Dr Chris van Tulleken explores the latest science around HIV, meeting health professionals, scientists, and individuals affected by it in the UK and South Africa.
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There is now a danger that has become a threat to us all.
It is a deadly disease, and there is no known cure.
It was just 30 years ago that the biggest public health campaign in
British history shocked us all into accepting a new epidemic.
Everyone was petrified.
And a lot of people that I knew died very, very quickly.
And a lot of people I knew died in the '80s.
I mean, it was one after the other.
But whilst it's easy to think that AIDS is a thing of the past,
here in the UK, the number of people
with the virus which actually causes it
still remains worrying.
My name is Chris van Tulleken.
These days, I spend most of my time in this lab at University College in London.
And I study HIV - a virus that's infected 76 million people
and killed 35 million of them.
The good news? The NHS in England and Wales have just announced trials
for a new drug that can prevent HIV, and in Scotland it's available now.
The bad news? There's still no cure.
So I'm getting out of the lab to meet people living with HIV.
He'd sort of spent the weekend in bed with what I thought was man flu
and then it was three days later that he died.
And I'll be questioning the scientists fighting the virus.
Will we cure it?
We're going to try, you know, and there's a real possibility.
There are billions of pounds of research money being invested
in labs like this all around the world.
We now have powerful anti-retroviral drugs that mean HIV
doesn't have to be a death sentence.
And PrEP, the new drug combination
that has been on all over the headlines recently,
can prevent you catching it in the first place.
But the battle is not over yet.
I'll travel to the front line of the AIDS epidemic...
She has lost six children.
..to discover how science is racing to stop
over a million deaths a year.
We were able to, in our trial,
-..of those individuals who are infected.
And I'll meet those dedicated to beating this disease.
We have a responsibility, all of us, to de-stigmatise,
to normalise the testing
and encourage more and more people to get tested,
so that every six months, every year, whatever it be,
you go and get tested for HIV just like you do everything else.
Despite what many of us might think,
HIV is still a problem in this country.
There are over 6,000 new infections every year.
And the risks are now being taught to a whole new generation.
When you think about HIV right now, what pops into your head?
What do you think about?
-Dirty things, don't you?
-Is it frightening?
In a way, yes.
I've heard some stuff that, like, the government made AIDS.
Write it down. Government conspiracy.
And then obviously it spread through needles.
People who are gay, they get blamed for the spread of it.
That's Freddie Mercury because he died of HIV.
I've come to William Farr School in Lincolnshire
and a special class on a unique virus.
So we're going to talk about how that virus actually gets passed on.
So which bodily fluids are we talking about?
-Yes, infected blood.
Yes. Any other body fluids that you guys know of?
It's OK. We've got vaginal fluids and rectal secretions.
But you know what? We're talking about them here today.
Do you think you could spot somebody with HIV?
So would you have any idea that I have HIV?
No? OK, so I'm HIV positive.
I was diagnosed over ten years ago.
You've all spent this time with me and couldn't tell.
And actually, anyone else you meet, you may not be able to tell.
Lizzie Jordan now works to educate young people about the virus.
She found out she was HIV-positive after her partner, Benji,
suddenly fell ill.
He went to work on a Friday.
Came home complaining of what he thought was a sinus infection.
He'd sort of spent the weekend in bed with what I thought was man flu.
And, you know, "Have some Lucozade and you'll be fine."
And then... So, it was three days later that he died.
Doctors broke the news that Benji
had died from an AIDS-related illness...
without ever even knowing that he was HIV positive.
I mean, that was probably six weeks before.
Seeing those pictures, even I find that amazing.
Come on. Yeah. Yeah. Yeah.
No-one knows when or how Benji contracted the disease,
but people can live for ten years or more without any symptoms at all.
SHE LAUGHS SOFTLY
Is it hard to watch that?
It's bittersweet because
that's the last piece of footage we have of him.
You must have been in...total shock.
It just didn't make sense.
How you can be so fit and well...
..and then die. You know, literally die and drop dead.
HIV, it never popped into your head?
-You never thought...?
-Not once, and it wasn't even on my radar.
It wasn't even something I considered.
When Lizzie discovered she was also HIV-positive, her next thought was,
had she unknowingly passed the virus to their baby?
Joe was 18 months old and had been breast-fed for 18 months.
All the things that I knew a HIV-positive mother wouldn't do.
Despite a one in four chance of infecting her child,
they were lucky.
The test came back negative.
I mean, the only reason your story is listenable to is cos you're
standing here kind of fit and well and looking amazing.
That fires me up even more to make people get tested.
You cannot tell.
Lizzie is one of over 100,000 people in the UK living with HIV,
and it's estimated around 13,000 of those are undiagnosed,
because for many years there are often no outward signs
that anything is wrong.
It's what helps the virus silently spread.
OK, so a quick lesson.
This is a quick biology lesson.
HIV is a virus and it specifically infects
the cells of your immune system.
So this is a white blood cell.
And on the surface, these little things that almost look like pollen,
those are HIV particles.
Like all viruses, in order to survive,
HIV needs to get inside the cell,
but then it does a very special thing.
It unstitches your DNA and it inserts its DNA into the gap.
The virus literally becomes a part of you.
That is why it's so hard to cure it.
You can live for years, even decades without any symptoms at all.
But all that time, the virus is replicating in your cells
so that your immune system will reach a point
where you can no longer defend yourself
against really minor infections.
And that's when you develop the syndrome of AIDS -
Acquired Immune Deficiency Syndrome.
The virus is HIV, the disease in the final stages is AIDS.
These days, I worry we've become complacent,
even ignorant of the risks.
So I want to find out how many of us have even taken a test?
Have you ever had an HIV test?
-I haven't, no.
Just because I've never felt the need to do it, really.
And actually, I'm pretty...
You know, I'm not that... What's the word?
I don't get involved with that many people,
partners and that kind of thing.
If you have a new partner...
-Do you always insist on an HIV test?
I insist on a full test.
-A full test. OK, so the whole lot.
-I'm a bit paranoid.
-Have you been tested?
-I have been tested.
Hopefully my mum doesn't watch this!
Your mum will be so happy to know
that her daughter is being responsible and having HIV tests.
Yeah, I mean, I think you can't be complacent.
-Have you ever had an HIV test?
-I've always had protected sex.
-As a general rule.
-As a general rule.
-You may be the only man on the planet
-who has always done it.
-Actually, that's a lie.
You're going to keep getting tested regularly?
Yeah, of course. Like, even if, like...
Sometimes even if I haven't had sex with anyone,
I'll go and get tested anyway.
-Do you think you'll go and have one now?
-Um... You know what,
I think that there is such a stigma around it that the thought
of going into a doctor and asking for one would actually be, like,
I would find it really uncomfortable doing that.
It's a bit of a mixed bag, and if I'm honest,
us blokes don't come out of it all that well.
And that's why it's all the more extraordinary that last year
a member of the British royal family did something almost unthinkable.
What I was going to do there... Your hands are quite cold.
July 14th, 2016,
and Prince Harry is taking an HIV test live on the internet.
Weirdly that didn't even hurt.
There you go.
I can tell you here, you have an HIV non-reactive result here.
-So everything is fine.
Was that your first HIV test that you'd ever had?
-It was my first HIV test.
-First ever, in your 30s?
Yeah, in my 30s. This is something that, from a guy's point of view,
is... It's nerve-racking.
I think it's nerve-racking regardless of who you are
or what you've been up to.
And all the media are sitting on this...standing on the other side
of this mirror. And I know exactly what they're thinking, like,
as I'm sure you know as well. And they're thinking,
"Oh, imagine if, imagine if. What if? What if?"
And I'm sitting there going, "Jeez, what if?"
Yes, I could have done it in private, what's the point in that?
I mean, for everyone else, go and get it done in private.
I don't suggest everyone else does it live, but, you know,
it's the responsible thing to do,
from my point of view, to get the message out there.
And what are the things that stop us all getting tested regularly?
It's the fear, isn't it?
It's the stigma.
The word AIDS.
I mean, just when you say that, it just gives me...
gives me goose bumps. And I think there's so much stigma
simply around a name.
When AIDS came along,
everyone was petrified.
a lot of people that I knew died very, very quickly.
And a lot of people I knew died in the '80s.
I mean, it was one after the other.
And everyone was so frightened.
You know, when you went for your annual blood test
or you had a cold or you had anything, you thought,
"Have I got HIV? Have I got AIDS?"
I was delivering meals to people who were so ashamed, they wouldn't come
out their front door.
We'd put the meal on the doorstep and then you'd walk down the
garden path and you'd hear the door open and slam very quickly.
Because they were so ashamed to be seen.
At the time, Caroline Bradbeer was a junior doctor
at St Thomas's Hospital in London, trying to cope as best she could.
We didn't really know what was happening.
We did know that statistically, at that stage,
once somebody had developed AIDS,
the average survival was less than two years.
I think it was about 18 months.
There was nothing really we could do.
And I felt so helpless, really.
I made them a little bit better for a while,
and that's what buoyed me up.
Sometimes when they died, you were glad for them.
The virus was a complete mystery to doctors.
And scientists didn't have a clue where it had come from.
But as we've learned more about HIV,
researchers have been able to trace the epidemic all the way back to
its very beginning.
Very nice to see you.
I've come to meet my friend and colleague Dr Stephane Hue,
who uses genetic analysis to track the spread of the virus.
Here you can see,
let's say a family tree
of the HIV strains that are circulating across the world.
This family tree goes down to a single point here,
to a single ancestor, right?
Hold on. So, to a single...person.
The first person who was infected with HIV.
So we believe that this jump has occurred between 1910, 1930.
Quite a lot before the virus was first identified.
So the virus that has infected 60 million people
-and killed half of them came from one person?
So, naturally, we want to know not who that person was, right,
but we want to know, where did that virus come from?
We realised very early on that this virus belongs to a family of viruses
that mainly infects primates, OK?
-So there's been a long...
-Monkeys and apes.
Exactly, monkeys and apes.
And it turns out, we inherited HIV from chimpanzees.
So in other words, in the world,
the virus that is most closely related to HIV is SIVcpZ,
which is a virus that infects chimpanzees.
The question that I get asked is,
did someone have sex with a chimpanzee?
If you see and watch chimpanzees in their habitat, right?
Their aggressivity, their teeth, right? Their strength.
Realistically, you know, that's not what's happened.
It's believed the virus made the jump to humans
in Central Africa where chimps are sometimes butchered for their meat.
-You know that I have lived in this part of the world.
And... So I brought some photographs.
This is a man butchering...
-..a small monkey.
But I think you get a very good idea that this is not an environment
where it's possible to avoid contact with the monkey blood.
-And we think this is how the virus was introduced
into the human population.
For more than 50 years,
the virus had such a small impact it wasn't noticed.
But by the early 1980s, the world was facing a new and deadly disease.
Without any effective drugs to treat it,
doctors like Caroline Bradbeer were delivering what amounted
to a death sentence to an increasing number of patients.
One of those was Jerry Patterson, who's managed to survive against
Oh, my God!
-This is an absolute delight!
-Come round here.
Sorry, I'm a bit welled up.
-They haven't seen each other for years, but the memories
are still vivid.
It really is. You look wonderful.
So do you.
Well, I was ushered straight into a cubicle.
And the curtain went back and in you walked.
And you'd got the result back, and it was an HIV-positive result,
and you said that I was being admitted.
I knew I could talk to you.
A spade is a spade. I said, "Give it how it is."
You said, two years.
And here we are 28 years later, and we're having afternoon tea!
It's wonderful, isn't it? I mean, it's just such an incredible thing.
I'm so glad you came through it.
So young. How old were you?
For young men like Jerry, the symptoms were devastating.
The immune system was just crashing.
The Kaposi's sarcoma, which was a form of cancer on the skin,
would be these lesions appearing.
-The banes of my existence were warts on my fingers, molluscum...
Which of course looks horrible because it looks like awful acne.
Yes. And of course the gauntness was the other thing,
the atrophy in the face.
Yes, yes. They shrunk down to a level where you think,
"Why are they still alive?"
Which was taken...
But by the late 1990s, everything was about to change.
Scientists had discovered the first effective treatments against HIV.
And Jerry had held on long enough to become one of the first to try them.
It was amazing when we suddenly had treatments that worked.
It took a while...
to believe it. It took a while to persuade both the clinicians
and the patients to take the medication
because we'd had so many false starts,
and there was always the worry that the side-effects would be worse than
But once it became clear that people could get better,
you saw the most amazing things.
I had the warts, I had the molluscum,
and within weeks, I looked at my hand,
the warts had gone.
He's very lucky, but it would have been even better if he hadn't been
infected in the first place.
Nowadays, if people are taking their medication properly,
actually the consultation goes along the lines of,
"Where are you going on your holidays?"
It's a bit like going to the hairdresser. It really is...
..just carrying on giving the same prescription.
Which is incredible.
So, 30 years later,
we now have drugs that can keep HIV under control.
But there's still a long way to go.
Whilst the diagnosis of HIV is not a death sentence in Britain any more,
thousands of us don't know we carry the virus.
I spoke to people in my lab about whether or not
they would have regular tests since we all handle live virus,
and they all said no!
None of them have regular HIV tests.
So why is that?
Is it because they're too afraid to have a test?
They don't want the information?
Or is it because they're not afraid enough?
It's been several years since my last test and, to be honest,
I've left it longer than I should have.
But these days, testing can be as simple as ordering
a do-it-yourself kit over the internet.
I think everyone should HIV test
because there is almost no-one for whom the risk is zero.
For me, it's much more than zero.
You know, I've had more than one sexual partner,
I've had unprotected sex previously,
and I work in an HIV lab, mainly.
I handle enormous quantities of live virus -
so fluid that is hundreds or thousands of times
more concentrated virus
than you'd ever find in the sickest patient's body.
Yeah, I'd be lying if I said
I didn't have some butterflies about this.
Your how-to test guide. HE CLEARS THROAT
So there's a "If your result is positive..." The basics.
If I test positive, I think I'm not comfortable,
but I think I'm OK with saying I have HIV.
Or at least...
..I think I would be...
..such a hypocrite if I didn't
that I wouldn't be able to live with myself.
So you need to remove the buffer part.
Push the test device hard into the buffer box.
So it's like a pregnancy test.
If you get two lines, you're positive.
OK. Let's make a cup of tea.
As I wait, I'm running through all the ways I might have caught HIV.
I've been careless in the lab.
My wife's recently become positive and hasn't told me.
This is a weird situation,
and I think that the legacy of the public health campaign
is it turns me about HIV, and I think many people...
ALARM SOUNDS Oh, there we go. It turns...
..people of my generation into HIV hypochondriacs.
OK, so that is a negative result.
HE EXHALES LOUDLY
Gosh, I feel real... Honestly, my heart is really...
..pounding. That is a load off, though.
The unequivocal truth is it is better to know.
It is better to know if you're negative, and it's better to know
if you're positive. And it's better to understand if you are negative
that you may not always be negative.
That the next time you have unprotected sex
warrants another HIV test.
So what's it like nowadays for the 6,000 people who test positive
in the UK each year?
-Hi, how you doing, Chris?
I've come to Glasgow,
where 31-year-old Michael is coming to terms with his recent news.
Fourth of July, it was. I'd been on a...
So, fourth of July, so two months ago?
Two months ago, yep. Really recent.
I was on a dating app.
Now, while you're on it, you always get messages popping up
saying to you, HIV tests, STI tests and things like that.
And I thought, "HIV test, I'll get it done, tick it off my list.
"Nothing to worry about."
I was actually quite blase with it,
assuming it was going to be negative.
I went in and the gentleman that was passing me my results says to me,
"We've got your results back, and they are HIV positive."
Yeah, it's probably the worst words that you can hear
getting told to you.
I just went numb. Completely numb.
I had no thought, I had no feeling.
There was nothing.
As far as I was concerned, that was my death certificate written for me.
-That was as much as I knew.
You get HIV, it develops into AIDS, and unfortunately there's no cure.
Obviously, cos I was crying, trying to take it in,
he told me this does not mean that I'm going to die.
It won't develop into AIDS because it doesn't happen any more.
Worst-case scenario what will happen is I'll be on two meds a day.
Two tablets that I'll need to take for the rest of my life.
There are very few miracle drugs in modern medicine, but this really is,
I would describe it as, a miracle drug.
We always say, "This isn't a cure.
"You're not cured. You still have HIV."
So if you ever stop taking these,
-you understand that the virus will come back.
But kind of the astounding thing to me is still that,
if you do keep taking these every day at the same time,
that your life expectancy is essentially unaffected.
-Have you missed a day?
-Not a single one?
-Not a single one.
Anti-retroviral drugs, or ARVs,
block the enzymes that HIV uses to infect immune cells.
This stops the virus multiplying any further and brings HIV levels in the
blood down to almost zero.
As long as you keep taking the pills.
Today, two months after starting treatment,
Michael is going to find out
how much virus is still present in his body,
what doctors call his viral load.
-We'll look at some of your results.
It's been a few weeks now, I think, since you started treatment for HIV.
Tell me how that has gone for you.
-Really well, actually.
-That's really good to hear.
As you are aware, I was really concerned about side effects.
-I've had none, absolutely none.
-What else would you want to know about this?
-My viral load.
-Your viral load, I thought you'd be coming on to that.
-That is the key one that I want to know.
So I've seen people whose viral loads
are more than a million copies,
and that number is the amount of virus that you have
in every millilitre of your blood.
So this value was just reported a few weeks ago,
and this value is not detected.
Physically, we've switched off
the virus making new copies of itself and
now there's no copies in your blood at all.
-I want a copy of that.
-A copy of that?
-I want that in black-and-white.
-We'll print that out for you.
I can get that framed. I'm amazed it can happen so quick.
How do I ensure that always stays non-detectable?
So, the virus is not cured.
-There are copies of the virus in your body, but they're all
and the reason of that is that you're taking your tablets.
And just to clarify as well, that's...
I am not infectious.
There's no way even with unprotected sex, if that happens,
that I can infect somebody?
So if you're able to take your tablets, a pill every day,
you'd have almost no risk of passing on HIV to anyone else.
I can just get on with my normal life
without actually having to think about HIV.
I've got my life back.
And it's great.
Michael is one of the lucky ones.
But the trouble is, you have to be diagnosed before you can benefit
from the amazing treatments we now have.
Nearly one in eight people who have the virus
don't know they are infected.
And one of them was 43-year-old Addie.
SHE READS WITH SPEECH IMPAIRMENT
This one is new to you, isn't it?
-It's new to me as well.
-She had no idea she had HIV until a brain
infection caused by her depleted immune system left her struggling
to walk and talk.
Brain infections are common in patients
where HIV has gone undiagnosed for many years.
Hi. I'm here to see Addie.
I've come to the Mildmay Hospital in East London,
where they specialise in rehabilitating patients like Addie.
-Hi, Addie, I'm Chris.
-How are you?
-Nice to meet you.
-Very, very nice to meet you, Addie.
-Nice to meet you.
-Can I join in, Addie?
-Yeah, yeah, yeah.
-Is that all right?
-Yeah. Yeah, yeah.
We've done our warm-up now, Addie,
so we might come across to the parallel bars.
Oh, we're going to walk over there, are we?
Addie is now on ARVs and her HIV is under control,
but the damage to her brain may never be fully reversed.
You can't just feel them?
And it's worth saying, it's very obvious,
simply standing here, I can feel your muscles flexing
and you're sweating to do this, aren't you?
Just standing here is quite hard work.
Is that true?
I shouldn't say sweating.
You're perspiring gently.
So Addie's been coming... Start in January 2015.
And when you came in January, how good were you at the parallel bars?
-Very bad, very bad.
Nice and slowly. One hand at a time.
It's very interesting for me as a doctor to try and work out
where the problem is.
What's happened here?
This is quite similar to if someone's had a stroke,
where there's been some damage to the brain and it's affecting...
..I guess her ability to contract her muscles,
with her strength and her co-ordination,
which leads to problems with her balance,
difficulty standing and also with your coordination in terms of your
-speech as well.
-It seems to me that you're working very hard to make the
-words with your mouth and tongue.
Is that a thing you've had to relearn to do?
Yeah, yeah, yeah.
Addie, are you always this cheerful?
Has that always just been your nature?
We're going to come and have a sit down.
-Do you want to gave a seat?
-Yeah, yeah, yeah.
I'm conscious you are really working away here.
Yeah, I bet you're getting tired.
What was Addie's prognosis when she came here?
It was very bad. She had just been given about three months to live.
So she had virtually no functioning immune system?
No, she didn't.
So you were in a bad way.
And you were given three months to live.
It's remarkable, I think, to work with someone like you, Addie,
where you've had this very severe brain damage, really.
Let's call it what it is.
But at your age, the brain is sufficiently plastic
that you can retrain it and gain a lot of function.
Exactly, and there has been quite remarkable improvement.
THEY SING "Amazing Grace"
Singing therapy is now helping Addie to rebuild her power of speech.
And the Mildmay has been at the forefront
of treating HIV and AIDS for the past 30 years.
-The Princess of Wales has been visiting AIDS sufferers
in an East London hospital.
This morning, she spent time with patients at the hospice wing
of the Mildmay hospital.
In 1989, in the full glare of the media,
Princess Diana openly shook hands with patients who had AIDS.
It was a landmark moment in challenging the stigma
surrounding the disease.
And her legacy continues to this day.
Addie, I think you've got a visitor.
Who? Prince Harry!
Stay, stay, stay. How are you?
-Nice to see you again.
-Nice to see you too.
-I heard you singing outside.
Yeah. Yeah, yeah.
-Amazing. Literally, Amazing Grace, wasn't it?
Prince Harry has met Addie before, and she has made real progress.
Understandably, there is huge frustrations for you
because of your speech.
-Can I have a...?
-Thank you, Prince.
-We'll see you.
Addie's story proves that when it comes to HIV,
an early diagnosis is crucial.
And the only way to be sure of that is regular testing.
The key point of this is how easy it was,
and how easy it was for you as well.
You had a home-testing kit.
I went in and the only reason I did it live was because I wanted to show
to everybody how easy it is and how normal it is.
Imagine if we could create a movement where everybody...
everyone goes and gets tested. You know, if you're not going to get
tested for yourself and you're not going to go
and get tested for your loved ones that you could possibly infect,
then - I don't know whether it's a selfish thing to say or not -
but if you respect what my mother stood for,
go and get tested for her.
You know, you've got 20 years next year since she died,
and 30 years ago,
she was in the hospital and she did something that no-one else had ever
done before, and she started this whole thing.
Is that partly what is inspiring you to do this?
Yes. You know, if she were still here today...
she would... Well, she'd probably get tested every month
just to prove the point.
There's so much stigma simply around a name or an acronym that we need...
You know, it's 2016, for God's sake.
I mean, we need to start rethinking
the whole Acquired... What is it? Acquired Immune Deficiency Syndrome.
When you actually lay it out and you spell it out, you suddenly go,
"It's not actually that terrifying at all."
Obviously, if you speak to someone who's suffering from it,
of course it's terrifying because it can kill you.
But the point I'm trying to make is,
if you can't even say the word without cringing or worrying
or freaking out about it,
how the hell are we going to help everybody and solve this
problem before it gets too big?
I think most people would admit that they've had sex without a condom,
and that is always a moment - the next day, probably -
when you think to yourself,
"You know what, Christ, I probably need to,
"you know, go and get a checkup."
Why did you want to take this on as a cause?
The issue itself needs...
..a straight guy, mid-30s, early 30s...
..to come in and try and normalise it.
And once again, I'm fortunate enough to be in this position to be able to
make a difference. Let's start in the UK.
Let's lead by example, and then help everybody else.
In Britain, we've come a long,
long way since Princess Diana extended the hand of compassion
to people with AIDS.
But huge challenges still remain.
I'm off to a part of the world where the worst-case scenario
the doctors feared for the UK
has now become a catastrophe of unimaginable proportions.
I've come to South Africa, the worst affected country in the world,
where nearly 200,000 people still die every year.
So South Africa is an example of what happens when you don't have
a really effective public health campaign
in the early stages of an HIV epidemic.
So, in the UK, we did.
In South Africa, they didn't.
So today, there are 7 million people living here with HIV.
It has one of the highest infection rates in the world.
This is the front line of the war against the virus.
In a bid to end the epidemic,
the UN has now set an ambitious global target.
They're calling it 90-90-90.
Diagnosis of 90% of people with HIV,
getting 90% of those onto medication,
and suppressing the virus in 90% of those.
The latest scientific models show
that if the 90-90-90 goal is achieved,
it could end the epidemic in less than 15 years.
So I'm heading to a clinic in KwaZulu-Natal,
the hardest-hit province in South Africa,
to see how they're trying to reach that target.
As I arrive, I take the opportunity to speak with some locals who are
selling fruit outside the clinic.
How are you guys? Do you mind talking to me?
THEY SPEAK ZULU
We're making a programme about HIV,
and I wanted to know what you all thought about it.
THEY SPEAK ZULU
My Zulu is a bit rusty, I'm afraid.
The lady, she's saying, basically,
all the kids have passed away
because of HIV.
I hadn't understood how serious it was.
She has lost six children?
I'm very sorry. I'm very sorry.
Is it a thing that young people understand?
You get these from the clinic?
Nothing can prepare you for hearing stories like these,
but at the Macabuzela Clinic,
this is what they're dealing with every single day.
SINGING IN ZULU
Which is why it's all the more amazing that they begin each morning
with such an uplifting song.
The clinic covers an area of 13,000 people,
roughly the same as a busy GP practice in the UK.
And many of the common conditions they treat are the same.
High blood pressure, diabetes,
mental health, epilepsy, diarrhoea, asthma.
But strikingly, at the top of the list is the term
"People living with HIV and AIDS".
I really want to understand why HIV is so widespread in this part of the
The first patient is a teenager.
Diagnosed HIV-positive just two months ago,
she prefers to stay anonymous.
What was it like to find out you were positive?
You told your mum?
You told your brother, OK.
So not your mum and your... So only one person knows?
Do you know the person that you think you caught it off?
Did you tell him?
He's 25 years older than you?
He's in his mid-40s.
OK. When you had sex, were you worried about HIV?
Did you say, "We should use a condom"?
And because she was in love with him,
-just allowed him to do unprotected sex.
They just dated for a week.
He just slept with her, then dumped her.
The girl collects her prescription,
the same anti-retroviral drugs as in the UK,
and heads to school.
It's a desperate story, but not unusual.
Teenage girls in this part of South Africa have an 80% chance
of becoming HIV positive during their lifetime.
How does this make you feel? Because you're a young woman.
Does this make you mistrust men?
So often by then it's too late.
It's too late most of the time.
It's not a shortage of drugs that is killing people here.
South Africa now has the biggest anti-retroviral treatment programme
anywhere in the world.
For a doctor like me,
it's baffling there are still nearly 200,000 AIDS-related deaths here
I think they have come to regard this as completely normal.
There's the market. In that room,
in that Portakabin, are all the drugs to completely...
..end transmission and mean that no-one, almost no-one has to die.
That's the thing I don't feel I've in any way
really got under the skin of.
What are all the complicated factors that mean that people
don't go and seek treatment?
On the way back to my hotel, I decide to drop in at a local bar.
As a bloke, I want to hear what some of the men have to say.
Can I get a beer? A bottle of beer?
How are you, sir?
-What's your name?
We've discovered, out in the clinics,
that the young men don't want to get testing
and they don't want to get treated,
and I'm trying to understand why.
Why haven't you had an HIV test in three years?
Do you have a girlfriend now?
-Yeah, I have three.
-You've got three girlfriends?
30% of people have HIV.
So there is a good chance that one
of your three girlfriends will have HIV.
You should go and get a test.
-Go and do it tomorrow. Go and get tested.
-My own time.
But going to the clinic can be fraught with embarrassment
and fear for these men.
When you go and you test positive, at a clinic, people will know.
It's so important for you to have some confidentiality.
If I knew when I went and had an HIV test, and then went every month
when I had to go and get my pills to be treated,
everyone would know, you know what,
honestly, I might not get tested.
I hope I would, but I can't say hand on my heart that that wouldn't push
me away from the clinic.
So, if the men won't come to the clinic,
a pioneering scientific trial is taking the clinic to the men,
in a bid to diagnose 90% of people who have HIV.
For the past four years,
testing teams have been visiting every home
in an area of 22,000 people.
No-one is singled out,
and people can avoid the stigma of their neighbours knowing.
How are you, my friend?
Themba, a 60-year-old widower,
was one of those who tested positive
when fieldworkers visited his home in 2014.
-Can we see?
-Yes, you can come in.
Can I sit on the bed?
Do you like taking the pills?
-One pill at seven o'clock?
Do you know your viral level?
Can we see the paper?
First viral load was 18,000,
and then, as soon as he started taking the drugs,
so, what, August to November, LDL,
which is lower than detectable limit.
Undetectable, undetectable, undetectable, undetectable.
So the pills are working very well.
Do you think you will ever have a girlfriend or a wife in the future?
He's thinking about it.
This treatment, it helps you live
a long time, but it also stops you
passing the virus on.
So that's the key thing.
There are two benefits.
It makes you live and it stops you giving the virus to anyone else.
So as long as your viral level
is undetectable, which yours is,
you won't give the virus to anyone.
Themba is just one small part of a much bigger plan
to try and end the epidemic within ten years.
But has the trial come anywhere close to reaching
the UN's 90-90-90 target?
To diagnose 90% of people with HIV,
to get 90% of them onto medication,
and suppress the virus in 90% of them.
At the Africa Health Research Institute,
I'm catching up with Professor Deenan Pillay,
who wants to show me how well they've done.
First up, diagnosis.
We were able to, in our trial,
-..of those individuals
who are infected in this area.
We achieved that target.
So the next question is what proportion of these individuals
come to clinics? And unfortunately,
what we find is only 47% get into care.
And that's too low to get anywhere near
to start to reduce the epidemic.
So you've managed to get less than half of people with HIV
into treatment. Why?
It's a tremendous success that we've been able
to go into people's homes and convince them to be tested for HIV,
-but the point of that is that they get onto treatment.
I want to understand - that isn't because of a shortage of drugs
or a lack of money. The resources are there
if you can get people
to use them. Is that right?
We provided mobile clinics,
we provided the care for their HIV infection with no shortage of drugs
or diagnostics and always with sufficient staff.
I think defeating this awful HIV epidemic
requires an understanding of
society, as well as individuals,
as well as medicine.
And without an understanding of all of those, we will never defeat it.
I think, you know, 20 years ago, no-one...
I don't think anyone thought we'd get to this point where,
we've overcome all those kind of scientific, medical obstacles.
We have highly effective treatment
that works with very few side effects,
and it's cheap, and there's enough of it for everyone out there.
At this point, we're batting up against the hardest problem of all,
that feels so simple -
just persuading human beings to be rational and do the right thing -
I'm sure we will get there, but that...
that, I guess... In any medical challenge, that is the hardest bit.
Back here in the UK,
it's easy to assume we are winning the battle against HIV.
Sitting here feels so different to KwaZulu-Natal
that it is hard to believe
that there could be any epidemic of infection at all.
But what can we do about the 6,000 new British infections every year?
Although condoms have made a huge difference to safer sex,
people still don't really like wearing them,
and given the choice, I'd rather not wear one either.
So what if there was a radical new way to prevent infection?
This is Harry Dodd.
As a sexually active young gay man,
he doesn't want to take any chances.
So he signed up to a clinical trial
of a revolutionary new pill called PrEP.
It contains two different anti-retroviral drugs
and can prevent HIV being contracted.
OK. Well done.
And Harry has regular checkups to make sure it's working.
What is PrEP?
PrEP stands for pre-exposure prophylactic,
so it's prevention that you take ahead of being exposed to a risk.
-Do you mind if I have a look?
Are the drugs the same as the ones we use to treat HIV?
They are. Cos they work brilliantly to control the virus,
and that's what you're doing,
whether you're preventing it or you're treating it,
so the advantage of pre-exposure,
if you think there's going to be an exposure in the future,
is that the drug is there ready and waiting.
If you take the pill properly, every day as instructed,
the chances of contracting HIV are negligible.
For Harry, it's removed a lifelong fear of contracting HIV.
Growing up knowing you're gay,
that fear haunts you from the first time you become sexually active.
You have this guilt and fear and worry and concern
with almost any sexual partner you have. Even with the condom,
there's still the worry of the big one, which is HIV.
And PrEP takes that fear and that anxiety away from that experience.
We look for that one spot for negative,
two spots for positive.
One spot, negative.
How do you feel? Are you relieved that the test is negative?
Of course I'm relieved that the result is negative,
but I didn't have any anxiety beforehand either...
-..because I appreciated that I've been taking PrEP
for three years and that the chances of me contracting HIV
are pretty much non-existent.
The thing that is amazing to me about this is, in this pot,
is the power to end the epidemic.
Yes. I mean, I completely agree with you.
This is the thing we need.
DRUMS AND MUSIC
At last summer's London Pride Festival,
Harry took to the streets with hundreds of others to campaign
for PrEP to be made available on the NHS.
-What do we want?
-When do we want it?
-What do we want?
-When do we want it?
Then, in December 2016,
the National AIDS Trust won an Appeal Court ruling
that NHS England and local authorities
do have the power to fund the provision of anti-retroviral drugs
for the prevention of HIV.
And so, a £10 million trial over the next three years was announced in
England, and then a further one in Wales,
whilst NHS Scotland announced that PrEP will be available there
this summer to those who need it.
Cost is a big factor,
and NHS England has challenged drug companies to supply at lower prices.
Now 10,000 more people will take part in these clinical trials
to answer what NHS England says are outstanding questions,
paving the way for a full roll-out.
But not all views on the subject were based on clinical concerns.
So this is an article in the Daily Mail.
Headline is, "NHS told to give out £5,000 a year
"lifestyle drug to prevent HIV as vital cataract surgery is rationed.
"What a skewed sense of values."
Calling it a lifestyle drug, I think, totally misunderstands.
Almost all the conditions we treat in the NHS
could be largely prevented
if people lived different lifestyles.
We never have a discussion saying we should not give out
blood pressure and cholesterol medication
to people who are overweight and unfit.
And to single out this particular highly effective pill as being a
is really poisonous.
But whatever our attitudes to sexual health, or even sexual morality,
the use of PrEP has been all over the headlines recently,
and it does raise interesting, difficult questions.
I wanted to ask my own boss, Professor Greg Towers,
a leading expert on HIV, what he thought.
What you think about the idea that, for a lot of people, PrEP is a
lifestyle drug? It allows them to have high-risk sex.
Well, it allows them to not get HIV, which is the point.
I mean, you know, it's not
our business to be focusing on what people do,
it's about making a decision based
on how to improve the health of people in the UK,
and how to do that in the most cost-effective way.
Those people taking that drug will cost the NHS less
if they don't get HIV.
There is more money to treat patients if you save money
through not having to treat people for their entire lives
with very expensive drugs rather
than for a period where they're at risk of getting HIV.
Why aren't we rolling it out in England and Wales
in the way they have in Scotland? We're doing another trial.
We need to work out what drugs we're going to give,
who we're going to give them to...
Will everybody take it? Will the right people take it?
Will the right people have access to it?
You have to have due process,
you have to make sure that this is going to be the appropriate thing to do,
and to work out the appropriate way to do it.
So it isn't like we're doing a little trial and testing it in a few
hundred people. It is actually, in practice, going to be offered
to quite a large proportion of the eligible population.
Yeah. I don't know how big the eligible population is, but, yeah,
10,000 people is a lot of people who won't be at risk.
So why do you think that condoms and personal responsibility
aren't enough to stop the spread of HIV?
People just don't use them. You know, some people object to using them,
they don't want to, so it just doesn't work.
We know that now, and I don't think that's a realistic proposition for stopping the spread of HIV.
Do you think a cure is on the horizon?
A cure for HIV is, unfortunately, I think, a big ask at the moment,
because we don't understand enough about the biology of the virus
and its relationship with the immune system.
A lot of people are working on it.
It's certainly a possibility.
Will we cure it?
We're going to try.
The truth about HIV is that its treatment has been
one of the biggest breakthroughs in medical history,
but it's a disease that's not going away.
And many people are still diagnosed too late.
We have a potential end in sight,
but we have to get rid of the stigma
and we have to get rid of the hate and the shame.
Science has already given us the tools we need to defeat HIV.
What a fantastic thing for humanity to be able to say,
you know, "We've cured HIV."
Let's start in the UK. Let's lead by example.
We've got some of the most powerful drugs in medicine
that mean people can live long, healthy lives with HIV,
and crucially, they'll be uninfectious.
We even have pills that you can take that prevent you catching the virus
in the first place. Pills that are now available on the NHS,
in Scotland at least.
The money you spend on PrEP will save you all that treatment.
I mean, it's like... It doesn't make any sense not to put it out there.
It's just an economic no-brainer.
So it seems to me that the remaining challenge is about harnessing social
and political will
to put these scientific breakthroughs to best use.
Because if we can do that, I believe we can bring the epidemic to an end.
HIV/AIDS has claimed around 35 million lives worldwide. But now, as Dr Chris van Tulleken reveals, cutting-edge science can keep the virus at bay or even prevent infection altogether. As a new preventative treatment called PrEP is rolled out on the NHS in Scotland, and new trials are announced in England and Wales, HIV is under control, in Britain at least, but only when it can be detected and the treatment with antiretroviral drugs (ARVs) can begin.
Chris meets a woman whose husband died without ever knowing he had the disease, by which time he had infected her too. But Chris also finds out how 'viral loads' can now be reduced to allow patients to lead healthy lives - and even prevent them infecting anyone else.
Chris meets HRH Prince Harry for an interview at the Mildmay Hospital, an HIV hospital made famous by Diana, Princess of Wales, where Chris also meets a patient whose undetected HIV led to serious brain damage.
With seven out of ten of people infected worldwide living in sub-Saharan Africa, Dr van Tulleken visits a clinic in KwaZulu-Natal, South Africa, where tens of thousands are still dying. He meets an infected schoolgirl and realises that local attitudes to testing are still leading to unnecessary deaths. But Chris also meets clinicians taking mass testing out to the villages and meets a man whose life was saved as a result.
Back in the UK, talk of a cure may be premature, but Chris finds out more about the controversy around the rollout of PrEP which, when taken daily, can prevent someone becoming infected in the first place.