It is four decades since the emergence of HIV/Aids sent shockwaves through societies across the globe.
In the 1980s and 1990s, an infection with the human immunodeficiency virus, whether from a blood transfusion, sexual activity, intravenous drug use or another cause, was often seen as a death sentence.
One particularly chilling Australian television advertisement from 1987 featured the Grim Reaper and the words, "Aids: prevention is the only cure we’ve got."
Prof Sharon Lewin, director of the Peter Doherty Institute for Infection and Immunity in Melbourne, told attendees that there was a "quite high" chance of finding a cure and hoped one could be delivered within the next two decades.
A cure would be welcome in the Mena region because, as Prof Lewin highlighted, it faces an "alarming" rise in cases, something that contrasts with the falls typically seen elsewhere.
Prof Sharon Lewin, director of the Peter Doherty Institute for Infection and Immunity in Melbourne, addresses the Arab Health conference on the topic of HIV and Aids last month. Chris Whiteoak / The National
Some other parts of the world are still severely affected by the illness. Africa accounts for most of the global total of more than 40 million deaths so far from Aids. This is out of more than 80 million people worldwide who have been infected with HIV.
Terrible though the death toll is, since the second half of the 1990s the situation has been much improved, especially in areas with well-funded healthcare systems. This is because infection can be managed effectively with antiretroviral treatment, which is typically taken daily.
These drugs help to prevent the virus from replicating, which reduces a patient’s viral load, the number of virus particles in the blood.
Patients who begin taking medication relatively soon after becoming infected often have a life expectancy similar to those without HIV
Antiretrovirals maintain high levels of CD4 cells, a type of white blood cell that stimulates the immune system, preventing the onset of Aids. If the CD4 cell count falls, the person becomes highly vulnerable to infection.
Patients who begin taking medication relatively soon after becoming infected often have a life expectancy similar to those without HIV.
What is more, antiretroviral drugs that need be injected every two months only are now being used in some countries, meaning that patients no longer have to take tablets daily.
Chronic low-level inflammation associated with HIV infection does, however, put people living with the virus at greater risk of, for example, heart, kidney and liver problems.
As a result, eliminating the infection remains a goal.
Given the myriad strategies being looked at, progress in preventing infection, or in treating or curing those who become infected – there are about 1.5 million new infections annually across the world – seems likely.
Already, in a small number of cases, the virus has been eliminated from patients’ bodies, something known as a sterilising cure.
The first and probably the most famous example concerns the Berlin Patient, real name Timothy Brown, who had leukaemia and so received a stem-cell transplant.
The donor had a mutation in a gene called CCR5, which makes the carrier almost completely resistant to HIV.
Great interest was sparked when, in 2008, it was revealed that this transplant had enabled Mr Brown’s body to rid itself of the virus, although he went on to die in 2020 after his leukaemia returned.
A number of others have been cured after transplants, but these are risky for those living with HIV. They typically have side effects, and they are not seen as a realistic cure for large numbers of patients.
Other methods to achieving a sterilising cure are being investigated. One is known as "shock and kill", a dramatic term that refers to using one drug to activate HIV lying dormant in cells before other drugs, such as normal antiretrovirals, destroy it. Several pharmaceutical and biotechnology companies are working on their own version of this.
Another strategy, often involving therapeutic vaccines, strengthens the immune system to help it attack HIV.
One approach has already reached clinical trials and been shown to be effective at enabling patients to live at length without the need for treatment.
Several other immunotherapy strategies, such as using broadly neutralising antibodies, which can prevent HIV from entering healthy cells, are at various stages of development and have in some instances shown promising results.
Often these offer the prospect of what is sometimes referred to as a functional cure, where the virus is still present, but it has been controlled without the need for ongoing treatment.
Another exciting avenue of research concerns preventive vaccines against HIV, in particular messenger RNA shots.
Developing an effective vaccine against HIV has been described by Prof Robin Shattock, of Imperial College London, as "one of the biggest biological challenges of a generation", but it is one that is moving closer to being achieved.
The Covid-19 pandemic led to the first large-scale use of mRNA vaccines in people. Now numerous companies and other organisations are working to test shots against HIV based on the same technology.
Early clinical trials have been successful, with injections being able to stimulate the hoped-for immune response in the vast majority of participants.
Even if a cure, more sophisticated treatments or vaccines are released, ensuring access is likely to be an issue.
Although the proportion of people who have access to antiretroviral treatment has significantly improved in recent years, about a quarter of the estimated 38.4 million people living with HIV are still not using the drugs.
So, although the number of deaths each year has dropped by more than half since its 2004 peak, 650,000 people still lost their lives from Aids-related illnesses in 2021, according to UN figures.
In the years to come, equitable distribution is likely to remain as much of a challenge as the science.
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Mercer, the investment consulting arm of US services company Marsh & McLennan, expects its wealth division to at least double its assets under management (AUM) in the Middle East as wealth in the region continues to grow despite economic headwinds, a company official said.
Mercer Wealth, which globally has $160 billion in AUM, plans to boost its AUM in the region to $2-$3bn in the next 2-3 years from the present $1bn, said Yasir AbuShaban, a Dubai-based principal with Mercer Wealth.
“Within the next two to three years, we are looking at reaching $2 to $3 billion as a conservative estimate and we do see an opportunity to do so,” said Mr AbuShaban.
Mercer does not directly make investments, but allocates clients’ money they have discretion to, to professional asset managers. They also provide advice to clients.
“We have buying power. We can negotiate on their (client’s) behalf with asset managers to provide them lower fees than they otherwise would have to get on their own,” he added.
Mercer Wealth’s clients include sovereign wealth funds, family offices, and insurance companies among others.
From its office in Dubai, Mercer also looks after Africa, India and Turkey, where they also see opportunity for growth.
Wealth creation in Middle East and Africa (MEA) grew 8.5 per cent to $8.1 trillion last year from $7.5tn in 2015, higher than last year’s global average of 6 per cent and the second-highest growth in a region after Asia-Pacific which grew 9.9 per cent, according to consultancy Boston Consulting Group (BCG). In the region, where wealth grew just 1.9 per cent in 2015 compared with 2014, a pickup in oil prices has helped in wealth generation.
BCG is forecasting MEA wealth will rise to $12tn by 2021, growing at an annual average of 8 per cent.
Drivers of wealth generation in the region will be split evenly between new wealth creation and growth of performance of existing assets, according to BCG.
Another general trend in the region is clients’ looking for a comprehensive approach to investing, according to Mr AbuShaban.
“Institutional investors or some of the families are seeing a slowdown in the available capital they have to invest and in that sense they are looking at optimizing the way they manage their portfolios and making sure they are not investing haphazardly and different parts of their investment are working together,” said Mr AbuShaban.
Some clients also have a higher appetite for risk, given the low interest-rate environment that does not provide enough yield for some institutional investors. These clients are keen to invest in illiquid assets, such as private equity and infrastructure.
“What we have seen is a desire for higher returns in what has been a low-return environment specifically in various fixed income or bonds,” he said.
“In this environment, we have seen a de facto increase in the risk that clients are taking in things like illiquid investments, private equity investments, infrastructure and private debt, those kind of investments were higher illiquidity results in incrementally higher returns.”
The Abu Dhabi Investment Authority, one of the largest sovereign wealth funds, said in its 2016 report that has gradually increased its exposure in direct private equity and private credit transactions, mainly in Asian markets and especially in China and India. The authority’s private equity department focused on structured equities owing to “their defensive characteristics.”
Marwan Lutfi says the core fundamentals that drive better payment behaviour and can improve your credit score are:
1. Make sure you make your payments on time;
2. Limit the number of products you borrow on: the more loans and credit cards you have, the more it will affect your credit score;
3. Don't max out all your debts: how much you maximise those credit facilities will have an impact. If you have five credit cards and utilise 90 per cent of that credit, it will negatively affect your score.
From Dubai-based clinical psychologist Daniella Salazar:
1. Solitary Play: This is where Infants and toddlers start to play on their own without seeming to notice the people around them. This is the beginning of play.
2. Onlooker play: This occurs where the toddler enjoys watching other people play. There doesn’t necessarily need to be any effort to begin play. They are learning how to imitate behaviours from others. This type of play may also appear in children who are more shy and introverted.
3. Parallel Play: This generally starts when children begin playing side-by-side without any interaction. Even though they aren’t physically interacting they are paying attention to each other. This is the beginning of the desire to be with other children.
4. Associative Play: At around age four or five, children become more interested in each other than in toys and begin to interact more. In this stage children start asking questions and talking about the different activities they are engaging in. They realise they have similar goals in play such as building a tower or playing with cars.
5. Social Play: In this stage children are starting to socialise more. They begin to share ideas and follow certain rules in a game. They slowly learn the definition of teamwork. They get to engage in basic social skills and interests begin to lead social interactions.
