August 16, 2006
Although a range of experimental HIV prevention methods could be available within a few years, they might not reach those who need them because many countries are not prepared to implement the methods, according to a report released on Tuesday by the Global HIV Prevention Working Group at the XVI International AIDS Conference in Toronto, USA Today reports (Sternberg, USA Today, 8/16). The report also finds that there are many practical and ethical challenges impeding research into the new methods. The working group is made up of public health experts, clinicians, researchers and people affected by HIV/AIDS and is co-convened by the Bill & Melinda Gates Foundation and the Kaiser Family Foundation. The report -- titled, "New Approaches to HIV Prevention: Accelerating Research and Ensuring Future Access" -- assesses the state of six new HIV prevention strategies -- including male circumcision; cervical barriers such as diaphragms; pre-exposure prophylaxis; treatment to suppress herpes, which increases the risk of HIV transmission by threefold; and HIV vaccines (Global HIV Prevention Working Group release, 8/15). Results from studies on microbicides and male circumcision are expected within five years, and some might be ready within one year (Altman, New York Times, 8/16). According to UNAIDS, about $11.4 billion annually will be required for HIV prevention by 2008, which is more than twice the amount currently being spent. In addition, more than 80,000 trial volunteers will be needed to test the new prevention methods, USA Today reports (USA Today, 8/16).
The report recommends ways to make preparations to adopt the prevention strategies as soon as they become available -- including making additional donor funding available, training health workers to administer services such as male circumcision, and developing education programs that stress the need to use the new methods with existing strategies (Global HIV Prevention Working Group release, 8/15). According to the report, no new prevention method is expected to offer complete protection from HIV transmission (New York Times, 8/16). To speed up clinical trials of the new methods, the report recommends that agencies take stock of trial capacity, identify needs and sites to increase capacity, and prioritize prevention methods that should be tested. The report also recommends that UNAIDS and the World Health Organization establish a panel of experts to update guidelines on ethical issues regarding the trials and that trial researchers and sponsors involve community members in key aspects of the process (Global HIV Prevention Working Group release, 8/15).
"Very soon, we could have new, highly effective ways to prevent many of the 4 million new HIV infections that occur every year," Working Group Co-chair Helene Gayle, who also is co-chair of the AIDS conference, said, adding, "But these tools will have little impact in the real world unless we take immediate steps to complete current trials, mount new ones, and reach people most in need" (AP/CNN.com, 8/15). Jennifer Kates, Kaiser Family Foundation vice president and director of HIV Policy, said, "The bottom line is that even if we see that a microbicide is effective or we find a vaccine in many years, or male circumcision works, no one thing is going to end HIV," adding, "We have to combine them and work with the existing things plus the new things on the horizon to really make an impact" (CTV, 8/16). David Serwadda -- director of the Institute of Public Health at Makerere University in Kampala, Uganda and co-chair of the Working Group -- said, "The development of effective new HIV prevention approaches could help millions avoid crippling illness and death." He added, "But unless we prepare now to make new, lifesaving tools accessible in developing countries, this scientific triumph will turn into a moral failure" (AP/CNN.com, 8/15).
The report is available online.
Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Daily HIV/AIDS Report, search the archives, or sign up for email delivery at www.kaisernetwork.org/dailyreports/hiv. The Kaiser Daily HIV/AIDS Report is published for kaisernetwork.org, a free service of the Kaiser Family Foundation, by The Advisory Board Company. © 2006 by The Advisory Board Company and Kaiser Family Foundation. All rights reserved.