However, when doctor and clinical researcher Boghuma Kabisen Titanji met Celine five years later, she had gone without antiretrovirals for a year and a half. She had little understanding of what the clinical trial she had been a part of was studying. Meanwhile, she couldn’t afford a bus ticket to the local health clinic, and was too sick to walk there.

Celine’s case hammered home an important question for Titanji: What happens to research subjects after the research is over?

As Titanji explain in today’s talk, filmed at TEDxGoodenoughCollege, HIV researchers have a wide variety of reasons for choosing to do research in sub-Saharan Africa rather than in their countries of origin. The first reason: because 70% of the approximately 30 million people with the disease live in the region. But there are other factors, too, less high-minded ones: because review of clinical research is far less stringent there, because the poor populations there are likely to sign on for any offer of medical assistance, and because there is a far lower risk of litigation there. Whatever the reason for doing research in sub-Saharan Africa, Titanji wants to make that researchers recruit their test subjects and take care of them with proper respect.

“I do not stand here today to suggest in any way that conducting HIV clinical trials in developing countries is bad. On the contrary, clinical trials are extremely useful tools and are much needed … However the inequalities that exist between richer countries and developing countries in terms of funding pose a real risk for exploitation,” Titanji says. “How do we ensure that in the search for the cure we do not take an unfair advantage of those who are already most affected by the pandemic?”

To hear the four areas that Titanji suggests researchers think deeply about before conducting studies, watch her talk. And here, 9 more powerful talks with ideas for rethinking — and hopefully stopping — the spread of HIV and AIDS.

The Wright Brothers’ flying machine took off from Kitty Hawk, North Carolina, on December 17, 1903. Credited as the first to successfully fly an airplane, the Wright Brothers were one of several in the early aviation game who were filing patents for their innovations and suing competitors who stepped on their turf. However, the US government eventually said ‘no’ to this patent warring.

“This was not so great for the development of the aviation industry,” says Ellen t’ Hoen in today’s talk, given at TEDxZurich. “This was a time when the US government was interested in ramping up the production of military airplanes. The US government decided to take action and forced those patent holders to make their patents available to share with others to enable the production of airplanes.”

t’ Hoen sees a parallel between this and the patenting of life-saving medications, like the antiretroviral drugs (ARV) used to treat HIV. Years ago, the cost for these drug cocktails was about $12,000 per person per year — meaning that people in wealthy countries had access to them while those in the developing world did not. India, however, did not recognize medical patents at the time and companies there began producing generic formulations. Soon, the cost dropped to $350 per patient per year. Many lives were saved as a result.

However, in 1995, the Word Trade Organization instituted new rules, calling for all countries to ensure 20-year patents for new medications. Since then, the number of patents in the area of ARVs has skyrocketed.

“Unless we do something deliberate and unless we do something now, we will very soon be faced with another drug price crisis,” says t’ Hoen. “Surely, if a patent pool could be established to ramp up the production of military airplanes, we should be able to do something similar to tackle the HIV/AIDS epidemic.”

t’ Hoen offers a radical solution. To hear about the Medicines Patent Pool, which allows inventors and pharmaceutical companies to offer up their patents for licensing by non-profits and generic drug makers in low income countries, listen to t’ Hoen’s talk. Below, hear more talks about issues with patents.

Drew Curtis: How I beat a patent troll
“Patent troll” is a term given to anyone who files a patent for something already being done, and then sues the people already doing it. In this talk from TED2012, Drew Curtis of Fark.com explains how his company was sued for violating a patent for “news releases via email.” While most companies in this situation settle — defending yourself can cost $2 million and take 18 months, if you win — Curtis shares why he opted to press on.

Kirby Ferguson: Embrace the remix
Creativity is not about coming up with something that the world has never seen before — it’s about copying, transforming and combining what’s already out there. This, however, complicates the idea of intellectual property. As Ferguson shares at TEDGlobal 2012, “American copyright and patent laws run counter to this notion that we build on the work of others. Instead, these laws and laws around the world use the rather awkward analogy of property. Creative works may indeed be kind of like property — but it’s property that we’re all building on.”

Beth Noveck: Demand a more open-source government
Beth Noveck, the former deputy CTO at the White House, thinks that a government should call upon its citizens to share their expertise for the sake of better governance. In this talk from TEDGlobal 2012, she shares how, in the past, a single person in the U.S. Patent Office has had the authority to bestow a patent. But with the new Peer-to-Patent system, anyone can weigh on applications, including those who have a deeper base of knowledge in a field.

Charles Leadbeater: The era of open innovation
Our patent system is based on an outdated idea, says Charles Leadbeater in this talk from TEDGlobal 2005. “All of our patents, our entire approach to patents and invention, is based on the idea that the inventor knows what the invention is for.” With rapidly expanding technology, however, Leadbeater says that innovations are cumulative, with new users adding on to previous uses on a near constant basis.

Johanna Blakley: Lessons from fashion’s free culture
While many creative industries are shackled by patents and copyrighs, there is one that remains the Wild West — fashion. In this talk from TEDxUSC, Johanna Blakley shares how, counterintuitively, this is a good thing. Because trademarking is virtually the only type of intellectual property in fashion, a culture has developed where designers build on each other’s ideas and where discount takes on popular items are created for different shoppers.

In the past decade, we’ve changed the way we collectively view the health of the 7 billion people who occupy this planet. Health issues were once seen as an isolated national or regional problem; now they are a global concern. In What’s Killing Us: A Practical Guide to Understanding Our Biggest Global Health Problems, 2011 TED Senior Fellow and healthcare expert Alanna Shaikh lays out the most important challenges and issues in global wellness – from tuberculosis and HIV/AIDS to flu, maternal mortality, and the diminishing effectiveness of antibiotics – while untangling the web of jargon that so often permeate those discussions. Shaikh, who runs the international development focused-blog Blood and Milk, also provides clear ideas about how these worldwide problems can be managed.

In What’s Killing Us, you concentrate on 10 major health topics. Why just 10?

Because they cover a wide and varied range of health issues. Understanding them will give you the background you need to learn about any global health topic. These are some of the most important issues that the human race is facing, although they’re just the highlights of the many health threats that endanger us.

What are the most promising initiatives you’ve seen to improve global health?

Although it has taken some criticism lately,  The Global Fund to Fight AIDS, Tuberculosis and Malaria has elevated global health to a consistent international priority. I am also excited about inviting more people into health care – training community health workers, giving nurses more responsibility, and teaching people to care for their own health. Making good health is everyone’s job, not just the job of physicians. Our new focus on improving health systems is also inspiring. Looking at health and health care in a broader social and national context makes a huge difference.

How real are the threats of a global pandemic?

Our globalized lifestyles mean that there is almost no way to stop infectious diseases from spreading rapidly and internationally. When a very contagious disease crops up, we’re all at risk. We got off easy with swine flu because it was highly contagious but was not all that dangerous once you had it. There is no guarantee the next pandemic will be as benign.

We see a number of philanthropists, Bill Gates among them, devoting a lot of time and cash to improving health. How important are these actions?

Tremendously important. Global health is a field where targeted international effort and investment has a powerful impact on human lives. Many global health problems are things we know how to solve if we just had the funding to do it.

What are the health issues that we should worry about the most in the next five to 10 years?

The two biggest are climate change and tuberculosis. Drug-resistant tuberculosis is the big one. Tuberculosis (TB) is evolving so that our current drugs can’t treat it. TB is also contagious through the air so it spreads in situations like crowded cities and public transport. And climate change will be the biggest single threat to human health, causing everything from famine to natural disasters to new infectious diseases. We should also worry about the growth of non-communicable diseases like cancer, diabetes, and heart disease. Rates of these diseases are rising rapidly. Finally, as the planet urbanizes we need to start make making good, deliberate choices about the design of cities. If cities just grow without any government thought about the health of people in them, it will be a health catastrophe.

What’s Killing Us: A Practical Guide to Understanding Our Biggest Global Health Problems is part of the TED Books series. They are available for the Kindle and Nook, as well as on Apple’s iBookstore.

On Monday, the TEDBlog had a long chat with Hans Rosling, the extraordinary global health professor that makes data come alive. He had his third TEDTalk posted yesterday and again wowed us all, explaining complex information with animated graphs — and humor. In this interview, he delves into his theories on concurrency and AIDS transmission, our ideological ruts and developing the Obama-meter!

Hans had so much interesting news to share, that we had to split our interview in two! Return tomorrow for Part 2 of the interview, when Hans will recount meeting Fidel Castro, explain how cancer changed him and divulge the secret of why we love him so.

So, you’ve seen your TEDTalk already?

Oh yes, and I got so disappointed because, first, I went over the time. Also, we had technical problems and spent the last two hours before my talk debugging the presentation. So, the presentation I gave is not as good as the version that was on my computer. It just did not come out well at all. You know, it’s a real challenge to talk about a subject as complicated as AIDS in front of a large audience.

And I made that one mistake. I said male circumcision prevents HIV transmission when really it reduces it in a population. And when someone hears this, he will think, “If I have a circumcision, I can’t contract HIV,” and this is not the case. However, at least this part was edited out of the talk.

I thought the talk was very good. Do you always feel this way about your talks? Have you given a talk that you thought was good?

TheTEDTalk from 2006 is almost perfect. Even the mistakes I made in that talk were almost perfect. Then, the screen was low and you could see the graphics around me while I was talking. It was so good for my style of presenting. But in 2007, you raised the screen.

Anyway, I didn’t know that format was going to be so good. This was a technique I discovered by serendipity, like the joke in my talk about solidifying the beam of the laser. People really liked that, because they are so fed up with laser pointers which are such an overused technology. Now, I’m working on a bamboo version so that it will be biodegradable.

We know AIDS spreads more rapidly with concurrent sex partners, but what exactly do Africa’s concurrent partner relationships look like?

Well, this concurrency I have only observed in some parts of southern and eastern Africa. You must remember that there are tremendous variations between practices in all of Africa. Remember in the talk, I spoke about the difference between Salt Lake City and San Francisco. For example, the gay community in Salt Lake City is not that strong. But where there is the practice of concurrent partners, between the ages of 15 and 30 you may have less partners and less intercourse and have 50 times more HIV.

Now, Swedes have serial monogamy, which is one partner after another but no overlap. And then there is polygamy. Concurrent partners does not mean polygamy. These are as different as snow and sand. I want to carefully explain this, because this area is so heavy with moral judgment.

Having concurrent partners means that during a one month period, on a regular basis, you have sex with more than one person. There is not one main partner and then little affairs, either. In these societies, sex is linked to the social transaction. Sex has a different social role. There’s not as much jealousy with regard to sex. Now, it sounds as if I am defending concurrent partners. But with the Swedish way, serial monogamy, you just drop partners. It’s not very nice.

There is another model as well. In the Middle East, you marry when you are between 17 and 21 and you only have sex with the person you marry. And, actually these people probably have more intercourse, with their spouse, than anyone else. Many of these couples have a great sex life, too.

Also, as I said in the talk, HIV doesn’t have the same risk of transmission at all times. From the time of infection, the virus’ levels grow and peak in the blood in the first six weeks. With no other STD present, the risk of transmission is actually very low at other times. So with serial monogamy, even if a person is infected, they continue to have sex only with the person that infected them until their viral levels have fallen. Whereas, if you have sex with two other people just after infection, the virus is more likely to spread.

Promiscuous parts of the gay community in the United States, and in Sweden, also have concurrent partners. Note that I said promiscuous. For heroin abusers, this concurrency pattern is also the same as they reuse needles from many different people. This is also significant as blood is more contagious than any other bodily fluid.

There is no research consensus on concurrency, but it is the most probable hypothesis.

READ MORE: Hans talks about ideological mistakes, circumcision, his swine flu commentary and the Obama-meterThis brings me back to a question I was going to ask on why the rate of AIDS is higher in Southeast Africa than in West Africa. So, clearly it’s not related to viral mutations but to culture, right?

No, no, no. Don’t say “clearly.” There is no research on this, as I said. Researchers haven’t done this yet, probably because it’s a very controversial topic. There’s lots of research on mother to child transmission, but they haven’t done the main method of transmission, you see. This is because this topic of sex is so delicate and also so methodologically difficult.

After 25 years of this virus, now UNAIDS is discussing funding someone to do this research. Peter Piot finally heard of it. But, I’m not complaining because this is how it is with these big diseases. It has taken 25 years, but we’ve finally gotten the big specialists.

So, I can’t completely defend everything in this theory scientifically. But, I can provoke research. I showed the differences between income groups. That was not what we thought it would be. There’s no war-torn country with more than three percent infection. That’s not what we thought it would be. The hypotheses don’t hold with the statistics. High literacy rates correspond with the highest infection rates. Going to school actually increases your risk of contracting HIV.

Wow.

Reality is like that.

When a new disease arises we want to use it for our old fights. And we are not really addressing HIV, we are using it to fight our old battles.

So we get stuck in ideological ruts?

Yes. And at the local community and neighborhood levels, and even city and state levels, our understanding of issues tends to be evidence-based. But at the global level, we tend to think on the only on the ideological level.

When Nathan (Wolfe) showed a photograph of a man who had killed a monkey and then defended him, that was my best moment at TED. The audience was silent. This went completely against the accepted idea of preserving and conservation of monkeys. But this man had to kill the monkey to feed his family.

I showed a powerpoint in 2007 that demonstrated the difference between the means of progress and the goals of progress. People mix up means and goals. Goals, like human rights and gender equity, are often used as means. These are very nice goals, but they are not means.

You see, it is very easy to be an evidence-based professor lecturing about global theory because many people get stuck in wrong ideas.

Speaking of ideological shifts, you mentioned circumcision earlier and I’ve read a few studies about it lowering AIDS transmission within populations. At the time these findings were considered controversial — are they still?

This is proven beyond a doubt. It was tested in randomized controlled trials, the strongest study design we have. It’s very well proven.

The problem is that it’s linked to religion and ethnicity, so that it also can become this anti-Semitic upheaval. Where you are, in New York, this sort of thing is more relaxed. Circumcision is the norm. In Sweden you can talk about condoms as much as you want, give them to all the teenagers. But circumcision — no. In many countries, it is socially, politically and culturally impossible to promote.

The only problem with circumcision is that more safety measures mean more risk-taking. You know, using a bike helmet means you ride more recklessly and seat belts mean you drive faster. A lot of the positive effects you get from safety measures, you lose in risk-taking. So this is a double-edged sword.

It’s difficult to understand how we can reduce transmission in countries with concurrency. But we must, because we can’t provide treatment to everyone at the poorest levels. It’s impossible. Of those that have received care from PEPFAR, 60 percent are alive after five years. In Sweden, we’ve got 98 percent of patients alive after 10 years. It may not seem like a nice thing to say, but perhaps the money could have been used more effectively. Diabetes, cervical cancer and heart disease are all without international support. Oh, and tuberculosis! Did you see my video on swine flu and tuberculosis?

Yes! We loved it at the TED office.

I’m a little afraid that it gets misinterpreted. I defended all disease control agencies. That should be done. Their work is very important. It’s the media hype! The story is too easy for them. It’s like putting a child in a candy shop. It’s like the first job for an intern — so simple.

The people in disease control have to be very serious and give proper warnings but I don’t think that the media supports them well. They give them attention for a short time and then they leave them. So people were just not aware of 60,000 deaths from TB in 13 days .

When I released this video, the Swedish media got very offended and started to defend themselves on their webpages. It’s a small place, like Vermont. They thought I was directly criticizing them, but it was global media. One of the heads of news in Sweden told me, “The thing about news is that it’s about things that are not continuous.” So I told him, “You’re right. You should never report about domestic abuse. But when one Swedish man is killed by one bear, that’s what you should report about.”

Actually, in North Sweden a man was killed by a bear in the same county where a man killed his wife two days before. The bear story made the news for weeks, but the other was featured once on the inside pages of the newspaper. There was a huge backlash. There were big protests of the media by women’s organizations.

The media misses a lot of things that change slowly. They have to use the annual report of the WHO on TB and explain those things. When I did my presentations at TED, no-one knew that Vietnam had become so healthy. Al Gore whispered to me, “I had no idea about what you said about Vietnam.” Steady change, they don’t report. The media is simply a bad source of knowledge and understanding.

What about your website, Gapminder.org? This is one way of informing the public. Is there anything new we can look for there?

Yes. It will be better! I’m going to do more videos and I will be developing an Obama-meter. I will plot his days in office against the number of African-American kids who die in D.C. You see, the infant mortality rate amongst African-Americans in Washington, D.C. is more than three times as much as that of African immigrants in Sweden. It’s also much higher than in the white population of D.C. You know, he said it himself, in one of his best speeches — D.C. has the highest income per person in the country yet the child mortality rate is higher than that of some African countries.

I’ll be creating the Obama-meter per 100 days. And people can put it on to their facebook accounts!

This is not just to pull him down. It’s also recognizing him. I could also put up a graph for George Bush showing no change when he was in office. But that’s unnecessary. We already knew that, huh?

To be continued tomorrow …

Get TED delivered:
Subscribe to the TEDTalks video podcast via RSS >>
Subscribe to the iTunes video podcast
Subscribe to the iTunes audio podcast
Get updates via Twitter >>
Join our Facebook fan page >>

Subscribe to the TED Blog >>