Épisodes

  • Undetectable, Then Detectable: Decoding the HIV “Viral Blip”

    Undetectable, Then Detectable: Decoding the HIV “Viral Blip”
    Jun 30 2026
    Why does an undetectable HIV viral load sometimes flip to “detectable” — and what does that actually mean for the patient? Host Ben Plumley talks with Ben LaBrot (Professor of Global Medicine, USC; Medical Affairs Lead, Roche Molecular Diagnostics) and Daniel Griffin, MD (Chief of Infectious Disease, Island Infectious Disease Medical, Instructor of Clinical Medicine, Columbia University, Host, This Week in Virology) about the “viral blip” — a brief, low-level detectable result that occurs even in patients on fully effective antiretroviral therapy. The conversation covers the science behind ultra-sensitive viral load assays, the real meaning of U=U (undetectable = untransmittable), why lab handling and patient illness can cause a temporary blip, and why so many patients are blindsided by results in their MyChart before their doctor has a chance to explain. Ben and Daniel also discuss “prebunking” — preparing patients in advance — and the underused role of community health workers in HIV education. Topics: HIV, viral load, U=U, undetectable, antiretroviral therapy, infectious disease, diagnostics, patient communication, global health. 00:00 Welcome and Setup 00:13 The Viral Blip Riddle 01:20 Meet the Guests 04:02 Why Blips Matter Now 05:54 Assay Sensitivity and LOD 06:22 What Undetectable Means 08:36 U Equals U Confusion 12:50 MyChart Panic and Context 17:09 Prebunking Patient Fear 18:21 Why Blips Happen 20:59 Tech Problem Analog Fix 22:26 Testing Noise Sources 23:28 RNA Fragments Explained 25:16 Sample Handling Pitfalls 26:46 Reporting Low Copy Results 29:02 Managing Patient Anxiety 33:14 When a Blip Matters 36:12 Changing the Landscape 40:48 Community Outreach Ideas 43:12 Key Takeaways Check Out Ben’s Substack: https://substack.com/@benplumley1 Join the Conversation! How do you see the future of global health unfolding? Share your thoughts in the comments! Subscribe & Stay Updated: Listen on Spotify, Apple Podcasts, or your favorite podcast platform. Watch on YouTube & subscribe for more in-depth global health.
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    47 min
  • AIDS 2060 Ep 02 - African-Led Research for an African Epidemic

    AIDS 2060 Ep 02 - African-Led Research for an African Epidemic
    Jun 26 2026
    In this second episode of AIDS2060, Ben sits down with Dr Andrew Kambugu, Executive Director of the Infectious Disease Institute at Makere University in Kampala Uganda. They discuss the state of the clinical response to HIV in Africa, and Andrew sets out a research and implementation agenda that gives equal weight to HIV prevention, treatment and diagnosis. He compares it to floor cleaning: you have to switch the water off at its source and not rely exclusively on mopping water up on the floor. In other words, African solutions for African problems of an epidemic that we know how to treat but can’t control rates of infection across the continent. 00:00 AIDS 2060 episode 2 intro 02:20 Three pillar overview 02:58 Prevention breakthroughs 04:19 Treatment momentum risks 06:00 Injectables and dual therapy 08:24 Integrating chronic care 10:12 Circumcision and ownership 14:07 Rethinking optimization 20:03 Africa led R & D 26:02 Africa CDC and AMA 27:42 Building Regulatory Capacity 28:21 Private Sector Momentum 29:37 Uganda Manufacturing Model 31:55 Academia Industry R&D 33:35 Africa Research Priorities 36:44 Biotech and Diagnostics 44:55 Funding and Innovation 49:51 Closing Thanks and Outro Check Out Ben’s Substack: https://substack.com/@benplumley1 Join the Conversation! How do you see the future of global health unfolding? Share your thoughts in the comments! Subscribe & Stay Updated: Listen on Spotify, Apple Podcasts, or your favorite podcast platform. Watch on YouTube & subscribe for more in-depth global health.
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    51 min
  • Redefining Global Health in the 21st Century, Chapter 1: The End of the Old Order – and What Comes Next

    Redefining Global Health in the 21st Century, Chapter 1: The End of the Old Order – and What Comes Next
    Jun 23 2026
    A Shot in the Arm Media in partnership with UCSF Institute for Global Health launched a nine-part series to explore the future of global health built around the book Redefining Global Health in the 21st Century, co-authored by Dr. mike Reid (UCSF Institute for Global Health Sciences) and Ambassador Eric Goosby (former U.S. Global AIDS Coordinator and former PEPFAR Chief Medical Officer). In this episode, what if the greatest threat to global health isn't a new virus — it's us? Our funding fatigue, our outdated playbook, our addiction to replication over adaptation. We've saved millions of lives. But are we sleepwalking inexorably into decline, into the enshittocene. Eric and mike don’t think so. And they’ve written a book, “Redefining Global Health in the 21st Century, that sets out an alternative, optimistic future. In this episode, they reflect on the end of the old order, and the implications for innovation and scale up into a new era in global health. mike and Eric are hosted by Ben Plumley from A Shot In The Arm Media. 00:00 Series Kickoff Recap 01:25 Early Wins Foundations 02:07 Global Fund and PEPFAR Tensions 04:40 What Worked Best 06:29 Malawi Dependency Shock 08:48 Why Systems Collapsed 12:50 Donor Ecosystem Incentives 18:30 Designing Better Partnerships 23:25 New Players Multipolar Era 27:21 Philanthropy Promise and Peril 31:44 Limits of Philanthropy 32:24 Gates Foundation Lessons 33:41 Sustainability Commitments 35:56 Country Led Coordination 37:45 Innovation Beyond Tech Fixes 39:28 Private Sector as Resource Motor 42:02 Equity Risks and Guardrails 44:24 Indigenous Knowledge in Trials 48:08 From Pilots to Scale 52:19 Access and Global Rollout Rules 54:34 Paradigm Shift Takeaways 55:25 Episode Wrap and Next Steps Learn more about the book: https://bit.ly/redefining-global-health More from UCSF Institute for Global Health Sciences: https://globalhealthsciences.ucsf.edu Check Out mike Reid’s Substack: https://substack.com/@reimaginingglobalhealth Check Out Ben’s Substack: https://substack.com/@benplumley1 Join the Conversation! What would it take for global health to avoid decline? Share your thoughts in the comments! Subscribe & Stay Updated: Listen on Spotify, Apple Podcasts, or your favorite podcast platform. Watch on YouTube & subscribe for more in-depth global health — and look out for a dedicated sub channel for Redefining Global Health in the 21st Century under A Shot in the Arm’s YouTube home. Redefining Global Health in the 21st Century: The Podcast (Playlist on Youtube) https://youtube.com/playlist?list=PLW7yagTEtywqvW9_bs6heRikREgwS9sE9&si=Tu-NEdwcA9Z-VKLH A Shot in the Arm Podcast Youtube (Main Channel) https://youtube.com/@shotarmpodcast
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    58 min
  • Redefining Global Health in the 21st Century: A New Series on Why Global Health Is at a Crossroads

    Redefining Global Health in the 21st Century: A New Series on Why Global Health Is at a Crossroads
    Jun 15 2026
    A Shot in the Arm Media launches a new nine-part series produced in partnership with the UCSF Institute for Global Health Sciences, built around the book Redefining Global Health in the 21st Century, co-authored by Dr. mike Reid (UCSF Institute for Global Health Sciences) and Ambassador Eric Goosby (former U.S. Global AIDS Coordinator and former PEPFAR Chief Medical Officer). In this prologue episode, Reid and Goosby explain why they wrote the book, what defined the “golden era” of global health since the early 2000s—the Global Fund, PEPFAR, Gavi—and why that progress now feels at risk under the Trump administration's cuts to USAID and PEPFAR. They introduce the book's central metaphor, borrowed from Cory Doctorow's concept of “enshittification,” to ask whether global health institutions are on the brink of decay, and argue that decline is a choice, not a destiny. The conversation previews the arc of the series—covering the old order, governance, financing, climate, technology and AI, and self-care for health workers—and closes with a call for honesty, bipartisanship and accountability, grounded in the legacies of Nelson Mandela and Steve Biko. 00:00 Introduction: Is the Greatest Threat to Global Health... Us? 00:49 Launching the Series: Redefining Global Health in the 21st Century 02:06 Meet the Authors: Dr. Mike Reid and Ambassador Eric Goosby 02:32 Why They Wrote This Book 03:28 Writing Through the Trump Transition 05:28 The Golden Era of Global Health 08:04 Shared Responsibility and Its Roots 10:21 What's Unraveling Now 11:34 Vancouver 1996 and the Roots of the Reckoning 12:18 Honoring Health Workers and Naming the Moral Injury 14:18 What Would Have to Change, Structurally and Politically 17:50 “Enshittification” and the Risk of Global Health Decline 20:30 Kuhn, Paradigm Shifts, and a New Vision for Global Health 22:17 Goosby's 38,000-Foot View: Aligning Need, Access and Governance 25:16 Reid on Financing, Governance, Science and New Tools 28:06 Mapping the Series and the Book's Chapters 32:11 Reform Agenda or Transformation Agenda? 35:19 Letters to My Daughters: Making Global Health Personal 37:31 Why Global Health Matters at Home 41:12 Does the Field Still Reflect Why We Got Into It? 43:18 Bipartisanship, Nelson Mandela and Steve Biko 46:18 Toward a Reckoning: Truth, Reconciliation and Accountability 51:02 “Not on Our Watch” 53:27 Holding the Administration to Account 56:32 The Book, Its Price, and Where to Find It 58:23 Sign-Off and What's Coming in Episode Two Learn more about the book: https://bit.ly/redefining-global-health More from UCSF Institute for Global Health Sciences: https://globalhealthsciences.ucsf.edu Check Out mike Reid’s Substack: https://substack.com/@reimaginingglobalhealth Check Out Ben’s Substack: https://substack.com/@benplumley1 Join the Conversation! What would it take for global health to avoid decline? Share your thoughts in the comments! Subscribe & Stay Updated: Listen on Spotify, Apple Podcasts, or your favorite podcast platform. Watch on YouTube & subscribe for more in-depth global health — and look out for a dedicated sub channel for Redefining Global Health in the 21st Century under A Shot in the Arm’s YouTube home. Redefining Global Health in the 21st Century (Playlist on Youtube) https://bit.ly/rgh-podcast A Shot in the Arm Podcast Youtube (Main Channel) https://youtube.com/@shotarmpodcast
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    1 h et 1 min
  • Episode 10 – Colon, Meet Cancer: Food Fight: The Impact of Cancer and Chemo on my Appetite

    Episode 10 – Colon, Meet Cancer: Food Fight: The Impact of Cancer and Chemo on my Appetite
    Jun 4 2026
    Another candid update from Ben Plumley on life with stage four colorectal cancer, focusing on one of the most under appreciated challenges of treatment: the daily battle to eat. Treatment Update — Ben is continuing maintenance chemotherapy and awaiting a PET scan at the end of June. The goal is non-progression — holding the cancer steady — which counts as a win. --- 01:30 - The Food Fight — Ben breaks down why eating has become such a struggle, covering two main culprits: the cancer itself and the side effects of chemotherapy -which damages the digestive tract lining and causes nausea, taste changes, and mouth and jaw pain. 03:37 - Taste Changes Explained — Ben describes the layered impact on his senses: from persistent metallic taste, a sulfuric reaction to eggs and squash, to complete tastelessness , and to brights including orange juice and alpine milk chocolate. 09:29 - Cannabinoids as a Tool — After a referral through Kaiser’s infectious disease department, Ben has incorporated CBD tinctures into his routine. 13:56 - And on a genuinely uplifting note, Ben’s vegetable garden is thriving with fruit and vegetables - a reminder that the garden remains a vital source of calm and energy throughout his journey. Hosted by Ben Plumley | A Shot in the Arm Media | Produced and directed by Erik Espera. Join the Conversation! If you or someone you know is living with cancer, share your experiences and thoughts in the comments! Check Out Ben’s Substack: https://substack.com/@benplumley1 Useful resources: https://fightcolorectalcancer.org https://colontown.org Subscribe & Stay Updated: Listen on Spotify, Apple Podcasts, or your favorite podcast platform. Watch on YouTube & subscribe for more in-depth global health news.
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    16 min
  • AIDS 2060 Ep 01 - Lessons from the Frontlines: San Francisco

    AIDS 2060 Ep 01 - Lessons from the Frontlines: San Francisco
    May 10 2026
    This is the first episode of AIDS 2060, a special multimedia mini-series of podcasts and Substack articles devoted to understanding what is needed to bring the HIV epidemic under control, how long that will take, and why the world has been unable to do so to date, notwithstanding overly ambitious public commitments that questionably are not rooted in science and hide the real threat HIV poses, even today. We are in San Francisco, one of the first epicenters of the epidemic, and meet the City’s Community Health Center which is on the frontline of providing comprehensive care and prevention services to the hardest to reach populations, people of color, the trans community, people who inject drugs, the homeless and people with mental health issues. Ending the HIV epidemic will not be achieved, let alone by an arbitrary date like 2060, unless human rights and evidence-based programs reach and are used by these people. Does a progressive city like San Francisco have the political will to do what the science tells us works? Host Ben Plumley is joined by Lance Toma (CEO), Dan O’Neill (Chief Medical Officer), and Dr. Tatyana Moaton (Chief Strategy & Workforce Officer). 00:00 Welcome to AIDS 2060 00:38 Why the Response Stalled 02:05 Picking 2060 as the Lens 03:01 San Francisco Frontlines 03:39 Targets and Reality Check 04:16 Meet the Health Center Team 05:35 Will AIDS 2030 Happen 07:46 Local Progress and Setbacks 10:52 Who the Clinic Serves 14:12 Trans Communities as Canary 18:15 Surveillance Data Under Attack 22:15 Leading Through Funding Chaos 26:53 Long Acting Injectables in Practice 28:47 Prep Access Gaps and Equity 30:14 Street Medicine and Viral Suppression 32:50 Worrying About Innovation Stalls 33:16 HIV Pipeline Reality Check 33:54 Long Acting Drug Revolution 35:10 New Classes And Regimen Design 36:02 Once Yearly Prevention Vision 37:09 Equity Over Innovation 37:52 Whole Person Care Infrastructure 40:31 Radical Roots And Community Power 42:58 Hard Reboot In Crisis 46:25 Coalitions Beyond HIV 49:43 Data Visibility And Erasure 53:55 Global Community Connections 55:32 2060 Hopes And Closing Check Out Ben’s Substack: https://substack.com/@benplumley1 Join the Conversation! How do you see the future of global health unfolding? Share your thoughts in the comments! Subscribe & Stay Updated: Listen on Spotify, Apple Podcasts, or your favorite podcast platform. Watch on YouTube & subscribe for more in-depth global health.
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    1 h et 4 min
  • Emily Bass on PEPFAR’s Data Spin, What South Africa’s Oral Histories Reveal & the future w/ AIDS2060

    Emily Bass on PEPFAR’s Data Spin, What South Africa’s Oral Histories Reveal & the future w/ AIDS2060
    May 6 2026
    Investigative journalist and public health expert Emily Bass returns to A Shot In The Arm with the most consequential update on the global HIV response in months. Drawing on a brand-new report from Physicians for Human Rights and South African partners — built from 40 oral histories — Emily walks Ben Plumley through the human cost of the Trump administration’s foreign aid disruptions, the staggering waste of dismantled prevention infrastructure, and the bizarre data spin emerging from the State Department. The episode also covers Dr. mike Reed’s headline-making resignation as PEPFAR’s Chief Scientific Officer, the dangerous quiet around supply chain contracts and bed-net procurement, and what the new “America First Global Health Strategy” is choosing to celebrate — and choosing to obscure. Ben closes with a preview of two new initiatives: AIDS 2060, a long-horizon project from A Shot In The Arm Media, and the rebrand of MTV Staying Alive Foundation to Shuga Global. 00:00 Welcome and Setup 01:18 Global Health Upheaval 03:13 PEPFAR Data Spin 04:07 South Africa Report 05:51 Prevention Platform Collapse 09:27 Clinic Breakdown Story 12:52 Why 18 Percent Matters 16:33 Community Resilience 19:22 Research Partnerships Lost 22:12 Treatment Disruptions 25:26 Trauma to Transition 31:11 Data Blackout Returns 39:07 Prep Data Mirage 42:08 Kids Treatment Declines 44:55 Age Data Removed 47:02 Congress Pushback 52:02 Supply Chain Breakdown 59:38 Last Mile Disaster Story 01:02:16 Orderly Transition Demands 01:06:23 AIDS 2060 Vision 01:10:35 Sugar Global Storytelling 01:15:20 Africa Led Future 01:20:42 Closing Thanks Read Emily Bass’ Substack: https://substack.com/@emilysbass Check Out Ben’s Substack: https://substack.com/@benplumley1 Join the Conversation! How do you see the future of global health unfolding? Share your thoughts in the comments! Subscribe & Stay Updated: Listen on Spotify, Apple Podcasts, or your favorite podcast platform. Watch on YouTube & subscribe for more in-depth global health.
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    1 h et 26 min
  • AIDS 2060 — An Exciting New Project from A Shot In The Arm Media

    AIDS 2060 — An Exciting New Project from A Shot In The Arm Media
    May 5 2026
    What the hell has gone wrong with the global HIV and AIDS response? Does it matter? And what do we need to do to fix it? Ben Plumley introduces AIDS 2060, a new project from A Shot In The Arm Media asking the questions the global health community has been quietly dodging for a decade. With 40.8 million people living with HIV, 1.3 million new infections every year, and the US sending the world into "septic shock" with sudden cuts to PEPFAR, the scale of the real challenge ahead is finally coming into focus. Over the coming months, we'll travel the world to gather insights from scientific, political, and community leaders — starting with an initial AIDS 2060 episode focused on San Francisco’s evolving epidemic and long-term plans. Look out for that episode dropping soon! 00:00 Welcome and Big Question 00:30 Why HIV Still Matters 00:57 Funding Shock and False Optimism 01:42 Introducing AIDS 2060 02:05 Looking Ahead to Future Conferences 02:19 World Tour and First Episode 02:42 Subscribe and Closing Thanks Check Out Ben’s Substack: https://substack.com/@benplumley1 Join the Conversation! How do you see the future of global health unfolding? Share your thoughts in the comments! Subscribe & Stay Updated: Listen on Spotify, Apple Podcasts, or your favorite podcast platform. Watch on YouTube & subscribe for more in-depth global health.
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    4 min