AIDS, the deadly virus-caused disease that dominated medical news in the 1980s – it’s still a scourge, especially in certain nations outside of the United States. And helping mitigate it remains a priority for the State Department. For an update, Federal Drive with Tom Temin turned to the senior adviser in the office of the US Global AIDS Coordinator and Health Diplomacy, Jirair Ratevosian.
Tom Temin: Mr. Ratevosian, good to have you on.
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Jirair Ratevosian: Thank you so much, Tom, thanks for inviting me over.
Tom Temin: And just give us the picture here. What is the AIDS/HIV outlook for the world outside of the United States? And I’m presuming, I hope correctly, that for the most part, it is under control in the United States.
Jirair Ratevosian: Thanks for that question, Tom. And thanks for spotlighting this issue. It’s not everyday we get a chance to continue to talk about HIV. To your point, you’re right. Globally, we’ve made progress on HIV here in the U.S. and around the world. If you go back to the 1980s, as you mentioned, HIV and AIDS-related deaths have been cut by almost two-thirds. People are not dying of HIV the way they were before. New infections have been halved by 50%. But if you look globally, new HIV infections are not falling fast enough. And still in 2020, for example, there were 1.5 million new HIV infections. So this epidemic is not over. In fact, HIV infections are growing in many parts and in communities across sub-Saharan Africa, Eastern Europe, as well as here in the United States in some of our communities in the south.
Tom Temin: You used the word epidemic, is it still considered by say the international authorities that decide these things an epidemic?
Jirair Ratevosian: Yeah, absolutely. It’s considered an epidemic and many countries where PEPFAR operates, and I know we’ll get into that. They’re battling HIV and COVID at the same time. And I would say that COVID also has impacted the HIV response in many places as well. So we have to just be mindful that over the last 18 months, HIV testing has declined, HIV prevention services have declined. Here also in the U.S., by the way, and that’s causing more infections. And so to answer your question, it is far from over, we have to recover from some of the challenges that COVID presented, and then get back on track to the goals that the United Nations set forward to end HIV by 2030.
Tom Temin: And tell us what your office actually does.
Jirair Ratevosian: The Office of Global AIDS Coordinator and Health Diplomacy is known as SGAC. And I know your listeners will appreciate the acronym SGAC. It’s in the S family of offices in the Department of State. We report directly to the secretary of State. SGAC is responsible for implementing what’s known as PEPFAR. This is the President’s Emergency Plan for AIDS Relief. It’s called President because President [George W.] Bush announced this initiative in 2003. And it focuses on ending HIV and AIDS and in turn improving health security. PEPFAR still is the largest commitment made by any nation to a single disease. And it is a global effort. We’re active in in 50 countries. And since 2003, when President Bush announced it and has been extended by bipartisan presidents and with congressional bipartisan support Congress has appropriated over $100 billion to PEPFAR. And these investments are working to create a healthier world and more prosperous world and achieving health security.
Tom Temin: What forms does the money going out take? What do you do overseas to help?
Jirair Ratevosian: So PEPFAR itself and this is interesting, is not implementing programs, so we’re not program implementers. But I think this is arguably our greatest attribute from a structural perspective. This is what I think makes us strong. The PEPFAR-supported programs are implemented in countries under the leadership of the Department of State and our office, through a multitude of US government agencies. And this includes our embassies. It includes HHS and CDC. It includes the Department of Defense, USAID, as well as the Peace Corps. And so we often refer to PEPFAR as a platform that coordinates a whole of government approach that is ultimately what makes it most effective. And this past World AIDS Day on Dec. 1, PEPFAR announced some results that included 19 million people around the world are on life-saving antiviral medications because of PEPFAR, his work over the past 20 years, and nearly 3 million babies, 2.8 million babies were born HIV-free from mothers who had HIV. So because of the scientific progress, we’re able to make these advancements and people are having normal prosperous lives.
Tom Temin: We’re speaking with Jirair Ratevosian, he’s senior advisor in the office of the U.S. Global AIDS Coordinator, and health diplomacy at the State Department. And just out of curiosity, how did you get into this particular line of work? I know you’ve done other disease-related work in other countries, and that seems to be a theme.
Jirair Ratevosian: I finished college, I’m going to date myself now, right around the time that PEPFAR started, as I said, in 2003. And my first trip ever outside of the country was to South Africa, and had nothing to do with health. It was just a total coincidence. But if you went to South Africa 20 years ago, when I did, or if you lived in South Africa, 20 years ago, you couldn’t help but notice the toll that HIV was having on communities, on families on the nation as a whole. And there was no treatment available at that time. Even though treatment was available in the United States, there was no PEPFAR to deliver HIV treatments to South Africans. And so for me, that experience just forever shaped the way I looked at the world, not only health, but just inequalities and human rights. And so fighting for HIV became a social justice imperative for me. And that led me down a path of public health, I went to public health school and often had roles with NGOs and the private sector and in Congress working to advance these public health issues internationally.
Tom Temin: And you mentioned that there’s interplay between the HIV virus and also the COVID virus, which is now circling the world and morphing itself into new and exotic forms daily, it seems. And so is there coordination among the State Department and the various U.S. health-related agencies that are working on this, to kind of see what those connections are, and maybe mitigate them more effectively?
Jirair Ratevosian: Yeah, absolutely. I think if you look at the leadership that came out of South Africa, it is actually because of the U.S. support through PEPFAR, 20 years of investments through PEPFAR, that the scientific leadership in South Africa was able to educate the world about Omicron, the variant. And as I said, underpinning that investment is two decades of health system support that the U.S. has given through PEPFAR that’s allowing South Africa and other countries to respond to COVID. The other way of looking at it is that still many people don’t have access to HIV treatment. Around 2.5 million in South Africa. And if you look at immunocompromised individuals, CDC and NIH said that these are the people who are most vulnerable to COVID infections. And not just people living with HIV, people have cancer and other illnesses that can cause the, to be immunocompromised. And so it’s an imperative that these issues work together to not only put more people on HIV treatment, but also then to fight their COVID infection or prevent COVID infection through vaccines, through public health measures, like masking and social distancing.
Tom Temin: And is there ever interaction, say, between the State Department and NIH, for example, or CDC on some of these things? You might learn something through a grantee overseas or health agency overseas that could come in? I’m just postulating this to the State Department maybe before it comes into one of the health agencies. So is there kind of an interplay within the federal government on these issues?
Jirair Ratevosian: Yeah, there’s a high degree of coordination not only across the State Department, but also with the White House. And as I said, through PEPFAR’s own platform of bringing these inner agencies together, we’re learning more about COVID as well as how we can better fight HIV together. If you look at the players on the ground, Tom, they’re actually all the same program. So the HIV program implementers are actually the ones on the frontline fighting HIV. The community health care workers that PEPFAR has trained are the ones who are now giving out vaccine doses. So it’s very much coordinated on the ground, and then here in Washington as well.
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Tom Temin: And what we’ve learned, with COVID, that seems to potentially affect everybody in the United States, to some degree unlike the AIDS/HIV epidemic might have or pandemic might have. Yet here we are nearly 20 years after the United States declared war officially at the presidential level. But really, as we know, the disease started to spread in a big way 20 years before that, it seems like there’s some lessons learned in that effort for dealing with COVID. And that is to not expect the latest new cycle to say a-ha! We’re done, free, it’s done with.
Jirair Ratevosian: And even if you look at some misinformation and stigma that is fueling the disparities to COVID vaccine access in our country, a lot of it is related to and I mean, in the United States, there are a lot of similarities with the early days of HIV and stigma and discrimination that still persists in our own communities here in the U.S., are the reasons why HIV continues to be a major challenge and why we’re continuing this fight here at home and around the world.
Tom Temin: Jirair Ratevosian is senior adviser in the office of U.S. Global AIDS Coordinator and Health Diplomacy at the State Department. Thanks so much for joining me.
Jirair Ratevosian: Thank you very much, Tom. Good to be with you.