AIDS 2010: Right Here, Right Now ... Right TrackAIDS 2010 Conference logo

By Robert Folan-Johnson
After a busy week in Vienna of meetings, presentations and discussions, many attendees of the 2010 World AIDS Conference headed home feeling optimistic about the future of the HIV/AIDS pandemic.

AIDS 2010 presented data revealing new potential advances in prevention, treatment, and vaccines that could, at some point, significantly contain the pandemic. But there are also economic challenges to overcome.


The most celebrated presentation (which earned a rare medical conference standing ovation) was the CAPRISA study on the tenofovir gel spermicide.

Although just 39% effective in preventing vaginal transmission, it could be an important new line of defense as the first spermicide that can significantly prevent HIV transmission. An effective spermicide would also help women who in many parts of the world have had few options they can use to protect themselves against HIV. Should the gel continue to test well in studies, pressure will be needed to assure it becomes affordable and available world-wide and not just in the West.

Another hot conference topic was test-and-treat as a public health method for curtailing the pandemic. A British Columbia study revealed the viability of well organized, wide-scale community HIV testing used in conjunction with antivirals.

Based on studies showing that when people know they are HIV positive they are more careful not to infect others and that antivirals can make one less infectious, the Canadians showed that test-and-treat reduced the rate of new infections in half (by establishing “AIDS free” or “undetectable” zones, one activist called them).

Using economic modeling covering a period of 30 years, the Canadians also showed that, in British Columbia at least, test-and-treat is also cost-effective

Dr. Julio Montaner, AIDS 2010 President, noted that test-and-treat, along with the other advances presented at the conference, all could usher in a potential new era of innovation in fighting the virus.

Discussions on the worldwide practicality of using treatment as a sort of vaccine to minimize HIV transmission were vocal however. Computer-model laden researchers like Reuben Granich of the World Health Organization and Brian Williams of South Africa, projected rosy scenarios of containing the African epidemic within decades if test-and-treat was implemented there.

The “realists”, such as Dr. Bernard Hirschel of the Infectious Diseases Service, said that by simply identifying and treating everyone infected, the epidemic would wither and die away, was a “pipe dream” and more research was needed.

A yet unpublished Harvard study on doing test-and-treat in Washington, DC backed up the skeptics by showing that some people will always fall through the cracks and not test or treat. The study did project, however, that although no panacea, test-and-treat would save lives and slow down new infections.

Test-and-treat community “pocket” studies are ongoing in South African and throughout the world.

Although a truly effective vaccine is still not available, there have been some recent advances in vaccine research, including an arguably successful vaccine trial and the recent discovery of a new human-antibody possibly much more effective in controlling HIV.

The Thai RV144 vaccine trial did somewhat protect 3 out of 10 people (30%) which was a modest breakthrough. Another new vaccine must be created to test the new antibody, however, and in theory there are other ways to use it including as a possible therapy.

Once an effective vaccine is found other challenges do await. According to a University of Toronto study, only 74% of the population would bother take a fully protective vaccine and even fewer (40%) would take a partially protective one. That reluctance could also affect vaccines being studied that, although they would not prevent HIV infection, might still provide enough immune protection to keep the virus from making people sick.

Although this conference's theme was “Right here, Right now,” it will still take time to determine the efficacy of much what was presented. Many researchers seemed optimistic that many of these tools against the virus could be improved over time and even a partially effective vaccine and spermicide, the test and treat approach, combined with old fashioned safe sex and condoms, could combine to produce a powerfully synergistic public health package against HIV significant enough to turn the tide of the pandemic.

AIDS in recession

Unfortunately, at the AIDS 2010 conference, it became apparent that more than ever the big issue was money.

A pre-conference demonstration banner boldly proclaimed “AIDS Is Not In Recession.” Yet the current economic climate, along with policy and guideline changes, make it more difficult for the world to fund an all-out offensive against the virus.

G8 nations are stepping away from commitments to the Global AIDS Fund while the U.S. is altering its commitments to the Bush era Presidential Emergency Plan for AIDS Relief.

Few countries, according to a new report by the Global HIV Prevention Working Group, seemed to have mustered a passing grade in their AIDS prevention efforts (the U.S. the single largest source of funding worldwide got higher grade, while ironically, ungenerous Austria, the wealthy host country of AIDS 2010, got an embarrassing F).

Despite this, the U.S. was on the defensive about the U.S. “Dismantling” of its AIDS funding pipeline to favor funding of new, broader world health goals the Obama administration believes HIV ravaged countries can better build upon on their own.

Eric Goosby, U.S. global AIDS coordinator, noted it was important to eliminate funding inconsistencies and better “construct a rational, ground-up delivery system that requires that populations using the services are in a dialogue with those providing the resources.”

The bottom line for many in Vienna was the U.S.'s new, holistic approach to world health could mean less direct funding to fight the pandemic.

This as the World Health Organization's new treatment guidelines recommend an additional 5 million people receive antivirals, a potential doubling of the world-wide cost of HIV treatment. All as countries throughout the world face new financial constraints and in the U.S., waiting lists grow for the vital Ryan White/HDAP HIV treatment program that the federal government is struggling to fund.

Rolake Odetoyinbo, an activist from Nigeria, best expressed the anger and frustration over the back-pedaling of world donors from more fully funding HIV treatment. Calling the issue of treatment access non-negotiable, she said that “treatment really is prevention and it should be early, accessible, and universal.”

South Africa seemed to have gotten the message. Despite its once notorious reputation as the African hub of AIDS denialism, it's now attempting to become a model on how a developing nation can persevere through a downturn and even take ownership of a crisis.

South Africa already pays more than for 4/5th of its HIV related costs and Deputy President Motlanthe reiterated his governments’ commitment to increase its budgets to make antivirals available to all South Africans needing them.

Some countries were called to account for their continuing inaction, however. One conference presentation opened with slides of limousines and jet planes, the perks and property of out of touch, or just callous and indifferent developing-world leaders and dignitaries. The point being, money could be better spent funding lifesaving prevention and treatment for their people.


Robert Folan-Johnson is the Editor of Healthy Living and can be reached at This e-mail address is being protected from spambots. You need JavaScript enabled to view it

 

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