XVII International AIDS Conference Opens Amid Calls for Universal Access to Treatment, Disappointing Vaccine, Microbicide Trials

More than 22,000 researchers, policymakers and advocates gathered in Mexico City on Sunday for the opening of the XVII International AIDS Conference, which has the theme "Universal Action NOW," AFP/Sydney Morning Herald reports (AFP/Sydney Morning Herald, 8/4). According to the Wall Street Journal, about 25 million people have died of AIDS-related conditions since 1981, and there are currently about 33 million HIV-positive people worldwide (Chase, Wall Street Journal, 8/2).

The conference was opened by several world leaders and health officials, including Mexican President Felipe Calderon and United Nations Secretary-General Ban Ki-moon (XVII International AIDS Conference release, 8/3). "As the fight against AIDS nears the end of its third decade, we are still facing a huge shortfall in resources," Ban said, adding, "The responses to HIV and AIDS require long-term and sustained financing. As more people go on treatment and live longer, budgets will have to increase considerably over the next few decades. In the most affected countries, donors will have to provide the majority of the funding."

Peter Piot, executive director of UNAIDS, said, "The end of AIDS is nowhere in sight," adding, "Every day, almost three times as many people become newly infected with HIV as those who start taking antiretroviral therapy."

Piot said, "We must categorically reject any attempt to so-called 'normalize' AIDS, or treat this epidemic as just one of many medical problems. Now, more than ever, do we need an exceptional response ... there's not 'too much money going to AIDS' but too little.'"

Margaret Chan, director-general of the World Health Organization, said, "AIDS is the most complex, the most challenging and probably the most demanding infectious disease humanity has ever had to face," adding, "We dare not let down our guard. ... We are going to be in this for the long haul."

Keren Dunaway-Gonzalez, a 13-year-old Honduran girl with HIV, during the opening ceremony said, "Many of us want to be doctors or teachers. I want to be a singer. But these dreams will only be possible when we have medicines, when we're accepted in schools, and when we can grow up in an atmosphere free from violence, stigma and discrimination" (AFP/Google.com, 8/4).

A major increase in funding for HIV/AIDS treatment and reduced prices for antiretroviral drugs have enabled nearly three million HIV-positive people in developing countries to receive the drugs. "There has been a spectacular advance, but we are still very short of the mark," Jean-Francois Delfraissy, head of France's National Agency for AIDS Research, said ahead of the conference. He added, "One of the tasks of the conference is to address the fact that there are three million people who now get the drugs, but another nine million who do not" (Agence France-Presse, 8/3).

Pedro Cahn, president of the International AIDS Society, said that the U.N. General Assembly has a commitment to provide antiretroviral drugs to all who need them by 2010, but there are signs that governments and international agencies are retreating from that promise and instead aiming for universal access by 2015. "After so much progress it appears that we are poised to accept defeat when victory is still within our grasp," Cahn said, adding, "This cannot be allowed to happen."

Stephen Lewis, former U.N. envoy for HIV/AIDS in Africa and current co-director of the group AIDS-Free World, said it is "reprehensible" that governments appear to be backing away from the universal access target, adding, "I don't believe for a moment this could break the bank. ... There is a humanitarian necessity of investing in prevention" (Picard, Globe and Mail, 8/4).

IAS Executive Director Craig McClure said, "HIV has spawned an interest in health systems that was never there before, and (investment in HIV) is helping to drive the expansion of public health systems globally to reach all those who need it." Cahn added that there is "no doubt that in order for us to achieve the 2010 universal access targets, health systems must be further strengthened" (Green, Star, 8/4).

First Conference in Latin American Country
The conference is the first to be held in a Latin American country, and attendees will focus on curbing the epidemic in the region, Inter Press Service reports (Ebrahim, Inter Press Service, 8/3). The U.N. Population Fund last week said that more than 500,000 Latin Americans ages 15 to 24 are HIV-positive, a 5% increase since 2006. Nils Kastberg, UNICEF regional director for Latin America and the Caribbean, said that regional taboos related to HIV/AIDS have delayed prevention campaigns in Latin America, adding that most governments in the region have not achieved universal access to antiretroviral treatment (Xinhua News Agency, 8/2).

The first international March Against Stigma, Discrimination and Homophobia "set the tone for the conference" -- that HIV among men who have sex with men "is an overlooked epidemic," Inter Press Service reports. McClure said that "stigma, discrimination and human rights would indeed be the focus of the conference" (Inter Press Service, 8/3).

Drug, Vaccine Development Expectations
Some experts have said they do not expect a "breakthrough" announcement to be made at the conference about HIV/AIDS drug development, but they are bracing for confirmation that research on HIV vaccines and microbicides are "mired in setbacks," AFP/Google.com reports (AFP/Google.com, 8/3).

According to the Journal, failed tests on vaccines, microbicides, diaphragms and a herpes treatment have caused researchers to "refocus" on the basic questions of what makes an effective HIV immune response and how researchers can create neutralizing antibodies that block HIV (Wall Street Journal, 8/2). Disappointing news in the field of HIV vaccine research came last year when Merck halted clinical trials of an experimental vaccine over safety concerns, Reuters Africa reports. The announcement "spurred a major shift" in U.S. government-funded vaccine research, leading to a recent announcement by NIH to abandon plans for a large-scale trial of another experimental vaccine that is similar to Merck's candidate. NIH has said it will focus funding on smaller studies aimed at increasing basic knowledge of HIV.

"We are in an interesting, and some would say, difficult period," Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said, adding, "The obvious empirical approaches have not worked." Seth Berkley, president of the International AIDS Vaccine Initiative, said, "There has been a sense ... that every vaccine trial is do or die," adding, "Most people don't understand that the product development process is rife with failures. The assumption is most candidates won't work. We are just looking for any signal of hope" (Quinn, Reuters Africa, 8/1).

Positive Developments
According to Reuters Africa, the "gloom" over disappointing research results "threatens to overshadow more positive" HIV/AIDS-related news, such as findings that male circumcision might reduce the likelihood of HIV transmission and that giving antiretroviral drugs to "high-risk" HIV-negative people could help protect them from infection -- a concept referred to as pre-exposure prophylaxis, or PrEP (Reuters Africa, 8/1). Robert Grant of the Gladstone Institute and the University of California-San Francisco is using funding from NIH and the Bill & Melinda Gates Foundation to test daily use of Gilead Science's antiretroviral drug Truvada among high-risk HIV-negative volunteers in Brazil, Ecuador, Peru and the U.S. Results are scheduled for 2010 but might come earlier, the Journal reports.

"[S]omething like PrEP has a good chance of becoming available before we have a 100% efficacious vaccine," Bill Gates, co-founder of the Gates Foundation, said, adding, "The challenges are a little less daunting. If we have that tool, it could have a very big impact." The Gates Foundation has allocated $93 million for PrEP research. The rest of the organization's $1.49 billion allocated for HIV prevention is spread between promoting existing prevention tools, such as condoms, and conducting research on new tools, such as vaccines, microbicides and drugs (Wall Street Journal, 8/2).

Kaisernetwork.org is the official webcaster of the XVII International AIDS Conference in Mexico City. Click here to sign up for your Daily Update e-mail during the conference. A webcast of the opening press conference is available online at kaisernetwork.org. A webcast of the opening ceremony also is available online. An interview with McClure also is available online at kaisernetwork.org.

Additional Coverage
Several media outlets included coverage related to the opening of the conference. Summaries appear below.

AP/Google.com featured an interview with Dunaway-Gonzalez (Olson, AP/Google.com, 8/4).

Deutsche Welle on Sunday posted an interview with German researcher Hans Jaeger about the progress of research on HIV vaccines and treatments (Usi, Deutsche Welle, 8/3). A transcript of the interview is available online.

The Toronto Star on Saturday reviewed progress since the XVI International AIDS Conference in Toronto in 2006, as well as previewed hot topics for the current conference (Toronto Star, 8/2).

VOA's "Our World" on Friday previewed the conference. The segment includes comments from Piot, VOA reporter Rosanne Skirble, McClure and conference Co-Chair Pedro Cahn (Honig, "Our World," VOA, 8/1). Audio and a transcript of the segment are available online.

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