CROI 2015: Ambassador Birx talks about the tyranny of averages, actionable data, and “skeptical optimism”

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Science Speaks is covering the 2015 Conference on Retroviruses and Opportunistic Infections in Seattle Washington live this week, from February 23-26, with breaking news on HIV research findings and implications.

Science Speaks is covering the 2015 Conference on Retroviruses and Opportunistic Infections in Seattle Washington live this week, from February 23-26, with breaking news on HIV research findings and implications.

SEATTLE WASHINGTON – When Ambassador Deborah Birx comes to CROI, she’s returning to her roots, she told a hall full of scientists here today. She got her start in the science of tackling HIV, and as leader of the U.S. Military Research Program led efforts to find biomedical answers to the global pandemic. That work culminated in championing the clinical research trial that provided the only evidence to date that a vaccine can reduce risks of people getting infected with the virus that leads to AIDS. Now the world’s most influential implementer, as head of the President’s Emergency Plan for AIDS Relief, she came to CROI to let the scientists know the future of the fight against HIV still depends on them. As always, she came with the numbers to support her point. She has the UNAIDS GAP Report, “a tour de force of the fundamental epidemiology of the epidemic,” she considers one of the agency’s best reports AmbBirxever, for its focus on locations and specific populations demanding the most attention, and for showing that “AIDS isn’t everywhere.” She also has the UNAIDS Fast-track report, which added up numbers to show that 28 million HIV infections could be averted by action that starts now.

“There’s no longer a turning back, and saying we didn’t know.” Birx said. “We do know.”

All of this adds up to her repeated call to “do the right things in the right places at the right time.”

“The good thing,” she told the hall full of scientists, “is that the right things are easy to identify because you defined them for us.”

“The right places” is trickier, because it means pulling resources from other places to go to those right places. But this is where data come in. On one hand, she pointed out, “There are sites that have never had a positive test.” Some of them are near places that have lots of positives, she added. “When we look at the data we have to get past the averages.”

The right places also means among the populations who have the highest burdens of HIV and the least access to services. With thousands of new people joining the ranks of those living with HIV ever day, she said, “We have to be 20 to 30 percent more effective just to stay neutral.” That means reaching men who have sex with men, sex workers, people who inject drugs, and, she added, young women.

Later in the day, after a Médecins Sans Frontières presenter had mentioned that surveys had shown viral loads in men diagnosed with HIV were about five times higher than viral loads in women diagnosed with HIV, the Ambassador added men to the list, and cited a need for “programming that shows men matter.”

If men who have sex with men, sex workers, people who inject drugs, young women, and heterosexual men are all counted among groups to target, someone asked, “isn’t that everyone?”

She noted again, “HIV isn’t everywhere. If we had to reach everyone, there couldn’t be an AIDS-free generation.”

Can there be an AIDS-free generation anyway, someone else asked, when Congress appears to have given up on the effort, with consecutive years of flat-funding?

The representatives of that body who she met in November hadn’t given up, she said. She hopes that’s not the case now. But in the meantime, the efficiencies gained in rolling out treatment have to be extended to combined prevention measures. The great thing about the call for an AIDS-free generation, she added is that it changed the terms of the fight. “Now we not only have to show our impact on lives saved, but we have to show our impact on controlling the epidemic. She is an optimist, she said, if a skeptical one.

“Sometimes we have more capabilities than we give ourselves credit for.”

 

 

 

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