Raphael Landovitz: "The US cuts will have a devastating and irreparable effect on global health."

BarcelonaRaphael J. Landovitz is one of the world's leading authorities on HIV prevention and control. He is the director of the Center for HIV Identification, Prevention, and Treatment at the University of California, Los Angeles (UCLA), and head of the Division of Infectious Diseases at the David Geffen School of Medicine at the same university, where he leads globally impactful clinical research on the disease. He visited Barcelona for a conference aimed at breaking down barriers to accessing the HIV prevention pill, a treatment called pre-exposure prophylaxis (PrEP), organized by BCN Checkpoint, a leading center for HIV infection control. In Catalonia, waiting lists for treatment are growing, and the Catalan government does not know how many people are waiting to receive it. The first infections have already been detected. among people who have been in line for over two years for a pill that would have protected them from the virus.

How does PrEP work?

— These are antiretroviral medications for HIV. If we think of the virus as a robot with gears, these medications act like throwing a wrench and getting it stuck, preventing the gears from turning and the robot from moving forward. This way, the virus can no longer replicate inside the person's body, and infection is avoided. It's a very powerful prevention tool.

And where does its implementation stand worldwide?

— We have failed to deliver it to the people who need it most, and this is one of the biggest challenges we currently face. We have increasingly more prevention tools, but if we cannot get them to the countries that suffer the most from the effects of HIV, we will have achieved nothing by developing these products.

Even in the wealthiest countries, access problems exist.

— Yes, in the United States, for example, we have a very fragmented healthcare system that means prevention tools don't reach the poorest populations, racial minorities, the trans community, or people who inject drugs. People with low socioeconomic status, little education, or who are not connected to the healthcare system will not be able to access PrEP.

Here we have long waiting lists.

— Yes, in Catalonia there are fewer preventative measures in place, and the cost falls entirely on the Health Department. This forces them to ration available medications. When these resources are diverted from hospital budgets, centers must make very difficult decisions about where to allocate them, and I don't envy them having to make these decisions, because no matter what happens, someone will be negatively affected.

The cost of treating someone with HIV is higher than the cost of preventing someone from becoming infected.

— Yes, it's a disease with lifelong consequences and carries additional costs if not prevented. For me, it's a missed opportunity, and I don't just blame the government. I believe there needs to be a collective effort to improve prevention. There needs to be support from the private sector, support from the healthcare system, and global support. And above all, political will—someone to coordinate it—and that hasn't happened yet.

Do you understand why more effort isn't being put into it when such powerful preventative tools are available?

— Many people think the HIV epidemic is over, that it's been resolved. They believe that with treatment available, it's no longer a problem. We need to conduct education and awareness campaigns for political leaders and decision-makers to make them understand that it's not over, neither locally nor globally. It's just one plane flight away from becoming a problem again. Ignoring this and the opportunities for prevention is a mistake.

This year the administration of Donald Trump has cut many international cooperation projects for HIV controlWhat impact do you think it will have?

— The US cuts to research will have a devastating and irreparable effect on global health. It took thirty years of progress to implement some of these HIV treatment and prevention programs—meaning that in just six months, three decades of fighting the virus have been wiped out. Even if the same resources were restored, the staff have already left and the clinics have been dismantled. It is a devastating loss from which it will take years to recover. If we ever do.

What do you think the response from other countries should be?

— I hope they step up and at least fill some of the gaps left by this neglect on the part of the US government. Looking back, perhaps an effort should have been made to be more independent, but no one could have foreseen that US foreign policy would change in this way. It hadn't happened with any administration until now.

What do you think will happen if new resources don't arrive?

— I am absolutely terrified that so many years of progress will be lost. It is already happening very dramatically in Africa, and it is only a matter of time before it happens in other regions. The most disturbing figure I have seen so far is that 400,000 people have already died as a result of the cuts made by the United States Agency for International Development (USAID) since January.