The AIDS Crisis: Episode 7 - Lazarus

Hey, this is Leon Napok. I'm the host of Fiasco, but you may also know me from the podcasts Slowburn, Think Twice, Michael Jackson, and Backfired the Vaping Wars. I'm excited to be sharing with you the next season of Backfired, titled Attention Deficit, which is now available exclusively on Audible. Backfired is a podcast about the business of unintended consequences.

My main job was to try and develop drugs that could treat this devastating disease.

The FDA announced today it would formerly streamline it's drug approval process.

This thing of hoping for like a magic bullet, that you know, we would all be activists for two or three years, and then the cure would come, the vaccine would come, and we would all go back to our lives wasn't going to happen.

People need medication now, ten years from now, they'll be dead.

When the virus that causes AIDS was isolated in nineteen eighty three, it looked kind of like a time bomb. HIV could eat away at someone's immune system for months or years before they experienced any serious symptoms. Then one day, pretty much any infection could become fatal. In nineteen eighty seven, a young chemist at the pharmaceutical company Murk came up with an idea for how to disable the bomb. His name was Irving Siegel.

What Siegel took on was really an impossible task. No pharmaceutical scientist had ever really taken on such a challenge as this.

David France is the author of the book How to Survive a Plague and the director of the documentary film by the same name. During the height of the epidemic France was an activist and a journalist who covered the search for AIDS treatments. He says that after the release of the first AIDS drug, AZT, many drug companies scrambled to produce knockoffs.

When AZT had come out in eighty seven, it immediately proved that there was a massive and very of financially rewarding market for drug companies to exploit.

But as you've heard, AZT was not a miracle drug. Even when AZT seemed to make someone better at first, the virus rapidly mutated inside their body, which meant that eventually almost everyone who took it still developed AIDS. Irving Seagull, the scientist at MERK, was convinced he could build something better than AZT, a new class of drug that would attack HIV in a totally different way.

Irving Siegel, he was young, he was charismatic. He pulled together a team of very excited researchers, and the very first thing that he focused on was a very novel approach. No one else was taking it, and that was an approach to look at protease inhibitors.

Maybe you've heard that phrase before protease inhibitors. I definitely had, but I also did not know what a protease was or what it meant to inhibit it. So as I've learned, the HIV one protease is an enzyme that plays a critical role in allowing the virus to replicate in the body. Siegel believed that the key to treating HIV was stopping

Can remember very clearly saying to myself, I have to keep up with this guy, because he's just he did. That's how rapidly he moved, That's how rapidly his brain worked too.

Emilio Emini is a virologist who worked with Siegel as the head of Murk's efforts on HIV. He was a co author on that first paper about the HIV protease.

So you can imagine, you know, a very you know, thin individual who is constantly moving and whose brain is constantly functioning, absolutely extraordinary.

By December of nineteen eighty eight, Siegel and his team were on the cusp of a major advance, producing the first three D image of the protease. After more than a year of intensive work, they finally had a clear understanding of its unique cellular structure. Emilio Emini sometimes compares the HIV protease to a pac man, introducing it has a wedge like mouth which it uses to chomp down on HIV proteins and slice them into smaller pieces. These

So if the protease is not functional, or if it's rendered non functional and cannot perform this cutting activity, then the viral proteins that are produced won't be assembled into new viral particles right, and therefore the viral infection cycle is terminated.

The three D image of the protease gave Segel and his colleagues a precise map of the enzyme, showing them where exactly they had to jam it. Now they could move on to the next step developing a drug, a protease inhibitor that could be digested by human beings. Siegel was confident that it could be done, but then shortly before Christmas, Siegel had to travel to London to deliver

Just after seven this evening, a jumbo jet crashed onto the town of locker Bit in the Scottish borders. It was a Pan American Boeing seven four seventh.

I remember very clearly where I was when I got the news. I was at home. Actually it was right before Christmas. It was right before Christmas in nineteen eighty eight.

We now know there were two hundred and forty four people on board, including three children.

Irving Seagull was just thirty five years old when he died in the locker be bombing.

It was absolutely devastating, as you can imagine. It was devastating for what we were doing collectively, was devastating for the science. It was devastating for the whole field. But more importantly, it was devastating personally for Irving and for his family.

Seagull's vision of a protease inhibitor would eventually lead to a massive paradigm shift in AIDS treatment as part of the so called triple cocktail. It would unlock the first effective therapy for HIV and AIDS, and it would finally make it possible for people who had the disease to survive. But none of that would happen until nineteen ninety six, nine years after Segel first saw promise in the HIV protease, and fifteen years after the first cases of AIDS were

Typically, the stronger the drug, the faster HIV adapts to resist it.

It seemed that everything we had done up to that point hadn't been enough.

Researchers say a new class of drugs are working.

Where once there was only desperation, there is now genuine hope.

I'm looking falling through a future, the Lazarus effect that people described it felt like a miracle.

In this episode, the darkest days of the AIDS crisis in America followed at long last by a glimpse of light. By the nineteen nineties, HIV had spread all over the globe.

Fourteen million people in the world are now HIV positive. The number grows dramatically every year.

And affected just about every demographic.

Still, no cure still no vaccine to prevent it.

In the US, cases among women and people of color were climbing at a particularly alarming rate, and as the time bomb went off and more and more people, the death totals were rising.

Every year in this country, four hundred thousand have gotten AIDS, two hundred and forty thousand have died.

Whatever we've been doing has not been enough.

It wasn't until we hit nineteen ninety three and nineteen ninety four and nineteen ninety five that the body counts became extreme.

David France again, these were.

Mass dying events each year. Forty three thousand Americans died in nineteen ninety three, fifty thousand Americans in nineteen ninety four. So we entered a period of real despair.

For many AIDS activists, the tragedy wasn't just about how many people were dying during this period. It was also that many of the dead had been leaders in the movement.

Nineteen ninety three opened with the death of Bob Ravski, who was a key member of Act UP, one of its kind of poet warriors.

Questions, what does a decent society do with people who hurt themselves because they're human? Who smoke too much, we too much, you drive carelessly, who don't have safe sex? And the answer, I think the answer is at a decent society does not put people out to pastor and let them die because they've done a human thing.

His death was a trauma for the movement and the community, and then by the end of the year, Michael Callen died.

You met Michael Callen in our second episode. He was the singer, an early AIDS activist who spearheaded a safe sex campaign in New York and helped create a Bill of Rights for people with AIDS.

It's hard to believe Michael Callen is no longer with us. For more than a decade, he made beautiful music and worked tirelessly to improve the quality of life for people with AIDS, all the while fighting the disease himself.

We won.

Michael Callen was the author of a book on surviving HIV and if the guy who was a self proclaimed long term survivor couldn't survive, then it seemed we were all lost.

I realized that some people could look at my life and say, oh, it was so sad when he died of AIDS, And isn't that tragic? But what I want to come through is that even after all the pain and all the torture, and even having AIDS, I can honestly say being gay is the greatest gift I was ever given. I wouldn't change it.

For the worlds.

Amid all of this death, more and more activists started to burn out Garantz. Frankie Ruda, who had joined Act Up as a teenager in the late eighties, was one of them.

I think people have just had a lot of unprocessed grief and we're just really like unraveling.

Honestly, Like many in the movement, Frankie Ruda was exhausted by the lack of progress on medical treatment and by infighting among her fellow activists.

All activist organizations have kind of a half life. They burst onto the scene, they're incredibly viral, and then they start to sort of change.

The changes Act UP was going through might have been easier to take if Frankie Ruda wasn't also losing friends to AIDS on a routine basis.

A lot of people had been infected around the same period of time, and there was a sense amongst a lot of people that they were not getting out of this alive. Some people were very pessimistic about whether or not they were going to see the end of the pandemic.

The sense of despair deepened in June of nineteen ninety three when scientists made a crushing announcement about AZT at the International AIDS Conference in Berlin.

Discouraging news Today about the effectiveness in some cases of AZT.

French and British researchers had conducted the largest study ever on AZT. Their conclusion was that in the long term the drug simply did not work well.

The T yes it was, there no significant benefit in terms of survival or profession to AIDS.

Reading from slides on a big overhead screen, the head of the European study told the delegates patients inspected with HIV who take AZT before they develop symptoms of AIDS are no better off than patients who take it after they come down with the disease.

The limits of AZT were already well known, but according to the new study, the drug didn't extend life for people with AIDS by a single day. In fact, patients in the placebo group actually lived a little longer. After the conference, the Washington Post described it as the most depressing moment in aid's treatment history. Mark Harrington, the act UP member you first met in our previous episode, was in Berlin at the time of the AZT announcement.

I think at that point it was pretty universally felt that we were all doomed and anybody that had HIV was going to die. We're not going to be changing the field fast enough to to save our lives or the lives of most of our friends that had HIV and most of the other millions and millions of people that had HIV. So it seemed that everything we had done up to that point hadn't been enough.

Three weeks after the conference in Berlin, a group of AIDS activists channeled their sorrow into a protest in Washington, Free.

The deaths of years we are taking any harm.

It was a new kind of protest known as a political funeral.

It got to the point where the community started this campaign to show our deaths, to show what AIDS looked like, and the most dramatic way that that happened was through political funerals, in which the corpses of the fallen comrades were taken out into the streets and displayed in these these really heartbreaking expressions of anger and rage.

The point of political funerals was to force an awareness of the death toll from AIDS onto those who might otherwise find it easy to look away. Mark Harrington says that activists didn't want AIDS to be a private epidemic.

We wanted the American people to see the cost, to see the lives that were being lost, and to be made aware by us putting it into their faces that the people that were dying were loved and were valued members of our society. And so this was a sign of desperation, of despair, but also a beautiful sign of solidarity.

It was the summer of nineteen ninety three when an act UP member with AIDS named Tim Bailey took a turn for the worse. As he lay dying, Bailey told his friends that he wanted his body thrown over the White House gate. It would be a nod to an act UP protest held the previous year when more than a dozen activists poured out the ashes of their loved ones onto the White House lawn.

And we're here today to bring home to George Brush the results of this murders in action.

Tim Bailey's idea to have people throw his actual body onto the lawn was a little more extreme, and his friends demurred, but they promised him they would do something in front of the White House.

True Love.

On July first, nineteen ninety three, a few days after Bailey died, his friends drove his body from a funeral home in New Jersey to Washington, d C.

This was carried out like a military operation. They rented a van and they called upon Act Up members around the country to meet them in Washington.

The plan was to meet up at the Capital reflecting pool, then marched down Pennsylvania Avenue in a procession, But by the time the activist van pulled into a parking lot near the Capitol, the authorities were already there. Some were wearing riot gear.

This is this is the last whistles, It's in the will.

There are legal permits, there are family members here.

You're going to You're going to interfere with a funeral procession in front of.

All this press.

It was a showdown of remarkable tension and anger. There was rage and tears coming from the protesters, who felt that they owed it to Tim Bailey to be able to accomplish what he had asked for and yet they were being blocked.

According to one witness, a federal agent at one point reached into the van holding Bailey's casket and snatched the keys from the driver. Activists surrounded van and sat down so it couldn't be driven away. After a tense standoff that lasted several hours, they flung open the back doors and forced the casket.

Out, But the pushback from this phalanx of police officers was such that the whole casket nearly fell over and nearly emptied itself in the parking lot. Everything you wanted to do, and now you're fucking hell.

You have to god damn more. Eventually, the activists regained control of Bailey's casket and managed to get it back into the van. The police then surrounded the van and escorted it onto the highway back towards New Jersey.

The escort lasted into Maryland to Baltimore, and Tim's body was returned ultimately to the funeral home and he was given a regular burial after that.

By nineteen ninety three, activists weren't the only ones losing hope. Scientists were also beginning to doubt whether an effective treatment for HIV was possible AZT like drugs had proven ineffective, and while MIRK was putting its energy behind protease inhibitors, there was no guarantee that those would work either. Here again is Emilio Emini, the virologist who ran Merk's HIV efforts.

What was in everyone's back of everyone's mind was, well, maybe every single drug we develop against this virus, or even an inhibit of the protease, maybe the virus can very quickly defeat it by simply becoming resistant quickly.

Thanks to Irving Siegel and his colleagues, MIRK had been early on protease research, but in the years after Siegel's death, progress had been slow. It wasn't just because Siegel wasn't there to help. Everyone I spoke to said his team continued working on protease inhibitors with the same urgency as before. It was just that making a functional drug out of Siegel's idea was extremely hard. Here's David Franz again.

It was the most complex pharmaceutical production ever undertaken. To create this molecule took fourteen painstaking steps, each one very time consuming. Each one depended on the one before it. The idea that this would work was certainly far from but reliable.

The drug that Merk was working on would eventually be called krick Savan. The scientist in charge of producing it happened to also be a chef, and in an interview with the Philadelphia Inquirer, he explained that making krick savan was like cooking an intricate, multi course meal for a thousand people. If you wrote the recipe for krick savan, he said, each of the fourteen steps would cover sixty pages.

As Merk and the HIV team were getting more and more excited about kricks evan from what they saw in laboratories, they wanted to push the thing into human trials very quickly, and they had such faith that it would work that they did something that is not done in pharmaceutical research.

Typically, after successful lab trials, pharma companies test their drugs on healthy animals to make sure the drugs aren't toxic and can be absorbed into the bloodstream. According to France's reporting, Merk skipped the animal trial.

Sort of What they did instead was they tested it among the scientists. They took it themselves, and so they knew that it was safe because they all survived the exposure to it. And it's something that has often joked about in the pharmaceutical world as a big chimp study, in which the big chimp is the scientist himself.

We asked Emilio Amini about the big chimp trial. He declined to comment. I told you a bit ago about the devastating AZT announcement in Berlin. It was about six months later that Merk ran a trial of krick Savan and a group of people who were all HIV positive. A week into the study, each patient's viral load fell dramatically. Krick Savan appeared to work, at least in the short run.

What we initially saw was that there was in fact, very clear and rapid decline a virus load in those individuals. And this was the first time that was seen with any drug, you know, for HIV. So it gave us a sort of a glimmer of hope that you know, we have, you know, something potentially useful here, right, you know, we felt, well, maybe there's something special about the proteuse.

The question was would the virus find a way to mutate around the drug like it had with AZT. The researchers at MERK were optimistic enough that they had shared their preliminary results with other AIDS researchers, but soon their hopes were dashed. Once again, HIV had mutated and effectively become resistant to the new drug.

So if if we go back to the pac man analogy, and you consider the protease inhibitor has been a something a ball of rock, whatever you want to call it, that gets in the mouth of the pac mand so that the pac man can no longer, you know, close its mouth and chump up the viral proteins. What the mutation does is that the mutation alters the structure of the pac man mouth just ever so slightly, but ald is it enough so that the inhibitor can't bind into that mouth anymore.

The one.

Just to make sure you got that, the mutation occurred right in the pac man's mouth. Now, the protease inhibitor that Murk had spent years developing and fine tuning didn't fit properly, and so the pac man the protease went right back to chomping and slicing HIV proteins and enabling them to replicate in patient's bodies. HIV was rebounding in Murk's study participants, and it was happening extremely fast. By that time, we had a good feel for this.

We already knew that what we were looking at here was resistant selection.

It was harder.

It was harder for the virus to become resistant against the protease inhibitor, but it wasn't that hard.

HIV was the ultimate Darwinian nightmare. It seemed to evolve around every obstacle put in its path. After years of effort and hundreds of millions of dollars spent, Merk's new drug appeared to be meeting the fate of every other HIV treatment. The disappointment of krick Savan didn't mean that protease inhibitors in general would never work, or that a different drug based on the same idea wouldn't produce different results.

But new drug called the most important advance since AZT.

The drug was called sequineverr.

Sha quivnaire, the first of a new generation of AIDS fighting drugs.

Hoffman Laroche was asking the FDA for accelerated approval, which was exciting news for AIDS activists patients across the country. Merk's protease inhibitor hadn't panned out, but maybe Hoffman the Rosch's version would turn out to be the real deal.

Researchers caution against too much optimism, but it is the most powerful weapon yet developed against the AIDS virus.

There was, however, a surprising hitch in the company's plan to get sequinevere to market quickly. A small but influential group of former act UP members was standing in the way. They called themselves the Treatment Action Group or TAG for short. TAG included many of the science oriented activists from act UP, including Mark Harrington. As you heard in our previous episode, Harrington and some of his colleagues had split off from act UP, in part because they wanted to work with

What happened Berlin happened.

After the conference in Berlin, where it was revealed just how much of a failure AZT was. Harrington had come to view the drug as a cautionary tale. Years earlier, AZT had been fast tracked and given the benefit of the doubt. Now the pitfalls of moving too fast were all too clear.

We recognized that some of the things that we'd done to change clinical trials had led to false answers that weren't accurate. We found out that the fast tracking for drugs resulted in some drugs that didn't work being released onto the market.

Harrington felt that he and his fellow activists had been naive for years. They had agitated for drugs to be released as quickly as possible to people with AIDS on the theory that anything was better than nothing, and.

We had gotten a scientist in the regulators to also be naive. But everyone was tired of all the deaths and all the sick people and the lack of hope. Everyone wanted these drugs to work, but just wishing.

Doesn't make it so sequinevere. The protease inhibitor developed by Merk's rival Hoff and Laroche struck the members of TAG as yet another source of false hope. Among other things, Harrington was alarmed by the way Hoff and Laroche had conducted its trials.

They did a little study in fewer than three hundred people, and in summer of ninety four they wanted to FDA to give it accelerated approval, and we said, no, this is three hundred people. You want to do the first of a new generation of AIDS drugs with a shitty inadequate sample size. That's far too load to tell us even if there's a side effects, let alone whether the drug works, and you need to redraw your whole clinical development plan from scratch.

From tag's perspective, if sequinavere were approved hastily, it had a good chance of dominating the market for protease inhibitors. That was what had happened with AZT after the FDA fast tracked approval of that drug back in nineteen eighty seven. David Franz explains.

They did not want an AZT like scenario to take place. If sequinavere was probably the least promising of the protease inhibitors, and yet if it had gotten to market before anybody else, they worried that it would you take all the oxygen out of the air for the other developed compounds.

TAG demanded that Hoffman Laroche go back to the drawing board and dramatically expand the trial size for sequinavier. They proposed eighteen thousand participants, a sixtyfold increase from the original study. Hoffman Laroche executives weren't exactly pleased to hear this, and to gin up support for their fast track application, they faxed tag's proposal to a bunch of other AIDS activist groups across the country. When those activists learned about tag's opposition, many of them were outraged.

When TAG went their own way, they stepped on a lot of feet. In fact, they stepped on just about every foot in the movement. AIDS activists had never before this point tried to slow down a drug to market, and it created an amazing shit storm in the activist community.

Dozens of AIDS groups signed a statement registering their disagreement with TAG over sequinivir, but TAG by this point had built up a lot of sway with the FDA, and Hoffman Laroche's application was rejected.

The controversy was fast and furious between libertarian activists who really thought people should just take anything they want, and then kind of more rigorous activists who thought we needed better data before approving drugs that were going to be taken by hundreds of thousands of Americans and millions of people around the world. People from the community were yelling at each other and calling each other killers and murderers and so on.

TAG made it clear that they were not just singling out Hoffman Laroche. They wanted every drug company working on protease inhibitors to take their time to run large, rigorous trials that would yield rich, clean data. Other activists stuck with what they had been saying for years, and people with AIDS didn't have time to wait. Back at Murk, Emilio Emini and his colleagues were continuing to track the

And that one patient, for reasons that to this day are never never been really understood, that one patient, the virus level came down but never came back up again.

And this was.

The first time any patient, as far as we knew, that had been treated with an HIV inhibitor, had actually demonstrated the ability for prolonged virus suppression. And we kept following that patient and never came back up, and just stayed down.

Amini and his colleagues didn't just write this off as an anomaly. The data was real, and patient one hundred and forty two wasn't some kind of superhuman And.

What we said to ourselves was, well, the fact that it happened in one patient doesn't tell us that, you know, we have a high probability that we're going to be able to do this, you know and everybody. But you know what it does tell us. It tells us for the first time that it's actually possible to do it.

Patient one hundred and forty two became Mrk's north star.

In fact, various members of the team had mouse pads actually made up that actually showed the virus load in this one individual. It was a way of saying to ourselves, look, we actually did it. Now what we now need to figure out is how do we do it in everybody.

Emini and his colleagues followed their small phase one study with a much bigger Phase two trial that would track thousands of subjects over many months. Even just producing enough drugs for a study that big was a challenge.

The process of making the drug was not trivial. It would require the establishment of literally a brand new chemical manufacturing facility. One of the steps was an extreme exotherm, which is a way of saying that it was an explosive step that if you didn't do it carefully, it would blow up your factory literally.

While the trial got underway, Amini and his colleagues began testing out different doses of cricksivan on patients. They also tested the drug in combination with other kinds of drugs, including AZT. That was a relatively new idea meant to address HIV's ability to rapidly mutate around pretty much every drug researchers had thrown at it.

A thought occurred to scientists, and it was simultaneously in multiple labs that it's simply a matter of math that two drugs is better at preventing the virus from mutating in ways that will escape the drug treatment.

Emilio Emini was one of the scientists who'd helped make this discovery. It's so called combination therapy was more effective than using a single drug. Before protease inhibitors were developed, there had only been in two classes of drugs to try in combination with each other, AZT and one other. Now there were three each one would attack HIV in its own way and essentially back the virus into a corner until it could no longer mutate its way out.

People wanted to try a third drug and to see if attacking the HIV virus in three different ways would indeed flummix the HIV to the point of being able to actually produce lasting results.

A group of patients were given cricksavan along with AZT and the other drug. The early results were remarkable, and by the end of nineteen ninety five, Amini and his colleagues at MURK were ready to tell the world about what they were seeing.

There's a major new reason for hope in the fight against age. Tonight, researchers at an age conference in Washington say a new class of drugs were working.

On January thirtieth, nineteen ninety six, Amini was in Washington, d c. To address the annual Conference on Retroviruses and Opportunistic Infections. There, he delivered some major news.

Studies presented at the conference show that over a six month period, the drug sharply reduced the level of virus in the body. Also, over a six month period, people taking the drugs died at half the rate of people not taking the drugs.

Crick Savan, combined with the two other drugs, had made HIV undetectable in most patients, and the effect didn't appear to be temporary. At the time of the conference, it had persisted for six whole months. Audience members gasped at the data. For the first time since the AIDS epidemic began, a treatment was having a lasting impact. The three drug

I'd be lying if I didn't say it wasn't emotionally and personally very satisfying. And what was most gratifying was not just looking at the virus load. But it was clear that as soon as the drugs became available and started to be used appropriately as a combination from the very beginning, that the impact it was having on progression to as was us extraordinary.

The three drug combination became known as the Triple Cocktail. It came with difficult side effects at a huge price tag upwards of fifteen thousand dollars a year. Still, many people were able to obtain it through their health insurance or through the federally funded AIDS Drug Assistance program. That summer, Mark Harrington began taking the Triple Cocktail and experienced an almost immediate change.

My fire load went from over two hundred thousand to nothing over the next three months, and it's been either very low or undetectable in the twenty five years since. And none of us could really believe it at first. It was too good to be true, But the truth was that these drugs really did stop the progression of HIV.

Nobody is proclaiming a cure for AIDS yet, but based on the results with a new drug combination, many people are starting to believe it may soon be a possibility.

Harrington's friend and fellow activist Garantz. Frankie Ruda had joined the movement at the tail end of the Reagan administration. By nineteen ninety six, she had scaled back her involvement and had enrolled in college hoping to become a doctor. She still remembers where she was when she heard the triple cocktail was working.

I was in New York that summer, and I remember talking to folks and sort of getting the news and just like being in this elevator to this crappy little apartment I was sharing with some friends in college.

Like.

Feeling like, even though I knew it was the work of men and science, it felt like some grand act of mercy made manifest. And I think the Lazarus effect that people described for these medications on people sort of coming off their deathbeds and coming back to life gives you a sense also that even the scientists and the doctors had to take a recourse in biblical and religious language to describe what happened, because it felt like a miracle.

Where once there was only desperation, there is now genuine hope.

Started getting weight, and little lakers and pains and problems that I had in my body started resolving, and sort of like everything went back to normal.

And now I feel that I have a great potential to live a much longer lifespan than was originally fought when I was diagnosed in nineteen eighty seven, and I look forward.

To being here for my daughter's graduation next year from college.

I have a fourteen month old grand.

Baby that I you know, so I'm looking forward to a future.

The opportunistic infections disappeared, a ma seated people began gaining weight again. The so called AIDS wards in America's hospitals emptied out and closed down.

In New York City, which has the most AIDS cases in the country, the death rate from AIDS dropped almost half from nineteen to day last January to eleven a day in July. Across the country, hospitals are seeing fewer AIDS patients and fewer deaths.

When I found out that they were working for me, and they were also working for other people that had started them, I could exhale, you know, I could say, okay, okay, we can move on now. We have got to this point.

Nineteen ninety six was a watershed year in AIDS.

It was the first year, the first time that treatment actually outpaced the virus.

And the first time in fifteen years of the pandemic, we had something that we could offer to anybody with HIV or AIDS that could keep them healthy if they had HIV OR, that could reverse their AIDS and save their life if they had AIDS, and that was truly unbelievable, and yet it was true.

With that, a new era in the history of AIDS began. But the nightmare wasn't over yet, not even close. On next week's season finale, why the HIV AIDS epidemic persists after the development of the Triple Cocktail, and why it continues to this day.

Anytime you're talking about sex and drugs, it's a moral issue rather than a public health issue.

Fiasco is presented by Audible Originals and Prologue Projects. The show is produced by Andrew Parsons, Sam Graham Felsen, Madelin kaplan Ula Cualpa, and me Leon Nafock. Our researcher is Francis Carr. Editorial support from Jessica Miller and Norah waswas archival research by Michelle Sullivan. This season's music is composed by Edith Mudge. Additional music by Nick Silvester of God Mode, Joel Saint, Julian and Dan English, Noah Hect and Joe Valley.