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A Shot in the Arm Podcast
HIV: Rethink, Rebuild and Rise Up - With the IAS’ Birgit Poniatowski
00:44:37
Ben talks with Birgit Poniatowski, the Executive Director of the International AIDS Society (IAS), about the role of professional associations in the HIV movement and IAS’s convening power.
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- [00:01]
A
Welcome to A Shot in the Arm podcast. I'm your host, Ben Plumley, and this is a podcast about innovation and equity in global health. Because let's face it, without equity, what is the point of innovation? Well, today we're going to do something we haven't done before, and that's look at, if you like, the professional association side of the HIV movement as it provides such useful insights into broader infectious disease strategies. We see this very clearly, obviously with the hepatitis, but people in the US particularly will have seen the very interesting way in which medical professional organizations in the recent past have been able to influence both a federal court decision about the US Government's vaccine strategy. And a group of medical professional organizations were part of the not so happy conversations with Dr. Oz over gender affirming care for teens. Well, in the HIV movement, we've got something a little bit different, dare I say, a little bit better. What's called the International Aid Society isn't just a group of medical professionals from around the world, although it started had roots in that, but it's made up of nurses, of researchers, anthropologists, communication specialists, patient groups, advocacy groups, politicians, you name it. And to help us navigate the fascinating world of the International Aid Society, which has sort of been a backbone, I think, for all of us as we look at our careers in hiv. And joining me to make sense of this joyful, chaotic circus that we have in the international AIDS movement is the executive director of the International AIDS Society, Birgit Poniatowski. Birgit, welcome to A Shot in the Arm podcast.
- [02:08]
B
Thank you so much for having me, Ben. It's my pleasure.
- [02:12]
A
Now, did I get a sort of a general, slightly cheeky description of the ias, sort of broadly right?
- [02:21]
B
You absolutely did. The IIS has been around for quite a while. It was established in 1988 by initially, as you rightly said, scientists who were concerned about the emerging and growing epidemic slash pandemic of HIV and felt that only concerted coordinated action and collaboration would make a response possible. Today we have about 13,000 members who are individuals, as you said, from all walks of the HIV response one's life, and very importantly including people living with and affected by HIV as equal members as well.
- [03:01]
A
A key feature of what the IAS does is convening power. Right. And we'll have one major conference standing over us like it always does. But before that, could you just let us know the range of conferences that the IAS now convenes?
- [03:20]
B
Absolutely. And I'll start not with a very big one. I'll Start with a medium sized one, which is the IAS Conference on HIV Science. That is a conference with usually between five and seven thousand participants that takes place in the odd years. And it's very much focused on innovation, on latest evidence across the various areas of science, from basic through clinical epidemiology, prevention science, social and behavioral sciences. The news coming out of this conference are new discoveries in HIV science really mostly most of the time. Now the international AIDS conference which takes place in the even years is significantly larger, between 7 and 10,000 participants. At its core it is like the IAS science conference. There is strong science across all areas of scientific discovery, but added to that is a very additional, a very strong additional focus on policy, on shifting evidence into service delivery on the ground, but also advocacy. And not to forget, because of its size and the very broad range of attendees, it also saves a purpose for all of us who work on HIV to keep the issue on the agenda because it does have significant media attention each time around. And then shifting from the biggest to the smallest. For a few years now, we've also been organizing what is called HIV research for prevention, that is a conference with about 1500 participants clearly focused on this crucial area of HIV prevention science. So those are the three regular conferences that we organize.
- [05:11]
A
And the smallest one gets a lot of attention on this podcast because my co host, Yvette Raphael, of course is deeply involved in the African HIV prevention strategy. But let's talk about the big, big conference. So you're saying up to 10,000. At one point it was even 25,000 in person, if I recall. But the biannual even years global AIDS conference, you love it or you hate it in that it brings thousands and thousands of people together. And for the week of the conference you simply don't sleep. And I can only imagine how little sleep you must get in that week and perhaps the weeks in advance. But the conference is unique as a marker. You think of 1996 in Vancouver, which was my second conference and we had the promise of the HIV treatment cocktails. It was announced there. It was a huge moment. And then you think there was the Geneva conference in between. But then you go to Durban in 2000 and that is when the world turns its attention away. You know, medical conferences just don't do, but turned their attention to the discrepancy and the disparity between what was becoming available in the global north, but the gaps in the global South. So both from a professional perspective, but also a personal perspective. Birgit, how important is this conference to You.
- [06:54]
B
The International AIDS Conference, as I said earlier, is important because it galvanizes attention on the issue. We organize it regularly. Everybody involved in the HIV response knows that and works towards it, be it the WHO with preparing new guidelines to be launched at the conferences, various civil society partners with their activities, other policies and science you know, are prepared, made ready for the moment the conference happens to be announced, launched there, where all the key stakeholders are united and where public attention is strong. And I think it's this interplay. It's not just us putting a conference together and it's definitely not just the IAS that guarantees that there's this attention. What we provide is the platform and all our partners utilize it to the maximum. I think this interplay makes the conference so important.
- [08:02]
A
Before coming onto the conference that we have this year, just some general observations and feedback that comes my way about the conference and I'd be interested in your thoughts. Now. This meme is completely wrong. I don't agree with it, but the idea is that with so much disruption to funding in hiv, how on earth can we afford an international conference, even an international conference in the Global South? My sort of firm response to this is no, there's any year that we needed the World AIDS conference. It is 2026. We have got to start getting our act together collectively after a year of, of essentially thunder and lightning thrown at us, funding cut strategies, cut approaches to development aid fundamentally transformed. So I think it's extremely important. But how do you answer it when folks ask you that question?
- [09:07]
B
Pretty much along the same lines, because it's time and many actors do there to shift out of crisis mode and focus squarely on the way forward. And the conference this summer will be the platform to do exactly that. It's not that. Only in Rio in July will everybody start thinking about it. That is not the case. We had the IH conference on HIV science in Kigali, Rwanda last year, and it was already so tangible. We had a very strong African participation there. And people must look forward and find ways to make do with what they have and reach their goals with what they have. And that drive was already very apparent in Kigali, and I am convinced we'll see more of that in leo. But HIV is not a disease that affects one country only. It affects the entire world. And the response can only be a joint one, a coordinated one as well. And that's why platforms, gatherings, convenings like the International AIDS Conference, I firmly believe are worth the investment.
- [10:17]
A
It is now the conference made its way through Covid and there was going to be one of the major conferences in San Francisco and Oakland. And it ended up being a virtual conference which I navigated empty halls for meetings I wanted to go to. I felt a bit like Nobby no Friends. But those were the early days. But it's become quite sophisticated. And yes, the 2026 conference that will be held in person in Rio de Janeiro in Brazil is also going to be accessible virtually. Have you found that the sort of digitization of conference attending has been something that plays well to an HIV audience?
- [11:10]
B
Obviously in 2020 we had to shift fully, virtually right away because there was no other option because canceling the conference entirely for us was out of the question because there was so much sites out there and so many things happening that we needed this convening space. So there was clear. And then from 2022 onwards, we organized the conferences in a hybrid format. There was a big pickup on virtual participation in 2020, but then it came down in 23, in 2024. Because one thing you cannot replicate in a virtual platform is the in person networking. It just does not work. And all those tools that are available in these applications, they just don't work the same way as walking a corridor, bumping into somebody and coming up with a new project. So we saw the decline and we had actually already, for Kigali planned to have a smaller virtual offering. But then with all the funding cuts happening, we felt there will be a lot of people who won't have the resources to travel or the permission we need to have the full virtual offer. And so we reinstated that and we are maintaining this for Rio as well. It's a great way for people who want to, who want the immediate access to the content that's delivered at the conference. And to maybe pose a question, yeah,
- [12:37]
A
it's not a surprise, is it? I think if there is, if there's one thing that really, really stands out from the conferences, besides of course, the presentations and posters, is the networking. And I know this happens to you in a way it's still happening to me after all these years. Feels a bit like a Comic Con event. As you walk down the main corridor, you are stopped by everybody. And it is both a very powerful reminder of how global the epidemic is, but also how global the response is that we, you know, we do know trials being conducted in Uganda and Tanzania and we, you know, we do know the state of the HIV response and community led response in Ukraine and it all comes together so well. But how long does it take you to get down A corridor?
- [13:36]
B
Yeah, that depends. But I do tend to plan on more than five minutes to get from one meeting to another.
- [13:43]
A
Yeah, it's a challenge. It's a challenge. So a bit about AIDS 2026. It's being held in Rio de Janeiro. What's the theme this year?
- [13:56]
B
So the theme this year is Rethink, Rebuild, Rise,
- [14:03]
A
which is a very short sort of almost a tiny little poem of what we need to do in the AIDS move after 2025. The rethink, rebuild and rise strategy has. It's also bigger than the conference, isn't it? You've been advocating and using it as a communications vehicle.
- [14:33]
B
Yes, because we think, we are totally convinced that this is exactly what we need right now. We need to rethink the way we do things. We need to rebuild the service delivery systems because some of these have been destroyed in countries as a result of the funding. We need to rebuild in a way that is fit for purpose in the longer term. And obviously as a movement we need to rise and keep rising to make all this happen.
- [15:07]
A
I've been really interested in the way particularly American stakeholders in HIV are beginning to try and look at how to accommodate the new strategies coming, particularly from the United States. But it's not just the United States. Traditional donors are not stepping up in HIV as they used to do. And I just wonder how, because if we're being really honest about it, we have the us, maybe Hungary, occasionally North Korea and the world when it comes to science. And so you need to respect the investments that are still being made from this major donor, the United States. But at the same time, how do you give parity and attention when some of those priorities perhaps no longer align with the kind of evidence and science based strategies that we have built over all these years.
- [16:04]
B
We of course please that certain bilateral investments are still being made by the US Government. We are not pleased by the way the transactional nature of these agreements are memorandum of understanding that link some aspects that have nothing to do with HIV or public health in a transactional way into this. I mean, you may have seen the article in the New York Times this morning talking about negotiations on an MoU Zambia where now access to critical minerals is used as leverage with this fact of not concluding an MOU in the end. So this we are very worried about. We are also very worried about the way that communities are totally left out of the framing of these, of these MOUs. So it's a difficult time and it's such a difficult time for countries as well.
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A
Yeah.
- [17:02]
B
To set their own priorities, to be able to pursue their own priorities in this, yeah, very difficult funding context. Overall, of course, we want every country to own their own response both in terms of what it looks like and, and how it's funded. But not every country is immediately in the position to do that. And we need to remember that these funding cuts last year that came abruptly, there was no transition.
- [17:35]
A
Well, you captured it very succinctly and I think it was the abruptness particularly that was so damaging and frankly unnecessary. I'll add that New York Times article about what's going on in Zambia in the show notes yet more brilliant reporting from Stephanie Nolan. Really great. And it highlights something that we really haven't seen before or we haven't seen since Classic Theodore Roosevelt gumboat diplomacy by the United States. Now, okay, Zambia is landlocked. But, but with the idea that you can bully a country into accepting a lower PEPFAR contribution in exchange for, you rightly said, transactional economic benefits, suddenly access to the copper belt where the US has reduced its interest significantly over the years, both parties and then these terrible, I mean, I just don't know what were they thinking. The idea that you would say in order to receive this money, you also need to give us information about patients and pathogens. And in regards to pathogens, you'll just get in the queue to access any biotechnological or cure benefit that comes from those, from investigating those pathogens to just get in the queue like anybody else. And I think it's a 19th century bullying approach and I don't know how we try and accommodate ourselves with that. I just don't think it's possible.
- [19:15]
B
Accommodate? No. Definitely accept. No. Well, I'm a glass half full sort of person, so in these times that's good for my sanity. Yes, the US Are powerful and they could do a lot of good. They also can do a lot of damage. I'm sure we agree, we all agree on that. But they're not the only players out there and that's what I'm setting my hopes in. Also, the current US Government isn't all of US policymaking. I do know that there is another radar work going on within Congress as well because otherwise there wouldn't have been the funding for bimultilateral cooperation that was approved this year because it was certainly not because Trump wanted that. It was because it went through, it came through the Congress. So there are powers and actors that make me hopeful, let's put it that way, and who we are more than happy and are working with as well.
- [20:26]
A
Well, I guess Birgit, you have to be glass half full leading a conference that comes into a town for, you know, about what, 15 days in total, setting up pre conferences, conference itself. I just know that from my perspective it has always been a central place to your advocacy, whether it was the Global Business Coalition, whether it was some of the private sector work I've done or when we were at Pangea. And in fact I think since 2020 the podcast has always been at the conference doing dailies, both projecting the advances that IES describes very helpfully but also, you know, as it were in the corridors, finding out the scoop. It's exhausting but hugely motivating. And I guess this year we're really going to see the experiences that Zambia, Zimbabwe, Kenya, some of these other countries that haven't yet signed their MOUs are, are experiencing. Do you think there will be sort of dedicated sessions where we'll be getting feedback either from communities or from the governments themselves?
- [21:41]
B
Absolutely. These will be across the program. We are also planning a special session. There's no competing other session going on that looks at financing and equity. Can't go into the details yet because they are still being confirmed, but definitely very high, very high on the agenda across the program.
- [22:01]
A
Yeah. And I imagine long acting biomedical interventions, the injections that can be used both for treatment and prevention will feature very heavily from the scientific perspective at the conference.
- [22:14]
B
Yes, yes, there will be further trial results that we're expecting at the conference. There will also be a lot of both science and policy discussions around access because access is, is crucial. But let me say as efficacious, as long acting lenacapavir and potentially other, you know, other long acting prevention options are, they will not be the one solution to getting incidents under control. It will need to be the whole toolbox of HIV prevention. Because a, a shot every six months or maybe later on every year will not work for everybody. Not everybody may want to choose this option. So others need to be available. And also there are issues around cost but also the services and systems required to offer the different options. And countries will need to look at that very carefully. Condoms are not out of the picture. Daily oral crack is not out of the picture. Neither is the delivery in ring. So this, the prevention discussion needs to remain broad and not zoom in on one technology only of which we don't know whether it will be accessible to everybody. We should have access.
- [23:44]
A
Yeah. How many times over the last 30 years have we had silver bullets suddenly appearing and then disappearing? It does sort of Raise a question, Birgit? I think on how, well, how extensive the reach of US Funding is because NIH early investments in Lena Caprevir, obviously, many of the implementation challenges, you know, research and implementation into those things have been so heavily funded by the U.S. have you been surprised just how reliant the AIDS movement has been on the United States?
- [24:31]
B
No, not really, because it was clear. It was clear definitely in research funding, there's nih, and then for certain aspects of HIV science like vaccines, vaccines and the cure, there's also the Gates Foundation. But Europe, other countries and regions fall far behind and stayed idle because they knew the US Was funding. So we knew this. It was not a surprise.
- [25:02]
A
So you're right about the failures of the Europeans to step up. But in this new era, the one European country that seems really interesting, both from a leadership perspective and although the funding is still very, very small, also from a funding perspective, and that's Germany. And if you look around the global AIDS response, there are a few Germans that are really well placed. The person we love to death, Christoph Benn, who, you know, connects the WHO to the Global Fund, to the Europeans at the European Commission level, but is rooted in Germany. Christine Stegling, one of the deputies of unaids, and she's now based actually in Bonn, but looking at how to engage communities over the long term. And then you, you know, you've come into the ias, International Aid Society. It's not the easiest organization to manage. And if there's one thing about our history, and I won't press you on it, but it is that we've had an interesting range and sometimes quite a frequent range of executive directors. But you've sort of, if you don't mind my saying, you've put a sort of a firmness and a calmness into the organization and its priorities. You don't do all things for all people, but it is very much focused on utilizing the convenings. So, you know, on the one hand, I took my cap to you, all credit to you for that. But I think also when you came into ias, how much change did you need to bring in to make it fit for purpose?
- [26:54]
B
Well, first of all, thank you for, for the praise, which I don't know whether it's warranted, but thank you so much. Well, I've been in my current role since 2020, so right smack in the middle of COVID and obviously we had to adjust and adapt in many ways. One of these was we had already started a process to rethink how we organize our Conferences before COVID hit and then finish that with learnings from COVID And one of the biggest changes we made that I helped shape and then that implemented is to bring communities, civil society into a regular decision making role around the conferences at the IAS as well, not per conference, but to have a group that is involved that helps us choose locations, that helps make sure that themes kind of flow through the different conferences we organize. And I think that that has brought us and then also myself a lot in a lot closer working relationship with our community partners as well. We've also over the years been able to sharpen our strategic focus and to as you said, not be everything to everybody. Although I have to say the conferences will remain that the conferences remain the platforms that we provide for people to raise any issue, discuss any topic related to the HIV response. But in addition to that, as you know, we don't only organize conferences, we utilize our convening power also to push agendas in certain areas and our priorities for 2026 onwards. Now explain later where I'm saying onwards are the sustainability of the response, prevention at scale, person centered and stigma free services and continuous scientific innovation. And these are the four priorities that we will put a particular emphasis on and effort into as the IES. Now why do we call our strategy 2026 onwards? Because we're not going to be done by 2030 and it was already clear a few years ago that we won't reach the targets by 2030 and we decided we'll just protect. Stop pretending we won't.
- [29:30]
A
Amen sister. I think that's really important and actually I'll just take the opportunity to dangle a bit of a heads up about a new initiative I'm doing looking at the longer term AIDS response over the next few decades. And I'm going to be using the AIDS conferences going into the future as a hook for some of this work. So I'll follow up with you separately about that. But everyone, just a little teaser of something coming around the corner. It's a good moment to sort of pause on the advocacy strategy around Rethink, Rebuild and rise, obviously theme of the conference, theme of a major component of your work. Now I had some moments reflecting on the use of Rebuild. There's an element of us needing to reclaim the scientific leadership we've always been at the forefront of being targeted by carpet baggers and fake science and snake oil sellers. I wonder as well how we embrace this idea that there will be no return to business as usual. Getting the CDC and the NIH back to what they were on 20 January 2025 is a long term investment.
- [31:06]
B
A long term advocacy investment, you probably mean. Yeah, I don't believe there will be a moment when everything will be as it was on the 24th of January last year. That's not going to be the case. So when we talk about and think about rebuild, it is making whatever system we talk about that's required in the HIV response and this goes from the community outreach in country to the way science is conducted and funded based in the current realities, obviously with an element of optimism in there, but fit for the longer term purpose because otherwise just to look back and wait for things to return to the past is not going to happen. And I think most people have, have gone through that curve of grief, right, and are now thinking about what the, what the way ahead is. When I was at the Croix Conference in San Francisco last year, it was all grief that was clear. It was in February, but orade in Qigali, you know, we were shifting out and this for me to say rebuild means looking ahead and reshape. Maybe we could have said that. But now we are way too far into the campaign. We're not going to change it now.
- [32:33]
A
We're ahead of it and it gets the conversation going, which is good. And I think the other part of it is that folk like you and me, who in previous generations after the Second World War might well have had very illustrious high level careers in global health, sort of have to, and it's true for everybody in the global health movement, have to step aside to some degree so that the leaders, particularly in Africa, who are more than competent, who are more than scientifically literate from an implementation side, have lessons to teach. You know, some of the poorest sections of San Francisco, frankly, just how you see the ies sort of helping, well, helping the old guard, but also bringing the new guard to the forefront so that we are truly being led by people at the forefront of the epidemic.
- [33:36]
B
From our side we do a bit for I think it was ever since 2016, so 10 years anniversary, we've been running a program for young leaders at our conference used to be called Youth Ambassadors. Now they're the young leaders. And here we talk about young scientists, we talk about program implementers, advocates, who we offer a curated program of learning and engagement at the conference too. And over the years the participants in this program, they have come back in different roles and some of them have ended up on our governing council, which is our strategic advisory body. Some of them have been plenary speakers at the conferences. So that's the little contribution we can make to nurture the next generation of yum leaders. And across all our the conference program, we made sure that it's not the well known names always who get to deliver the big speeches because there are younger people, emerging leaders as well who have a lot to say and can say it well. So we are drawing out our networks, not least our young leaders network, to identify people and give them a stage and give them the opportunity to connect. But we can't do this alone. Others need to do that, need to do that as well. But that's our oh card here.
- [35:09]
A
And if any of them would like to do a podcast with a wide global reach, they are most welcome. So we should again, that's something we can follow up on.
- [35:18]
B
Absolutely, absolutely. We can suggest people.
- [35:21]
A
Yeah. So we're coming to the top of the hour, but there's one question I've really been wanting to ask you. What's your journey? How did you come to work in global development?
- [35:35]
B
Right. It was not a straight path. So after university I first worked in public policy in Germany, then had an opportunity, kind of building on that to join the United nations system at the UN University in Tokyo. And there I started being exposed to global health issues as well during the six years I was there. And my interest just kind of naturally grew. Then after that I worked for the Global Fund in Geneva. And while I had been exposed to HIV before, and maybe this is a little anecdote on the side, we're talking here about 2000, 2001 when I was in Tokyo, we had a training program for young scientists from different resource limited settings to go to India for training. And then I find out that India was testing people for HIV upon entry. So with really no background, I felt I need to come up with some sort of a policy support system system for our fellows to not go unprepared. So I looked around and in the end, you know, we told people that they, if they wish to, they can get tested beforehand. They make whatever decision they make, at least they going knowingly. So that's a long time ago. So anyway, I then worked at the, at the Global Fund and in, in Board Relations. So I got to know and understand the HIV community a lot better and was just amazed by the way the different actors as well as they can fight with each other. When push comes to shove, everybody pulls in one direction. I did not find that when I was working in global health, but in nutrition for a number of years thereafter. Another very important, a really important global health topic. But the sector, the community just doesn't come together like that. And then I was very, very happy when the opportunity came to join the International Aid Society. And I have no regrets.
- [37:59]
A
Yeah, well, I don't think the movement has any regrets either. So you really do get. We're coming up to the top of the hour, as I said. But I think you really do get a good sense of the people we meet by the music they listen to. And do you have any favorite song going around your head at the moment?
- [38:22]
B
Oh, I have my four bags. Very old school. I would turn on Peter Gabriel or David Bowie or Patti Smith. But I also really enjoy a Korean jazz singer. Her name is Yoon Son Naomi. I can only recommend the Voice, the music. Excellent. That's what I put on when I come home from work in the evening.
- [38:48]
A
Oh, lovely. Well, I'm still mourning for the loss of Anna R. From Rosenstoltz who passed last year. So Rosenstoltz is at the top of my playlist at the moment. But. Well, look, Birgit, is there anything that we've missed, anything that you think are viewers and listeners would find useful?
- [39:14]
B
I think think about it. With all the negative things that are happening around that remind yourself of the positive things that are out there and in our space. It is the power of communities. And by this I mean science, policy, advocacy, everybody coming together and actually accomplishing change. And that has been the case and is the case and will continue to be the case. And for me, this is very important to not forget because that's what gives us hope. But realistic hope.
- [39:56]
A
Yeah. And we can't come to riot in a state of grief. We have to be forward and action oriented.
- [40:05]
B
Exactly. Because we will get it done.
- [40:08]
A
Yeah, absolutely we will.
- [40:10]
B
Yeah.
- [40:11]
A
Well, great. So much for us being really hip, happening now kind of people that get all the information about Rio 2026 up and about. I should have asked you this at the beginning, but if people want to learn more about about the conference, how they can help, how potentially they could volunteer or be a part of. How do they go about doing it? Where can they go for information?
- [40:36]
B
Well, all the information is available on our website. So that's the easiest way to understand how the program works, what the opportunities for engagement are on that we will be opening volunteer applications. I believe it's the this week or you know, in the next week. We always need volunteers to help us run the conference. So if you're interested in doing that and have the. The means or are to come to Brazil or are based there. Please have a look and see if this is something that could be interesting for you. So the website follow us on social media. But that's don't just look and feel, follow. You can also be engaged. Join our movement and let us know what we think Rebuild Rise need to you. We'd love to hear that.
- [41:30]
A
Lovely. Thank you. Birgit. What a great call to action to wrap the podcast up. Yeah, I'll let you get back. You've only got a few months before the conference is upon us.
- [41:42]
B
Oh yeah.
- [41:43]
A
But thank you for giving us your time today. Really appreciate it.
- [41:48]
B
Thank you, Ben. Thank you so much for giving me the opportunity.
- [41:53]
A
Well, that's it for this episode. Thank you to Birgit for a comprehensive conversation. Thanks also to Sophia and Teddy from her team in getting the podcast organized quickly and easily. Thanks to Eric Espera, our director and producer of News Doc Media Media. And finally, a big thanks to you. Now you know of course that you can subscribe and like wherever you download your audio podcasts. But did you know that we are on YouTube as well with our video recordings of the channels of our podcasts. The channel covers all five years of the conversations that we've had. So check it out and as they say, hit that subscribe button and give us five stars. So with that, I wish you a great week and a safe week, everyone.