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Walter Armstrong Walter Armstrong

AIDS Progress Is a Casualty of the Downing of Flight MH17

Leading researchers, officials and advocates were killed in the disaster, including Dr. Joep Lange, a veteran advocate for IV drug users worldwide

3 Substance

The international AIDS community is mourning the deaths of reportedly as few as seven to as many as 100 activists, researchers, policy makers and others in Thursday’s downing of Malaysia Flight 17 over eastern Ukraine. (Malaysia Airlines had not released the manifest as of Friday a 3:30 pm EST.) Their comrades were flying from Amsterdam to Kuala Lumpur and then on to Melbourne, Australia, to attend the 2014 International Conference on AIDS. The conference has been the premier AIDS gathering since the start of the epidemic in 1981, bringing together leaders of every AIDS constituency on every continent to share good and bad news in every field, from science and medicine to policy and politics.

The estimated 20,000 participants are getting bad news of a completely unexpected kind as they arrive in Melbourne for the confab set to start on Sunday. Among the victims of the MH17 crash, which is widely thought to have been caused by a surface-to-air missile fired by Russian-backed Ukrainian separatists, was Dr. Joep Lange, a towering figure in AIDS advocacy and research. He was 59.

“There’s a huge feeling of sadness here, people are in floods of tears in the corridors,” Dr. Clive Aspin, a veteran HIV researcher told Guardian Australia. “These people were the best and the brightest, the ones who had dedicated their whole careers to fighting this terrible virus. It’s devastating.”

Joep Lange began working in AIDS in 1983, a time when AIDS stigma was fierce because the vast majority of people with the disease were gay men, IV drug users, sex workers and hemophiliacs. In Lange stigmatized people found a fierce supporter who pioneered some of the most innovative solutions to some of the epidemic’s most intractable problems.

Most notably, Lange was at the forefront of the treatment-as-prevention movement—the use of HIV drugs to stop HIV transmission to the uninfected. He led studies among African women proving that mothers with HIV could protect their child from the virus during pregnancy, birth and breast-feeding, slashing the infection rate to a mere 1%. Lange announced his findings at the 2003 International AIDS Conference in Paris.

Soon Lange was spearheading global studies into pre-exposure prophylaxis, or PrEP, expanding the treatment-as-prevention principle to people at high risk of infection, including the millions of IV drug users around the world. Many in the AIDS community criticized Lange, calling PrEP a waste of scarce resources and arguing that condoms and needle exchange were good enough for the uninfected, even though condom use was inconsistent and clean needle access limited.

The first study in injection drug users was launched in 2006 by HIV-NAT (HIV Netherlands Australia Thailand Research Collaboration),  which Lange had cofounded in 1996 to promote the inclusion of Thailand’s many injection drug users, sex workers and men who have sex with men in global HIV clinical trials.

As Lange had predicted, PrEP is now recognized as highly effective, with a 92% success rate in general and a 99% success rate among people who are able to take the pill every day. Both the Centers for Disease Control and the World Health Organization recently endorsed PrEP as the standard for HIV prevention. If the price of PrEP can be cut to make it affordable to most people at high risk, it promises to be the most significant innovation in HIV prevention since the start of the epidemic.

In addition to HIV-NET, Lange also founded the PharmAccess Foundation in 2000, which develops innovative public/private funding to increase access to HIV drugs to people in poor nations. He also served in the early aughts as the president of the International AIDS Society, which organizes the International AIDS Conference.

Lange was only one of the 100 AIDS experts, officials and advocates who died in the crash on Friday. Onboard the plane were some of the most accomplished first-generation AIDS leaders and some of the most promising from the second generation.

“This will have ramifications globally because whenever you lose a leader in any field, it has an impact. That knowledge is irreplaceable,” Dr. Richard Boyd, as Australian HIV researcher, told the Guardian.”We’ve also lost some bright young people who were coming through. It’s a gut-wrenching loss. I was involved in the aftermath of 9/11 in New York and it brings back that level of catastrophe.”

Trevor Stratton, a Canadian HIV researcher, described the ramifications of the loss in the starkest of terms. “There were some really prominent researchers that have been doing this for a very long time and we’re getting close to vaccines and people are talking about cures and the end of AIDS,” he told ABC. “What if the cure for AIDS was on that plane? Really. We don’t know.”