"Interview1": [ { "speaker": "A", "text": "Seven people have been cured of hiv. There is a cure for hiv, but the big pharma and the governments are holding it because they're not going to make profits.", "start": 480, "end": 8800 }, { "speaker": "B", "text": "All my patients died between 1996 and 2004. I watched how badly he was treated. I could potentially do something to change this. But if you take this treatment every day, your lifespan will be the same as somebody without hiv.", "start": 10880, "end": 28080 }, { "speaker": "A", "text": "Today's guest is someone I've admired for a very long time, not just for her brilliance, but because she cares and dedicated her life to this cause. Prof. Kathryn Orell has spent over two decades on the front lines of this HIV epidemic, training healthcare workers, running clinics, and leading research that has shaped the way we see, treat and manage hiv. Today, she's going to be answering all your most commonly asked questions, debunking some myths, and letting us know what the future holds. Prof. Thank you for being here.", "start": 34700, "end": 67610 }, { "speaker": "B", "text": "Thank you. That's an amazing introduction.", "start": 68330, "end": 70330 }, { "speaker": "A", "text": "You're welcome. I'm really glad you could make it. Before we dive into the science and all the details, I want to take you a few years back and actually ask doctors what made you go into medicine and what was the moment that made you realize that HIV is your calling?", "start": 70410, "end": 91620 }, { "speaker": "B", "text": "A long story. So in terms of medicine, I just think I've always known biology was my favorite subject at school, and I was just, this is my root. And despite my parents saying maths or law, I was always medicine. And I've been very fortunate in that I've always loved my job. I knew I was in the right thing straight away as far as HIV goes. In fact, when I was in fourth year, I met a young man living with HIV who became a very good friend, and I watched how badly he was treated by the health care system. In the very early years of HIV in South Africa, he was a young gay man and he essentially had no treatment. He was put in ambulances with people in full ppe, and you could hear them on the radio saying how they've got to scrub it out afterwards because they've got someone with HIV in this ambulance. And the only people that really offered him any care were some amazing nursing sisters in Somerset Hospital. And it was that, that I think when I, when I was doing my clinical pharmacology registrar time, and I was offered a chance to work in the HIV clinic, I'm like, right, I could potentially do something to change this. And was at that clinic with Prof. Robin, Robin woods and Prof. Gary Martens and have essentially never looked back. You know what those two eminent people have taught me, has stayed with me and I've added a little bit of advocacy and some community based work and just carried on going.", "start": 92740, "end": 185930 }, { "speaker": "A", "text": "In the next section, we're going to answer some of the most commonly questions I get in my DMs or being googled. I just tested positive for HIV. Am I going to die?", "start": 189770, "end": 201130 }, { "speaker": "B", "text": "No, is the short answer to that. You could die of hiv, but you don't have to. If you go to your nearest antiretroviral clinic and ask to be treated, you will be offered treatments, which is a single tablet a day. For the majority of people, it's tenofovir, lamivudine and dolutegravir, which we call TLD to make a whole lot easier. So if you take your one TLD a day and that would be for the rest of your life, you could live with HIV and certainly not die.", "start": 203860, "end": 238080 }, { "speaker": "A", "text": "From HIV and have a normal life expectancy.", "start": 238080, "end": 240600 }, { "speaker": "B", "text": "And have a normal life expectancy.", "start": 240600, "end": 242080 }, { "speaker": "A", "text": "And it's the same if you're diagnosed with diabetes and I don't get your medication. You can get complications.", "start": 242080, "end": 247280 }, { "speaker": "B", "text": "Exactly. So we treat HIV as what we would call a chronic disease and that means a disease that you live with for your life.", "start": 247840, "end": 255360 }, { "speaker": "A", "text": "Okay, next question. My partner just tested positive for hiv. I'm freaking out. What should I do next?", "start": 256240, "end": 262620 }, { "speaker": "B", "text": "Well, I think the first thing, there's two things. One is to go yourself to be tested as soon as you can because sometimes the not knowing is worse than the knowing. And then to encourage your partner to go and get treatment. Because if your partner is treated and their viral load, that's the amount of HIV in the blood is suppressed by the tld, then that, then there's no risk of transmission. So there's a whole campaign you can Google called U equals U or undetectable equals untransmissible, which effectively means for people who are taking their treatment and their viral load from HIV is suppressed, they cannot pass that infection on to their sexual partners. So two aspects there, that's for the.", "start": 263580, "end": 310330 }, { "speaker": "A", "text": "Partner and if she's negative, then if.", "start": 310330, "end": 312810 }, { "speaker": "B", "text": "She'S negative, she, if she's had recent sexual exposure, then she should take post exposure prophylaxis. If there's been no recent sexual exposure, then prep is a very good idea. And prep is also a tablet a day. It's just the T and the L, the tenofovir and lamivudine or Truvada that you take one tablet daily to prevent HIV infection.", "start": 312810, "end": 337310 }, { "speaker": "A", "text": "Perfect. Okay, next question. What is HIV and how does it affect the body?", "start": 337710, "end": 342830 }, { "speaker": "B", "text": "So HIV is A human immune deficiency virus. So it's a very small infectious particle that is transmitted through sexual contact. So it's basically passed by exchange of body fluids, which happens during sex. Can also happen during a blood transfusion, although that doesn't happen anymore because now all our blood is screened for hiv. It can also pass from a mother to a baby in the womb or at the time of delivery. And what that virus does is attack the cells of the immune system. So if you think of your immune system as your body's army or soldiers, the general of that army that tells them all what to do is the CD4 cell. And HIV attacks the CD4 cells. And gradually, over a number of years, three to five years, because your body makes new ones. As they're attacked and killed, that CD4 count will drop. And when it gets low, it means that your body soldiers are around in your body not doing anything because no one's telling them what to do. And other infections can come into your body and make you sick. So what we need to do is push down the level of HIV in the blood with the medication. And once you've kind of contained that HIV with the medication, the CD4 count will recover and you can live a normal, healthy life.", "start": 343950, "end": 425470 }, { "speaker": "A", "text": "Perfectly explained. Okay, what's the difference between HIV and aids?", "start": 425870, "end": 430560 }, { "speaker": "B", "text": "So HIV is a human immune deficiency virus, is the actual particle, the infectious particle you're infected with. So if you are infected with hiv, then you are HIV positive. AIDS is the sort of end stage of untreated HIV. So when the CD4 count, which is your body's soldier cells, become really low, and the count would be less than 200. Some people go down under 100 or under 50 if they haven't been treated. And then other infections can, and those are acquired. So AIDS is an acquired immune deficiency syndrome. So your immune system is deficient because the HIV has killed off all the CD4 cells. And then you acquire other infections and you die from those other infections, and that is aids. And hopefully we don't go there anymore because we have treatments. We can treat people with HIV much earlier while their immune system is still strong, and we don't have to go as far as aids.", "start": 431990, "end": 488980 }, { "speaker": "A", "text": "Great. How is HIV exactly transmitted? Like, what is the most common way that people get it and what are ways that. It's myths, like from mosquitoes or from kissing, for example. Yeah.", "start": 490090, "end": 504570 }, { "speaker": "B", "text": "So I think in the early days of hiv, because it is a virus particle in the blood that can be passed to somebody else, people were nervous about things like mosquitoes. People were Nervous about toilet seats and all sorts of spoons and forks. And, you know, I know from personal experience experience, when a friend was positive in the early days of the epidemic, the ambulances would get scrubbed out afterwards because they'd just been in an ambulance. But HIV is actually a fairly fragile virus and it doesn't live outside the body. So transmission of HIV literally requires putting the fluid with the HIV from one person into another person kind of directly. And that happens during sex, unprotected sex. And it happens to unborn babies can be affected. It can happen during breastfeeding. It could also happen through sharing needles for IV drug users. If there's blood in one needle, it's injected into a person with another one. But it really does need that direct transmission. It's not going to be spread through a table or a toilet seat. And it really is. Blood and sexual fluids, even oral fluids, are not as infectious.", "start": 504650, "end": 580030 }, { "speaker": "A", "text": "So kissing and oral sex are.", "start": 580750, "end": 583150 }, { "speaker": "B", "text": "If kissing and oral sex are mostly safe, you can't say absolutely. There's hardly any absolutes unless you have a wound. But if you had like a tooth infection or a wound in your mouth, an open wound, then that might be that, then that might be the risky. Okay, increase the risk.", "start": 584350, "end": 600350 }, { "speaker": "A", "text": "Okay, this question, I get it all the time. I think I've been exposed to hiv. What should I do next? How often do I need to test? Or I was having sex last and the condom broke. What do I need to do now?", "start": 601160, "end": 616120 }, { "speaker": "B", "text": "So you need to go and get post exposure prophylaxis, which is essentially at the moment, tld, which is the same treatment we use for treating people living with hiv. And at the time you approach your provider, you could go to a casualty, you could go to your gp. They would test you for HIV right now to ensure that you're not already positive. They also test you for other sexually transmitted diseases. They will offer you TLD for 28 days, and they will also offer you prevention for pregnancy, if that is, because that is another potential result of a burst condom. And then you would need to probably test again six weeks and three months after this, after this exposure, to be safe. And then going forward, it might be worth considering taking PrEP, which is prevention, which is a tablet you take every day. So then even if a condom bursts or you're having unexposed sex, you're not at risk of HIV, at least.", "start": 617080, "end": 677300 }, { "speaker": "A", "text": "Okay, so if you're negative after 90 days, you are negative, because if you're.", "start": 677300, "end": 681180 }, { "speaker": "B", "text": "Negative after 90 days,. You are negative.", "start": 681180, "end": 682860 }, { "speaker": "A", "text": "Okay, yeah.", "start": 683180, "end": 684020 }, { "speaker": "B", "text": "People like that, provided you've had no other exposures in the meantime.", "start": 684020, "end": 686940 }, { "speaker": "A", "text": "Oh, that's. Of course. That's important. Okay, quickly, once more again. Can you please explain? U equals U.", "start": 686940, "end": 696670 }, { "speaker": "B", "text": "So U equals U means undetectable equals untransmissible.", "start": 697710, "end": 703230 }, { "speaker": "A", "text": "Yeah.", "start": 703230, "end": 703510 }, { "speaker": "B", "text": "And if we think of each of the U's, when we talk about undetectable, that is the term we use for someone on treatment who's taking treatment for HIV and their viral load. The HIV viral load in the blood is undetectable, so it can't be counted. It usually means that's less than 50 copies per mil in medical terms. But that means that the TLD is holding the HIV down in the blood so low that our laboratory tests can't measure it. Doesn't mean the HIV is not there. It will re emerge if you stop taking medication. But with that undetectable viral load in the blood, you cannot transmit the virus. So the second U in the U equals U is untransmissible. So if you take your medication every day and your viral load is undetectable, you cannot pass that virus on to somebody else through sexual contact.", "start": 703510, "end": 755540 }, { "speaker": "A", "text": "If somebody's viral load is undetectable, can they test negative on an HIV test?", "start": 757220, "end": 762580 }, { "speaker": "B", "text": "No, they wouldn't test negative on an HIV test. There's various different types of HIV tests. And the one you do for diagnosis of HIV is to look and see if you have antibodies to hiv, and that's your body's immune system response. If you've been exposed to hiv, you produce antibodies, and those antibodies are there all the time. So if we test you for hiv, those antibodies will be there. Okay, when we say undetectable, we're looking for actual viral particles which are going to be held down in the blood. So we can't count those particles. But the immune response to the HIV is still there in the blood, and we will still see that.", "start": 762980, "end": 795710 }, { "speaker": "A", "text": "So if you get exposed, you might be negative in the first test or second, but that's why you do it on the. That's why third month to make sure. Okay. If antibodies develop.", "start": 795710, "end": 804750 }, { "speaker": "B", "text": "Yeah.", "start": 804830, "end": 805310 }, { "speaker": "A", "text": "Okay, quickly go through this again, people. Here. CD4. CD4. Count viral load. What do those two terms mean?", "start": 805390, "end": 815870 }, { "speaker": "B", "text": "So a CD4, it's a type of immune cell. And I explain it to people as the general in your body's army. So your immune system is your army, and it's got many soldiers. And the CD4 is the guy in charge, and he's the one, or she, maybe he's the one that tells them all what to do. And it's this cell that HIV attacks and kills. So when HIV enters the body, it inserts itself into the CD4 cells particularly, and it's between your own body's immune response to that cell being attacked and the HIV's replication process, those CD4 cells die. And so measuring number of CD4 cells gives us an idea of how advanced someone's HIV diseases. So if it's 500 and above, we're like, you're fine, your immune system's doing well. And then if it's 200 or below, we're like, we need to do something soon because your immune system is quite weak and other infections will start to come in and your immune system will not respond properly to those infections.", "start": 816350, "end": 879470 }, { "speaker": "A", "text": "Is it. That's why when we diagnose someone with a CD4 less than 200, we give them antibiotics to protect them from.", "start": 879470, "end": 885910 }, { "speaker": "B", "text": "We do. So we want to start antiretrovirals that will push the HIV viral load, which is the number of HIVs in the blood, down so that they are undetectable, and that will allow the CD4 cells to recover. But in the meantime, we would like to protect people with certain antibiotics for that period of time until that CD4 is back up above 200.", "start": 886070, "end": 907882 }, { "speaker": "A", "text": "200. I want to ask, like, how long does it take for TLD to suppress to make it virally suppressed? But then I feel like if I say it, people not going to go to do their first for monthly viral load because they'll be like, I'm suppressed already after two weeks, you know?", "start": 907978, "end": 921230 }, { "speaker": "B", "text": "Yeah, well, you know, you still have to take it. So TLD works quite fast, so it can actually suppress a viral load within a month, which is why it's a great option for people who test late in pregnancy and are testing positive for the first time. We can get that viral load down, suppressed within a few weeks. But, you know, you can't rest on your laurels. You still have to take your tablets every day to maintain viral suppression, because once you stop. Once you stop, it'll come back up. Yeah, true.", "start": 921230, "end": 950120 }, { "speaker": "A", "text": "If we are both positive, do we need to use condoms?", "start": 951080, "end": 954680 }, { "speaker": "B", "text": "If you're both positive and you're taking TLD and your viral load is suppressed, then you probably don't need to use condoms, because undetectable equals untransmissible and you're not passing. However, you don't need condoms for HIV purposes if you're both suppressed. But there are other reasons to use condoms for pregnancy, for other STIs. I know quite a lot of my patients who arrive with Gonococcus or Neisseria. You know, other STIs, or chlamydia, you know, so syphilis. So in general, you know, if you're in. If you're not in a monogamous relationship, it's probably safer to use a condom for multiple reasons.", "start": 955240, "end": 994110 }, { "speaker": "A", "text": "I talk about STIs a lot, especially that you cannot see symptoms. No, if a guy has sti, it's not like he's going to have a sign saying, I have sti. It could be an hpv, which is probably most common. Is it most common STI in the world? I think could be. Could be. And it's one of the main reason for cervical cancer.", "start": 994590, "end": 1018130 }, { "speaker": "B", "text": "Cervical cancer, yeah.", "start": 1018130, "end": 1019170 }, { "speaker": "A", "text": "Which is. I mean, the condom can not only protect you from STIs, but fertility issues. Cancer, future cancer. Okay, good. Oh, every question I go through is, I've been asked so many times, can someone with HIV have a healthy baby?", "start": 1019170, "end": 1034600 }, { "speaker": "B", "text": "Definitely. So, in fact, any woman who presents to an antenatal clinic who's pregnant will be tested for hiv because it is something we can treat and we can prevent. So again, if you are HIV positive and you're pregnant, you take your treatment, you take it every day. Pregnant women are often pretty good at taking their medication every day because they realize it's not only for themselves, but also for the unborn baby. And that will suppress the viral load and then it won't be transmitted to the baby. It's also important to carry on taking that treatment postpartum after the baby's born, because if you're breastfeeding, HIV can be transmitted through the breast milk. So we can't say completely u U for pregnancy and breastfeeding. There are some times when, and it's very, very rare, but it are sometimes when a baby does become positive over the long period of time that they're exposed to their mother's bodily fluids. But in general, if someone takes TLD throughout their pregnancy and breastfeeding, they will have a normal, healthy baby.", "start": 1035480, "end": 1104240 }, { "speaker": "A", "text": "So through pregnancy, it's almost zero.", "start": 1105040, "end": 1107760 }, { "speaker": "B", "text": "It's almost zero in pregnancy.", "start": 1108240, "end": 1109870 }, { "speaker": "A", "text": "If I'm HIV positive, can I breastfeed safely?", "start": 1110420, "end": 1113860 }, { "speaker": "B", "text": "If you're taking treatments and your viral load is suppressed, breastfeeding is nearly always safe, but there are very occasional cases where the baby does become positive, but they are very rare. And you can reduce that even further by offering the baby prep. So you can give the baby medication every day. It's a syrup that you can give every day to the baby that will further reduce that risk.", "start": 1115380, "end": 1144790 }, { "speaker": "A", "text": "For how is it given until the breastfeeding stops?", "start": 1144790, "end": 1147910 }, { "speaker": "B", "text": "Ideally, should Give it till the breastfeeding stops.", "start": 1148870, "end": 1151190 }, { "speaker": "A", "text": "We all hear about PEP and prep. Can you please tell us the difference between them, when to take each one?", "start": 1151510, "end": 1157350 }, { "speaker": "B", "text": "So PEP is post exposure prophylaxis so that you take it after you've been exposed. And it's usually got three antiretroviral medications in it. So it's like you would take TLD and it's the same as taking treatment for HIV because we don't know if you've been exposed and we need to treat any HIV in your body and make sure it doesn't get into the CD4 cells. Pre exposure prophylaxis is something you take before you are exposed. So it's in the body already before the HIV is, you know, before you're infected or exposed to the hiv. So you really only need two drugs because it's kind of in advance, ready to go, instant. And you can take PREP daily as a tablet. For men, you can actually take evidence prep link event based prep.", "start": 1158230, "end": 1217390 }, { "speaker": "A", "text": "So for the prep, how long before you need to take it for it to be effective?", "start": 1217870, "end": 1222450 }, { "speaker": "B", "text": "So for it to be effective, the drug needs to reach the place where it needs to be. So for women, that's their vagina and the vagina is a very thick membrane and so probably a week of tablets before exposure. So for women daily prep is probably the best option for at least a week before the, the time of having sex. For men, the mucosa in the penis is thinner and in the rectum is also thinner. So one to two doses before the.", "start": 1223010, "end": 1257860 }, { "speaker": "A", "text": "Exposure is usually enough signs of hiv. There are people who says I had signs already the next day. Some people say you have flu like symptoms after a week or two. But, but I always say HIV can have no symptoms up to 10, 15 years. That's why you need to test. So what are signs of HIV that people need to look for?", "start": 1257860, "end": 1282500 }, { "speaker": "B", "text": "So there are a few people who have flu like symptoms. So you're infected with a virus, you get that feeling like you've got flu a few days to weeks afterwards. But the vast majority of people experience nothing. And you can have no symptoms for hiv, HIV for years, you know, three, five, seven more years. If I was examining someone with HIV as a doctor, what I might see that's different from someone who doesn't have HIV is maybe some lymph nodes, generalized lymph nodes. You look in the neck, you look behind the neck and under the arms and you might see those lymph nodes where the body is busy making the CD4 cells because they're being attacked. But you may see nothing for quite, quite a long time.", "start": 1283540, "end": 1327520 }, { "speaker": "A", "text": "And I don't think symptoms are also very specific like weight loss, diarrhea for two weeks.", "start": 1328160, "end": 1333480 }, { "speaker": "B", "text": "So further down the line you can get weight loss, you can get more frequent coughs and colds. You can, you know you can, yeah, some minor things that are not specific to hiv so you would still need to be tested.", "start": 1334920, "end": 1348040 }, { "speaker": "A", "text": "Are there any foods or drinks that people with HIV need to avoid?", "start": 1349000, "end": 1353400 }, { "speaker": "B", "text": "So I don't think anything specific. But a healthy diet is always a good thing. That's the exact, I mean whenever we look, you look at evidence for anything and getting enough sleep, not smoking, not drinking, exercising and eating a healthy diet are good for everything, for diabetes, for hypertension, for hiv, for depression. So yes, it's like not too much fast food, not too much sugar. We all know what bad is. When we're eating that muffin, we know what bad is. So it's trying to put more fruit and vegetables into your diet, less processed foods, less sugar. And I realize people don't often have a lot of options, but picking when you do have some options, trying to pick the healthier one is always good.", "start": 1355490, "end": 1409140 }, { "speaker": "A", "text": "Always good. Not the easiest, not the easiest, but always good. When I was working in the HIV clinic there are many people that come with supplements, whether this, my immune system stronger or stuff like this. And I always say your treatment is the only thing you need. Gonna have a normal life expectancy. You can eat, drink, anything, are there any supplements?", "start": 1409540, "end": 1431860 }, { "speaker": "B", "text": "So when we talk about evidence based medicine it means we've shown a difference in a clinical trial between the supplements and the non supplements. And there is very little evidence for any supplements. I think there was one study in pregnancy that showed that vitamin B co, you know those little brown vitamin B co's had benefit for women in pregnancy over not having the vitamin B co. But that's like one study out of a ream of studies. So again, if you're eating healthily and you're taking your tld, you really don't need to worry too much about supplements. The problem is people worry more about their supplements than they do about their TLD. And they end up taking 19 tablets and saying, Doctor, I'm taking so many things and you like list them up and there's only one medicine in there, it's the tld and that's the one they need to focus on. And it worries me that people lose their focus on what's important because they've got so many other things that other.", "start": 1433460, "end": 1486630 }, { "speaker": "A", "text": "People have told them are important now to this. The biggest question, it's actually I made a video about it and then people asking me more details. Seven people have been cured of hiv. Okay, what have we learned from it? Or are we closer to the cure?", "start": 1486630, "end": 1506270 }, { "speaker": "B", "text": "I don't think we're close to a cure, but we have learned that people can be cured. And for me, that that is a critical thing in itself because for 20 years we didn't think we could cure people from HIV. There was no cure agenda, there was no cure research. And then Timothy Brown was cured and we're like, oh well, if it can happen to him, it can happen to other people. And it just means that, you know, the human brain is now being applied to cure research. And I think that is critically important. And we're learning more about timing of infection and timing of treatment in relation to infection. Because the longer you have untreated hiv, the bigger the pool of HIV in your body is and that's called a reservoir. And if when you're infected, you're treated very early and you keep your virus down and your reservoir is small, the chances are that one day when we find something for cure, we might be able to cure you. But if You've lived with HIV for 10 years and you've not been very good about taking your medication and your reservoir is large, then the chances of that ever being cleared out of your body is very, very small. But we're certainly not going to be able to cure people the way the Berlin patient and the London patient and people were cleared. I mean those poor people also got leukemia, had like chemotherapy and complete wiping outs of their bone marrow, bone marrow transplants, and then given a bone marrow transplant, very invasive weeks in an ICU with a donor that has cells that are harder to, that are resistant to HIV infection. And one of the patients had that twice. I mean it's, and he was cured of hiv, but I think in the end did die of the leukemia. So it's like that is, that's not the solution for our 7 million people in South Africa. But it has opened the door to thinking about solutions and research on the solutions. And there's a lot in this time of funding crisis, there are still many open calls for pure research. So you know, I have faith in the human mind and human research and we will, that will come. But it's not like in the next couple of years.", "start": 1508350, "end": 1645420 }, { "speaker": "A", "text": "Then. It was also one of the most challenging time for HIV in this country. I mean government was very slow in rolling out treatments. So how did you manage or what, what, what, what was going through your mind?", "start": 1648300, "end": 1660400 }, { "speaker": "B", "text": "So, yes, it was an extraordinary time. I mean, when you work with HIV like I did, I worked at Red Cross, I saw mothers at the pediatric clinic, I worked at Somerset Hospital in Prof. Woods HIV treatment units, and essentially and in the HIV clinic at Kritiskurt, all my patients died between 1996 and 2004. And that is a life defining moment. And we fought, as I think, an HIV community to access treatments over a very long period of time. The Global Fund finally came in in 2004 and brought broader access. But there'd been a number of groups, the Desmond Tutu HIV foundation where I worked, and also Maison Sans Frontiere, who'd been bringing medication in through grants and through other small pieces of funding for a while before then. So, in fact, in Cape Town, we started offering antiretrovirals to the very sickest people. In 2002, I would drive into the Guguletu Clinic with medication in my car. So I had a little office in a box with a stapler and some papers and a whole lot of boxes of ARVs. And all my colleagues who were working in the HIV community in the HIV clinics would send me these really, really ill people. And we got the first few people onto treatment. I think we started with 350 treatment places for a single year. And this was through a grant that Lindsey Gale Becker had one with the Hanan Crusade Charity, which is how the name of our treatment center, Gugulhetu, came about. So, yeah, it was a tough time, but, you know, I think every little bit counts. And, you know, we were fighting in Cape Town and arguing, and we import. There were other charities bringing in medications from Lesotho in trucks. And the people in Joburg were fighting and the people in Durban were fighting. And in the end, I think the need was seen. Despite our political challenges and even with our sort of HIV denialist president and health minister, we still managed in the sort of mid 2000s to have the most people on ARVs per country in the world. So I think there was a time when we had 300,000 people on ARVs, when our health minister was sitting at one of the conferences with her lemon and garlic and, you know, which was very embarrassing. You couldn't like actually show face, but we still had the Most people on ARVs of any country in the world at that stage. And I think we still, in that situation, which could be a good thing, could be a bad thing, I think India might be on a par, but we still have the most individuals on treatment? Yes.", "start": 1660880, "end": 1837200 }, { "speaker": "A", "text": "What is it like for someone with HIV in two days?", "start": 1837200, "end": 1840560 }, { "speaker": "B", "text": "So if you are diagnosed early and you take treatment early and you're good at taking your treatments, then your lifespan will be the same as somebody without hiv. Unfortunately, not everybody's in that situation. A lot of people don't come for testing and are diagnosed late. And we still have a lot of people with advanced HIV disease and AIDS, and those people's lifespan are probably 10 to 15 years shorter than someone without HIV.", "start": 1840960, "end": 1867280 }, { "speaker": "A", "text": "I believe that, that HIV is one of the easiest conditions to manage if you're taking a treatment daily. I mean, I've seen diabetes, asthma, epilepsy, they are much more complicated. One, you have to take medication morning, night, lifestyle choices, everything but hiv. One tablet every day and it should be fine.", "start": 1867360, "end": 1886910 }, { "speaker": "B", "text": "Yeah. So this is the thing, having come from this part where a time of life where receiving antiretroviral therapy was a privilege and, you know, it was only for people who were stage four. It was only for people with CD4s under 200 or CD4s under 350. You know, those times now we've moved into a stage where anyone can have it. It's more of a. Right. And it does still surprise me that people don't take their medication when it's offered. I mean, yes, I've spent a lot of time researching adherence and I know there's many reasons for that, but you sort of think, yes, this is quite straightforward. You have an illness which is a chronic illness, meaning you're living with it for your life, but if you take this treatment every day, you will live with it for your life and you will not die from it. And yes, it's. It's much easier to manage than it used to be. I mean, we used to. When we started out, it was three tablets in the morning, three tablets at night.", "start": 1887150, "end": 1936340 }, { "speaker": "A", "text": "Exactly.", "start": 1936340, "end": 1936860 }, { "speaker": "B", "text": "You know, a D4, T3 and nevirapine. And they had horrible side effects.", "start": 1936860, "end": 1940620 }, { "speaker": "A", "text": "Alluvials. When I started, we went from Alluvial, atazana, ver, etanaver to just a shorter period of time.", "start": 1940620, "end": 1947220 }, { "speaker": "B", "text": "We've moved very fast. So now on one tablet a day, that is robust, it's forgiving. If you miss doses, it's hardly any side effects. So we can get easier. We can move on to once a week, tablets, once a month. Tablets or injections.", "start": 1947620, "end": 1963260 }, { "speaker": "A", "text": "Injections. That's where we are going next. In a short period of time, working in the HIV unit, as I mentioned, there was huge change in regimens and guidelines. I remember the Alluvials Those huge tablets, two in the morning, two in the night, plus other ones to like one tablet a day. And now injections, we're talking about injections, what they are, do we have them here, what the researches or clinical trials are showing?", "start": 1963260, "end": 1995250 }, { "speaker": "B", "text": "So there are a number of options for longer acting antiretrovirals, of which injections are one. The only regiment registered in the country at the moment is cabotegravir, which is like dolutegravir, which is given together with rilpivirine, which is like Favrins. So in terms of they're both drugs, both in the same groups of drugs that we've had before. It's once every two month injection, three mils into each bottom. So some people might choose, would choose not to have that, that those two products are registered by Sapra but have not been launched by the company. And one of the reasons is that they feel there isn't demand. It seems the wrong way around to me. Like whenever, as you say, people are asking where are these injections? Because it is being registered and we are moving forward with cabotegravir for prevention and also lenacapavir, which is a capsid inhibitor for prevention. There's a lot of awareness of injections and it seems that the prep field is moving forward, but the treatment field is not yet moving forward. And there has been a fair amount of advocacy about that in the places where I've been. But you know, any community demand is very welcome because I think we need to be, you know, I feel like going back 20 years where you're actually arguing for treatment, you know, actually.", "start": 1995970, "end": 2080659 }, { "speaker": "A", "text": "Exactly. It would make no sense.", "start": 2080739, "end": 2082019 }, { "speaker": "B", "text": "Why is this medication available in Europe, an America with 14,000 people on these injectables, but it's not available in Africa? And people say, oh well, we've had lots of effavarins in the past. So that might undermine the rilpivirine. But that's not based on data and the data that's coming out is not showing an impact of previously previous non nuke use. They're saying, oh we can't, you can't manage rilpivirine. It has to be kept in the fridge. And you're like, come on, we do vaccines for children. There are fridges in all our clinics. Exactly.", "start": 2082579, "end": 2116340 }, { "speaker": "A", "text": "All of them.", "start": 2116820, "end": 2117500 }, { "speaker": "B", "text": "What? You know, so there's, there's that thing and then they're saying there's no demand. And so I feel that there needs to be a little bit of pressure to have this, this combination released. It's not going to Be the easiest. I really, much as I love the injections and the work we've done with adolescents and Gugulet, who have shown their very much appreciated. You know, young people who've been taking medication their whole lives suddenly feel free. They don't have to take the medication, but it does require a nurse to inject its deep intramuscular injection every two months. We can't bring all 7 million people living with HIV back to clinic every two months. Like the rest of the time, we're focusing on giving people six months of medicine, getting them to manage their thing there themselves. But there are certain groups of people, younger people, pregnant women, postpartum women, maybe the elderly, who have more medications to take or struggle with taking medications more. And I really do think it should be an option that is available in our, in our setting.", "start": 2117500, "end": 2180750 }, { "speaker": "A", "text": "I mean, it's okay. I don't believe in supplements, but I take them now and then and it's difficult to just like, remember taking it every day. So have an injection that you can take it and just come back in two months. That's gonna make people's lives. So basically, you're facing challenges. Just different challenges, different challenges.", "start": 2180750, "end": 2199440 }, { "speaker": "B", "text": "And I think with injections, the challenges will be different. I mean, if we had these products, we could work out what those challenges are in our setting, but we don't have the product to work that out just yet. But, you know, it changes your focus from taking a tablet every day to, you have to come for your visit every two months, you know, because they're, they're much less forgiving of missed doses than tablets. So you really do need to be at that clinic every second month for your injection.", "start": 2200240, "end": 2228240 }, { "speaker": "A", "text": "And resistance wise, I know the lutegravir is okay. Before talking about resistance, let's talk about adherence.", "start": 2229520, "end": 2237920 }, { "speaker": "B", "text": "Okay.", "start": 2238080, "end": 2238520 }, { "speaker": "A", "text": "Okay. Lots of people start, but then stop. Or just from my experience, before the lutegravir, lots of people become resistant because they stop, or as you call it, default. Start again, stop, start again. What do you think the reason is for people not adhering to medications? I'm sure there's many factors, but from.", "start": 2238520, "end": 2264230 }, { "speaker": "B", "text": "Your experience, there are multiple factors. And I think what we've realized over time is that people cycle in and out of care. So if you take 100 people starting antiretrovirals today, you'll only have 75 to 80 of them in hand coming back to clinic at month four for their first viral load, and then maybe 75 of them at the end of the year. But it might be a different 75 because people are cycling in and out of care. And there are multiple reasons for that. Personal reasons, including feeling stigmatised by having those tablets at home, having not disclosed to their family, having no safe place to keep the tablets where they can take them in privacy, alcohol issues, people being depressed. So there are many personal issues. But a big factor is the difficulty, the structural barriers that, you know, coming to clinic is a big deal. You've got to sit there the whole day. You know, you arrive at six in the morning, you stand in the queue, you go to the clinic, you're shouted at by the staff because you're a few days late or it's not your appointment. You then go and sit in a long pharmacy queue and. And they give you two months of medicines and you have to do the whole thing all over again. So there are structural barriers in place as well. We're not good at transferring people from one place to another. You can't just arrive at another clinic. And so people then arrive at another clinic because that's where they can be that day. And then they say, well, I'm newly diagnosed, I need to start treatment. So now we've got multiple records for an individual person. True. It all becomes chaotic because we don't allow for the mobility of people. So there are structural things we can change as well as individual things we can change. There's also medication things we can change. Like we could make it give people the option. People who can't take tablets every day, we can give them the option of injections or more like a tablet every week. The study's looking at that at the moment. So many reasons.", "start": 2264230, "end": 2379770 }, { "speaker": "A", "text": "Or even money to come to the clinic.", "start": 2379770, "end": 2381290 }, { "speaker": "B", "text": "Or even money to come to the clinic. Yeah. There's been a lot of work on incentives and they definitely work. Food parcels also work. So when people are struggling with food and we're often told to take medication with food and if they don't have food at home, they often don't take the medication. So food parcels are something that has, if you talk about evidence based medicine, food parcels work to improve medication taking.", "start": 2381450, "end": 2411770 }, { "speaker": "A", "text": "So the first one is most controversial. Statements that have been told. Not questions, statements.", "start": 2415460, "end": 2421060 }, { "speaker": "B", "text": "Okay.", "start": 2421060, "end": 2421620 }, { "speaker": "A", "text": "It's only four of them. I didn't want to make it overwhelm me.", "start": 2422020, "end": 2425060 }, { "speaker": "B", "text": "You want me to come back?", "start": 2427460, "end": 2428580 }, { "speaker": "A", "text": "Yeah, I can come back for more controversial ones. The first one, COVID vaccine, took less than a year to be created. But we don't have a vaccine for hiv.", "start": 2430500, "end": 2439700 }, { "speaker": "B", "text": "They're different viruses. The coronavirus is a much simpler virus and the HIV is a complicated virus. And essentially what you want a vaccine to do is create an antibody, which is a little protein in the blood that your body makes when it sees a piece, say, of a coronavirus and makes an antibody. And then when the actual coronavirus comes, the antibody joins onto it. And it's like waving a flag to your immune system to say, come and kill this virus. And that worked. But that's because the coronavirus doesn't change its outside proteins very much. It looks more or less the same all the time. So if you make an antibody, that antibody can find the coronavirus quick sticks and sort it out. With hiv, some very big brains, much bigger than yours or mine, have been working on trying to create a vaccine for a long time. But the HIV divides many, many millions of times in your body every day. And each one looks a little bit different. The proteins and sugars on the outside change all the time. It's like a mosaic. So if you make an antibody to today's virus, it's not going to recognize tomorrow's virus. So it just is a whole lot more complicated. There are people who have maintained their own viral suppression for years, and their antibodies have been extracted from them. And there are studies looking at those people's antibodies. The elite controller, the elite controllers, they're very few, but they're there. And so that's kind of the route now that people are looking at. What about passive immunity with antibodies from an elite controller? As in you give the people the antibodies and that's kind of where the research is at the moment. I don't think we should give up on HIV vaccine research. People are very down a few of.", "start": 2440390, "end": 2550260 }, { "speaker": "A", "text": "The trials, there's MRNA ones.", "start": 2550260, "end": 2553220 }, { "speaker": "B", "text": "Yeah, there have been a few trials that haven't worked and there's no product right now ready to go into sort of the late phase trials. But. And even with all the amazing advances in prep, I still think, you know, you still have to take prep every day or give an injection every two months or give an injection every six months. It would be amazing if we could give a vaccine. And that's. That's it. So I don't think we should give up on the search. And even after 30 years of searching, I think, you know, we will get there. It's just, it might be another 20 years, but it's still worth it.", "start": 2553220, "end": 2588720 }, { "speaker": "A", "text": "So there is a cure for hiv, but the big pharma and government are hiding it because they're not going to make profit if we cure hiv.", "start": 2589600, "end": 2596480 }, { "speaker": "B", "text": "There isn't a single cure for hiv, and it's not being hidden at the moment. Cure research is in the very early phases and it's still at the phases where it's in the universities and in the academic field. There's no product that's gone to that far, that far to pharma. And I think with hiv, certainly in Africa, pharma don't make profit. Our government in some ways in the past has been good and they've been generic companies. And you know, when you look at the drug prices, they're very low, relatively speaking. You know, we can get treatment for a month for 500 rand in private, and I don't know what it is in tender pricing for government, but it will be less. And companies are not making lots of profit from rhiv, particularly in Africa.", "start": 2598880, "end": 2649600 }, { "speaker": "A", "text": "Going to my next one. There are herbs that cure hiv, so.", "start": 2649919, "end": 2656280 }, { "speaker": "B", "text": "There'S no cure for HIV at the moment. As I said, the best scientific brains are working on it, but there are no cure. So essentially, when you're infected with HIV, the HIV's genetic genetics, which is a little piece of RNA, turns into DNA in your body and it inserts itself inside your own DNA of the CD4 cells. So it's got a little integrase enzyme and it splits your DNA and it kind of wiggles itself inside your DNA and joins up. And now that DNA, it's made up with your DNA building blocks that it stole from your cells. Looks just like your DNA hiding. It's hiding. And it's not like looking for a needle in a haystack. It's like looking for a piece of particular piece of hay in a haystack. There isn't. And then you have those cells all over the body, hidden in lymph nodes, hidden in your brain, hidden in your bone marrow, in your thymus, all over the place. There is no way that a herbal remedy is going to find 7 million billion, I don't know how many CD4 cells, find the exact little piece of DNA that is the virus and take it out. It's just not plausible in any way at all. However, if you believe they will work, the brain is a powerful thing and you might feel better for a while, but you will not be cured of your hiv.", "start": 2656280, "end": 2738370 }, { "speaker": "A", "text": "Yeah, I'm not sure if that's the right thing to tell people. There are another group of people who say Jesus will heal. And I tell them, if you don't take your treatment, you'll meet Jesus a lot sooner.", "start": 2738690, "end": 2749910 }, { "speaker": "B", "text": "I think so. I mean, people say God will find a cure. And I'm like, well, maybe God Sent tld. And you're just being. What are you waiting for? He's like, blooming heck. I've sent nevirapine, I've sent lapidavir. Now I've said tld.", "start": 2750070, "end": 2762310 }, { "speaker": "A", "text": "I'm a firm believer. Prayer helps, but take your medication and pray and pray and pray.", "start": 2763270, "end": 2767990 }, { "speaker": "B", "text": "Exactly.", "start": 2767990, "end": 2768630 }, { "speaker": "A", "text": "So it's. Yeah, it's been a challenge for me because as I mentioned, many people believe in these things and they fall for it because they.", "start": 2768790, "end": 2778190 }, { "speaker": "B", "text": "Because they're desperate. They're desperate.", "start": 2778590, "end": 2780110 }, { "speaker": "A", "text": "People prey on people's desperations. Last statement that I always. Not always, now and then. HIV medications are toxic and they're going to damage your kidney and liver. I'm not sure, but I believe at some point the HIV indication had more side effects in the past, if you can just elaborate.", "start": 2780750, "end": 2801270 }, { "speaker": "B", "text": "So, yes, I think when the medications first came out, so we're talking about 96, 98, 2000 medications were probably given in slightly higher doses than they needed to be because the main thing was to get that viral load suppressed. And at that stage, people were dying of hiv. So having peripheral neuropathy or pains in your feet or die. Well, you, like, you pick the peripheral neuropathy, you know, or having strange fat distribution around your body. Or die. You pick the fat distribution. But now more and more people are living with HIV and we've also had 20 more years to develop these medications. The side effects are minimal. To be honest, there's no lipodystrophy anymore. We still have people say to me, oh, my body's going to change. No, your body's not going to change. From a lipodystrophic point of view, you might regain weight that you've lost because you've been living with hiv. So you might have some healthy body weight gain with your medication, but in general, the side effects are far, far fewer. Faron's used to give people strange sleep patterns, nightmares, dreams. Dolutegravir does that much less. There are a few people, but much less. So as we move forward, there's no advantage in making a medication that has more side effects than a previous one. Of course, it just gets shut down. It doesn't make sense. So every new medicine is going to be a little bit better than the last one. There's no. They have to be able to take over the market, and they're not going to take over the market if they have a particular side effect or they cause problems or they're twice a day or those kind of things. Like we're going to move forward from once a day. And we're going to move forward from having any side effects. So that's kind of the way the field has gone. And right now they're fine.", "start": 2801590, "end": 2913140 }, { "speaker": "A", "text": "The kidney, toxic to kidney, kidney damage, that is from HIV, basically. Lots of my patients with HIV, they have renal.", "start": 2914500, "end": 2923780 }, { "speaker": "B", "text": "Renal damage and liver damage from HIV as well. Yeah.", "start": 2924100, "end": 2927100 }, { "speaker": "A", "text": "And once they go on ARV stain.", "start": 2927100, "end": 2928500 }, { "speaker": "B", "text": "Yeah, you go on ARVs and you monitor that. You check. You check your creatinine, you check your liver functions. And if there are issues, you can pick them up long before there's any damage to those organs.", "start": 2928500, "end": 2941930 }, { "speaker": "A", "text": "Almost at the end. There's two questions that I always like to ask people. It could be related to your career, or it could be just general life. Okay, two questions. What is your biggest regret?", "start": 2944970, "end": 2958260 }, { "speaker": "B", "text": "Oh, my word. Do I have one? I can't think of a big one.", "start": 2959460, "end": 2965780 }, { "speaker": "A", "text": "That's good.", "start": 2966740, "end": 2967380 }, { "speaker": "B", "text": "Yeah, I've made good decisions, I think, in my life.", "start": 2967940, "end": 2971300 }, { "speaker": "A", "text": "You know, I went on the promenade and I asked a bunch of people, what is your biggest regret? And they all said, none. And I was like, does it mean the ones with regret are at home and not on the promenade? What's happening?", "start": 2972260, "end": 2986940 }, { "speaker": "B", "text": "Probably because those that are, like, out there and happy are out there walking on the property. They're the ones that are sitting at home, like, I should have done this.", "start": 2986940, "end": 2994740 }, { "speaker": "A", "text": "Okay.", "start": 2994740, "end": 2995140 }, { "speaker": "B", "text": "I was like, they're the ones that didn't go walking because they should have gone walking. They're now regretting.", "start": 2995140, "end": 2998860 }, { "speaker": "A", "text": "So I've learned. I was surprised. I was like, are you guys.", "start": 2999100, "end": 3001900 }, { "speaker": "B", "text": "Maybe. I'm gonna go and think about it in the car, and I'll have to phone you later and say, by the way, I do have a regret. I just didn't have it. Instantly.", "start": 3002700, "end": 3010060 }, { "speaker": "A", "text": "I'll make an AI copy your voice and say it now. Second question. What advice you would give your younger self?", "start": 3010540, "end": 3018500 }, { "speaker": "B", "text": "Wow. So I've always thought that my younger self did okay. I think I would probably.", "start": 3021140, "end": 3030980 } ], "Interview2": [ { "speaker": "A", "text": "We are sitting down with Africa director of Gates Foundation, Dr. Paula Bassinga. We're going to ask him about what Gates foundation is doing on this continent, their missions and goals and also we'll throw in some personal and fun questions to get to know him better. So let's go. Hello everyone. My name is Dr. Sia and today I'm honored to be joined by Dr. Polon Masinga, Africa Director of Gates Foundation. I'm particularly excited about this interview because we share the same mission and and passion for improving lives and public health. This conversation going to be fun, inspirational, motivational and of course we're going to talk about the amazing work that Gates foundation is doing in this continent. Dr. Masinga, welcome to the beautiful South Africa. How has your trip been so far and what's been the best part?", "start": 80, "end": 48550 }, { "speaker": "B", "text": "Thank you very much for having me. Dr. Sia, I've been watching you. Your TikTok. You're famous. It's a privilege for me to be here today. I'm loving it. Seems like everything was just planned for us to be here this week. Cape Town weather is amazing this week. Perfect, beautiful mountains, great people. It was fascinating to be here.", "start": 49110, "end": 71730 }, { "speaker": "A", "text": "You've just visited some sites and initiatives and projects on the ground. Which ones stood out most to you?", "start": 71970, "end": 79890 }, { "speaker": "B", "text": "We spent three days here. I'm going to be in Johannesburg for the next two days. But yeah, we've done a lot. We visited the primary school, you know, we do, we support work on health, education, you know, sanitation, many, many programs. So this time we want to visit a primary school where I spend time hanging out with grade one and grade two kids, seeing how they learn math, how they learn reading in Xhosa, I need to pronounce it well. So we're working with some really great local organizations here that are supporting the school systems here. How to adapt to support teachers in the classroom, how to really teach them and support them, how they transmit knowledge to the young learners was fascinating. And then we went to visit TB clinical trial site. Actually South Africa is known because if you list universities across Africa, the first five, six are from South Africa. So the quality of medical research here is top notch. It's like global research that are here. So the Gates foundation has been supporting some work to try to find a new vaccine for tuberculosis. As you know, South Africa account for 1% of the world population. But 18% of HIV cases are in South Africa and 6% of all TB prevalence are in South Africa is quite huge. So it makes sense for us and the global community to actually test the new Vaccine because there's been more than 100 years that we didn't get new vaccine for tuberculosis. So there is two candidates that are getting ready probably by 2027. And South African researchers are actually testing those vaccines. So I want to see how they are doing it, the process they are going through, etc. It's just fascinating to see.", "start": 80050, "end": 195800 }, { "speaker": "A", "text": "It's going to be groundbreaking if the vaccine gets approved.", "start": 195800, "end": 198800 }, { "speaker": "B", "text": "Yeah.", "start": 198880, "end": 199360 }, { "speaker": "A", "text": "Personal question. Do you do any sports or arts?", "start": 200240, "end": 203360 }, { "speaker": "B", "text": "Yes, I play soccer, so I used to play theatre when I was younger, but I continue to follow art quite a lot.", "start": 204480, "end": 213040 }, { "speaker": "A", "text": "Okay. Just for the audience. Favorite football team?", "start": 213680, "end": 217280 }, { "speaker": "B", "text": "Oh, you know, I don't. It depends on the which leagues, etc. But I copy my son, who's 12 years and who followed England, the Premier League. The only thing I know is that Arsenal is number two now. So I do support Arsenal, but I love seeing Liverpool and all the others play. So I love just seeing the beautiful soccer game. Game, how it plays.", "start": 218570, "end": 245290 }, { "speaker": "A", "text": "That's amazing. So, Dr. Bassinga, you are a medical doctor. You have Master's and a PhD in international development. You've been working with the Gates foundation for over a decade. Please tell us a little bit about your journey and what inspired you to join the foundation.", "start": 245290, "end": 262359 }, { "speaker": "B", "text": "Thank you very much. So, you know, I'm from Rwanda, so I did my medical school in Rwanda in 1995, just after the genocide. The government did an amazing job to actually make sure that the university was able to open very early on. And I lived in exile at that time. Before that, I lived in DRC, came back to Rwanda 1995, did my medical school, finished in 2001, 2002. And that was really the beginning of the phase of global health that you see today. Right with the beginning, the creation of gavi, the creation of the Global Fund. And at that time, we really started working to restructure and rebuild the Rona health system, as was part of the. The colleagues who were working with the government of Rwanda at that time wanted to be a pediatrician. I worked in the pediatric department for a year. But at that time, an opportunity opens up to do A Master's and PhD in Public Health at Tulane University, which I jumped into that opportunity and then worked for the School of Public Health in Rwanda and I did a sandwich program. So I'll go to the state for six months, take classes, and then come back to Rwanda to actually teach students, support the Ministry of Help doing research. I did a lot of consultancy in the regions, et cetera. At that time, we were very privileged to be bilingual. So I spoke both French and English. So I can support, I could support at that time French speaking countries and Anglophone speaking countries. And it was just a golden age of global health from 2004, 5, 6 up to 2013. Then I was working on HIV at that time. And an opportunity opens up at the Gates Foundation. When the Gates foundation was thinking about how to expand and bring more people with global health research and African experience, et cetera, then I joined the Gates foundation at that time.", "start": 263240, "end": 379050 }, { "speaker": "A", "text": "Amazing. As we know, the Gates foundation has been working in Africa for over two decades. What are some of the biggest success stories in the continent?", "start": 379130, "end": 387290 }, { "speaker": "B", "text": "Yeah. So the Gates foundation is celebrating 25 years this year. Right. And I'm so privileged to have been with the Gates foundation half of that time. So 13 years with the Gate Foundation. And when I joined the gate foundation in 2012, Dave had already built some really global health partnerships. Right. And the plan at that time was to say, you know, let's build global health partnership, you know, GAVI and Global Fund and other platforms that will create global public good and then the world will take those innovation up. Right. And then, you know, around 2012, 2013, they get foundational, really expanded its presence on the continent to say, let now open offices in the continent, let's place staff on the continent, let's engage more with government so that we can accelerate the introduction, innovation, adoption by countries. And I would say a few of the areas that we've really made huge impact. The top one is polio eradication, for example. Bill Gates really took that on as a top priority for the foundation to work with the global Polio Education platform, which includes the donors like the US government, like who, UNICEF and others. They all came together and really worked to really drive the case of polio down significantly. So we've reduced the case of polio in Africa to close to zero. While polioviruses is think of the past. Yes, we still have challenges with the derived polioviruses in some places, northern Nigeria or DRC or other countries. But partners are working very hard to try to decrease that. There continue to be some cases of world polio in Afghanistan and Pakistan. And we are that close, as the polio team will tell you, very, very close on radical polio, that one. And then the second one is really expanding routine immunization systems across Africa. We've been able to support many countries working with many of our partners like UNICEF and other partners to really increase the coverage of routine immunization. Because we know that the world used to lo Many kids because of vaccine, preventable diseases, right? And the fact that we have vaccines that are available, being able to provide those vaccine for our kids so that we can continue to decrease maternal in under five mortalities is critical. So since 1990 up to today, mortality has been halted by 50%, which is one of this, you know, biggest achievement. And then the third area is maternal health, you know, maternal health also we continue to lose our moms. As, you know, a mother in Africa, it's the pillar of the family. Like imagine a mom who is pregnant and then go through. We know that 85% of pregnancies will just go without any problem. But there is a probability that 15% of those, like 1 to 2% of that 15% will need special care. So like losing moms because of, you know, MH et cetera has been critical. So we've been working very hard with our partners to try to find ways to decrease maternal mortality. So these are the kind of things that we are doing. And then top of that is just like strengthening health system to be able to be managed very well. Working with community health workers, you know, to identify cases from the community, refer them to the health post, the health facilities, et cetera. So that the kind of thing that we've been doing. And then the wraparound data for accountability to really make sure that the government has the appropriate data to manage.", "start": 388250, "end": 600920 }, { "speaker": "A", "text": "It's amazing all the support that Gates foundation giving to all the governments and communities. Africa is constantly evolving and so many people are shaping its future. If you could describe Africa's future in.", "start": 601000, "end": 611680 }, { "speaker": "B", "text": "Three words, I would say the future is bright, promising and full of colors. You know, despite everything that is happening in the world, I think the future of Africa is brighter. I think in global health in general. As I mentioned before, we are entering a new era of global health and global development which will be shaped by how Africa will actually react on what is happening globally. And then Africa will actually provide the way for the future of global health.", "start": 611680, "end": 647720 }, { "speaker": "A", "text": "Would you include amapiano in one of these three words?", "start": 648110, "end": 650350 }, { "speaker": "B", "text": "You know, to be honest and to be fair to the whole Africa, I'll not take amapiano alone. I would say amapiano and afrobeats, right? Because those are the two biggest trend dance that are dancing the world, right? So because when you take the combination of, you know, Afrobeat in Nigeria, I'm appearing in South Africa, I'm from East Africa. We have very good beats as well, you know, in between Tanzania, Kenya and Rwanda, you know, in drc, et cetera. So good music I think, you know, Africa is making the world dance today. So I think now if you look at the future of global health, we need that, you know, creativity, that localization, that way of creating the future of our global health. We need to define it from Africa because for quite long time it was defined for us from the global North. Now it's really time to actually think about how we generate a new way of taking care of our people from here.", "start": 651710, "end": 717140 }, { "speaker": "A", "text": "True. Last question for our South African audience. No pressure on this one, but what's your favorite thing about South Africa? And trust me, we're not going to judge.", "start": 717220, "end": 727700 }, { "speaker": "B", "text": "I think what I really love about South Africa is to truly experience what you here call the rainbow country. It's so diverse. It is, you know, to your point, as you're saying, when you are in South Africa, it's like you are going to an international conference.", "start": 728100, "end": 742890 }, { "speaker": "A", "text": "Exactly.", "start": 743050, "end": 743570 }, { "speaker": "B", "text": "You know, you have, you know, different, you know, you know, cultures, religions, races and, you know, you know, tribes and languages, et cetera, just all living in this beautiful place. It's just amazing to see and to experience.", "start": 743570, "end": 758490 }, { "speaker": "A", "text": "It is an amazing feeling. And for the audience who are listening and they want to take action to make an impact and change in Africa, what you would advise them, you know.", "start": 758870, "end": 769430 }, { "speaker": "B", "text": "I would say this is the time to actually take care of our health systems and our people. You know, it's really time to realize that the African solution for Africa problem is not to wait. It's now. It needs to really, really happen now.", "start": 769430, "end": 790070 }, { "speaker": "A", "text": "Yeah. Thank you very much, Dr. Basinger, for your time and really appreciate it. Thank you very much for watching. Leave your thoughts down in the comments and make sure to follow.", "start": 790140, "end": 799340 } ]