Sleep deprivation increases serotonin 2a receptor response in brain

The serotonin 2A (5-HT2A) receptor is widely distributed in the brain and plays a critical role in perception, cognition and psychosis. It is also responsible for the psychedelic effects of drugs, such as psilocybin (hallucinogenic mushrooms) and LSD. Abnormal 5-HT2A receptor function is associated with psychiatric disorders, including schizophrenia. The leading class of antipsychotic drugs used to treat schizophrenia targets 5-HT2A receptors to reduce symptoms of hallucinations and impaired cognition.
A study led by Amelia Gallitano, MD, PhD, professor in the Department of Basic Medical Sciences and Psychiatry at the University of Arizona College of Medicine — Phoenix, found that an environmental stressor, sleep deprivation, can significantly increase the levels of serotonin 2A neurotransmitter receptors in 6 to 8 hoursin animal models. For individuals with schizophrenia, these findings suggest environmental stressors may alter the balance in brain receptors that are controlled by antipsychotic drugs.
“Our study shows it is possible for environmental stimuli to change the levels of receptors that have important roles in the brain — in a matter of hours,” said Gallitano, whose labfocuses on investigating the interaction of environmental stress and genetic predisposition in the development of psychiatric illnesses. “Now we think we know the mechanism through which this happens; it’s through the gene EGR3.
Signaling Mechanism
The role of 5-HT2A receptors in controlling one’s ability to understand and process information has been extensively studied. However, the signaling process that regulates this gene expression has remained poorly understood – until now.
Receptor proteins on the surface of brain cells control the internal communication network of the brain. These receptors are created when a gene (a region of DNA) is turned on and produces the instructions (messenger RNA) that the cell uses to create the protein, in this case the 5-HT2A receptor. How many of the receptors are made, and present on the cell surface, determines how the brain cell responds to the neurotransmitter serotonin, and also to drugs that bind to the receptor, such as antipsychotics, LSD and psilocybin.

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Ketamine and psychological therapy helped severe alcoholics abstain for longer in trial

People with severe alcohol disorder were able to stay off alcohol for longer when they were treated with low doses of ketamine combined with psychological therapy in a clinical trial.
The Ketamine for reduction of Alcohol Relapse (KARE) trial was led by the University of Exeter and funded by the Medical Research Council.
The phase II trial is the first of its kind to examine whether a low dose of ketamine could help prevent people from quickly returning to heavy drinking after stopping, when combined with therapy.
A biotech company AWAKN Life Sciences has licensed the therapy from University of Exeter to use in their clinics and partnerships. University of Exeter and Awakn have also signed an agreement with Devon Partnership NHS Trust to explore NHS readiness for ketamine-assisted psychotherapy.
The trial followed preliminary evidence that controlled ketamine therapy can reduce the numbers of alcoholics who relapse. Currently, few effective treatments exist for severe alcoholism, which has a devastating impact on lives. The KARE trial was the first trial to compare ketamine with and without therapy in any mental health context.
Published in The American Journal of Psychiatry, the study included 96 people with alcohol problems who were abstinent at the time of the trial. The team found that people who had ketamine combined with therapy stayed completely sober for 162 of 180 days in the six month follow-up period, representing 87 per cent abstinence. This was significantly higher than any of the other groups, indicating that the therapy may also have promise for preventing relapse. This group was more than 2.5 times more likely to stay completely abstinent at the end of the trial than those on placebo.

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Breastfeeding reduces mothers’ cardiovascular disease risk

Women who breastfed were less likely to develop heart disease or a stroke, or die from cardiovascular disease than women who did not breastfeed, according to a meta-analysis published today in a pregnancy spotlight issue of the Journal of the American Heart Association (JAHA), an open access, peer-reviewed journal of the American Heart Association.
The special issue, JAHA Spotlight on Pregnancy and Its Impact on Maternal and Offspring Cardiovascular Health, includes about a dozen research articles exploring various cardiovascular considerations during pregnancy for mother and child.
The health benefits of breastfeeding for children are well known. According to the World Health Organization (WHO), it is linked with fewer respiratory infections and lower risk of death from infectious diseases among the children who were breastfed. Breastfeeding also has been linked to maternal health benefits, including lower risk for Type 2 diabetes, ovarian cancer and breast cancer.
“Previous studies have investigated the association between breastfeeding and the risk of cardiovascular disease in the mother; however, the findings were inconsistent on the strength of the association and, specifically, the relationship between different durations of breastfeeding and cardiovascular disease risk. Therefore, it was important to systematically review the available literature and mathematically combine all of the evidence on this topic,” said senior author Peter Willeit, M.D., M.Phil., Ph.D., professor of clinical epidemiology at the Medical University of Innsbruck in Innsbruck, Austria.
Researchers reviewed health information from eight studies conducted between 1986 and 2009 in Australia, China, Norway, Japan and the U.S. and one multinational study.
The review included health records for nearly 1.2 million women (average age 25 at first birth) and analyzed the relationship between breastfeeding and the mother’s individual cardiovascular risk.

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Modular super-enhancer controls retinal development

Enhancers are regions of DNA that do not code for proteins, but control how genes are expressed. Super-enhancers are clusters of enhancers that together regulate genes with important roles in cell identity. Scientists at St. Jude Children’s Research Hospital studied the Vsx2 super-enhancer and its role in the development of the retina. Their assessment showed the super-enhancer has four distinct regions with different functions. This modular super-enhancer provides a way to study gene expression during development. A paper on the work was published today in Nature Communications.
Gene expression is important during development as cells establish their identity and become various cell types with distinct functions. The transcription factor Vsx2 is essential to proper eye development. It is expressed in retinal progenitor cells and found in established bipolar neurons and Mu?ller glia.
For decades, researchers studied Vsx2 to understand how it affects development. Gene function is typically studied by knocking out (removing) the gene and observing what changes. However, when Vsx2 is knocked out, the eye does not form. Researchers cannot study something that does not form, so they needed the ability to fine-tune Vsx2 expression, at different times during retina formation.
“In brain development, important transcription factors, like Vsx2, and many others, are often expressed in different parts of the developing brain at different times but in a precisely orchestrated way,” said corresponding author Michael Dyer, Ph.D., St. Jude Department of Developmental Neurobiology chair and Howard Hughes Medical Institute Investigator. “We wanted to better understand how this complicated dance of expression is controlled where the gene is turned on at one moment in one cell type, then turned off in another and later activated in a different region completely.”
Testing the first modular super-enhancer
A super-enhancer of Vsx2 controls the complex and dynamic pattern of expression involved in retinal development.

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Man gets genetically-modified pig heart in world-first transplant

SharecloseShare pageCopy linkAbout sharingImage source, University of Maryland School of MedicineA US man has become the first person in the world to get a heart transplant from a genetically-modified pig.David Bennett, 57, is doing well three days after the experimental seven-hour procedure in Baltimore, doctors say.The transplant was considered the last hope of saving Mr Bennett’s life, though it is not yet clear what his long-term chances of survival are.”It was either die or do this transplant,” Mr Bennett explained a day before the surgery.”I know it’s a shot in the dark, but it’s my last choice,” he said.Doctors at the University of Maryland Medical Center were granted a special dispensation by the US medical regulator to carry out the procedure, on the basis that Mr Bennett – who has terminal heart disease – would otherwise have died.He had been deemed ineligible for a human transplant, a decision that is often taken by doctors when the patient is in very poor health.The pig used in the transplant had been genetically modified to knock out several genes that would have led to the organ being rejected by Mr Bennett’s body, the AFP news agency reports.For the medical team who carried out the transplant, it marks the culmination of years of research and could change lives around the world.Surgeon Bartley Griffith said the surgery would bring the world “one step closer to solving the organ shortage crisis”. Currently 17 people die every day in the US waiting for a transplant, with more than 100,000 reportedly on the waiting list.GM pigs take step to being organ donorsDr Christine Lau, chair of the Department of Surgery at the University of Maryland School of Medicine, was in the operating theatre during the surgery. “He’s at more of a risk because we require more immunosuppression, slightly different than we would normally do in a human-to-human transplant. How well the patient does from now is, you know, it’s never been done before so we really don’t know,” she told the BBC. “People die all the time on the waiting list, waiting for organs. If we could use genetically engineered pig organs they’d never have to wait, they could basically get an organ as they needed it. “Plus, we wouldn’t have to fly all over the country at night-time to recover organs to put them into recipients,” she added. The possibility of using animal organs for so-called xenotransplantation to meet the demand has long been considered, and using pig heart valves is already common.In October 2021, surgeons in New York announced that they had successfully transplanted a pig’s kidney into a person. At the time, the operation was the most advanced experiment in the field so far.However, the recipient on that occasion was brain dead with no hope of recovery.A glimmer of hope alongside huge risks This watershed moment provides hope of a solution to the chronic shortage of donor human organs. But there is still a long way to go to determine whether giving people animal organs is the way forward. Pig hearts are anatomically similar to human hearts but, understandably, not identical. It’s not ideal, compared to swapping in a human donor heart. But it is possible to plumb them in and get them working.The bigger issue is organ rejection. These pigs are bred to lack genes that can cause rejection. They are cloned with certain genes “knocked out” and reared until they reach an age where their organs are big enough to be harvested for transplantation. It is too soon to know how Mr Bennett will fare with his pig heart. His doctors were clear that the surgery was a gamble. The risks are huge, but so are the potential gains.Mr Bennett, however, is hoping his transplant will allow him to continue with his life. He was bedridden for six weeks leading up to the surgery, and attached to a machine which kept him alive after he was diagnosed with terminal heart disease.This video can not be playedTo play this video you need to enable JavaScript in your browser.”I look forward to getting out of bed after I recover,” he said last week.On Monday, Mr Bennett was reported to be breathing on his own while being carefully monitored.But exactly what will happen next is unclear. Mr Griffith said they were proceeding cautiously and carefully monitoring Mr Bennett, while his son David Bennett Jr told the Associated Press that the family were “in the unknown at this point”.But he added: “He realises the magnitude of what was done and he really realises the importance of it.””We’ve never done this in a human and I like to think that we, we have given him a better option than what continuing his therapy would have been,” Mr Griffith said. “But whether [he will live for] a day, week, month, year, I don’t know.”

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China: Doctor charged for treating fever patient

SharecloseShare pageCopy linkAbout sharingImage source, VCG/VCG via Getty ImagesA doctor in China’s Zhoukou city has been charged with a crime for allegedly treating a fever patient while working at a hospital without a fever clinic.Patients with possible Covid symptoms in China can only get treatment at specially designated hospitals. The doctor, only known by their surname Guo, was charged on suspicion of “obstructing the prevention and control of infectious diseases”.China is pursuing a zero-Covid policy, with a tough elimination strategy.According to a notice by authorities in Henan province, Guo had treated the patient at a hospital in Zhoukou from 29 October to 2 November last year.The hospital, of which Guo was the vice-director, had not set up fever clinics as part of its operations. In China, doctors are not allowed to treat patients exhibiting Covid-like symptoms at hospitals that are not equipped with fever clinics.Instead, patients are meant to be sent to “fever clinics” – medical facilities initially set up to combat the severe acute respiratory syndrome (Sars) outbreak in 2002 – to prevent further infection. It is not clear how the alleged incident was uncovered, or why Guo might have decided to treat the patient. If convicted, Guo may face up to seven years’ imprisonment, according to state-run news agency Xinhua. China has been battling sporadic outbreaks of Covid, along with emerging cases of the highly contagious Omicron variant in cities like Xi’an and Yuzhou – both of which were recently placed into total lockdown. Authorities are already advising people to stay put ahead of the peak travel season of Chinese New Year that starts at the end of January and runs well into February, during which millions of people are expected to make trips. Beijing is also ramping up to host the Winter Olympics at the start of next month, casting into doubt its ability to maintain its zero-Covid stance. You may also be interested in:This video can not be playedTo play this video you need to enable JavaScript in your browser.

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The Soldiers Came Home Sick. The Government Denied It Was Responsible.

Listen to This ArticleAudio Recording by AudmTo hear more audio stories from publications like The New York Times, download Audm for iPhone or Android.The soldiers with inexplicable breathing complaints started appearing in Dr. Robert F. Miller’s pulmonology clinic in 2004, the year after Baghdad fell to invading United States forces. These new patients were active-duty troops from nearby Fort Campbell, men and women who came home from war with mysterious respiratory ailments. The base asked Miller, an unassuming and soft-spoken lung specialist at Vanderbilt University, to take a look.Miller was baffled to see formerly healthy soldiers gasping for air after mild exertion. Some of them had been close to the fire at the Mishraq sulfur mine outside Mosul, thought to be the largest release of sulfur dioxide ever caused by humans. But others had never gone anywhere near the burning mine. Some of them could no longer run or climb stairs, and yet their X-rays and pulmonary-function tests looked normal.Confounded, Miller decided to try something radical: He began ordering lung biopsies under general anesthesia to look for more subtle damage known as small-airways disease. Sure enough, the tissue revealed toxic lung injury, which Miller diagnosed as constrictive bronchiolitis. To the doctor, this meant two things: First, the soldiers were not exaggerating their symptoms. And more important, noninvasive screenings couldn’t be trusted to detect these new post-deployment ailments.Eager to share his discovery, Miller contacted doctors at Walter Reed Army Medical Center. This led, at first, to what Miller recalls as an enthusiastic collaboration. Army doctors flew to Tennessee to review Miller’s biopsies, and together they went to Fort Campbell to develop a protocol for evaluating patients.That early collaboration collapsed, however, after Miller presented his findings to a large 2009 conference of doctors, including contingents from the Department of Defense and the Department of Veterans Affairs. In the following months, his Fort Campbell patients stopped coming for treatment. When Miller asked for an explanation, a Department of Defense official told him in an email that the abrupt change was because of a realignment in military command regions. Miller wasn’t convinced: He believes that senior officials realized that the implications of his research could be sweeping — and could stick the government with expensive medical bills for untold numbers of returning troops. Whatever the reason, he says, the military abruptly stopped cooperating or referring patients to Miller. “The D.O.D. said: ‘Well, we’ll take it from here. We don’t need to send any more people to Vanderbilt,’” Miller recalls. (A spokesperson at Fort Campbell said the base had decided to send patients, instead, to an Army medical center in San Antonio for treatment and study within the military’s health system.)Miller’s breakthrough findings and what he described as the sudden end of collaboration with military officials marked an early clash in what would become a long, bitter struggle over ailments associated with military trash fires and other airborne toxins during America’s post-Sept. 11 wars. More than 200,000 people who deployed to Iraq or Afghanistan believe they suffer permanent damage from exposure to burn pits, as the military’s notorious garbage-disposal fires are known. They describe ailments ranging from shortness of breath to rare cancers but have struggled to convince the government that shipped them off to war that their suffering deserves redress. Instead, veterans’ pleas have been met with bureaucratic inertia and widespread perceptions of stonewalling. Researchers who uncovered early suggestions of links between burn pits and health problems say their work was discouraged or even censored by the V.A. At the same time, citing a lack of conclusive data, the V.A. was denying the vast majority of burn-pit-exposure claims. Since the first anecdotes of mysteriously sickened service members began to filter out of clinics in the early years of the war on terror, the battle over burn pits has unfolded as a bleak saga that brought together foreign wars and military contractors, health care dysfunction and distrust of government.A burn pit at Bagram Air Base in Afghanistan in March 2002.Joe Raedle/Getty ImagesIt was clear from the beginning that this new problem could be disruptive, costly and vast in scale. If burn pits were indeed causing health problems, a staggering number of service members — pretty much anybody who spent time on bases in Iraq or Afghanistan — could make a reasonable claim. What’s more, because military trash fires were still common practice on overseas campaigns even as backlash to burn pits was rising back home, any acknowledgment that troops were getting sick could force the Pentagon to adjust the logistics of ongoing wars. Only in 2009 did the Pentagon begin to scale back the practice, which is still used when the military can’t find another way to dispose of garbage. On top of the cost to taxpayers and disruption to war planners, burn-pit fallout threatened private industry: Many of the burn pits were operated by KBR, a powerful contracting company that won, and continues to win, billions of dollars in contracts from the Department of Defense.Pieces of burn-pit legislation were periodically drafted in a show of support for the troops but never seemed to pick up much momentum. The most significant breakthrough came in 2013 when Congress ordered the V.A. to establish the Airborne Hazards and Open Burn Pit Registry so that veterans could log their symptoms. (Officials at the V.A. had fought against creating the database until lawmakers forced the department to do it, several former V.A. employees told me.) For years, that relatively minor concession was as close as the federal government came to a large-scale response to burn pits.It would take a pressure campaign from an unexpected source before burn pits finally started to pick up political momentum. Starting in 2020, the comedian and political commentator Jon Stewart and a coalition of Sept. 11 first responders threw their considerable lobbying muscle behind the long-marginalized movement. These new allies proved remarkably effective. By the end of 2021, 16 distinct bills were introduced as lawmakers vied to affix their names atop a piece of burn-pit legislation.The bustle of interest in Congress, in turn, sparked a rare reaction within the opaque and ponderous offices of the V.A. In August, breaking with years of precedent, the department abruptly reversed its position on the damages wrought by “fine, particulate matter,” including burn pits. Veterans diagnosed with asthma, rhinitis or sinusitis within 10 years of returning from Iraq, Afghanistan or certain other foreign deployments are now presumed to have suffered respiratory damage during their service and are eligible for benefits.In November, President Biden, who has publicly blamed his son Beau’s death — from glioblastoma brain cancer at 46 — on burn pits in Iraq, followed up by ordering the V.A. to look into potential links between toxic exposure and rare cancers.While advocates cautioned that the expansion of V.A. benefits has so far been relatively modest, it’s still a radical turnaround for a department that, until late in 2020, kept the same line of denial emblazoned on its website: “Research does not show evidence of long-term health problems from exposure to burn pits.” The message to veterans had long been clear: You can’t prove that military service made you sick, and that means your illness is not our problem. Now, suddenly, the V.A. had swung abruptly to align with the department’s most vocal critics, openly acknowledging that respiratory disease was a likely result of airborne particulate exposure during deployment.A burn pit is exactly what it sounds like: A hole is dug in the ground and filled with trash, including medical waste, vehicles and plastics. Then the whole mess is doused with jet fuel and set on fire. Operated in large part by KBR, the huge contracting firm that was enriched by lucrative wartime contracts, burn pits were a ubiquitous feature of the post-Sept. 11 wars — a primitive disposal method for the tremendous loads of garbage generated by occupying forces.At least some of the health issues ascribed to burn pits were probably caused by particulate matter, smoke inhalation or air pollution breathed on deployment, and specialists are generally careful to refer to “toxic exposure” or “airborne hazards” instead of singling out burn pits. But returning service members and their families tend to zero in on the trash fires. Monstrous conflagrations consumed acres of American bases, sometimes adjacent to working and sleeping quarters. The troops grumbled about the noxious smoke but to no avail: The burn pits were considered an imperfect but inevitable way to avoid hauling garbage through streets held by hostile occupation.To understand the scale and toxicity of burn pits, you have to realize how much material the United States dragged into these wars. Artificial villages hardened like scabs over the landscape in Iraq and Afghanistan. Teeming communities of trailers, air-conditioners, table-tennis sets, weapons depots, a thousand things fetched by armed guards in truck caravans that traveled over the weakened highways, cracking them apart.A burn pit at a command outpost in Kandahar, Afghanistan, in 2013.Andrew Burton/Getty ImagesHundreds of thousands of troops passed through those bases, and that’s not counting the civilian bureaucrats and local employees, diplomats and contractors. There were hospitals, prisons, offices, garages, industrial kitchens, all of it generating waste of every imaginable kind, and nowhere to put it but into the fire. Some soldiers spent months in the thick smoke, inhaling particles small enough to lodge into tissue, pass through lungs and swim through the blood. The burn pits melted the mundane waste of the wars off the landscape and hid it deep in the bodies of the troops. According to V.A. estimates, about 3.5 million military members have been exposed to burn-pit smoke since the 1991 invasion of Iraq.But when they got home, claims of burn-pit exposure were met with institutional skepticism at both the Pentagon and the V.A. Service members and veterans were dismissed as anxious or out of shape, prescribed psychiatric drugs and asked to produce trash-fire documentation they couldn’t possibly have: Where were they deployed? Where was the burn pit? Had they smoked or experienced stress? How did they know what had made them sick? From 2007 to 2020, the V.A. denied 78 percent of veterans’ disability claims mentioning burn pits, a senior V.A. official testified before Congress in September 2020.KBR, meanwhile, fought a class-action lawsuit all the way up to the United States Supreme Court to avoid paying damages to sickened soldiers. In 2019, the court let stand a ruling that private contractors were protected by the same immunity that covers the military’s battlefield decisions.Many Americans are under the mistaken impression that veterans receive free health care. They don’t. Combat veterans who were discharged in 2003 or later are entitled to five years of free V.A. health care. After that, they are eligible for free or subsidized treatment and disability benefits for any diagnosed health conditions or chronic injuries linked to their military service. But because burn-pit ailments were new, and therefore, research was scarce, veterans had little chance of meeting the threshold of proof tying their symptoms to deployment — a point the V.A. seemed keen to emphasize in the website message that categorically rejected any link between burn pits and illness.David Shulkin, a doctor and hospital manager known for his patient-friendly policies, became under secretary for health at the V.A. in 2015 and ascended to the agency’s top job in 2017 — the lone holdover from the Obama administration appointed to a Trump cabinet position — only to be pushed out 15 months later. Since then, he has emerged as a passionate advocate for burn-pit victims.“Simply outrageous,” he told me in August when I asked about the website’s message rejecting a correlation between burn pits and health issues. “It was a slap in the face to anybody who was suffering and to the families, and I was very outspoken that it needed to be removed.” I pointed out that the message had stayed on the V.A. website all the way through his time overseeing the agency and had only disappeared in late 2020. Shulkin told me I was wrong. I assured him that I was not.That’s when Shulkin said that all through his three years in senior V.A. leadership, nobody had ever discussed burn pits with him. But this seemed impossible: During his tenure, the V.A. had already started logging details of toxic-exposure claims in its national burn-pit registry, and, in 2017, Shulkin signed off on the National Academy of Sciences, Engineering and Medicine’s review of the use of the data. PBS, The New York Times and others had reported on the controversies around burn pits. The class-action lawsuit against KBR was winding through the courts, making headlines along the way. Shulkin had also visited a New Jersey research facility focused on studying airborne hazards and burn-pit exposure in 2016.But Shulkin doubled down, even suggesting that the topic may have been purposely downplayed: “Burn pits weren’t even an issue while I was there,” he said. “There are very good mechanisms that prevent things from surfacing, and I can’t say whether it was deliberate. There was no discussion or visibility on it.”I repeated Shulkin’s description of V.A. silence about burn pits during a phone call with current V.A. officials. “I’d find it surprising,” Dr. Patricia Hastings, the V.A.’s chief consultant for health outcomes of military exposures, finally said.In months of reporting, I interviewed a range of current and former V.A. employees, both on and off the record, and ran into many professed gaps in knowledge. Nobody at the V.A. seemed willing or able to articulate a coherent explanation for the department’s shifting position on burn pits. Officials pointed out that the agency was enormous, the largest after the Department of Defense, and that some of the clashes over the science had taken place a long time ago. The V.A., they said, has always prided itself on rigorous research, academic freedom and compassionate care for veterans. Over the years, the agency has commissioned four reports related to airborne hazards; none of them uncovered any connections between health problems and burn pits, officials said. Nevertheless, after reviewing the existing research in late 2020 and 2021, the V.A. last year decided to reverse its position. The science, the V.A. said in a statement, “has changed and represents less of an abrupt shift than an evolution in the V.A.’s understanding.”The Miller biopsies have remained a landmark, albeit controversial, breakthrough in burn-pit research. Some returning soldiers grew so desperate to prove they were truly ill — not malingering or delusional, as other doctors had suggested — that they traveled to Tennessee and paid for a biopsy using private insurance. But Miller has also been criticized, in particular by military doctors, for encouraging patients with normal test results to undergo the painful and invasive procedure.In the contentious realm of burn-pit research, doctors have squared off against one another with unusual rancor. The stakes are both professional and personal, with some scientists believing their life’s work has been ignored or misused for political purposes. There are burn-pit believers (activists, their critics say) and burn-pit skeptics (obstructionists, the others say).In 2013, after years of silence, Miller heard from the V.A.: He was one of two pulmonologists asked to develop a criterion to evaluate respiratory disability. But when it came to constrictive bronchiolitis — the disease Miller believed he found in his biopsies — the agency stymied his efforts to create a criterion, he says. In email exchanged that year, Miller pressed Dr. Gary Reynolds, a medical officer with the V.A.’s benefits administration, for an explanation, even threatening to “make a congressional inquiry,” citing his past work with the Senate Committee on Veterans’ Affairs. But Reynolds deflected, citing “some unanticipated administrative issues.” In an email to me, Reynolds said that he couldn’t comment.In the years since then, Miller has remained outspoken and doggedly weathered the resulting criticism. “It’s horrible,” he said of service members’ struggle for care. “I know these stories, and I know how impaired they are, and I know how they’ve been treated.”The dearth of evidence was repeatedly invoked over the years as justification for denying burn-pit-related claims. V.A. officials had long maintained that there simply wasn’t enough data to prove a link between trash fires and health problems. And why not? One explanation upon which all of the doctors can agree: Symptoms might take years to manifest and evolve, and patients should be tracked for decades after deployment to get a full picture.But that’s not a complete explanation. Because the military knew (or should have known) the range of materials being burned, presumably the established knowledge behind the Environmental Protection Agency’s online warnings that burning plastic and trash “can be toxic,” for example, could have been applied to the cases of the returning soldiers.Instead, interviews with medical researchers suggest a troubling pattern of denial and cover-up. Several V.A. doctors told me that their bosses pressured them to ignore data pertaining to burn-pit exposure; prevented them from publishing findings; and threatened or retaliated against those who persistently argued for a link between such exposure and illness.Dr. Anthony Szema was the allergy section head at the Northport V.A. Medical Center in New York from 1998 until he quit in 2015. In recent years, he and his team have studied lung tissue from returning service members in the brilliant X-ray beams of the National Synchrotron Light Source II. The metal-detecting beam lines, which are not generally used to study body parts, revealed a dramatic abnormality in patients’ lungs: titanium bonded to iron in a fixed 1:7 ratio. This was shocking, Szema says, because the compound hardly exists in nature, suggesting man-made car parts or computer equipment.Szema’s team also exposed laboratory mice to dust samples that had been gathered by a colleague from war zones. As a control, they exposed other mice to dust from similar geological regions outside combat — inert titanium dioxide from Georgia clay; samples from a Montana titanium mine; dirt from Camp Pendleton in California. The pattern was clear: Lung tissues of mice and humans exposed to the war dust were marked with crystals. “Those crystals are metals, and they’re from inhaling the dust and everything else that got into the dust,” he said. “The burning smoke and the burning computers, the Humvee that blew up in the air.”An airman tossing refuse into a burn pit outside Balad, Iraq, in 2008.U.S. Air ForceSzema started investigating this issue to try to understand the unexplained breathing ailments he was seeing among post-Sept. 11 veterans. His 2011 analysis of health data from thousands of troops concluded that those who served in Iraq or Afghanistan were far more likely to struggle with breathing symptoms requiring lung-function tests — a phenomenon Szema’s team called “Iraq/Afghanistan war lung injury.” But his supervisors became angry about the team’s findings, Szema says, and warned him that the V.A. wanted it “squashed.” “They told me to change stuff in the paper, which I refused to do,” Szema says. (A V.A. adviser says he raised concerns with Szema about his methodology but that he did not ask Szema to alter his findings.) After the research was published in The Journal of Environmental and Occupational Medicine, Szema’s colleagues from the V.A.’s public-health office wrote a letter to the publication that criticized the paper for failing to adjust the data to account for respiratory risk factors. Szema rejects their criticism.Szema is not the only V.A. scientist who says he was pressured over burn pits. In 2009, the V.A. began the National Health Study for a New Generation of U.S. Veterans, a sweeping survey of 20,500 veterans meant to evaluate the overall health of those who deployed to Iraq or Afghanistan. When Steven Coughlin, the study’s lead epidemiologist, began to analyze the results for publication, he found that service members who reported exposure to burn pits suffered higher rates of asthma, chronic bronchitis and other respiratory problems compared with troops who were not deployed. But Coughlin’s V.A. supervisors ordered him to ignore that data, he said, and forbade him to publish any suggestions of links between burn pits and illness. When a defiant Coughlin included his findings anyway, he says, his supervisor edited out those sections. Outraged, Coughlin demanded his name be removed as co-author of the study. “They weren’t publishing the results,” Coughlin said. “They either manipulate the findings or they don’t release them.”Coughlin left the V.A. in 2012 after becoming a whistle-blower. He testified to Congress the next year about what he described as the agency’s mishandling of both burn-pit data and suicidal impulses among veterans. He lived briefly in his brother’s basement before rebuilding his career in academic research.“The V.A. has a not-so-subtle conflict of interest,” Coughlin says, echoing a complaint I heard frequently. The agency’s dual responsibility for paying out disability compensation and for research, V.A. critics say, puts the department at odds with itself. Current V.A. officials pushed back against suggestions of stifled research, insisting their commitment to science was unassailable. They also denied having any financial incentive to deny benefits, pointing out that the disability-compensation budget is separate from the research budget and that the two budgets do not affect each other. The V.A. and the Pentagon have recently collaborated on what officials say is a groundbreaking new data-gathering app (the Individual Longitudinal Exposure Record) that will create a detailed portrait of every service member, including deployments, potential exposures and symptoms. This, they say, will help clear up the lingering ambiguity around toxic exposures. “We are taking this seriously and are actively engaged in outreach,” says John Kirby, the Department of Defense spokesman.Dr. Cecile Rose occupies a somewhat singular position among the lung researchers I interviewed. As director of the Center for Deployment-Related Lung Disease at Denver’s National Jewish Health, a respiratory hospital that has received millions of dollars in Defense Department grants, Rose has treated hundreds of patients. She believes that the damage from airborne toxins is real and can be severe, and she told me that Miller’s controversial biopsies were “seminal.” But she objected to the suggestion that research had been stymied.“It’s probably simplistic to say the V.A. has no interest in this or is just trying to bury it,” she said. Rose acknowledged the widespread perception of “nefarious efforts going on,” but suggested that researchers on both sides had taken hardened stances on a little-understood medical question. “There are people who I think have been kind of unpersuaded and unsympathetic and unconvinced from the outset and have brought bias to the discussion,” she said. “And there are people who are advocates.”Rose seemed to be choosing her words carefully, and she asked several times what this article was going to say. When I described the other researchers’ run-ins with the V.A., she replied that she wasn’t the best person to comment. “Everybody has a conflict of interest here,” she said. “I mean, you know, people can argue that we get D.O.D. funding so we’re part of the problem.”Perhaps the researcher least convinced of a link between burn pits and health problems is Dr. Michael Morris, a pulmonologist at Brooke Army Medical Center in San Antonio and a frequent critic of Miller’s biopsies. Having carried out a sweeping series of studies from 2011 through 2020 into the lungs of active-duty military members, Morris maintains there isn’t enough evidence to say that toxic exposure during deployment is causing disease. He feels strongly that Miller should not have ordered the lung biopsies. Morris suggested asthma, sleep problems, anxiety or depression as alternative explanations for the breathing complaints, adding that many of the patients are neither young nor healthy. “Just because you have a headache doesn’t mean you have a brain tumor, OK?” he said. “Just because you’re short of breath doesn’t necessarily mean you have lung disease.”Morris described himself as a beleaguered researcher dutybound to follow the data to unpopular conclusions. He has been frustrated by the perception that his studies and those of others, which have not established links between burn pits and disease, have been largely ignored by the press and the public, even as critics accuse the Defense Department of inaction and indifference. “I don’t have any evidence that it’s definitely the burn pits,” he said. “I’d be the first to be honest with you and say, ‘Hey, I don’t know.’”One day in 2008, a lawyer named Susan L. Burke picked up the phone in her Philadelphia office. A onetime military kid who spent her childhood on bases, Burke specialized in suing military officials and contractors. Now she found herself talking to a former KBR employee who said he had watched a dog pull a human arm from a burn pit in Iraq. The man said he was traumatized and that he wanted to sue his former employer. Burke took the case and, as word of the litigation spread, found herself flooded with other complaints about burn pits from sick veterans and contractors. By the following year, her clients’ grievances would be among 63 claims consolidated into a class-action lawsuit accusing KBR of negligence. Burke was one of the lead lawyers.At the time of the invasions of Iraq and Afghanistan, KBR was a wholly owned subsidiary of the multinational conglomerate Halliburton, which was run by Dick Cheney until he ran for vice president. When the United States invaded Iraq, KBR received a no-bid contract capped at $7 billion to rebuild Iraq’s oil infrastructure; the company also won a number of contracts to provide wide-ranging logistical services in Afghanistan and Iraq, including trash disposal.The relationship between KBR and the United States government is close, occasionally contentious, and peppered with litigation. The government has repeatedly sued KBR for alleged malfeasance, including inflating costs, arming security subcontractors without authorization and taking kickbacks, although most of the cases were dismissed in court. KBR has also sued the government for access to documents it wanted to help defend against separate civil lawsuits, although none of the legal bickering has hindered the company from continuing to win government contracts.By the time the burn-pit lawsuit reached the Supreme Court in 2019, more than 800 current and former service members, family members and former employees had joined as litigants. The case was regarded not only as a David-and-Goliath contest between veterans and a sophisticated corporate giant but also as a test of the legal protections a company might expect while engaging in war for profit.The veterans had argued that KBR was functioning outside the chain of command, even operating some burn pits without military authorization. But the Fourth Circuit Court of Appeals flatly rejected that argument, finding that KBR was following the instructions of the military and, therefore, could not be judged in civil court.In the end, the Supreme Court declined to hear the case, letting stand the appeals ruling that favored KBR. The case turned on the “political question” doctrine, which holds that battlefield decisions by the military can be overseen only by the White House or Congress, without second-guessing from the courts. If taken as precedent, legal experts say, the ruling would solidify an even greater degree of integration of for-profit companies within the military command structure. It also suggests that contractors in theaters of war exist in a legal twilight zone, unanswerable to either civilian or military court.Military contractors have pressed for, and received, some measure of immunity as early as World War II, when the war effort leaned heavily on private industry to produce vehicles, weapons and hardware. Since 2001, that legal protection mushroomed as the military outsourced more and more of the tasks once performed by soldiers.It’s impossible to talk about the dynamic between the government and its contractors without acknowledging a broader reality: the personal relationships and professional crossover between military commanders and the companies that dangle a lucrative retirement for high-ranking officers looking to cash in on their experience.Kerry Baker is a former V.A. policy chief who, in 2010, wrote a department-wide letter (which he says went largely ignored by V.A. clinicians) detailing the toxic exposure risks of trash fires. Baker told me that military officials “hated” the issue of burn pits and, like the V.A., had tried to downplay links between airborne toxins and health issues. At the time, he says, he assumed it was because the Pentagon didn’t want to give people still deployed the idea that they would get sick. But he has come to think there was another explanation.“I now think they were protecting their contractors,” says Baker, pointing out that the class-action lawsuit was already underway during his time at the V.A. and that military officials were providing testimony on behalf of KBR. (Other military officials testified on behalf of the plaintiffs.) “The more the lawsuit got traction, it seemed like the more the D.O.D. stepped up and defended them,” he said.A running joke held that the government forced soldiers to sleep near a burn pit so they would die too young to collect pensions.Chris Heinrich, a lawyer for KBR, gave a sworn deposition in 2010 acknowledging that, on the eve of the Iraq invasion, he personally pressured the Pentagon to sign an unusually broad indemnification clause as part of the contract to rebuild Iraq’s oil infrastructure. The Pentagon ended up granting KBR sweeping protection from lawsuits, including negligence or death, and agreed that United States taxpayers would reimburse KBR for any legal costs if anyone sued the company. (Philip Ivy, KBR’s vice president of global marketing and communications, denies that KBR’s lawyers coerced the Pentagon and says the indemnification for “extraordinary situations” was authorized under federal law.) The indemnification deal was classified until it was finally made public in 2012.This was another way that KBR insulated itself from being held accountable. The oil contract did not cover the burn pits, but KBR claimed in a 2015 lawsuit filed against the Department of Defense that the logistical agreement that included garbage disposal also obligated the government to “reimburse KBR for costs incurred defending third-party tort suits.” That means that, by the time all the lawsuits and legislation play out, taxpayers will be required to pay the original cost of KBR’s contracts, the price of health care and benefits for troops disabled by burn pits and, finally, reimbursement for damages and any corporate legal fees paid out by KBR as the company fought against the veterans’ claims. “This kind of reimbursement is not at all unusual,” Ivy says. The Department of Defense declined to comment on its previous contracts with KBR, citing potential for future litigation.KBR has toggled cannily between leveraging personal ties to the government and, when necessary, bringing to bear the impersonal might of expensive legal teams. A 2010 letter from KBR to the Army pressed for Lt. Gen. Ricardo Sanchez, former commander of the multinational forces in Iraq, to testify on behalf of the company in yet another lawsuit, warning “KBR has carefully refrained from pointing its finger at the United States as the culpable entity” and “KBR can no longer sit silent, and instead intends to aggressively make its case to the public.” (A KBR spokesman said this was not a threat but an “affirmative statement” that KBR would “correct false and misleading statements.”) Sanchez acknowledged under oath that KBR paid him $650 an hour for time spent preparing and delivering his burn-pit testimony.Sanchez testified that when problems with KBR arose, “I would call in my buddies, the retired general that was in charge of KBR, and we would have a session to sort out the issues.” But for military leaders lower in rank, wrangling KBR was impossible. In 2006, Lt. Col. Greg Kleponis became the commander of the security unit in Camp Bucca, Iraq, a congested encampment containing a large United States-run prison (which would eventually gain notoriety as an Islamic State radicalization hub), a hospital, sleeping quarters for about 10,000 detainees and personnel and a foul-smelling burn pit run by KBR.A kind of grim gallows humor infected the encampment, Kleponis recalls. A running joke held that the government forced soldiers to sleep near a burn pit so they would die too young to collect pensions. Kleponis complained to his own superiors as well as to the KBR supervisors on the site. He asked if the garbage could be taken elsewhere to burn or dump, but KBR balked at the idea. So Kleponis suggested they hire a local subcontractor to come and collect the trash. They refused. (Ivy says that the contractors didn’t have the authority to make changes to military decisions about the burn pits.)“I have zero power over what they serve for breakfast, let alone whether they’re going to burn hazardous waste on our living site,” Kleponis recalls of his KBR counterparts. “I’m sort of a pawn in the game, and they are too.”On a chilly morning in Washington last April, Susan Zeier, a graying grandmother from Ohio, put on a dead man’s uniform and positioned herself on the sidewalk outside the V.F.W. office. The hem of the camouflage Army jacket dangled long down her thin legs, making her look like a child playing dress up. The clothes had belonged to Zeier’s son-in-law, a young man who survived Iraq only to die slowly of lung cancer back home, leaving Zeier’s daughter a single mother. Zeier had stuck a sign to her back: “Ask me why the soldier who wore this uniform in Iraq is dead.”Zeier stood with a group of ailing veterans and the survivors of dead veterans who had traveled to the capital from places like Tennessee, Minnesota and New York. A few wore oxygen concentrators strapped to their torsos, hissing and sighing softly like a distant shoreline. These were the contemporary torchbearers of a sorrowful tradition stretching back to the enraged Revolutionary War militiamen who barricaded a group of the founding fathers into the Philadelphia capital to demand unpaid wages: disillusioned veterans begging the federal government to take care of them.Zeier had been trying for years to get the government’s attention. Years before President Biden was elected, she drove to his book event in Pittsburgh and paid $400 for a meet-and-greet ticket just so she could ask him, in person, to help burn-pit victims. Biden, she recalled, said: “I want what you want. I’m working on this.”But it was Jon Stewart who finally supercharged the burn-pit movement. As Zeier stood on the pavement last spring, Stewart was arguing her cause in a closed-door meeting with Jon Tester, the chairman of the Senate Appropriations Subcommittee on Defense. Stewart was accompanied by his lobbying partner, John Feal, a tough-talking demolition expert who lost a foot after it was crushed at ground zero only to emerge as a ruthless advocate for Sept. 11 first responders and, now, burn-pit victims. Nobody was surprised that Tester had agreed to see them; few in Washington were willing to risk snubbing the pair.Stewart wasn’t just famous; he was also feared, having shown himself willing to subject feckless politicians to public shame. A protracted struggle to force Congress to pay for the medical costs of sickened Sept. 11 first responders came to a head when a tearful and indignant Stewart dressed down lawmakers for their indifference. “You should be ashamed of yourselves,” he told a half-empty chamber in 2019, “but you won’t be.” The video went viral and, the next month, Congress approved permanent funding for the 9/11 victims. Only two lawmakers dared to vote no.“Members of Congress wouldn’t give us the time of day,” says Rosie Torres, a founder of the advocacy group Burn Pits 360, when I asked her about Stewart’s influence. “If you said, ‘Here’s a widow,’ they’d have their staff playing goalie. And then Jon Stewart walks in, and they say, ‘Absolutely,’ and the whole staff wants to be at the meeting.”No matter whom I interviewed for this article — doctors and veterans; lawyers and scientists — they all, eventually, pointed to Stewart’s involvement as a driving force of the long-awaited acknowledgment of burn pits as a legitimate health threat. And maybe it’s true; maybe the science and the victims’ stories were never going to be enough. Maybe it was always a matter of publicity and political appetite. “I’ve got one monkey trick,” Stewart told me. “I can get a media organism to turn with me and to focus on something in particular. A moment in time. If we can make that moment count, maybe we can get something done.”With Stewart and Feal hounding lawmakers to take action, the V.A. went to Congress in May to ask for a grace period before imposing any new legislation, promising to use the time to review its own airborne-exposure policies. The new, more generous burn-pit coverage was announced three months later. In another indication of a changed federal approach to airborne hazards, Miller has recently been called to join a V.A. working group to study constrictive bronchiolitis. “I’m kind of being asked back to the table,” he says.But even Stewart has struggled to get a clear answer on what prompted the V.A.’s policy change in August. No significant research breakthrough had occurred; no study had suddenly proven toxic-smoke exposure to be more harmful than previously understood.In a September interview on his new current-affairs show, Stewart repeatedly asked Denis McDonough, the V.A. secretary, to explain the precise research metrics or standards that decided which ailments were “presumptive.” Why had the respiratory conditions qualified while cancers and autoimmune diseases had not? “I’m asking them to go get as much science as there is on this,” McDonough said.“What’s the bar you’re looking for?” Stewart pressed. “If you don’t know the answer, how do you know when you’ve found it?”“I wish it were like a puzzle,” McDonough said. “I keep asking the same series of questions. OK, so like, we’ve got all these pieces and just tell me where to put them and then let’s figure out which piece we’re missing and then we’ll build that.”“This delay is killing people,” Stewart said.McDonough replied: “I’m not rebutting that notion.”Megan K. Stack is an author and a journalist in Washington. Her most recent book is “Women’s Work: A Personal Reckoning With Labor, Motherhood and Privilege.” She last wrote a feature about the journalist Behrouz Boochani. João Ruas is a painter and an illustrator from São Paulo, Brazil, whose work focuses on folklore, magical realism, the concept of wabi-sabi and human conflict.

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Covid-19: India lab investigated over 298 positive tests on flights from Italy

SharecloseShare pageCopy linkAbout sharingImage source, Getty ImagesIndian officials are investigating a private laboratory accused of faulty Covid-19 tests on passengers on two flights from Italy last week.At least 173 passengers from Rome, and 125 travellers from Milan tested positive on arrival in Amritsar.Thirty of them were tested again at the airport – but only three people tested positive for Covid the second time. Airport officials told BBC Punjabi they have stopped using the services of the lab, SpiceHealth, for now. “If it’s a manufacturing fault, we have to follow certain guidelines. If it’s a human or procedural fault, then we will certainly take action,” airport director VK Seth said. Dr Charanjit Singh, civil surgeon of Amritsar, told the BBC that preliminary investigations suggested that the controls of the machines were not working properly, and that the issue was being investigated at the “highest levels”.Mr Singh added that SpiceHealth was hired by the Airports Authority of India (AAI) on 15 December to test passengers arriving from high-risk countries as per government rules. India is currently in the third wave of the pandemic, which experts believe is led by the Omicron variant. It added more than 167,000 news cases on Tuesday. In a statement, SpiceHealth said that given the “alarmingly high positivity rate of passengers” on the two charter flights from Italy, “we have decided to conduct a detailed technical investigation and decontamination”.”SpiceHealth has used technology specified by the airport and followed all protocols listed by the manufacturer and national accreditation agencies,” the lab said.At least 13 passengers who arrived on the flight from Milan and tested positive escaped institutional quarantine. Footage from that day showed ambulances lined up outside the airport to take the infected passengers to hospital as crowds gathered and chaos ensued. Many of the passengers appeared furious, alleging that their positive test results were inaccurate as they had tested negative before boarding the flight. Several states, including Punjab – where Amritsar is located – have introduced restrictions to curb the spread of the virus amid a surge in infections. Punjab has shut schools and colleges, and imposed a night curfew. India has so far recorded more than 35 million Covid cases and around 484,000 deaths from the virus.You might also be interested in:This video can not be playedTo play this video you need to enable JavaScript in your browser.

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First pig heart to human transplant is a game-changer, say surgeons

Surgeons at the University of Maryland in the US have successfully completed the world’s first pig to human heart transplant. Muhammad Mohiuddin, who co-founded the university’s xenotransplantation programme, said that the heart is beating very well and beyond expectations.David Bennett, 57, who received the pig heart in a seven-hour experimental operation, had been deemed ineligible for a human heart transplant.The operation marks the culmination of years of research for the medical team behind the transplant and could change lives around the world.More on this story: US man gets pig heart in world-first transplant

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In Southern Africa, Success Against H.I.V. Offers Hope for Beating Back Another Virus

A former Africa correspondent, who covered the height of the AIDS epidemic there 15 years ago, finds lessons in the remarkable progress against that virus for our current fight.CHONGWE, Zambia — On a visit to a public hospital in a farming community in late November, I saw something that astonished me.Empty beds. Rows of them, their black plastic-covered mattresses stripped of sheets. Blue privacy curtains folded up over rails, out of the way.I had never seen a Zambian hospital like this. When I last toured one, nearly 15 years ago, patients lay two or three to a bed, head-to-feet-to-head. And more on the floor. More on thatch mats in the hallways. The patients were gaunt, their eyes huge above sunken cheeks. Hopelessness and suffering hung in the air.Now, the wards were silent, and not just because a Covid-19 wave had recently ended. There was only the bounce of my voice off the walls as I asked Morton Zuze, the doctor giving me a tour, where everyone was. When I told him that I had last spent time here in the mid-2000s, he knew what I was asking.“Well,” he said matter-of-factly, “there are 200,000 people in this district and 20,000 of them are on ART.” That was a staggering figure: 20,000 people on antiretroviral treatment for H.I.V.The only sign of H.I.V. that I saw in Zambia was glossy billboards dotted around the capital, Lusaka, showing stylish, smiling people, with the slogan “I’m ending AIDS with …” and some helpful strategy: testing regularly or taking treatment or using drugs to prevent infection.I was a correspondent based in Johannesburg at the height of the African H.I.V. epidemic, the last pandemic to batter this region. In the early 2000s, there were 28 million people living with the virus in sub-Saharan Africa, and about a third of young adults in Zambia were infected. More than two million Africans were dying of AIDS each year.H.I.V. had long since become a treatable illness in wealthy nations, but here the price of antiretrovirals was still more than $10,000 per person per year. Entirely, impossibly, unaffordable.The H.I.V. ward of the Hlabisa Hospital in Nongoma, South Africa, in 2001.João Silva for The New York TimesZackie Achmat, an AIDS activist, and Nelson Mandela in 2002.Mike Hutchings/ReutersBack then, I reported from villages in Eswatini, then known as Swaziland, where I couldn’t find more than a handful of people my age — just children and elderly people. I wrote from Johannesburg about the day that Nelson Mandela broke a powerful taboo and told South Africans his son had died of AIDS. I told the story of a grandmother named Regine Mamba in Zambia raising 12 orphaned grandchildren. And I interviewed the brave, and often desperately ill, activists, such as Zackie Achmat, a co-founder of South Africa’s Treatment Action Campaign, who were fighting with their lives to get access to treatment.Almost two decades later, the fruits of what they fought for were vividly on display, and a reminder — useful at this moment as another Covid wave makes this pandemic seem unending — of how much is possible.Science, in the form of drugs that quelled if not vanquished a deadly virus; a network of fierce, courageous activists; coordinated international efforts, including a massive investment by the U.S. government — they all combined to deliver the miracle of that empty, echoing Zambian hospital ward.We know how to do this.In a clinic outside Cape Town, Linda-Gail Bekker, a renowned H.I.V. researcher, mentioned to me almost in passing that “our longevity is back.” When I asked what she meant, she showed me the data: The life expectancy of South Africans, which H.I.V. drove down from 63 in 1990 to a low point of 53 in 2004, has risen steadily since treatment began to be delivered by the public health system, and will pass 66 this year.This was just one of a dozen interactions I had that I could not have imagined 25 years ago, when I began covering H.I.V. in Africa.In a public clinic in Soweto on my recent trip, I spent time with a community health care worker named Nelly Zulu, who told me that when people test positive for H.I.V. at the clinic where she works, they are given their first pills to suppress the virus that day: no more of the grim wait I used to watch, as people tracked the decline of their immune systems until they qualified for the scarce drugs.Nelly also told me the number of positive cases was falling. She and her co-workers said they attributed this in part to pre-exposure prophylaxis, better known as PrEP. It’s an antiretroviral taken every day that helps keep people from being infected if they are exposed to H.I.V. Gay men in the U.S. have been using it for years, but it’s only recently come to Africa. Nelly and her colleagues said that young women come to her clinic asking for it: “the ones who have older boyfriends who they can’t trust.”Nelly Zulu, a community health care worker, in November in Soweto, South Africa.João Silva/The New York TimesAntiretroviral drugs and hand sanitizer being distributed in 2020 at a clinic in Ngodwana, South Africa.Bram Janssen/Associated PressResearch shows that PrEP use isn’t high in Africa yet, but it was fascinating to me to hear Nelly talk about it casually. For so many years, the only thing that counselors like her had in their AIDS prevention arsenal was condoms, or trying to convince people not to have sex at all. In Durban, I happened to visit a clinic as nurses were screening young women volunteering for the first clinical trial of a South African broadly-neutralizing antibody to fight H.I.V., which researchers hope could be the key to new drugs to prevent infection, new treatments that would be easier to take, and perhaps even a cure.That same day, I visited the Africa Health Research Institute, where an infectious disease expert named Thumbi Ndung’u talked about that trial and other upcoming ones that represent real, strategic steps to a cure. I teared up when I began to understand the implications of the work he was describing.“You believe this is going to work, don’t you?” I asked Professor Ndung’u after he explained the hypothesis he would soon begin to test for inducing H.I.V. remission. His normal demeanor is somber to the point of sternness, but he broke into a wide grin. “If it works it will be very exciting,” he said.In Zambia, I stopped by the white bungalow in Lusaka that houses the H.I.V. treatment campaign. I wanted to interview Felix Mwanza and Carol Nyirenda, veteran activists I first met two decades ago, about lessons for the Covid response from the H.I.V. epidemic — including the idea that government must take vaccines to people where they are, the way they learned to take H.I.V. tests to bars and markets.But when I asked Carol and Felix how they were, they had more immediate concerns. They talked about the challenges of late middle age — a loss of bone density, the miseries of menopause — and how it troubled them that there was little research into long-term use of antiretroviral drugs in African settings. When they ask their doctors if something is “normal,” or perhaps a treatment side effect about which they should be concerned, they’re most often met with a shrug.Thumbi Ndung’u, an infectious disease expert leading research towards an AIDS cure at the Africa Health Research Institute in Durban, South Africa.João Silva/The New York TimesVeteran activists Carol Nyirenda, left, and Felix Mwanza, right, at the offices of the Treatment Advocacy and Literacy Campaign in Lusaka.João Silva/The New York TimesIt was a valid point: a source of frustration and real concern. And it also left me a little bit delighted, because when I met Felix, now 51, and Carol, now 58, no one imagined them having the luxury of aging.Back then, Carol, was getting A.R.V.s from friends abroad. But when they ran out of money and couldn’t send the drugs, she “sat back and waited to die,” ravaged by a tuberculosis infection that her immune-suppressed body could not fight.Last month, she was wearing a pink face mask made for her daughter’s bridal shower. Research hasn’t kept up with the needs of people who have lived for decades with H.I.V. in places such as Zambia, and it must. It’s also the best kind of problem to have.That night I had dinner with my friend Ida Mukuka and her family. I hadn’t seen Ida in 13 years. When we first met in 2003, she was a counselor at an H.I.V. clinic known for her ability to handle the tough cases — the men who threw their pregnant wives out of the house, or worse, when they were tested at the prenatal clinic and learned they were H.I.V.-positive.In 2006, Ida found out that her own husband had infected her. Treatment was still a rare commodity in Zambia then, and there was no guarantee she would survive until she had reliable access to it. I met her two daughters when they were small, wide-eyed girls, and Ida confided to me back then that all she wanted was to keep them in school so that they might one day go to university and never feel they had to stay married to a violent, untrustworthy man, the way she did.A mobile H.I.V. testing laboratory in 2003 in Sikwaazwa, Zambia.Ida Mukuka, an H.I.V. counselor, right, and her daughter, Teba, a lawyer, on the day Teba was called to the bar.via Ida MukukaOn this trip, those daughters joined us for dinner, coming straight from work. Mwamba is a brisk, funny woman of 25. She has a degree in development and is saving to go abroad for graduate school. Then Teba, 27, a lawyer, arrived, fresh from arguing her first case in front of the High Court.I was mesmerized by the young women and the way their lives have turned out so differently than the future their mother feared for them in 2006.So much of what I saw on this trip was unfathomable 25 years ago, or even 15. It was a shamefully long fight. The solutions came decades later than they should have. Each time I saw activists-turned-friends such as Carol and Ida, we talked about the colleagues and friends who didn’t survive, who were ghostly presences as we sipped tea.AIDS is far from over. Covid has caused a critical disruption in testing, interrupted drug delivery and undermined livelihoods in ways that make people more vulnerable to that other virus, too. An estimated 700,000 Africans were newly infected this year.But H.I.V. has been significantly beaten back. It’s a credit to former President George W. Bush’s PEPFAR program and the money it poured into treatment. To brilliant scientists such as those in Durban and Cape Town. And to activists like Ida, Felix and Carol.I’m taking heart in what I saw in Chongwe: proof of human resilience and ingenuity, a reminder that the timeline in a battle with a virus is not short — not nearly as short as we would like it to be. But it is possible to come out the other side, into a future we can barely envision right now.

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