October 25, 2014
Jim Pickett is a one-man example of the blurring lines in HIV prevention. The longtime advocate became an early champion of rectal microbicide research as one of the founders of International Rectal Microbicide Advocates (IRMA), but is quite fluent in the language of vaginal rings and contraception. He's now logged many hours in the world of PrEP (pre-exposure prophylaxis), from on-the-ground demonstration projects of Truvada (a coformulation of the antiretrovirals tenofovir and emtricitabine) to interest in the early research on long-acting injectables. And as a gay man living with HIV, he's deeply immersed in the realities of sexual health and human rights that can affect the perception, reach and use of HIV prevention. As one of the planners of the first HIV Research for Prevention (HIV R4P) conference, coming up in South Africa, Pickett was packing his bags to join other crosscutting prevention researchers and advocates when he took a few minutes to talk with TheBodyPRO.com about why he thinks this conference could float all the boats of prevention technology.
I'm talking with Jim Pickett of International Rectal Microbicide Advocates and AIDS Foundation of Chicago. You're about to get on a plane and fly to South Africa. Where are you off to, and why?
I am headed to the first ever HIV Research for Prevention conference (HIV R4P). This is the first time that the biennial microbicide conference and the annual vaccine conference are coming together and sharing space. So it's the first time this field has really had a unified conference that's covering new prevention technologies broadly. It's pretty exciting.
It does sound exciting. Why is it important to have a unified conference?
Mainly, the different modalities, the different strategies are all starting to blur. So we're thinking about long-term injectables for PrEP. We're thinking about vaccines that are given with PrEP as a starter to make sure you have some protection before the vaccine comes into play.
There's a blurring between treatment and prevention. We're using the drugs we've used for treatment in various ways for prevention. So it makes sense that we all come together and break the silo.
With all this blurring that's going on, what things are clear? Are there clear barriers, or clear opportunities, across the modalities that people will be talking about?
A huge thing that we've been talking about for a while and that will always need to be discussed is adherence. Adherence is such an issue with every single thing we do -- not just with new prevention technologies, but everything. Certainly, we've seen adherence issues gumming up trials, and making it so we can't get results from trials.
There's this fantasy among some people that, when we have things like long-term injectables -- which could provide three months' protection -- that somehow adherence will be off the table. But a quarterly injection also requires adherence. It requires retention. It requires the ability to follow up. So I think we're going to always be dealing with this, both in terms of how we conduct trials -- so we can get answers to the questions we're asking -- and then, just as importantly, how these are implemented in the real world.
We have to continue to really listen to people and ask what they want, and help figure out what that is, and develop things that fit those needs, as opposed to creating things and then saying, "Here. This is something you should want." It needs to start with communities. I think it's always a struggle, that kind of balance.
We're also pretty clear that nothing's off the table. We have PrEP now. It doesn't mean we don't need vaccines. It doesn't mean we don't need microbicides. We have one kind of PrEP. And it's really just available in one country. So we have huge implementation needs around the rest of the world.
But we also need to continue to support new technologies. A daily pill isn't going to work for everyone's lifestyle. We need things like microbicides. We need rings and gels. We need shots. Not everyone is going to want a shot. Some people are going to think about a shot every four times a year, and they're going to run the opposite way. So we need lots of different things for people.
Coming together is a really big statement around that. We're not thinking about just my intervention, or your intervention. We want interventions that work for people.
I'm wired for microbicides [as a long-time rectal microbicide advocate], but I want things that work. So when we showed that Truvada works with prevention, I became a full-throated PrEP advocate. And I'm going to continue to advocate for all these other things.
I want a vaccine. I want a therapeutic vaccine. Having us all together and sharing information, and sharing our different understandings, is going to be really fantastic.
It's a new relationship. We haven't done this before. So we'll see how we all blend together for the next several days in Cape Town.
You've been listening to people and asking what they want about rectal microbicides; what will the community voices be like at this conference? Is there a community participation component? How much of it is researchers, clinicians, advocates? What's the mix of people there and how will community voices be heard?
Microbicide conferences have always had a very strong community representation -- very strong community engagements, lots of activities. At the vaccine conferences, it was not nearly as robust.
I'm very pleased we kept that robust community engagement. The day before the conference actually kicks off, on Oct. 27, there's going to be a day-long pre-conference, which is really designed for advocates. Other people are welcome to come, but it's got a focus on community and advocates. We'll probably have well over a hundred people there.
And we also open it up to locals. So you don't need to be registered for the conference to come to our day-long pre-conference. You can come and get lots of information and get looped in on what's happening in research advocacy without attending a long scientific conference.
Throughout the conference there's a space that's been designated the Advocacy Corner, where we will have some light programming; but it's really meant to be a space where people are free to network and mingle casually, do ad hoc meetings.
What are some of the top stories you think can, or should, come out of this conference?
I think we're going to learn a lot more about adherence issues. We're going to learn a lot more about what's happening in implementation, in terms of PrEP. We're going to see lots of opportunities to do better.
I mentioned earlier that only the United States has really rolled out PrEP in any kind of way. It's not really happening anywhere else, outside of a demonstration project scenario. So I'm hoping that this will give advocates, researchers and other folks like funders and policy-makers the kind of kick in the butt we all need to start doing better on implementation.
And, speaking of the United States, while we've gotten it rolling, there's a lot we could do to improve here.
I think we'll also see some early data on long-term injectables. We'll hear some interesting updates on the rectal microbicide field, vaginal rings and newer strategies like films and nanofibers; we'll start getting glimpses of that. A lot of this is earlier in the pipeline.
I also expect to hear a lot about multipurpose technologies, which have really taken off in the last few years. That's the idea that we want products that do multiple things -- so, for a woman, a product that's a contraceptive and provides protection against HIV and an STD or two, for instance. Or a product that allows a woman to get pregnant, but she can get pregnant without having HIV come on board, or syphilis.
This idea of multipurpose technologies is really exciting; and they're starting to grab people's attention more and more.
We're also seeing developers thinking about (in terms of microbicides) products that are dual compartment -- something that would work in the vagina and the booty. Imagine one product that could go in either place. This could be a gel, or a lubricant, or it could be a film, or a nanofiber, for a person who has sex both anally and vaginally. If we just had one microbicide and it worked wherever you put it -- and we don't need to know where you're putting it, because we know it works and it's safe -- it would also take away some of the stigma that can be attached to anal sex and rectal microbicides, and some of the criminalization issues around the world.
A few years ago this would have been like crazy talk. But we're actually moving in that direction. And that's super exciting.
That is super exciting.
Thanks for all this, and best wishes for your travels. Let us know what comes out of the conference.
This transcript has been edited for clarity.
Julie "JD" Davids is the managing editor for TheBody.com and TheBodyPRO.com.
Follow JD on Twitter: @JDAtTheBody.
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