:00:09. > :00:18.risen to 61 people. Time for HARDtalk. Could we soon
:00:18. > :00:21.see a cure for her HIV/AIDS? Francoise Barre-Sinoussi thinks so.
:00:21. > :00:25.She is a Nobel Prize winner who helped to identify the virus 30
:00:25. > :00:30.years ago. She says the need to pour money into fighting the
:00:30. > :00:34.disease is as great as ever. Already, nearly 30 million have
:00:34. > :00:37.died from it. By the time I have finished this introduction another
:00:37. > :00:47.three people will have contracted it. Another two will have died. But
:00:47. > :01:09.
:01:09. > :01:11.with budgets being cut, can we afford more expensive research?
:01:11. > :01:16.Francoise Barre-Sinoussi, welcome to HARDtalk.
:01:16. > :01:20.Thank you. It seems extraordinary that a short
:01:20. > :01:23.time ago scientists were barely talking about a cure for AIDS, and
:01:23. > :01:27.now you are saying that it is a potential reality for the near
:01:27. > :01:35.future. How did the change come about?
:01:35. > :01:38.First of all, it is not new to talk about a cure. But with any great
:01:38. > :01:41.certainty it is. Of course it has been researched
:01:41. > :01:48.already. A bunch of scientists were working already on that aspect
:01:48. > :01:57.without any results. The reason why we're talking about a cure today is
:01:57. > :02:01.because we have some evidence that it might be possible. First of all
:02:01. > :02:04.we have what we call the Berlin patient, the patient that is HIV
:02:04. > :02:08.positive, had a bone transplant because he developed leukaemia, and
:02:08. > :02:18.it turned out that after two bone marrow transplants, we can say that
:02:18. > :02:22.
:02:22. > :02:25.we cannot detect the virus in his body anymore. It is the proof of a
:02:25. > :02:28.concept somehow that we did not have before. There is also this
:02:28. > :02:38.group of individuals that are HIV positive for many years, some of
:02:38. > :02:44.
:02:44. > :02:47.them 15 years. It is a small group, less than 1%. They have never
:02:47. > :02:50.received any treatment and they are doing well. They control their
:02:51. > :02:55.virus. I want to talk to you more about
:02:55. > :02:58.the science behind it, how it might work, in a moment. But first of all,
:02:58. > :03:05.you have described the search for a cure as a necessity. Because of
:03:05. > :03:08.your concerns about the long-term efficacy of treatment. Why are you
:03:08. > :03:17.saying that now more than ever before it is necessary to find a
:03:17. > :03:20.cure? Why is it so necessary? First of all I will not say that it
:03:20. > :03:24.is because of a lack of long-term efficacy of the treatment, because
:03:24. > :03:34.the treatment we have today it is a good treatment. We know that we can
:03:34. > :03:38.reduce the mortality by 90%. It is not a bad treatment at all. The
:03:38. > :03:43.reason why we are pushing for a cure is because we know that it is
:03:43. > :03:51.a lifelong treatment. We know that it is of course very difficult for
:03:51. > :03:54.access, universal access to treatment, for everybody. We know
:03:54. > :04:01.as well that there is a small proportion of patients that on
:04:01. > :04:08.long-term treatment are developing complications. That means that we
:04:08. > :04:14.need to have new tools for the future. We have wonderful treatment
:04:14. > :04:17.that is efficient today. Presumably there is also a danger
:04:17. > :04:21.with the treatment, because it is something that people have to take
:04:21. > :04:25.every single day for the rest of their lives. If they cannot do that
:04:25. > :04:30.you could end up with a resistant strain of the virus.
:04:30. > :04:32.That is right. We know that adherence to the treatment is very
:04:32. > :04:35.important otherwise they can develop resistance to treatment,
:04:35. > :04:45.and they can also transmit a resistant form of the virus to
:04:45. > :04:48.
:04:48. > :04:53.others. Of course this is a problem. But mostly, the current treatment
:04:53. > :04:56.is very efficient. Is there a danger if you find a
:04:56. > :04:59.cure, though, that it will mean people will be less concerned about
:04:59. > :05:06.preventing getting the disease in the first place?
:05:06. > :05:13.If we have new tools for a cure... Maybe we should define 'cure' first.
:05:13. > :05:18.'Cure' means that you totally eliminate the virus from the body.
:05:18. > :05:24.But there is another definition of cure. It is what we call functional
:05:24. > :05:32.cure. That means that you control persistently the infection without
:05:32. > :05:37.total elimination of the virus on the body.
:05:37. > :05:46.Forgive me for interrupting. The effects could mean that people will
:05:46. > :05:56.revert to the sort of behaviour that help spread the disease. Using
:05:56. > :05:59.
:05:59. > :06:02.condoms for example. That was difficult to get people to use them.
:06:02. > :06:05.If people can control by themselves their infec their infecey
:06:05. > :06:11.will not transmit to others. We know that already. We know that
:06:11. > :06:14.with the actual treatment. We know that treatment is also prevention.
:06:15. > :06:22.We know that if we are efficiently controlling the virus in the body,
:06:22. > :06:26.then the virus is not transmitted to others. Imagine the future.
:06:26. > :06:30.Imagine that we have a treatment that the patient can stop, but they
:06:31. > :06:35.keep their virus under control. They will not transmit to others
:06:35. > :06:38.anymore. Understood, but do you not fear
:06:38. > :06:41.that people will become less responsible about the way in which
:06:41. > :06:47.they have sexual relations, the way in which they use intravenous
:06:47. > :06:55.drugs? I mean, of course there is always
:06:55. > :06:58.education, counselling, and that will be a continuing effort. It is
:06:59. > :07:05.part of the prevention. It is part of education. That should remain
:07:05. > :07:09.forever. Let me ask you to explain a little
:07:09. > :07:13.bit, take me through gently if you will, but a little bit about the
:07:13. > :07:16.science of how this cure might work. From what I understand it involves
:07:16. > :07:23.interfering with some protein in the cell which is an entry point
:07:23. > :07:27.for the virus. Is that correct? It is one target. It is not the
:07:27. > :07:30.only one. Of course, the fact that the current treatment we have
:07:30. > :07:40.cannot be stopped and is lifelong is because the virus remains
:07:40. > :07:45.
:07:45. > :07:48.dormant in some cells of the immune system. What you are mentioning is
:07:48. > :07:56.one of the approaches, to reactivate the dormant virus from
:07:56. > :08:06.these cells. We have already some data indicating that probably will
:08:06. > :08:07.
:08:07. > :08:12.not be sufficient. You also have to probably stimulate the immune
:08:12. > :08:22.that reactivates the virus from the dormant cells with a kind of
:08:22. > :08:25.
:08:25. > :08:35.vaccination. And you need to eliminate immediately the
:08:35. > :08:37.
:08:37. > :08:42.reactivated cells. Isn't this a form of gene therapy?
:08:42. > :08:52.If it is, I realise I am probably using a shorthand, but if it is, I
:08:52. > :08:56.
:08:56. > :09:00.am just wondering how far can that be scaled up? Gene therapy is
:09:00. > :09:03.labour intensive. It is expensive. It is difficult to see it being
:09:03. > :09:08.rolled out across the world. Gene therapy is one approach, but
:09:08. > :09:11.not the only one. For example, there is also the approaches that
:09:11. > :09:16.are already ongoing, like using drugs targeting some of the enzymes
:09:16. > :09:24.that explain why the virus remains dormant. That is not gene therapy
:09:24. > :09:28.at all. It is just using a drug. Do you fear that in this search, in
:09:28. > :09:38.the push to find a cure, that you could end up diverting money away
:09:38. > :09:41.
:09:41. > :09:43.from more established ways of tackling the disease?
:09:43. > :09:48.Certainly that is not the goal at all.
:09:48. > :09:51.I realise that. But is that not a concern given that money is tight?
:09:51. > :10:00.People know that there is a certain amount of money for AIDS research.
:10:00. > :10:05.It could leave other people exposed. The idea is to try to have
:10:05. > :10:13.investment of both. We as a group of researchers are trying to
:10:13. > :10:19.accelerate research on HIV cure. Investment for current access to
:10:19. > :10:29.care, of prevention and treatment should continue. Research for a
:10:29. > :10:37.vaccine should continue. Indeed, a vaccine might be part of the cure.
:10:37. > :10:40.So we need to continue to invest in both. The treatment that we have
:10:40. > :10:50.today is short, middle term approach to try to control the
:10:50. > :10:55.
:10:55. > :10:59.infection. We are thinking about the future.
:10:59. > :11:03.What do you say to those people who say, as it is, AIDS research gets
:11:03. > :11:11.basically too much money? There is too much money for this disease
:11:11. > :11:21.when there are other diseases out there not being dealt with.
:11:21. > :11:31.
:11:31. > :11:34.HIV is a virus that attacks the cells of the immune system. It is
:11:34. > :11:40.also a tool to understand better the immune system and how the
:11:40. > :11:43.immune system functions. Why in that case would somebody
:11:44. > :11:47.like an AIDS expert, somebody like Dr Malcolm Potts from the
:11:47. > :11:55.University of California, say that if we look at data objectively we
:11:55. > :11:59.are spending too much on AIDS? I know this kind of statement from
:11:59. > :12:02.several scientists in the world that are not generally involved in
:12:02. > :12:06.HIV research. Well, he is.
:12:06. > :12:16.I think myself that you have to consider what is the progress that
:12:16. > :12:23.
:12:23. > :12:26.has been made that may be useful for other diseases.
:12:26. > :12:32.But it is not just about high-end science that you are talking about.
:12:32. > :12:34.It is about aid budgets generally. If we think about one-fifth of all
:12:34. > :12:44.global deaths from diarrhoea occur in just three African countries,
:12:44. > :12:45.
:12:45. > :12:48.but they have relatively low HIV prevalence.
:12:48. > :12:52.Yet they get very scant attention from those preventable deaths, but
:12:52. > :12:55.a huge amount of money for their AIDS-related programmes. You can
:12:55. > :13:05.understand why some people say that the AIDS programme completely
:13:05. > :13:06.
:13:06. > :13:13.distorts medical budgets. It is a question of budget for
:13:14. > :13:17.global health. That is not related to science. If you look at the
:13:17. > :13:20.effort that has been made in several countries for HIV/AIDS, we
:13:20. > :13:28.are starting to see the impact on the global health in those
:13:28. > :13:34.countries, not only in the HIV/AIDS field. I agree there is not enough
:13:34. > :13:37.data. I used to say to people, we must have more data and evidence
:13:37. > :13:47.showing that investment that has been made for different diseases
:13:47. > :13:52.
:13:52. > :14:02.and the impact on other diseases. My point is that there is finite
:14:02. > :14:07.
:14:07. > :14:11.amount of money and even more money is set to go. It could end up that
:14:11. > :14:17.money is going into AIDS research and away from other programmes
:14:17. > :14:21.which could possibly prevent more deaths.
:14:21. > :14:24.I do not believe so myself because when we look at the research, one
:14:24. > :14:33.characteristic of HIV is that the virus can induce chronic
:14:33. > :14:35.inflammation. And we are trying to understand chronic inflammation,
:14:35. > :14:44.which is one characteristic of cancer and cardiovascular disease
:14:44. > :14:54.and ageing disease. If we understand better the mechanism of
:14:54. > :14:57.
:14:57. > :15:01.chronic inflammation, we can help other diseases as well. Instead of
:15:01. > :15:11.opposing HIV research or funding I think it will be more intelligent
:15:11. > :15:18.
:15:18. > :15:23.to work together. Especially at a time of economic crisis.
:15:23. > :15:32.We have talked about money. Let's also talk about how people see the
:15:32. > :15:35.disease. You became very upset when the Pope, on his visit to Africa in
:15:35. > :15:38.2009, said that AIDS was a tragedy that could not be overcome by money
:15:38. > :15:42.or the distribution of condoms, which even aggravated the problem.
:15:42. > :15:46.You wrote an open letter to the Pope and he seemed to change his
:15:46. > :15:56.stance slightly after that. To allow for the use of condoms in
:15:56. > :16:01.
:16:01. > :16:09.How do you respond to the apparent shifting? Some changes in his
:16:09. > :16:18.position. Was it an improvement? Certainly not because he mentioned
:16:18. > :16:28.specific circumstances. The original statement was indicating
:16:28. > :16:43.
:16:43. > :16:47.that condoms were not fully demonstrated as efficient.
:16:47. > :16:57.principle point was that the problem about the prevalence of
:16:57. > :17:06.condoms is that it makes, in his words, sexuality banal. If you look
:17:06. > :17:16.at the reality. Myself, I have met nuns and priests working in Africa
:17:16. > :17:19.
:17:19. > :17:24.and Asia. They are facing the reality. They are distributing
:17:24. > :17:31.condoms themselves. The evidence is that you are struggling to win the
:17:31. > :17:34.argument. If we look at a couple of states in the US Utah and Wisconsin
:17:34. > :17:41.- they are considering bringing in a new law which will teach
:17:41. > :17:51.abstinence as the contraceptive to children. Why are you losing the
:17:51. > :17:55.
:17:55. > :18:05.argument in places like that? counselling that is done before and
:18:05. > :18:05.
:18:05. > :18:15.after testing for HIV. All the means you mention - abstinence, or
:18:15. > :18:20.
:18:20. > :18:25.at least education, are part of the counselling given. If people do not
:18:25. > :18:28.have sex they will not contract HIV. But, given that you think it is not
:18:28. > :18:38.the most efficient or the only route, why are you losing the
:18:38. > :18:41.
:18:41. > :18:44.argument in places like Utah and Wisconsin? I am not losing the
:18:44. > :18:54.argument. I say that prevention is a combination of different
:18:54. > :18:57.
:18:57. > :19:07.approaches. Changing behaviour is part of prevention. Condoms and
:19:07. > :19:16.circumcision and treatment are all parts of prevention. Already we
:19:17. > :19:22.know that the combination of tools for prevention are needed. I am not
:19:22. > :19:27.pushing only the condom. Let me take you into an area where you are
:19:27. > :19:35.pushing something quite dramatic - intravenous drug use. You have
:19:35. > :19:45.called for a complete decriminalisation of drug use.
:19:45. > :19:54.
:19:54. > :19:58.That flies in the face of most legislation in the world. There are
:19:58. > :20:05.few politicians who would endorse such a move. I am a scientist so I
:20:05. > :20:15.always take that into consideration. The French government is opposed to
:20:15. > :20:16.
:20:16. > :20:23.the creation of supervised injection centres for drug addicts.
:20:23. > :20:25.Why do you think it would help to have it decriminalised? Research
:20:26. > :20:35.shows that repressive measures do not improve access to care,
:20:36. > :20:47.
:20:47. > :20:57.prevention and treatment for IV drug users. Repressive measures are
:20:57. > :20:57.
:20:57. > :21:00.negative. As a scientist I base my opinion on that. Even if it flies
:21:00. > :21:03.in the face of political orthodoxy, you are willing to go there? It is
:21:04. > :21:10.interesting to hear you talk in this way because you do not just
:21:10. > :21:18.see yourself as a scientist, but also an activist. You use terms
:21:18. > :21:25.which are not scientific, not cool and calculating. You talk about
:21:25. > :21:29.your upset, your fury about your fight for funding, for example. Why
:21:29. > :21:32.in these terms? Because, as a scientist, like many others, I have
:21:32. > :21:42.worked to contribute to the development of truth for the
:21:42. > :21:46.
:21:46. > :21:56.benefit of humanity. Globally. And why I say sometimes that I am
:21:56. > :22:00.
:22:00. > :22:07.furious is because we have to live together today. And when I see that
:22:07. > :22:17.the tools are not available for everyone, that makes me furious.
:22:17. > :22:24.
:22:24. > :22:27.Because they are diverted to the banking crisis? To what? Because of
:22:27. > :22:37.discrimination and stigmatisation of some of the population. That is
:22:37. > :22:38.
:22:38. > :22:41.opposing access to testing and counselling and care and treatment.
:22:41. > :22:51.Because of the restricted funding that limits the access to treatment
:22:51. > :22:54.
:22:54. > :22:57.for everyone. We have seen during the last year that there is all the
:22:57. > :23:07.international affect we have been able to go from 50,000 people on
:23:07. > :23:11.treatment to 7 million people on treatment. How concerned are you
:23:11. > :23:15.that even if the fight against Aids is won that the next pandemic is
:23:15. > :23:23.just around the corner? Especially with the increasing
:23:23. > :23:30.interconnectedness of the world? That can happen but I think we
:23:30. > :23:40.should keep in mind the experience of HIV/Aids. Think of it as a kind
:23:40. > :23:44.
:23:44. > :23:50.of model. In the early 80s we used to say it was a crisis. An
:23:50. > :23:53.emergency. People were dying. has been an emergency for 30 years,
:23:53. > :24:03.and one which you have been involved in. When will we see a
:24:03. > :24:06.
:24:06. > :24:10.cure? I cannot answer this question if I am honest. We do not know.