Science
A Powerful H.I.V. Drug Lands in Zambia. But Will It Reach Those Who Need It?
Dozens of students freshly trained as recruiters streamed into the dormitories on the sprawling green campus of the University of Zambia on a muggy morning in March. They wended their way past piles of papers, laundry and instant noodle packages, pouncing on any classmate who slowed long enough to listen to their pitch:
“Come with me, right now, and get an injection! It will protect you from H.I.V. infection for the next six months. It will take two minutes! And it’s free!”
It was an early experiment in delivering the most scientifically advanced weapon that exists in the fight against H.I.V. targeted to the people who need it most: young African women who, statistically speaking, are at greater risk of infection with the virus than anyone else on earth.
A line soon formed, and students filed one after another into a small room, pulled up their T-shirts and received two injections, on either side of their navels, of a drug that prevents infection in people exposed to H.I.V.
For the researchers, clinicians and health officials who gathered on the sidelines to watch, it was a hopeful moment, at a time when Zambia’s H.I.V. response has been badly damaged by the Trump administration’s overhaul of foreign aid.
In clinical trial results published in 2024, the drug, called lenacapavir, showed an astonishing 100 percent protection from infection in patients who received injections every six months. Ever since, there has been a concerted push to get the medication to sub-Saharan Africa.
When the Trump administration made deep cuts to foreign aid last year, there were fears that it would renege on a Biden administration commitment to help get lenacapavir to developing countries. But the State Department has not only honored that commitment, it has also recently increased the investment. The department said it would work with an international health organization to help fund the purchase of enough of the drug to reach three million people by the end of 2028.
“This is a really exciting opportunity to actually bend the curve of the epidemic,” Jeremy Lewin, the top official for foreign aid at the State Department said in announcing the expanded commitment last month. He added, “Lenacapavir is one of the best ways to actually have a chance at ending it.”
Still, whether the distribution of the drug can achieve its full promise of eventually ending the H.I.V. epidemic here is far from clear. The Trump administration’s other aid cuts have left the country’s health system so fragile that it may not have the infrastructure — to do tests, to deliver the drug, to keep records — necessary to get the drug to all those who need it. And it’s not clear whether Zambia will receive enough donated doses — or be able to buy enough — to have a meaningful impact on rates of H.I.V. transmission.
Gilead Sciences, which developed lenacapavir, sells the drug for more than $25,000 per patient per year in the United States. But Gilead has also licensed several generic drug companies to produce it, and they are expected to start supplying it for about $40 per person per year in 2027. In the meantime, Gilead is making the drug at a no-profit price (estimated to be about $100 per person per year). The Global Fund to Fight AIDS, Tuberculosis and Malaria and the United States’ H.I.V. program are supplying it in eight developing countries so far with plans to reach 24 countries by the end of this year.
Zambia was one of the first two countries in Africa to receive lenacapavir, and in December it started offering it to women in a maternal health clinic at the national teaching hospital in Lusaka.
On a March morning, harried nurses at the clinic were weighing patients, checking blood pressure, listening for fetal heartbeats, examining newborns and testing for H.I.V. And they were explaining lenacapavir.
Many women are eager to try it, said Dr. Suilanji Sivile, the technical director of the national H.I.V. program. But the clinic give it to just a few each week because they are not sure how much of the drug Zambia will receive, and when it will arrive. The upheaval in the aid relationship with the United States has clouded planning and the delivery timeline.
“You cannot start someone without knowing you will be able to give them their next dose when they return in six months’ time,” Dr. Sivile said.
Mavis Mwanza, 19, was one of the women who made the cut in March. Four months into her first pregnancy, she had heard about lenacapavir on social media and thought it seemed like a good idea. She lives far from the hospital, she said, so H.I.V. prevention she could get once, at this appointment, and then not think about again for months, would be a relief.
Ms. Mwanza got her first dose of lenacapavir (actually two injections plus two tablets that a patient takes the first time they receive the drug) from a midwife, in a clinic room so small the door could not open all the way.
Glenda Malyangu, the nurse who oversees the H.I.V. program in the clinic, peered over the top of her glasses at benches packed with women, many holding new babies bundled in blankets.
She wants to put every woman who tests negative for H.I.V. on pre-exposure prophylaxis, or PrEP, a medication to prevent them, and their babies, from getting infected. And she has been frustrated by the lack of options. For a decade there has been a daily pill she can offer, but that method is impractical and unpopular with young women, the group she most urgently needs to protect.
“But this lenacapavir, it is popular,” she said. It works for the women she sees because it is discreet — no need even to mention it to a partner — and does not require a pill every day. They can stop thinking about H.I.V. risk for a full six months.
But explaining how it works and giving the shot is more work for her team than handing over a bottle of pills. “It would have been easier if we were many,” she said. The clinic staff was cut by two-thirds last year, when many positions funded by the United States were eliminated.
This has meant that lenacapavir is being introduced into Zambia’s health system when it is already under new strain. More than 1.4 million Zambians live with H.I.V. The country was receiving close to $400 million a year through the U.S. President’s Emergency Plan for AIDS Relief, or PEPFAR, program, to provide treatment, testing and prevention, before President Trump took office. The H.I.V. program has been significantly scaled back, while the government negotiates a contentious new health funding agreement that the State Department has tied to giving American companies more access to Zambian mineral resources.
Under that agreement, Zambia, one of the world’s poorest countries, would receive about half the money it used to, tapering to zero over five years.
While a major challenge in delivering lenacapavir is lack of personnel, Ms. Malyangu said, there is another that is more basic: water. The country’s major maternal health center lacks reliable clean water to give patients so they can swallow the pills that accompany for their initial injection.
To adjust to the reduced budget, Zambia has scaled back its H.I.V. testing and prevention programs. Dr. Lloyd Mulenga, the head of the program, said he hoped that rolling out lenacapavir could cut new infections enough to make up for much of what has been lost.
But that will require health workers to do education and build demand for the new injection; testing to see who is H.I.V. negative and eligible to receive it; and a records system to track when people need to return for their next dose and make sure they show up to get it. To slow the epidemic, lenacapavir will have to reach every corner of the country.
“We will need new partnerships, new funding, new resources,” Dr. Mulenga said.
And lenacapavir will have to be delivered outside of medical facilities — PrEP, he noted, is for healthy people, and healthy people do not go to hospitals.
That is what sent the recruiters into the university dormitories for a first experiment in March, shepherding interested students into the campus clinic, while a team from the Ministry of Health carted in boxes of lenacapavir. Esther Banda, a second-year arts student, joined the line.
College is expensive, she said, and she and her friends cannot get by on what their families can afford to give them. So, she said: “You find someone like a boyfriend and he pays you something, it might be one time or you see him a few times.” One of those meet-ups might leave a young woman with $25 in her pocket at the end of the night — money that, Ms. Banda said, pays for food and cellphone airtime and manicures.
The students — many young men turned up, too — cycled in and out of the injection room, a five-minute appointment that protected them for the next six months.
But the university event had the support of five internationally funded agencies whose continuing presence in Zambia is in question. Even with all the extra support, the rollout began hours late: Someone on the campus clinic staff had been supposed to leave an on-paper authorization for the health ministry, but did not turn up, so a half-dozen health care workers sat around for hours, and students brought in by the recruiters drifted away.
The names and phone numbers of students who eventually got the injection were recorded in a variety of paper files, stacked in the leftover boxes; there was no electronic record, making it harder to track the students down for their next injections.
Ms. Banda’s hurried appointment concluded without her receiving any information about what she should do to get a crucial follow-up dose six months later. A half-dozen other appointments a New York Times reporter observed ended the same way.
“I think this could be very good for me,” said Ms. Banda, 22, who came from the dorm to get lenacapavir still in her pink pajamas. “I hope that I can find it again in six months. I hope it’s still free.”
NEW YORK — Scientists have unearthed communities of marine life — including jellyfish, tubeworms and brittle stars — thriving on a whale graveyard that is millions of years old.
These graveyards form when whale carcasses fall to the sea floor, becoming a sustaining snack for nearby critters. This one, located up to 23,000 feet below the surface of the southeastern Indian Ocean, spans the largest area and is so far the deepest and oldest found.
A whale’s sheer size and the unique chemistry of its bones are the keys to forming these unique underwater neighborhoods, said Xikun Song, a biologist with the Chinese Academy of Sciences’ Institute of Deep-sea Science and Engineering.
“At the same time, the very nature of the deep ocean makes these sites exceptionally difficult for scientists to locate,” Song, who was involved with the latest find, wrote in an email.
Researchers explored the remains during multiple deep-sea submersible trips in 2023, collecting samples and mapping the extent of the necropolis. They found five carcass sites and fossils, including skulls belonging to beaked and baleen whales. The oldest bones date back 5.3 million years.
Feeding and living on the carcasses were myriad creatures, large and small, including sea cucumbers, squat lobsters and saltwater clams. Many of them are likely species that have never been documented, according to findings published Wednesday in the journal Nature.
“The potential number of specimens is just astounding,” said paleontologist Stephen Godfrey with the Calvert Marine Museum in Maryland, who wasn’t involved in the research.
Many factors likely conspired to preserve the bones for millions of years, according to the study authors. They’re dense enough to outlast attacks from bone-eating worms, and located deep enough in the ocean to avoid getting buried by dust and loose particles. The bones also were coated with a light layer of minerals from the surrounding seawater, which may have prevented them from degrading.
Why did so many whales die here? Maybe they were already living in the area and died of natural causes. A few could have perished from exhaustion or illness caused by deep-sea diving. The area’s shape, akin to the letter V, could also have funneled the remains to their resting spot, the authors wrote.
Such discoveries are important because they clue scientists into the vibrant communities that find a way to live even in remote, hard-to-reach environments.
Studying the whale graveyards “is important for understanding how life can adapt to such extreme conditions, not only due to the lack of light and oxygen but also to the incredibly high pressure,” said study co-author and paleontologist Giovanni Bianucci with the University of Pisa in Italy in an email.
Ramakrishnan writes for The Associated Press.
The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education and the Robert Wood Johnson Foundation.
Science
El Niño turns crumbling California pier into climate battleground over what to save — and who pays
As a historic El Niño supercharges the Pacific Ocean and San Francisco experiences record high seasonal sea levels, the latest structural casualty of intense wave action is prompting Bay Area politicians to call for help from the state and federal governments.
They want to rebuild a concrete pier shut down this month after officials deemed it unsafe because of cracking from decades of pounding surf and storms.
As waves crashed against the derelict structure Monday morning, U.S. Rep. Sam Liccardo (D-San José) held a news conference and asked the federal government to follow through on $50 million in climate resilience funding promised by the Biden administration but terminated by the Trump administration in 2025.
The city of Pacifica had been on the shortlist for the Building Resilient Infrastructure and Communities program, managed through FEMA. California and 22 other states successfully sued to reinstate the program, but the funding has yet to be allocated.
Liccardo also asked for nearly $1 million in promised funds from the National Oceanic and Atmospheric Administration for a handrail project on the pier and an additional $9 million to protect coastal bluffs.
Coastlines are already being buffeted and inundated by rising seas. With the closed-off Pacifica Municipal Pier in the background, local politicians and community members said they’re on the front lines and want to rebuild.
“Pacifica is ground zero for coastal resilience,” said state Sen. Josh Becker (D-Menlo Park), as he asked Gov. Gavin Newsom to declare a state of emergency and “help us fix this pier and help this community recover again.”
“This is very much a reminder that an ounce of prevention is worth a pound of cure,” he said, noting that previous attempts for funding went unheeded. “We cannot wait until infrastructure fails before we invest in protecting it.”
As climate change starts to become expensive, it prompts questions about what to protect and what to abandon.
Chad Nelson, chief executive of the Surfrider Foundation, a coastal environmental advocacy organization, said city piers provide coastal access to people who can’t swim or walk on the beach; they are often popular fishing spots and tend to serve a broad swath of their communities.
On the flip side, he said, they keep getting beat up by the ocean and costing taxpayers millions of dollars to repair or replace.
In Santa Cruz, a public wharf damaged by storms in 2024 recently reopened after $1.3 million in repairs. In Capitola, a storm-damaged wharf reopened earlier this year after $10 million had been sunk into repairs. The city is now considering building an open-air restaurant, public bathrooms, a bait shop and a boat launch.
“I think the larger question is: Are we subsidizing bad responses to problems that we know are going to persist?” he said, responding to a question about infrastructure that won’t last.
Charles Lester, director of the Ocean and Coastal Policy Center at UC Santa Barbara, agreed with Nelson that it’s important to distinguish public from private benefits.
“There’s a bit of a difference between a public recreational pier, for example, and your private development that’s going to impact the beach,” he said.
And at some point, he said, we have to acknowledge things are only going to get worse.
In a white paper authored by Lester and Nelson, the two described the coming El Niño as a “reckoning” for the California coast.
El Niños result in larger waves, elevated sea levels and powerful storms — “predictable signature(s) of a climate pattern that returns every two to seven years and is expected, as the planet warms, to intensify,” they wrote.
Wave energy along the shore can run 50% above average during an El Niño, while sea levels can climb 6 to 12 inches — flooding coastal homes, roads and infrastructure. Coastal erosion increases by more than 69% during extreme El Niño events, according to the U.S. Geological Survey.
During the 1997-98 El Niño, seven Pacifica seaside houses were condemned after powerful waves and storms made them unsafe and irreparable. Seventeen people in the state died as a result of the historic flooding and storms.
The funding requests for the pier also come as San Francisco sees its highest summer water levels ever. On Saturday, the National Weather Service recorded levels 1.83 feet above normal high tide. Early Monday morning, the popular Pier 14 along the city’s Embarcadero waterfront was submerged.
High surf along the coast killed a young girl in Laguna Beach, and hundreds of people have been rescued at Newport Beach. Water stranded a hiker along the cliffs of San Francisco’s Presidio — requiring a seven-hour rescue mission that ultimately left the hiker and a rescuer injured as the waves crashed them into the rocks.
“This stretch of coast has been a continuous coastal emergency declaration for almost 10 years due to the repeat damage of storms in recent El Niño years,” the mayor of Pacifica, Christine Boles, said.
Pacifica has been planning for climate change for years, she said. But climate change is outstripping those efforts, and without financial and regulatory support from the federal and state governments, the battle will be all but lost.
Science
Californian is infected with rare tick-borne illness. What to know about the deadly bacteria
A Northern Californian has been confirmed as the fourth-ever person diagnosed with a newly recognized and rare tick-borne disease that causes symptoms similar to Rocky Mountain spotted fever.
The California Department of Public Health confirmed the latest case of Rickettsia lanei bacteria in a patient who was diagnosed in April of this year. Two other California cases were reported in 2004 and 2023.
Public health officials told The Times that the infected person “was seriously ill, hospitalized and has since been discharged and is recovering.”
It is unclear how long the person was in the hospital or what their symptoms were. The state agency said it could not disclose the home county of the person but confirmed the infected person lived and worked in Northern California.
Rickettsia lanei comes from the spotted fever group Rickettsia, bacteria transmitted to humans from the bite of an infected tick.
In California three types of ticks — the American dog tick (Dermacentor similis), the Pacific Coast tick (Dermacentor occidentalis) and the brown dog tick (Rhipicephalus sanguineus) — can transmit the bacteria that cause Rocky Mountain spotted fever in humans and dogs, according to the California Department of Public Health.
Symptoms of Rocky Mountain spotted fever can range from fever and a rash to long-term effects that include damage to internal organs or neurological disorders.
The tick-borne disease has been spreading globally since the early 2000s, most notably in Mexico and Brazil, with reported fatality rates that can exceed 50%, according to a study published by UC Davis.
What is Rickettsia lanei?
Rickettsia lanei bacteria were identified this year in a few Pacific Coast ticks, including a tick in Contra Costa County, according to SFGate, where the latest case was first reported in April.
The new bacterium was added to the list of potentially transmittable pathogens in 2024 by the state public health department after its severe symptoms were studied in two cases of infected men nearly 20 years apart, according to a report published in the Centers for Disease Control and Prevention Emerging and Infectious Diseases journal.
“Sustained investment in public health has enabled development of the advanced molecular tools that detected these infections,” the California Department of Public Health said in a statement to The Times.
According to the report, both men fell ill after spending time outdoors, one playing golf at five courses in Alameda and Contra Costa counties within 14 days of the onset of his symptoms. This first patient had fever, headaches, muscle pain, malaise, loss of appetite, diarrhea and abdominal pain, among other symptoms. His condition worsened on his third day in the hospital, according to the report. The man was ultimately in the hospital for 22 days, including 11 in the intensive care unit with a primary diagnosis of rocky mountain spotted fever and a secondary diagnosis of acute kidney injury.
The other infected person had visited and camped at a county park and state beach in San Mateo and Marin counties. The second man reported a five-day history of headaches, vomiting, light sensitivity, neck pain and confusion, according to the report. On the third day of hospitalization, the man became comatose and was intubated, the report stated. After 13 days, he was discharged with a primary diagnosis of severe Rickettsia.
Researchers have known about Rickettsia lanei since 2018 when it was detected in rabbit ticks in Sonoma County, but they didn’t know its potential harm to humans because the rabbit tick rarely bites people.
“The Pacific Coast tick, which bites humans more frequently, may occasionally acquire the organism from an infected rabbit, which is the most likely route for the rare human infections that have been identified,” the state health agency said.
Should I be worried about contracting Rickettsia lanei?
Human infections are rare but could be underreported because Rickettsia lanei symptoms are very similar to those of rocky mountain spotted fever, said Janet Foley, veterinarian and disease ecologist at UC Davis.
“I think it’s so new that I don’t know if anybody’s really gotten a grant to study it or put it under a microscope,” Foley said.
Rickettsia lanei bacteria cases could also have gone undetected for so long because some cases were not severe, she said.
Foley said Californians should be aware of Rickettsia lanei and take precautions against tick bites.
How to keep disease-carrying ticks at bay
The best way to avoid ticks and tick bites is to be vigilant in your surroundings, Foley said, noting that ticks can transmit other diseases such as Lyme disease.
To keep a disease-carrying tick at bay, Foley recommends:
- Covering up your arms and legs when outdoors by wearing pants and long-sleeved shirts.
- Staying out of the grass where a tick can latch onto your clothing. Instead stay on a cleared path.
- Wearing light-colored clothing so it’s easier to spot a tick if one jumps on you.
- After an outdoor activity, take off your clothes, toss them in the wash and take a shower.
- If your dog goes with you for outdoor activities, give it a bath and then apply tick medication.
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