Forty years after the start of the epidemic, HIV may not seem as pressing an emergency as it did initially. Along with improvements in education and testing, antiretroviral therapy has been a lifesaver for millions of people with the virus. But there is still no cure. At best, HIV-positive patients face a lifetime of managing their viral levels. Meanwhile, many people and communities, both in the U.S. and around the world, lack sufficient access to the support and therapies that do exist. As for the philanthropic sector, support for people with HIV and AIDS has been pretty flat for years.
A recently announced grant from the Bill & Melinda Gates Foundation to accelerate the development of HIV vaccines serves as a reminder that philanthropy could be doing more to combat the disease, which is still a significant threat, not only in distant countries but among many communities and marginalized people across the U.S. In other words, there’s plenty of work yet to be done.
The recent Gates grant will support joint work by scientists at the California Institute of Technology and Absci Corporation, a drug development company based in Washington State that uses artificial intelligence to speed research, in part to discover an affordable HIV vaccine. Despite the efforts of many researchers over the decades, the goal of an effective HIV vaccine or cure has proved to be an elusive biomedical problem. While governments have committed significant sums to research and other efforts to care for those with the virus and to prevent new infections, Gates is one of the few philanthropies to focus on vaccines and cures. Another is the Gilead Foundation, a funder endowed by the pharmaceutical company Gilead Sciences.
The Gates-backed collaboration between Caltech and Absci will leverage expertise in biology, immunology, protein design and AI, among other specialties, to develop a novel approach that aims to both treat and prevent infection from all strains of the virus. Also in focus is the desire to develop lower-cost drugs that can more easily reach people in low and middle-income countries. Current antiretroviral therapies are relatively expensive, and not universally available to people in poorer countries and marginalized communities.
The Gates Foundation has been funding work in this area for years, often with multimillion-dollar, multi-year grants to research institutions and companies, including MIT, Beth Israel and Vir Biotechnology. While the size of the new grant was not immediately available, Gates’ long-term commitment to this tough biomedical problem demonstrates the capacity for philanthropy to stick with research that might not show any immediate signs of bearing fruit. And the partnership with Absci is another sign of rising philanthropic interest in applying artificial intelligence to medical research and pharmaceutical development.
Nevertheless, philanthropy still has a long way to go on this issue. The global HIV/AIDS epidemic has claimed an estimated 40 million lives (maybe as many as 50 million) since 1980. The good news is that governments and public entities have been devoting considerable resources to HIV/AIDS research and to medical care and support for people living with HIV. The less-good news is that philanthropic support represents only about 2% of total funding for HIV, even as many people continue to contract the virus and face significant struggles. This has HIV advocates worried. In addition to the need for research funding for new treatments, there remains considerable unmet need among people with HIV for access to today’s treatments and other forms of support.
“Something like a vaccine can seem very, very far away for somebody living in sub-Saharan Africa [who’s] trying to figure out basic access to health care and support,” said Masen Davis, executive director of Funders Concerned About AIDS (FCAA), which tracks and supports HIV-related grantmaking.
HIV philanthropy totaled about $707 million in 2020, according to FCAA, about the same as the year before. (FCAA publishes regular reports on HIV/AIDS funding; they expect to release an updated report later this year.) In terms of dollars, Davis said that philanthropic giving is roughly split three ways: two-thirds from the Gates and Gilead foundations, and a third from all the other funders combined.
“But the 2% of philanthropic giving for HIV is super-critical, because as you can imagine, a lot of the governmental funding tends to be quite restrictive, and doesn’t always get to local community groups. The philanthropic response is much more likely to move more quickly, and get to populations that governments might not get to,” Davis said.
Many of the smaller-dollar donors in HIV/AIDS philanthropy — that is, not Gates and Gilead — provide support for a range of social and healthcare services. But when it comes to HIV vaccine research, Gates and Gilead are the biggest sources of philanthropic grants, Davis said.
As for potential funders in the U.S. who may feel that HIV is under control — as a result of antiretroviral medicines, preventive pre-exposure medicines like PrEP, improvements in education and so on — advocates warn against bias among people from the coasts and more affluent cities, where such resources are more readily available. Of course, those are also the areas where philanthropists and large grantmaking organizations tend to be based.
Worldwide, at least 70% of new infections involve gay men or men who have sex with men, sex workers, people who use injection drugs and transgender women. And in certain parts of the world, such as sub-Saharan Africa, HIV has become common among women and girls. Meanwhile, in certain parts of the U.S., HIV infection is higher among Black men and women.
“So the epidemic varies depending on where you are and who you’re talking about,” Davis said.
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