 --> 00:48:40,785
having done that work is
listening to people who

949
00:48:40,785 --> 00:48:42,987
are…who are saying stuff, and I
could just take it

950
00:48:42,987 --> 00:48:45,189
as somebody just letting off, or
I say, “This is

951
00:48:45,189 --> 00:48:47,319
real information. [laughs] This
is really what’s

952
00:48:47,319 --> 00:48:49,493
happening. What do we…what do we
do with that?”

953
00:48:49,493 --> 00:48:52,581
And it was difficult. I’m not a
policy person,

954
00:48:52,581 --> 00:48:55,800
not an economics person. I’m not
an actuarial.

955
00:48:56,834 --> 00:48:59,349
But I knew that folks were
saying, “Here’s

956
00:48:59,349 --> 00:49:02,039
what we want to do.” And I think
typically,

957
00:49:02,039 --> 00:49:05,001
not in all universities, but I
guess on average,

958
00:49:05,001 --> 00:49:08,145
we have our ideas, we have our
interventions, and

959
00:49:08,145 --> 00:49:11,126
we want to get them out there
into the world. And

960
00:49:11,126 --> 00:49:14,285
some folks call this sort of a
“put the innovation

961
00:49:14,285 --> 00:49:17,079
push” right? “I’m going to get
this out to you,

962
00:49:17,079 --> 00:49:19,990
and Birmingham, and Montgomery,
and Dallas, and

963
00:49:19,990 --> 00:49:22,353
I’m going to do it for you.”
Which is different

964
00:49:22,353 --> 00:49:24,962
from when communities are
pulling. They’re saying,

965
00:49:24,962 --> 00:49:27,244
“That’s nice, but here’s what we
need.” [laughs]

966
00:49:27,244 --> 00:49:29,667
Right? And we have to be willing
to try to figure

967
00:49:29,667 --> 00:49:32,169
out a way to do what they’re
telling us they want

968
00:49:32,169 --> 00:49:34,772
and how they want it. And that’s
not always easy,

969
00:49:34,772 --> 00:49:37,132
and that requires new thinkings
and us to make

970
00:49:37,132 --> 00:49:39,643
new…forge new partnerships. But
I think that is

971
00:49:39,643 --> 00:49:42,179
sort of one example. And I think
for long act…for

972
00:49:42,179 --> 00:49:44,815
these…these new long-acting
options, it’ll really

973
00:49:44,815 --> 00:49:47,493
be listening [laughs] to what
they’re saying.

974
00:49:47,493 --> 00:49:50,287
And it doesn’t even have to make
sense to us,

975
00:49:50,287 --> 00:49:52,731
but they’re telling us [laughs]
“Here is how it

976
00:49:52,731 --> 00:49:55,226
has to work if you want to do
it.” And finding

977
00:49:55,226 --> 00:49:58,279
ways to do it. And again, I…I
think there’s more

978
00:49:58,279 --> 00:50:01,332
of an appetite in the scientific
community. It

979
00:50:01,332 --> 00:50:03,665
seems that NIH is more willing
to consider

980
00:50:03,665 --> 00:50:06,270
supporting studies like that,
that might seem

981
00:50:06,270 --> 00:50:08,719
unconventional because this is
what community

982
00:50:08,719 --> 00:50:11,275
is demanding. And they know.
They know if you

983
00:50:11,275 --> 00:50:13,836
do what…what you’re proposing
that you want to do,

984
00:50:13,836 --> 00:50:16,447
it’s not going to change
[laughs] how I practice.

985
00:50:16,447 --> 00:50:18,301
You know? And…and we’re good at
measuring.

986
00:50:18,301 --> 00:50:20,284
So I…I agree, we got to figure
out a way to

987
00:50:20,284 --> 00:50:22,981
measure…make sure what we’re
testing works. But

988
00:50:22,981 --> 00:50:25,789
we know how to do that, I think.
But if we move

989
00:50:25,789 --> 00:50:28,386
away from strictly, sort of, a
push innovation

990
00:50:28,386 --> 00:50:30,928
to, sort of, pull—let
communities pull from

991
00:50:30,928 --> 00:50:34,378
us what they need—I think we can
be ready for,

992
00:50:34,378 --> 00:50:37,902
you know, that product when it
comes to market.

993
00:50:37,902 --> 00:50:40,402
DR. LATESHA ELOPRE: Can I just 
add one last thing? I’m so

994
00:50:40,402 --> 00:50:40,704
sorry.

995
00:50:40,704 --> 00:50:40,738
DR. GERI DONENBERG: Of course.

996
00:50:40,738 --> 00:50:43,844
DR. LATESHA ELOPRE: But I just
wanted to say, as

997
00:50:43,844 --> 00:50:47,077
really important aspect of this
that I…I want to

998
00:50:47,077 --> 00:50:49,141
stress, even if we have perfect
systems—and there

999
00:50:49,141 --> 00:50:51,081
have been studies like this
where things are

1000
00:50:51,081 --> 00:50:53,278
completely free—we go out into
communities, there

1001
00:50:53,278 --> 00:50:55,519
are people who aren’t going to
approach the van,

1002
00:50:55,519 --> 00:50:57,633
who aren’t going to use the
modality that we’re

1003
00:50:57,633 --> 00:50:59,790
talking about because of stigma
and because of

1004
00:50:59,790 --> 00:51:02,609
the lived experience they carry
that prevents

1005
00:51:02,609 --> 00:51:05,796
them from being able to move
forward in that way.

1006
00:51:05,796 --> 00:51:08,543
I…I think that we have to
understand on a deeper

1007
00:51:08,543 --> 00:51:11,402
level this implementation- and
implementer-level

1008
00:51:11,402 --> 00:51:13,634
barrier that we’re experiencing
with these

1009
00:51:13,634 --> 00:51:16,073
types of modalities, but we
can’t forget the

1010
00:51:16,073 --> 00:51:19,727
people that we’re trying to
reach and why we

1011
00:51:19,727 --> 00:51:23,380
haven’t ended the epidemic up to
this point.

1012
00:51:23,380 --> 00:51:25,094
DR. JEANNE MARRAZZO: If…if I
could just add to

1013
00:51:25,094 --> 00:51:26,917
that, it’s one of the reasons I
think tele-PrEP

1014
00:51:26,917 --> 00:51:29,336
delivery, which takes away that
interface of

1015
00:51:29,336 --> 00:51:31,755
somebody having to go to a
clinic and…and,

1016
00:51:31,755 --> 00:51:34,500
sort of, interact with someone
and admit to

1017
00:51:34,500 --> 00:51:37,494
a human that they actually need
this and they

1018
00:51:37,494 --> 00:51:41,046
are “at increased” likelihood of
getting infection

1019
00:51:41,046 --> 00:51:44,668
is really important. I wanted to
speak to LaRon’s

1020
00:51:44,668 --> 00:51:47,890
point really quickly, because I
think making sure

1021
00:51:47,890 --> 00:51:51,241
that research at every stage is
representative of

1022
00:51:51,241 --> 00:51:53,824
the populations who need the
results most,

1023
00:51:53,824 --> 00:51:56,647
is something we don’t talk about
enough. And

1024
00:51:56,647 --> 00:51:59,812
that has to be, like, from
collection of invasive

1025
00:51:59,812 --> 00:52:02,786
samples in early studies—if you
want to call

1026
00:52:02,786 --> 00:52:05,234
it invasive, whatever, phase
one—all the way

1027
00:52:05,234 --> 00:52:07,791
to recruiting for large efficacy
trials. So,

1028
00:52:07,791 --> 00:52:11,030
one thing that our division of
AIDS did last year

1029
00:52:11,030 --> 00:52:14,398
was they began requiring
research teams to screen

1030
00:52:14,398 --> 00:52:17,686
every new study protocol,
wherever it was in that

1031
00:52:17,686 --> 00:52:21,105
pipeline, to ensure that we are
doing our best to

1032
00:52:21,105 --> 00:52:24,488
design representative processes
and studies. So,

1033
00:52:24,488 --> 00:52:28,078
I…I think we don’t often think
about that enough,

1034
00:52:28,078 --> 00:52:30,147
and by the time we get to the
end point where

1035
00:52:30,147 --> 00:52:32,216
we’re talking about distributing
something,

1036
00:52:32,216 --> 00:52:34,060
we think, “Oh, yeah, we should
see if people

1037
00:52:34,060 --> 00:52:35,986
want to use this.” And
that’s…that’s not the

1038
00:52:35,986 --> 00:52:37,654
way that this is going to work.
And

1039
00:52:37,654 --> 00:52:39,323
that’s why it’s so great to
have,

1040
00:52:39,323 --> 00:52:43,571
again, this spectrum of…of
scientists

1041
00:52:43,571 --> 00:52:47,931
and community membership on the
panel.

1042
00:52:47,931 --> 00:52:50,420
DR. GERI DONENBERG: Thank you. I
would agree,

1043
00:52:50,420 --> 00:52:53,070
and I…I kind of want to
highlight a point that

1044
00:52:53,070 --> 00:52:56,190
I think all of you have been
making but haven’t

1045
00:52:56,190 --> 00:52:59,309
specifically said. But I think
the ideas that

1046
00:52:59,309 --> 00:53:02,994
there needs to be choice of what
kinds of

1047
00:53:02,994 --> 00:53:07,117
innovation someone will choose
to adopt. You

1048
00:53:07,117 --> 00:53:11,022
asked…Dr. Freed, you asked about
the uptake of

1049
00:53:11,022 --> 00:53:15,092
long-acting injectables. And
even that I think

1050
00:53:15,092 --> 00:53:17,824
will vary around the world. This
is World AIDS

1051
00:53:17,824 --> 00:53:20,731
Day, and I know we’ve made a lot
of progress in

1052
00:53:20,731 --> 00:53:24,798
sub-Saharan Africa. But one…one
issue that I think

1053
00:53:24,798 --> 00:53:28,705
is relevant here is within
sub-Saharan Africa,

1054
00:53:28,705 --> 00:53:33,346
many of the adolescent girls and
young women are

1055
00:53:33,346 --> 00:53:38,082
accustomed to…to taking
injectable reproductive

1056
00:53:38,082 --> 00:53:41,928
health methods. So, injections
for pregnancy

1057
00:53:41,928 --> 00:53:45,689
prevention and so forth. So,
what we see,

1058
00:53:45,689 --> 00:53:49,280
have seen so far
in…in…in…particularly in South

1059
00:53:49,280 --> 00:53:52,796
Africa in my experience, has
been that those

1060
00:53:52,796 --> 00:53:55,931
young women are eager for
long-acting injectables

1061
00:53:55,931 --> 00:53:59,002
because it…they’re accustomed to
that approach

1062
00:53:59,002 --> 00:54:01,635
around reproductive health. That
may not be

1063
00:54:01,635 --> 00:54:04,508
the case in other parts of the
world. And so,

1064
00:54:04,508 --> 00:54:07,626
this issue of choice and
continuing to build our

1065
00:54:07,626 --> 00:54:10,681
toolbox so that you can go out
and say, “Here

1066
00:54:10,681 --> 00:54:14,836
are the variety of choices you
have to prevent

1067
00:54:14,836 --> 00:54:19,256
HIV, prevent pregnancy,
prevent…or receive your

1068
00:54:19,256 --> 00:54:22,063
treatment.” I think that’s going
to be a key to

1069
00:54:22,063 --> 00:54:25,162
our success and understanding
why some populations

1070
00:54:25,162 --> 00:54:29,566
prefer certain methods over
others. So…and I’m

1071
00:54:29,566 --> 00:54:33,971
also hearing from all of you
that we need to

1072
00:54:33,971 --> 00:54:37,583
really think about the whole
person from the cell

1073
00:54:37,583 --> 00:54:41,411
to the quality of life, even for
folks who are…who

1074
00:54:42,412 --> 00:54:44,736
have HIV. And I…and I want to
emphasize that

1075
00:54:44,736 --> 00:54:47,317
because I think that it’s
representative of our

1076
00:54:47,317 --> 00:54:52,085
panel, but it’s also
representative of what we are

1077
00:54:52,085 --> 00:54:56,760
saying for…for all of us in
this…in this event,

1078
00:54:56,760 --> 00:55:00,693
so. Anybody have anything else
they

1079
00:55:00,693 --> 00:55:04,735
would like to add to the
discussion?

1080
00:55:04,735 --> 00:55:07,667
DR. LARON NELSON: I want to ask
Mr. Ruiz—because

1081
00:55:07,667 --> 00:55:10,240
he’s had such a…sort of
bird’s-eye view,

1082
00:55:10,240 --> 00:55:12,753
if you will, across what we’ve
been

1083
00:55:12,753 --> 00:55:15,546
doing in different sectors,
research,

1084
00:55:15,546 --> 00:55:17,508
practice,—any ideas you have
about

1085
00:55:17,508 --> 00:55:19,750
where we…you think we…should be
going

1086
00:55:19,750 --> 00:55:22,753
in terms of the investment in
prevention and

1087
00:55:22,753 --> 00:55:25,622
treatment domestically or
internationally?

1088
00:55:25,622 --> 00:55:27,382
MR. FRANCISCO RUIZ: Yeah, thank
you for that. I

1089
00:55:27,382 --> 00:55:29,326
think, you know, one of the…the
conversations that

1090
00:55:29,326 --> 00:55:31,844
we’ve been having around the
whole of government

1091
00:55:31,844 --> 00:55:34,464
or whole of society approach is
making sure that

1092
00:55:34,464 --> 00:55:36,690
we don’t forget to center the
people that we’re

1093
00:55:36,690 --> 00:55:38,869
serving. And I think oftentimes
we get, sort

1094
00:55:39,636 --> 00:55:41,317
of…because we’re so busy doing
the work and the

1095
00:55:41,317 --> 00:55:43,173
research, that we forget to
center people. And so,

1096
00:55:43,173 --> 00:55:45,414
a lot of that’s a lot of the
work that we’ve been

1097
00:55:45,414 --> 00:55:47,611
trying to make sure that was
being…develop new

1098
00:55:47,611 --> 00:55:49,630
policies that they’re informed
by the lived

1099
00:55:49,630 --> 00:55:51,648
experiences of people. I think,
you know,

1100
00:55:51,648 --> 00:55:54,883
the National HIV Strategy that
was released in

1101
00:55:54,883 --> 00:55:58,255
Biden’s first year also talks
about racism and

1102
00:55:58,255 --> 00:56:01,047
how racism is a public threat,
right? And I think

1103
00:56:01,047 --> 00:56:03,727
we need to…we can’t separate the
HIV research

1104
00:56:03,727 --> 00:56:06,198
and the implementation of the
research without

1105
00:56:06,198 --> 00:56:08,932
understanding the context within
where that this,

1106
00:56:08,932 --> 00:56:12,492
this work is happening, right?
We’re seeing more

1107
00:56:12,492 --> 00:56:15,906
and more as of recent anti-LGBTQ
legislation

1108
00:56:15,906 --> 00:56:18,225
happening around at the state
and local level.

1109
00:56:18,225 --> 00:56:20,544
So, we can’t forget about that,
right? We’re

1110
00:56:20,544 --> 00:56:22,822
seeing the xenophobia happening
around this

1111
00:56:22,822 --> 00:56:25,515
country, particularly in the
South and also where

1112
00:56:25,515 --> 00:56:28,030
we’re receiving new arrivals.
And so, I think

1113
00:56:28,030 --> 00:56:30,654
when we talk about HIV programs
and research,

1114
00:56:30,654 --> 00:56:32,680
we also have to make sure that
we, sort of, think

1115
00:56:32,680 --> 00:56:34,625
about how is this is being
received for folks

1116
00:56:34,625 --> 00:56:37,547
who are oftentimes in media,
either in social

1117
00:56:37,547 --> 00:56:40,597
media or in the news, that
they’re less than,

1118
00:56:40,597 --> 00:56:43,474
that they’re not worthy of. And
so, I think our

1119
00:56:43,474 --> 00:56:46,470
policy needs to reflect not only
that, but also

1120
00:56:46,470 --> 00:56:49,839
the work, the science, right?
And so having folks

1121
00:56:49,839 --> 00:56:53,410
who represent community at the
table is paramount,

1122
00:56:53,410 --> 00:56:56,079
right? Making sure that folks
get the message, but

1123
00:56:56,079 --> 00:56:58,749
also see the messenger as
themselves as a member

1124
00:56:58,749 --> 00:57:01,513
of the community, I think is
really important.

1125
00:57:01,513 --> 00:57:04,454
I think we’ve made some inroads
in that regard.

1126
00:57:04,454 --> 00:57:07,316
And so, I think the…the other
thing that is…that

1127
00:57:07,316 --> 00:57:10,294
was mentioned in all that…that
I’ve been saying,

1128
00:57:10,294 --> 00:57:12,919
but also in what was mentioned
earlier, is

1129
00:57:12,919 --> 00:57:15,666
really tackling stigma,
discrimination and

1130
00:57:15,666 --> 00:57:19,269
the socioeconomic factors,
right? We…we could have

1131
00:57:19,269 --> 00:57:22,873
all the great tools in our…in
our…at a disposal,

1132
00:57:22,873 --> 00:57:24,641
but when we have these
issues…and we’re

1133
00:57:24,641 --> 00:57:26,276
seeing stigma, discrimination
even

1134
00:57:26,276 --> 00:57:29,125
from…from the onset of…of just
testing, right? I

1135
00:57:29,125 --> 00:57:32,149
think Dr. Elopre…Elopre
said…mentioned, you know,

1136
00:57:32,149 --> 00:57:34,414
so you see a van…it’s great that
we have these

1137
00:57:34,414 --> 00:57:36,920
vans, but when folks have this
hesitation because

1138
00:57:36,920 --> 00:57:39,239
of stigma, because who’s going
to see me walk

1139
00:57:39,239 --> 00:57:41,558
into that van? I think we need
to, sort of,

1140
00:57:41,558 --> 00:57:44,327
really address that. So, I think
public campaigns

1141
00:57:44,327 --> 00:57:46,763
that really, sort of, speak to
community,

1142
00:57:46,763 --> 00:57:49,125
that are created by community is
really,

1143
00:57:49,125 --> 00:57:51,601
really important, especially
when folks,

1144
00:57:51,601 --> 00:57:55,208
again, are seeing themselves as
in the media, in

1145
00:57:55,208 --> 00:57:59,109
the news, in legislation by
people who have power,

1146
00:57:59,109 --> 00:58:01,179
right? It’s not, sort of, just
random people

1147
00:58:01,179 --> 00:58:03,480
saying these things, it’s people
who are making

1148
00:58:03,480 --> 00:58:05,769
policy-led decisions at the
state and local

1149
00:58:05,769 --> 00:58:08,318
level. And so, I think that is
something that,

1150
00:58:08,318 --> 00:58:09,942
you know, I’ve been keeping an
eye on. You

1151
00:58:09,942 --> 00:58:11,755
know, there’s…there’s a case
right now that’s

1152
00:58:11,755 --> 00:58:15,092
being discussed in the Supreme
Court around access

1153
00:58:15,092 --> 00:58:18,428
and…to health care issues. And
so, I think it’s,

1154
00:58:18,428 --> 00:58:20,888
we can’t, you know, as we…as we
move forward

1155
00:58:20,888 --> 00:58:23,567
in our HIV research, as we move
forward in the

1156
00:58:23,567 --> 00:58:25,943
implementation of these
programs, we also need

1157
00:58:25,943 --> 00:58:28,472
to…how does this…how are we
implementing within

1158
00:58:28,472 --> 00:58:31,202
the context of…of these lived
experiences? So I’m

1159
00:58:31,202 --> 00:58:33,877
not sure if I answered your
question directly,

1160
00:58:33,877 --> 00:58:35,994
Dr. Nelson, but that’s…those are
the things

1161
00:58:35,994 --> 00:58:38,015
that I’m thinking about, is
like, “Yes,

1162
00:58:38,015 --> 00:58:40,948
we have these tools. Yes, and?
[laughs] Yes, we

1163
00:58:40,948 --> 00:58:44,187
have these tools and how do we
make sure that they

1164
00:58:44,187 --> 00:58:47,457
reach the communities in a way
that is effective

1165
00:58:47,457 --> 00:58:50,927
and sort of culturally relevant
to the needs that

1166
00:58:50,927 --> 00:58:53,506
they have?” You know, obviously
folks are dealing

1167
00:58:53,506 --> 00:58:56,032
with housing issues, right?
Employment issues.

1168
00:58:56,767 --> 00:58:58,465
They’re not thinking about a
PrEP pill. They’re

1169
00:58:58,465 --> 00:59:00,270
not thinking about going in to
get an injection.

1170
00:59:00,270 --> 00:59:01,669
They’re thinking about how am I
going to get food

1171
00:59:01,669 --> 00:59:03,039
on my table? How am I going to
get a roof over

1172
00:59:03,039 --> 00:59:06,697
my head? And so you know,
tomorrow, actually,

1173
00:59:06,697 --> 00:59:10,514
at the White House, we’re having
a symposium,

1174
00:59:10,514 --> 00:59:12,704
that a few of you will be
joining us, that is

1175
00:59:12,704 --> 00:59:15,085
focusing on quality of life,
right? So, yes, we

1176
00:59:15,085 --> 00:59:17,996
need these medicines. What are
these other things

1177
00:59:17,996 --> 00:59:21,024
like mental health, housing,
employment? What are

1178
00:59:21,024 --> 00:59:23,337
these other things that we need
to make sure that

1179
00:59:23,337 --> 00:59:25,695
we’re also having conversations
about? So sorry,

1180
00:59:25,695 --> 00:59:27,655
the…the caffeine started kicking
in. So, I

1181
00:59:27,655 --> 00:59:29,933
hope…I hope I answered your
question, Dr. Nelson.

1182
00:59:29,933 --> 00:59:32,491
DR. LARON NELSON: Yeah. Thank
you so much. If

1183
00:59:32,491 --> 00:59:35,105
I’ll just say one more thing
then, which is,

1184
00:59:35,105 --> 00:59:37,968
you know, I’ve been thinking
about…just even as

1185
00:59:37,968 --> 00:59:41,011
you were talking, this…something
that I’ve heard

1186
00:59:41,011 --> 00:59:44,540
for a long time—I’ve even said
it—about the need

1187
00:59:44,540 --> 00:59:48,285
for sustainable everything,
funding for research,

1188
00:59:48,285 --> 00:59:50,863
long-term research
implementation in communities,

1189
00:59:50,863 --> 00:59:53,390
having community-based
organizational clinics,

1190
00:59:53,390 --> 00:59:56,177
being able to sustain these
interventions for a

1191
00:59:56,177 --> 00:59:59,196
longer period of time. And I…I
have more recently

1192
00:59:59,196 --> 01:00:03,789
sort of wondered—maybe more than
wondered—sort of,

1193
01:00:03,789 --> 01:00:08,472
pursued thinking about what’s
the role of private

1194
01:00:08,472 --> 01:00:12,891
industry other investment into
communities.

1195
01:00:12,891 --> 01:00:18,215
Because I’m not convinced that
the types of things

1196
01:00:18,215 --> 01:00:20,673
we say we want, that we’re going
to get it from

1197
01:00:20,673 --> 01:00:23,386
government agencies. We can’t…I
don’t think we can

1198
01:00:23,386 --> 01:00:28,359
rely on it. [laughs] And…and I
think that some of

1199
01:00:28,359 --> 01:00:33,530
the things for years, some of
the creativity that

1200
01:00:33,530 --> 01:00:35,704
comes from community are things
that just

1201
01:00:35,704 --> 01:00:38,034
never make it through the
bureaucracy, the

1202
01:00:38,034 --> 01:00:40,947
peer-reviewed or whatever you
call it. Those ideas

1203
01:00:40,947 --> 01:00:43,974
never make it because
they…they’ve not been tested

1204
01:00:43,974 --> 01:00:46,763
empirically for long enough or
enough studies,

1205
01:00:46,763 --> 01:00:49,613
and so they come across as
risky. And I think

1206
01:00:49,613 --> 01:00:52,864
private sector’s more…has a
better appetite for

1207
01:00:52,864 --> 01:00:56,319
things that might seem too risky
for governments

1208
01:00:56,319 --> 01:01:01,914
to take on. And I think
businesses, companies

1209
01:01:01,914 --> 01:01:07,631
have a…this is going to sound
odd. They know

1210
01:01:07,631 --> 01:01:10,179
how to make money. If there’s a
dollar to

1211
01:01:10,179 --> 01:01:12,969
be found, they can find it.
[laughs] And so

1212
01:01:12,969 --> 01:01:15,749
they…they …they are good at
keeping things going

1213
01:01:15,749 --> 01:01:18,642
to the degree that there’s a
payoff for them. In

1214
01:01:18,642 --> 01:01:20,700
business sometimes it’s, it’s,
it’s financial,

1215
01:01:20,700 --> 01:01:22,846
but there are other, sort of,
value and payoff

1216
01:01:22,846 --> 01:01:26,716
that I think we can have from
having folks be

1217
01:01:26,716 --> 01:01:30,587
willing to take on communities’
risky, odd,

1218
01:01:30,587 --> 01:01:33,431
bizarre ideas that they know
will work for them

1219
01:01:33,431 --> 01:01:36,393
but that need an investment that
is really hard

1220
01:01:36,393 --> 01:01:39,897
to get from our current
grant-making system that’s

1221
01:01:39,897 --> 01:01:43,333
super competitive, as it should
be. But…so I’ve

1222
01:01:43,333 --> 01:01:46,097
been thinking about, about that,
too. The role of

1223
01:01:46,097 --> 01:01:48,972
government, whole government,
and then the limits

1224
01:01:48,972 --> 01:01:51,366
of that and where…where we can
also find other

1225
01:01:51,366 --> 01:01:53,810
partners who can build on a lot
of the events

1226
01:01:53,810 --> 01:01:56,112
that we have because of
government investment

1227
01:01:56,112 --> 01:01:58,515
in research. So, yeah, thank you
for…for your

1228
01:01:58,515 --> 01:02:00,752
response to that question. And
thank you, Dr.

1229
01:02:00,752 --> 01:02:03,086
Donenberg, for allowing me
[laughs] to pose it.

1230
01:02:03,086 --> 01:02:05,988
DR. GERI DONENBERG: Of course.
It…It brings

1231
01:02:05,988 --> 01:02:08,692
up two issues for me that I’d
like to,

1232
01:02:08,692 --> 01:02:13,496
to raise. And then I know we…we
want to move on

1233
01:02:13,496 --> 01:02:18,401
to the question and answer. But
one is we call

1234
01:02:18,401 --> 01:02:21,524
planning for sustainability.
That means from the

1235
01:02:21,524 --> 01:02:24,774
beginning, you start to plan for
sustainability.

1236
01:02:24,774 --> 01:02:27,977
And sometimes that means
you’re…you find

1237
01:02:27,977 --> 01:02:31,648
industries or sometimes you
actually engage,

1238
01:02:31,648 --> 01:02:35,126
let’s say, the Ministry of
Health at the very

1239
01:02:35,126 --> 01:02:38,755
start of a project so that
there’s engagement

1240
01:02:38,755 --> 01:02:41,691
and commitment and buy-in. And
you, you…for

1241
01:02:41,691 --> 01:02:44,694
some of my studies in the past,
we needed,

1242
01:02:44,694 --> 01:02:48,124
sort of, a Ministry of health
letter that said,

1243
01:02:48,124 --> 01:02:51,768
“If this intervention turns out
to be effective,

1244
01:02:51,768 --> 01:02:55,233
we will then work towards
scaling it broadly

1245
01:02:55,233 --> 01:02:58,775
and we will contribute.” So, I
think it’s a

1246
01:02:58,775 --> 01:03:00,729
little bit of what Dr. Marrazzo
said, rather

1247
01:03:00,729 --> 01:03:02,812
than waiting till the end. But
it’s actually,

1248
01:03:02,812 --> 01:03:05,039
you know, right when you’re
starting the study,

1249
01:03:05,039 --> 01:03:07,450
you’re planning for
sustainability. And a related

1250
01:03:07,450 --> 01:03:12,300
comment is the use of folks from
those communities

1251
01:03:12,300 --> 01:03:16,960
to deliver these innovations—and
we’ve sort of

1252
01:03:16,960 --> 01:03:18,640
danced around that a little, I
think, in this

1253
01:03:18,640 --> 01:03:20,430
conversation., so I’m going to
bring it to the

1254
01:03:20,430 --> 01:03:24,373
forefront—that we really have, I
think, both

1255
01:03:24,373 --> 01:03:28,405
an obligation and a good
research question,

1256
01:03:28,405 --> 01:03:31,992
which is, can we really
facilitate uptake,

1257
01:03:31,992 --> 01:03:35,745
and reach, and sustainability by
training,

1258
01:03:35,745 --> 01:03:38,514
let’s say, community health
workers or whoever

1259
01:03:38,514 --> 01:03:41,518
it is to actually deliver these,
these programs?

1260
01:03:41,518 --> 01:03:44,233
And we’ve done some of that in
Africa, where

1261
01:03:44,233 --> 01:03:47,190
we’ve trained young adults with
HIV to deliver

1262
01:03:47,791 --> 01:03:50,516
trauma-informed cognitive
behavioral intervention

1263
01:03:50,516 --> 01:03:53,296
to their younger peers, who are
also living with

1264
01:03:53,296 --> 01:03:56,295
HIV. And, you know, it’s obvious
that we can train

1265
01:03:56,295 --> 01:03:59,235
folks to do this. They can do it
with fidelity,

1266
01:03:59,235 --> 01:04:01,774
and then we can assess whether
that works.

1267
01:04:01,774 --> 01:04:04,607
But then we’re building capacity
within those

1268
01:04:04,607 --> 01:04:08,223
settings to continue to deliver
these programs.

1269
01:04:08,223 --> 01:04:11,915
And we’re strengthening the
actual setting and

1270
01:04:11,915 --> 01:04:14,630
environment to deliver effective
programs, not

1271
01:04:14,630 --> 01:04:17,287
just going in with our research
assistants,

1272
01:04:17,287 --> 01:04:20,594
doing it and…and leaving. So, I
just wanted

1273
01:04:20,594 --> 01:04:24,127
to call those two pieces out.
And I think at

1274
01:04:24,127 --> 01:04:28,548
this point I want to turn it
back over to Mr.

1275
01:04:28,548 --> 01:04:32,969
Ruiz to lead our question and
answer session.

1276
01:04:32,969 --> 01:04:35,305
MR. FRANCISCO RUIZ: Awesome. I
stood up, put the

1277
01:04:35,305 --> 01:04:37,640
standing desk up because we got
some questions

1278
01:04:37,640 --> 01:04:40,727
queued in. And so, thank you
everyone who’s been

1279
01:04:40,727 --> 01:04:43,813
putting in chat…questions in the
chat. And so,

1280
01:04:43,813 --> 01:04:46,298
we have several questions. Let
everybody come

1281
01:04:46,298 --> 01:04:49,052
in. Welcome more. So, folks,
as…as they come up,

1282
01:04:49,052 --> 01:04:52,353
please put them in there.
And…and I’ll ask from

1283
01:04:52,353 --> 01:04:55,792
my esteemed panelists: try to
keep it condensed

1284
01:04:55,792 --> 01:04:59,469
in terms of your response if you
can. Maybe 60…60

1285
01:04:59,469 --> 01:05:03,366
sec…60, 90 seconds so they can
get to you. We have

1286
01:05:03,366 --> 01:05:05,885
a…a bunch of quick but good
questions here.

1287
01:05:05,885 --> 01:05:08,404
The first one I’m going to…is
directed to

1288
01:05:08,404 --> 01:05:12,168
Dr. Marrazzo. Can you speak more
to the goal of

1289
01:05:12,168 --> 01:05:16,246
ensuring fair pricing prior to
launch of efficacy

1290
01:05:16,246 --> 01:05:19,830
trials? How will this be
determined, and who will

1291
01:05:19,830 --> 01:05:23,486
decide fair pricing to U.S.
residents or globally?

1292
01:05:23,486 --> 01:05:25,655
DR. JEANNE MARRAZZO: So, I can 
say it’s not us, right? So,  

1293
01:05:26,156 --> 01:05:31,380
we at NIH have no sort of direct
impact or control

1294
01:05:31,380 --> 01:05:36,399
in this area. I think where our
responsibility

1295
01:05:36,399 --> 01:05:39,188
lies is when you think about
designing,

1296
01:05:39,188 --> 01:05:42,605
particularly the later phase
efficacy studies,

1297
01:05:42,605 --> 01:05:45,181
you got to think about that in
terms of investing

1298
01:05:45,181 --> 01:05:47,911
in that, right? So, you’re not
going to invest in,

1299
01:05:47,911 --> 01:05:50,699
generally…in a gigantic phase
three efficacy

1300
01:05:50,699 --> 01:05:53,550
study if the intervention is
going to cost,

1301
01:05:53,550 --> 01:05:56,477
you know, a million dollars
because why would

1302
01:05:56,477 --> 01:05:59,722
you ever do that? So…so I think
for us it’s more

1303
01:05:59,722 --> 01:06:03,305
about how we design the…the …the
studies as…as

1304
01:06:03,305 --> 01:06:06,963
they move into later phase in
particular. And

1305
01:06:06,963 --> 01:06:11,516
also having conversations with
our partners

1306
01:06:11,516 --> 01:06:16,172
who can impact those things more
profoundly.

1307
01:06:16,172 --> 01:06:19,409
MR. FRANCISCO RUIZ: Awesome.
Anyone else want to

1308
01:06:19,409 --> 01:06:22,645
add to that? Alright. Give you
guys a…alright.

1309
01:06:22,645 --> 01:06:25,982
Next question. So, this one is
focusing on aging

1310
01:06:25,982 --> 01:06:29,319
population with HIV, which is a
very important

1311
01:06:29,319 --> 01:06:31,359
topic that we’ve been talking
more and more

1312
01:06:31,359 --> 01:06:33,723
about, thankfully. So, given
that the population

1313
01:06:33,723 --> 01:06:37,372
of people in HIV in the U.S. is
increasing over 60

1314
01:06:37,372 --> 01:06:41,164
years old, the time available to
impact length and

1315
01:06:41,164 --> 01:06:44,180
quality of life in the aging
population is growing

1316
01:06:44,180 --> 01:06:47,136
shorter. How are you planning to
accelerate the

1317
01:06:47,136 --> 01:06:50,256
move from basic research to
things that impact

1318
01:06:50,256 --> 01:06:53,243
our lives? As a member of this
population,

1319
01:06:53,243 --> 01:07:00,721
basic research is great, but I
have to ask,

1320
01:07:00,721 --> 01:07:07,690
so what? Anyone want to respond
to that?

1321
01:07:07,690 --> 01:07:10,910
DR. LARON NELSON: I don’t have a
response to the

1322
01:07:10,910 --> 01:07:14,063
“so what” part but just wanted
to raise that,

1323
01:07:14,063 --> 01:07:17,667
you know, in my work in
prevention primarily,

1324
01:07:17,667 --> 01:07:21,271
we are trying to take get more
attention to

1325
01:07:21,271 --> 01:07:23,361
folks as they age both
understanding

1326
01:07:23,361 --> 01:07:25,508
how their needs evolve as they
age,

1327
01:07:26,075 --> 01:07:27,950
appreciating that they still
have needs as

1328
01:07:27,950 --> 01:07:29,913
they age [laughs] for
prevention, and then

1329
01:07:29,913 --> 01:07:32,726
finding smart, relevant ways
to…to respond to

1330
01:07:32,726 --> 01:07:35,785
those and the types of
interventions we develop

1331
01:07:35,785 --> 01:07:39,567
and…and studies we develop with
communities. So,

1332
01:07:39,567 --> 01:07:43,426
I appreciate that, that comment.
I…I think that

1333
01:07:43,426 --> 01:07:45,828
I…I can’t speak for basic
research because

1334
01:07:45,828 --> 01:07:48,398
I’m not a basic scientist, but
certainly in

1335
01:07:48,398 --> 01:07:50,850
the form of work that we do, we
try to make sure

1336
01:07:50,850 --> 01:07:53,403
that folks are involved because
what we develop,

1337
01:07:53,403 --> 01:07:56,413
we wanted…want to make sure that
it’s relevant

1338
01:07:56,413 --> 01:07:58,975
to broadest across that kind of
people.

1339
01:07:58,975 --> 01:08:00,901
DR. JEANNE MARRAZZO: And…and
just real quick, if

1340
01:08:00,901 --> 01:08:02,946
I could jump in, Francisco. You
know, I…I…I think

1341
01:08:02,946 --> 01:08:05,549
this is hugely important. We
have been working

1342
01:08:05,549 --> 01:08:08,484
closely with not just National
Institute of Aging,

1343
01:08:08,484 --> 01:08:12,194
but…but more obviously with a
reprieve trial with

1344
01:08:12,194 --> 01:08:16,125
the National Institute of…of
Cardiac and…and Heart

1345
01:08:18,928 --> 01:08:21,208
[laughs]…NI…National Institute
of Heart, Lung,

1346
01:08:21,208 --> 01:08:23,633
and Blood. And so…so…and we
remember we did the

1347
01:08:23,633 --> 01:08:26,364
reprieve study, which showed
that in people who

1348
01:08:26,364 --> 01:08:29,038
were living with HIV, even when
they did not

1349
01:08:29,038 --> 01:08:32,422
have high cholesterol, statins
improved multiple

1350
01:08:32,422 --> 01:08:36,012
markers of metabolic health in
clinical outcomes.

1351
01:08:36,012 --> 01:08:38,056
So, I think that we have to keep
pushing

1352
01:08:38,056 --> 01:08:40,350
this. To me, we haven’t really
talked about

1353
01:08:40,350 --> 01:08:43,024
the fourth 95 today, right? If
you think about

1354
01:08:43,024 --> 01:08:45,755
the three 95 buckets, you know,
the, sort of,

1355
01:08:45,755 --> 01:08:47,829
getting diagnosed, getting into
care, getting

1356
01:08:47,829 --> 01:08:49,993
virally suppressed, to me the
fourth—and what

1357
01:08:49,993 --> 01:08:52,219
we’ve been talking about—is
quality of life of

1358
01:08:52,219 --> 01:08:54,731
people living with HIV. And that
means aging care,

1359
01:08:54,731 --> 01:08:57,181
mental health, reproductive
health, sexual health,

1360
01:08:57,181 --> 01:08:59,535
all the things that we have been
talking about

1361
01:08:59,535 --> 01:09:02,822
that are the benefit of helping
people live longer

1362
01:09:02,822 --> 01:09:06,109
with HIV. So, please don’t feel
like when we say

1363
01:09:06,109 --> 01:09:08,288
we’re talking about basic
science, that leaves

1364
01:09:08,288 --> 01:09:10,513
this group out. Because we need
to understand

1365
01:09:10,513 --> 01:09:12,932
the basic science of aging and
inflammation and

1366
01:09:12,932 --> 01:09:15,451
why people living with HIV have
an inflammatory

1367
01:09:15,451 --> 01:09:18,978
profile that is very much more
accelerated than

1368
01:09:18,978 --> 01:09:22,725
people living without HIV. So,
lots of fantastic

1369
01:09:22,725 --> 01:09:25,365
basic science, as well as
implementation

1370
01:09:25,365 --> 01:09:28,197
science, in this area. We got to
get there.

1371
01:09:28,197 --> 01:09:30,168
DR. ERIC FREED: I might jump in
and…and

1372
01:09:30,168 --> 01:09:32,435
address the “so what” part of
the question,

1373
01:09:32,435 --> 01:09:34,903
which is basic science led
directly

1374
01:09:34,903 --> 01:09:37,440
to the development of
lenacapavir,

1375
01:09:37,440 --> 01:09:39,859
which is a game changer in PrEP
and

1376
01:09:39,859 --> 01:09:42,345
also potentially in treatment.
So,

1377
01:09:42,345 --> 01:09:45,648
I think it’s really important
that we

1378
01:09:45,648 --> 01:09:49,385
continue our investment in basic
research.

1379
01:09:49,385 --> 01:09:51,106
MR. FRANCISCO RUIZ: Awesome.
Thank you so

1380
01:09:51,106 --> 01:09:53,156
much. All right, so the next…I
have next set of

1381
01:09:53,156 --> 01:09:56,893
questions combined. If we take
community-centered

1382
01:09:56,893 --> 01:10:00,630
approach of this…the …the
dissemination of this

1383
01:10:00,630 --> 01:10:03,013
research and innovation must be
in language

1384
01:10:03,013 --> 01:10:05,234
that the community can
understand. So,

1385
01:10:05,234 --> 01:10:07,347
too often, good news is shared
without the

1386
01:10:07,347 --> 01:10:09,705
community understanding it. So,
Dr. Marrazzo,

1387
01:10:09,705 --> 01:10:12,539
I think you mentioned that
people living with

1388
01:10:12,539 --> 01:10:15,311
HIV can be organ donors to
others with HIV

1389
01:10:15,311 --> 01:10:17,376
in a nod to the secondary
prevention,

1390
01:10:17,376 --> 01:10:19,549
but many people do not know that
this

1391
01:10:19,549 --> 01:10:22,172
has existed over a decade. Can
you send…can

1392
01:10:22,172 --> 01:10:24,854
you spend some time talking
about the HOPE

1393
01:10:24,854 --> 01:10:27,285
Act to the audience to sort of
explain

1394
01:10:27,285 --> 01:10:29,592
a little bit more what that
entails?

1395
01:10:29,592 --> 01:10:31,938
DR. JEANNE MARRAZZO: So, the
HOPE Act is…is

1396
01:10:31,938 --> 01:10:34,230
…is…comprises a number of…of key
things.

1397
01:10:34,230 --> 01:10:36,293
The…the …the main thing, I
think, just

1398
01:10:36,293 --> 01:10:38,568
given the little time that we
have left,

1399
01:10:38,568 --> 01:10:42,588
is that it emphasizes that
people living with HIV

1400
01:10:42,588 --> 01:10:46,609
can be both recipients and
donors for…if organs

1401
01:10:46,609 --> 01:10:48,866
are healthy. And…and people
can…can sustain that.

1402
01:10:48,866 --> 01:10:51,214
And you can, of course…the study
that was done on

1403
01:10:51,214 --> 01:10:53,209
deceased organ donors, so
obviously that’s

1404
01:10:53,209 --> 01:10:55,251
a source. But it really just
emphasizes…I

1405
01:10:55,985 --> 01:10:59,601
think that it…it makes clear
that HIV as an

1406
01:10:59,601 --> 01:11:03,793
infection, as a condition in
somebody should not

1407
01:11:03,793 --> 01:11:07,480
be a barrier to appropriate
management of the need

1408
01:11:07,480 --> 01:11:11,167
for an organ transplantation.
And that’s really,

1409
01:11:11,167 --> 01:11:13,755
that’s like…that may sound like
kind of

1410
01:11:13,755 --> 01:11:16,472
evident, but that’s come…that’s
taken a

1411
01:11:16,472 --> 01:11:18,467
long time. You know, there have
been people

1412
01:11:18,467 --> 01:11:20,643
who’ve been doing it, but it’s
all been under

1413
01:11:20,643 --> 01:11:22,328
very specific compassionate use
or research

1414
01:11:22,328 --> 01:11:24,280
protocols. I’m not sure about
compassionate use,

1415
01:11:24,280 --> 01:11:27,166
but research protocols. So, now
this sets the

1416
01:11:27,166 --> 01:11:30,052
standard for health care
wherever you live,

1417
01:11:30,052 --> 01:11:31,940
whether it’s in a research
hospital, a community

1418
01:11:31,940 --> 01:11:33,790
hospital, which we’re
increasingly doing lots

1419
01:11:33,790 --> 01:11:36,692
of transplants. So, that’s,
that’s really

1420
01:11:36,692 --> 01:11:39,595
the key thing about the HOPE Act
to know.

1421
01:11:39,595 --> 01:11:44,467
MR. FRANCISCO RUIZ: Thank 
you. Our next question is:  

1422
01:11:44,467 --> 01:11:47,896
what is the best way to enhance
social behavior

1423
01:11:47,896 --> 01:11:51,040
changes as it pertains to HIV
prevention,

1424
01:11:51,040 --> 01:11:55,189
especially in young people where
we are

1425
01:11:55,189 --> 01:11:59,649
having high incidence of new
infections?

1426
01:11:59,649 --> 01:12:03,386
So, how do we enhance
social-behavioral

1427
01:12:03,386 --> 01:12:06,656
changes on the side of
prevention?

1428
01:12:06,656 --> 01:12:08,874
DR. LATESHA ELOPRE: So, I do
think we’re in

1429
01:12:08,874 --> 01:12:11,294
a state where we’re seeing
growth in STIs and

1430
01:12:11,294 --> 01:12:13,853
especially among our adolescent
populations. And

1431
01:12:13,853 --> 01:12:16,465
I think that probably one of the
biggest things

1432
01:12:16,465 --> 01:12:18,508
we found with most of our
prevention trials

1433
01:12:18,508 --> 01:12:20,736
is that we can engage adolescent
populations,

1434
01:12:20,736 --> 01:12:23,956
but it’s hard to have them
persist in care. And

1435
01:12:23,956 --> 01:12:27,109
I think probably a part of that
is linked to

1436
01:12:27,109 --> 01:12:29,161
the first question that you
asked in regards

1437
01:12:29,161 --> 01:12:31,214
to dissemination of information
and really

1438
01:12:31,214 --> 01:12:33,875
getting the message to
adolescent populations

1439
01:12:33,875 --> 01:12:36,652
in a manner in which they desire
to have that

1440
01:12:36,652 --> 01:12:39,377
message be delivered to them.
And then providing

1441
01:12:39,377 --> 01:12:42,325
them services in a manner in
which they can easily

1442
01:12:42,325 --> 01:12:45,146
access those services.
Confidentiality is a huge

1443
01:12:45,146 --> 01:12:48,197
issue in regards to people
accessing services when

1444
01:12:48,197 --> 01:12:51,466
they’re adolescents, and it
varies by state. In

1445
01:12:51,466 --> 01:12:54,870
regards to your ability to have
private medical

1446
01:12:54,870 --> 01:12:58,367
health records, also varies by
state, and it can

1447
01:12:58,367 --> 01:13:02,078
be effective in regards to
protecting adolescents

1448
01:13:02,078 --> 01:13:03,959
from unintentional disclosure
when they’re

1449
01:13:03,959 --> 01:13:06,015
trying to access sexual health
services. So,

1450
01:13:06,015 --> 01:13:08,351
I think there’s all of these
very special

1451
01:13:08,351 --> 01:13:10,519
situations that an adolescent
has to

1452
01:13:10,519 --> 01:13:13,873
face when they’re trying to be
sexually

1453
01:13:13,873 --> 01:13:17,226
healthy that our science needs
to meet.

1454
01:13:17,226 --> 01:13:20,603
DR. LARON NELSON: Yeah, and you
know,

1455
01:13:20,603 --> 01:13:25,134
adolescents…their preferences
change so quickly.

1456
01:13:25,868 --> 01:13:28,565
I mean, not day-to-day, but like
at 5 years out,

1457
01:13:28,565 --> 01:13:31,207
you’re sort of old again. Like
you…you need a

1458
01:13:31,207 --> 01:13:33,337
new strategy. And so, that’s
part [laughs] part

1459
01:13:33,337 --> 01:13:35,511
of the challenge, is staying
current with what

1460
01:13:35,511 --> 01:13:39,542
adolescents, sort of, what’s
in…what they’re into.

1461
01:13:39,542 --> 01:13:43,653
But I think really finding out
what they’re into,

1462
01:13:43,653 --> 01:13:47,519
what makes them tick, and then
finding a way to

1463
01:13:47,519 --> 01:13:51,627
do that. The challenge is that
most of the folks

1464
01:13:51,627 --> 01:13:53,922
who are leading research are not
adolescents,

1465
01:13:53,922 --> 01:13:56,465
they’re adults. And it kind of
has to make sense

1466
01:13:56,465 --> 01:13:58,650
to you as an adult, and to the
degree that

1467
01:13:58,650 --> 01:14:00,937
it makes more sense to you as an
adult, it

1468
01:14:00,937 --> 01:14:04,241
makes less sense to them as an
adolescent. And so,

1469
01:14:04,241 --> 01:14:07,610
somehow you have to find a way
to be…be rigorous,

1470
01:14:07,610 --> 01:14:10,400
but—I don’t know how to say
this—I want to say

1471
01:14:10,400 --> 01:14:13,249
pure, but give them what they
want as they’ve

1472
01:14:13,249 --> 01:14:15,809
requested it, and try not to
filter it as much

1473
01:14:15,809 --> 01:14:18,587
through your adult brain,
because you’ll—I mean,

1474
01:14:18,587 --> 01:14:20,297
Dr. Donenberg knows this, she
worked with

1475
01:14:20,297 --> 01:14:22,291
adolescents—you…[laughs] the
more you do that,

1476
01:14:22,291 --> 01:14:24,844
the more you…it’ll lose
credibility with them.

1477
01:14:24,844 --> 01:14:27,396
And that’s tough because as an
adult person,

1478
01:14:27,396 --> 01:14:30,355
there’s some things that I think
are appropriate.

1479
01:14:30,355 --> 01:14:33,135
And that…that is what ends up on
the…getting

1480
01:14:33,135 --> 01:14:36,024
designed and getting
implemented, which means

1481
01:14:36,024 --> 01:14:38,974
it’s…it will work really well
for me, right?

1482
01:14:38,974 --> 01:14:41,369
Not as well for them. And so,
that’s…that’s the

1483
01:14:41,369 --> 01:14:43,913
challenge. And there’s…our
institutions regulate

1484
01:14:43,913 --> 01:14:46,104
that. IRBs regulate that. So,
you…there

1485
01:14:46,104 --> 01:14:48,351
are things that have to balance,
but I

1486
01:14:48,351 --> 01:14:51,636
would say trying ways to give
them what they’ve

1487
01:14:51,636 --> 01:14:54,991
indicated that they want and how
they wanted it.

1488
01:14:54,991 --> 01:14:55,680
DR. JEANNE MARRAZZO: [Crosstalk]
DR. GERI DONENBERG: Can I add

1489
01:14:55,680 --> 01:14:55,758
to…oh.

1490
01:14:55,758 --> 01:14:57,727
DR. JEANNE MARRAZZO: Oh, I’m
sorry. Go ahead.

1491
01:14:57,727 --> 01:14:59,737
DR. GERI DONENBERG: Oh, I was
just going

1492
01:14:59,737 --> 01:15:01,797
to add—because I have spent the
past 30

1493
01:15:01,797 --> 01:15:04,538
years working with adolescents—I
think you

1494
01:15:04,538 --> 01:15:07,470
bring adolescents into the
process. I think

1495
01:15:07,470 --> 01:15:10,272
there’s a…a very big movement on
“nothing

1496
01:15:10,272 --> 01:15:13,409
about us without us” among young
people. And

1497
01:15:13,409 --> 01:15:17,279
there are some terrific
researchers doing work

1498
01:15:17,279 --> 01:15:21,150
around youth voices informing
the messaging,

1499
01:15:21,150 --> 01:15:27,223
the dissemination, the research
methods that you

1500
01:15:27,223 --> 01:15:33,295
use, a recruitment of
participants, retention,

1501
01:15:33,295 --> 01:15:36,251
engagement. There are, you know,
great folks

1502
01:15:36,251 --> 01:15:39,468
doing that work, and I think we
can learn from

1503
01:15:39,468 --> 01:15:41,912
them. And they’re really
directly engaging

1504
01:15:41,912 --> 01:15:44,640
young people in the process. We
have advisory

1505
01:15:44,640 --> 01:15:47,843
boards that are youth driven and
that are

1506
01:15:47,843 --> 01:15:51,046
comprised of youth. And I think
choice,

1507
01:15:51,046 --> 01:15:54,583
again, becomes a big issue. And
I’m just going

1508
01:15:54,583 --> 01:15:58,120
to do a plug that I think family
members—and

1509
01:15:58,120 --> 01:16:01,174
I don’t mean like a parent
necessarily, but a

1510
01:16:01,174 --> 01:16:04,493
trusted family member who that
youth identifies

1511
01:16:04,493 --> 01:16:07,298
as someone they can relate to
and would like

1512
01:16:07,298 --> 01:16:10,166
to have these conversations
with—is someone

1513
01:16:10,166 --> 01:16:13,967
I think is a very underutilized
and unleveraged

1514
01:16:13,967 --> 01:16:18,007
resource in our prevention
efforts. And I really

1515
01:16:18,007 --> 01:16:21,497
think that’s an area that
could…could work. And

1516
01:16:21,497 --> 01:16:24,914
then I’ll pass it over to Dr.
Marrazzo. Sorry.

1517
01:16:24,914 --> 01:16:26,515
DR. JEANNE MARRAZZO: Yeah,
sorry. I just wanted

1518
01:16:26,515 --> 01:16:28,150
to share a great quote that I
heard when I was

1519
01:16:28,150 --> 01:16:30,223
in South Africa in August,
because, to

1520
01:16:30,223 --> 01:16:32,455
me, again, I think one of the
things we

1521
01:16:32,455 --> 01:16:34,747
haven’t talked about a lot is
that we have

1522
01:16:34,747 --> 01:16:37,093
done so well treating HIV in
many places,

1523
01:16:37,093 --> 01:16:40,710
that there isn’t the visibility
of disability and

1524
01:16:40,710 --> 01:16:44,400
death that was so…that so shaped
our growing up,

1525
01:16:44,400 --> 01:16:47,289
right? And our perceptions. And
so, adolescents

1526
01:16:47,289 --> 01:16:50,239
already are invulnerable, right?
Nothing bad’s

1527
01:16:50,239 --> 01:16:53,201
going to happen to them. On top
of that, they’re

1528
01:16:53,201 --> 01:16:56,345
not seeing any of the really
dire effects of HIV.

1529
01:16:56,345 --> 01:16:59,105
And I went to a PrEP clinic
where young women

1530
01:16:59,105 --> 01:17:01,984
were being offered PrEP and one
of them said,

1531
01:17:01,984 --> 01:17:04,587
“You know, why would I take a
pill every day to

1532
01:17:04,587 --> 01:17:07,189
prevent myself from taking a
pill every day?”

1533
01:17:07,189 --> 01:17:09,469
And so the idea was, “Why should
I take daily PrEP

1534
01:17:09,469 --> 01:17:11,794
when, if I get infected, I can
just take one pill

1535
01:17:11,794 --> 01:17:15,147
a day and I’ll be fine?” And to
me, like, that is

1536
01:17:15,147 --> 01:17:18,634
like so classically, sort of,
minimizing the risk

1537
01:17:18,634 --> 01:17:20,938
and…and just, sort of, “It
doesn’t matter, you

1538
01:17:20,938 --> 01:17:23,439
know, I’ll be fine.” And so I…I
…I think we have

1539
01:17:23,439 --> 01:17:26,464
to really also think hard about
that because we

1540
01:17:26,464 --> 01:17:29,678
don’t have that leverage to…to
sort of, frankly,

1541
01:17:29,678 --> 01:17:32,974
scare people the way that they
were naturally

1542
01:17:32,974 --> 01:17:36,485
really scared before about
getting HIV infected.

1543
01:17:36,485 --> 01:17:38,054
MR. FRANCISCO RUIZ: Thank you
for that. And,

1544
01:17:38,054 --> 01:17:39,588
and this summer, I was in South
Carolina,

1545
01:17:39,588 --> 01:17:42,294
not South Africa, and the same
thing came up. “Why

1546
01:17:42,294 --> 01:17:44,894
am I taking a pill to take…to
not take another

1547
01:17:44,894 --> 01:17:47,008
pill?” and so I think those are
real conversations

1548
01:17:47,008 --> 01:17:49,165
that we need to have and why the
potential of…you

1549
01:17:49,165 --> 01:17:51,102
…you know, the injectable
conversations that

1550
01:17:51,102 --> 01:17:53,169
we’re having for those who don’t
want to take

1551
01:17:53,169 --> 01:17:56,718
pills. And so…we, we’ve hit some
of the questions

1552
01:17:56,718 --> 01:18:00,409
that are already…we have about a
couple more one,

1553
01:18:00,409 --> 01:18:03,279
two-ish minutes left. I’ll ask
one more question

1554
01:18:03,279 --> 01:18:06,148
and then see if any folks want
to…who wants to

1555
01:18:06,148 --> 01:18:09,757
join this one. What do you see
as the role of

1556
01:18:09,757 --> 01:18:13,522
community in HIV research taking
place? Also,

1557
01:18:13,522 --> 01:18:15,753
how can we transition from our
community

1558
01:18:15,753 --> 01:18:18,093
not only being participants in
research,

1559
01:18:18,093 --> 01:18:20,935
but co-leading as partners in
the development and

1560
01:18:20,935 --> 01:18:23,832
implementation of research? So
again, how do…you

1561
01:18:23,832 --> 01:18:28,278
know, how do we intentionally
engage our community

1562
01:18:28,278 --> 01:18:32,374
members in this work? And
one…open for anyone.

1563
01:18:32,374 --> 01:18:34,365
DR. LARON NELSON: Yeah, I mean,
I would just

1564
01:18:34,365 --> 01:18:36,445
go back to what Dr. Donenberg
said about the

1565
01:18:36,445 --> 01:18:40,321
approach of…she mentioned youth,
but the “nothing

1566
01:18:40,321 --> 01:18:44,119
about us without us”. I think
that…that is it.

1567
01:18:44,119 --> 01:18:46,702
I think investigators who are
typically leading

1568
01:18:46,702 --> 01:18:49,391
this have to adopt that. I think
there are ways

1569
01:18:49,391 --> 01:18:51,335
you can incentivize them to
adopt that because

1570
01:18:51,335 --> 01:18:53,195
they need you to participate.
[laughs] And

1571
01:18:53,195 --> 01:18:54,823
if they aren’t participating on
your terms,

1572
01:18:54,823 --> 01:18:56,599
then you don’t do it. They can’t
do the study

1573
01:18:56,599 --> 01:19:00,491
without communities. I think
the…I think recently,

1574
01:19:00,491 --> 01:19:04,306
I’ve seen announcements from
NIH, or maybe CDC,

1575
01:19:04,306 --> 01:19:07,107
or both, that required sort of
community

1576
01:19:07,107 --> 01:19:10,112
leadership of co-leadership of
studies. I

1577
01:19:10,112 --> 01:19:13,332
think that is important because
that structures

1578
01:19:13,332 --> 01:19:16,685
that expectation into the…the
…the grant design

1579
01:19:16,685 --> 01:19:18,957
and that can make sure that
happened. I…I think

1580
01:19:18,957 --> 01:19:21,323
the best work I’ve
seen—certainly the best work

1581
01:19:21,323 --> 01:19:23,616
I’ve done—has been work that
I’ve done in

1582
01:19:23,616 --> 01:19:26,128
collaboration with communities.
And I think

1583
01:19:26,128 --> 01:19:28,384
without that, none…nothing that
people might say

1584
01:19:28,384 --> 01:19:30,733
was innovative that I’ve ever
done would’ve been

1585
01:19:30,733 --> 01:19:36,013
considered. So, it…it was only
so because of

1586
01:19:36,013 --> 01:19:41,176
the support and direction from
communities.

1587
01:19:41,176 --> 01:19:42,811
DR. LATESHA ELOPRE: I’ll
just…100 percent agree

1588
01:19:42,811 --> 01:19:44,446
with that. I think the most
meaningful aspect

1589
01:19:44,446 --> 01:19:47,569
of all the research that usually
is done is led

1590
01:19:47,569 --> 01:19:50,886
and meaningfully engaging
community members. And

1591
01:19:50,886 --> 01:19:53,455
I’ve been really excited in
being able to see more

1592
01:19:53,455 --> 01:19:56,025
collaborations where you have a
community member

1593
01:19:56,025 --> 01:19:58,692
as your co-I…as your PI leading
publications

1594
01:19:58,692 --> 01:20:01,597
and saying, “This is the aspect
of the science

1595
01:20:01,597 --> 01:20:03,931
that I think is the most
important.” And then

1596
01:20:03,931 --> 01:20:06,468
also telling you in a meaningful
way how do you

1597
01:20:06,468 --> 01:20:10,249
disseminate information to
community so that it

1598
01:20:10,249 --> 01:20:14,109
actually impacts change. So, I
think that this

1599
01:20:14,109 --> 01:20:16,496
is something that’s been really
exciting, and I

1600
01:20:16,496 --> 01:20:19,081
think it’s actually what
I…[laughs] led to all of

1601
01:20:19,081 --> 01:20:21,436
us being so invested from a
government standpoint

1602
01:20:21,436 --> 01:20:23,886
and epidemic was community
advocating and saying,

1603
01:20:23,886 --> 01:20:26,387
“We want you to invest in the
end of

1604
01:20:26,387 --> 01:20:29,158
the HIV epidemic.” So, it makes
sense,

1605
01:20:29,158 --> 01:20:32,906
naturally, that we are always
engaging them and

1606
01:20:32,906 --> 01:20:36,498
listening to their voices as we
move forward.

1607
01:20:36,498 --> 01:20:38,684
MR. FRANCISCO RUIZ: That is
great. We have come

1608
01:20:38,684 --> 01:20:40,869
to the end of the Q&A. Thank you
everyone who

1609
01:20:40,869 --> 01:20:42,962
was putting in questions, and
hopefully

1610
01:20:42,962 --> 01:20:45,107
we…we try to answer most of
them, but,

1611
01:20:45,107 --> 01:20:47,860
you know, time is of the
essence, and I’m really

1612
01:20:47,860 --> 01:20:50,612
excited to pass it back to
Captain Glenshaw. I

1613
01:20:50,612 --> 01:20:53,382
really hope that the
conversations that we had

1614
01:20:53,382 --> 01:20:56,151
today, that the spirit of
dialogue, sort of,

1615
01:20:56,151 --> 01:20:58,365
continues beyond just, sort of,
the…the

1616
01:20:58,365 --> 01:21:00,856
webinar. And I know that this
work is more

1617
01:21:00,856 --> 01:21:03,018
than just a scientific endeavor,
but really,

1618
01:21:03,018 --> 01:21:05,227
it’s about the commitment to a
humanity and

1619
01:21:05,227 --> 01:21:08,718
the work that we need to do
collectively. So,

1620
01:21:08,718 --> 01:21:12,134
with that…passing it back to…to
the Captain.

1621
01:21:12,134 --> 01:21:13,924
CAPT MARY GLENSHAW: [laughs]
Thank you,

1622
01:21:13,924 --> 01:21:15,804
Francisco, Geri, Latesha, Eric,
Jeanne,

1623
01:21:15,804 --> 01:21:18,674
and LaRon so much for today’s
dynamic discussion,

1624
01:21:18,674 --> 01:21:21,543
highlighting opportunities to
ensure that those

1625
01:21:21,543 --> 01:21:24,869
with and affected by HIV
participate, inform,

1626
01:21:24,869 --> 01:21:28,484
and importantly, benefit from
the life-changing

1627
01:21:28,484 --> 01:21:31,318
impact of research innovations.
We appreciate all

1628
01:21:31,318 --> 01:21:34,323
of those watching today’s event
for joining us and

1629
01:21:34,323 --> 01:21:37,059
for helping underscore the NIH
role in supporting

1630
01:21:37,059 --> 01:21:39,795
the science that is truly the
foundation of the

1631
01:21:39,795 --> 01:21:42,537
HIV response. Thank you
sincerely to the NIH

1632
01:21:42,537 --> 01:21:45,401
colleagues who coordinated this
event. We’re

1633
01:21:45,401 --> 01:21:48,699
so grateful for your dedication
and commitment

1634
01:21:48,699 --> 01:21:52,207
to excellence in everything you
do. Colleagues,

1635
01:21:52,207 --> 01:21:56,188
please pause to remember the
estimated 42 million

1636
01:21:56,188 --> 01:22:00,249
lives lost to HIV-related
causes, including more

1637
01:22:00,249 --> 01:22:03,870
than half a million people
worldwide this

1638
01:22:03,870 --> 01:22:07,923
year alone. In closing, we honor
the members

1639
01:22:07,923 --> 01:22:12,152
of our community whom we have
lost since the last

1640
01:22:12,152 --> 01:22:16,465
World AIDS Day in 2023. Each of
these remarkable

1641
01:22:16,465 --> 01:22:20,527
individuals dedicated their
careers to improving

1642
01:22:20,527 --> 01:22:24,506
the health and well-being of
people with HIV.

1643
01:22:26,508 --> 01:22:30,746
Among these, we remember Dr.
Adaora Adimora,  

1644
01:22:30,746 --> 01:22:33,584
an esteemed HIV researcher and
professor of

1645
01:22:33,584 --> 01:22:36,552
medicine and epidemiology at the
University

1646
01:22:36,552 --> 01:22:39,223
of North Carolina School of
Medicine and

1647
01:22:39,223 --> 01:22:42,024
Gillings School of Global Public
Health.

1648
01:22:42,024 --> 01:22:44,568
Adaora dedicated her career to
studying the

1649
01:22:44,568 --> 01:22:47,229
socioeconomic and racial
disparities in HIV

1650
01:22:47,229 --> 01:22:50,612
transmission and management with
a particular

1651
01:22:50,612 --> 01:22:54,436
focus on the impact on women. A.
Cornelius Baker,

1652
01:22:56,238 --> 01:23:00,092
a steadfast advocate for LGBTQ+
rights and people

1653
01:23:00,092 --> 01:23:03,946
with HIV, who dedicated his life
to championing

1654
01:23:03,946 --> 01:23:06,933
health equity. Cornelius was
instrumental in

1655
01:23:06,933 --> 01:23:10,385
building coalitions, creating a
holistic approach

1656
01:23:10,385 --> 01:23:14,052
to HIV, and establishing
multiple in…initiatives

1657
01:23:14,052 --> 01:23:17,793
and organizations that helped
shape the federal

1658
01:23:17,793 --> 01:23:21,289
and community responses to HIV.
He served as a

1659
01:23:21,289 --> 01:23:24,933
mentor to countless individuals,
including me,

1660
01:23:24,933 --> 01:23:28,670
and was a long-time advisor of
PEPFAR in the NIH

1661
01:23:28,670 --> 01:23:32,407
Office of AIDS Research. Ms.
Hydeia Broadbent,

1662
01:23:32,407 --> 01:23:35,388
an AIDS activist who was born
with HIV and became

1663
01:23:35,388 --> 01:23:38,547
a leading voice in the fight
against the epidemic.

1664
01:23:38,547 --> 01:23:41,316
Adopted at 6 weeks old, Hydeia
was ultimately

1665
01:23:41,316 --> 01:23:44,386
diagnosed with HIV when she was
3. She developed

1666
01:23:44,386 --> 01:23:47,339
AIDS at age 5 and was predicted
to have a short

1667
01:23:47,339 --> 01:23:50,292
lifespan, but with early
pediatric treatment,

1668
01:23:50,292 --> 01:23:53,754
she persevered. She used her 39
years of life

1669
01:23:53,754 --> 01:23:57,366
as a public spokesperson to
destigmatize HIV,

1670
01:23:57,366 --> 01:24:01,134
raise awareness, and share
messages of hope

1671
01:24:01,134 --> 01:24:05,073
and inspiration. Dr. Steven D.
Douglas, who

1672
01:24:05,073 --> 01:24:07,796
explored the neuroimmunology of
HIV and led the

1673
01:24:07,796 --> 01:24:10,746
development of novel targets for
the treatment of

1674
01:24:10,746 --> 01:24:13,765
viral inflammation and
infection. He spent much of

1675
01:24:13,765 --> 01:24:16,785
his remarkable career at the
Children’s Hospital

1676
01:24:16,785 --> 01:24:19,758
of Philadelphia and as Professor
of Pediatrics at

1677
01:24:19,758 --> 01:24:22,791
the Perlman School of Medicine
at the University

1678
01:24:22,791 --> 01:24:26,959
of Pennsylvania. Dr. Gao Yeojie,
a pioneer in

1679
01:24:26,959 --> 01:24:31,400
HIV activism who investigated
the HIV epidemic

1680
01:24:31,400 --> 01:24:34,462
in China in the 1990s. While Dr.
Gao’s work

1681
01:24:34,462 --> 01:24:37,873
earned her national and
international acclaim,

1682
01:24:37,873 --> 01:24:40,878
she was kept under close state
surveillance and

1683
01:24:40,878 --> 01:24:43,946
eventually fled to the U.S. Her
efforts in HIV

1684
01:24:43,946 --> 01:24:46,872
prevention and anti-stigma
education resulted in

1685
01:24:46,872 --> 01:24:49,918
the recognition of HIV in China
and the creation

1686
01:24:49,918 --> 01:24:54,072
of policies to prevent and
manage HIV. And lastly,

1687
01:24:54,072 --> 01:24:58,226
Dr. Victoria Anne Johnson,
Professor Emeritus of

1688
01:24:58,226 --> 01:25:01,213
Infectious Diseases at the
Department of Medicine

1689
01:25:01,213 --> 01:25:04,199
at The University of Alabama in
Birmingham. Dr.

1690
01:25:04,199 --> 01:25:06,896
Johnson was a pioneer in HIV
drug resistance

1691
01:25:06,896 --> 01:25:10,072
research and the use of
combination antiretroviral

1692
01:25:10,072 --> 01:25:13,762
drug regimens that are now the
standard approach

1693
01:25:13,762 --> 01:25:17,679
in HIV treatment. We are humbled
and grateful for

1694
01:25:17,679 --> 01:25:20,798
their lifelong dedication of
these remarkable

1695
01:25:20,798 --> 01:25:24,052
individuals. We join the entire
HIV community

1696
01:25:24,052 --> 01:25:26,579
in celebrating their impact and
drawing

1697
01:25:26,579 --> 01:25:29,358
inspiration from their legacies
to…affirm

1698
01:25:29,358 --> 01:25:33,762
our commitment to the HIV
movement. In closing,

1699
01:25:33,762 --> 01:25:38,166
on behalf of the NIH Office of
AIDS Research,

1700
01:25:38,166 --> 01:25:40,674
thank you for joining today’s
NIH Observance

1701
01:25:40,674 --> 01:25:43,405
of World AIDS Day. We invite you
to sign up to

1702
01:25:43,405 --> 01:25:48,827
receive important updates from
our office and our

1703
01:25:48,827 --> 01:25:54,249
program. This concludes today’s
event. Thank you.