As HIV prevention needs and contexts vary, it is important
to expand the range of effective prevention options that people can use.
Archbishop Desmond Tutu said in a video link at the first-ever international
conference on all HIV-related biomedical prevention research, that, "No single
method of prevention can end this epidemic on its own." That is why
conferences on microbicides and vaccines merged to provide one single global
platform to deliberate on a spectrum of biomedical prevention research for HIV.
HIV Research for Prevention (HIVR4P) is being held in Cape Town, South Africa.
Professor Helen Rees, Executive Director, Wits Reproductive
Health and HIV Institute and HIV R4P conference co-chair, explained the value
of breaking the walls between vertical conferences on specific biomedical
prevention options such as microbicide and vaccine. "There are commonalities.
There are issues which HIV vaccine basic scientists might be looking at which
may also be very important for microbicide or Pre-Exposure Prophylaxis (PrEP)
scientists too and vice versa."
Challenges of adherence to drugs-under research or ways to
modify trial design to fast track the process are also common across the sector
of HIV prevention research. Mechanisms in which socio-behavioural research
informs the basic science are also a priority across the board. By organizing
one conference on biomedical prevention research for HIV, "we were able to look
at these commonalities together while not losing the uniqueness of these
specific fields," said Rees.
Synergy between different streams of HIV prevention is
crucial so that new infection rate dips faster than ever before to end AIDS.
South African Minister for Science and Technology Mrs GNM Pandor said at HIVR4P
that more people get newly infected with HIV than those people living with HIV
(PLHIV) who are put on antiretroviral therapy (ART). "There are 2.4 million
PLHIV on ART in South Africa" said Pandor.
It is important to underline that there are estimated 6.3
million PLHIV in South Africa as per latest data from UNAIDS. The road to scale
up treatment for everyone is still long. Alongside scaling up ART to every
PLHIV and other measures, we surely need to scale up effective prevention
"Increase in ART has resulted in reduction in number of people
dying as result of HIV infection and significant reduction in mother to child
transmission of HIV. We remain many years away from eliminating HIV. We are not
investing in social sciences enough. We have to get the behavioural aspects
right in HIV prevention research" said Pandor to Citizen News Service (CNS).
"As we know, No single method of prevention can end this
epidemic on its own, our focus remains in offering a package of HIV prevention
together. We need to respond to epidemic in more comprehensive manner than
merely offering individual interventions."
Developing safe and effective HIV prevention tools are
critically important but not enough. "We need to move research outcomes into
clinical practice, which continues to remain a challenge" said Pandor.
She was right on spot. Female condoms got approved by US FDA
in 1993 but lot more needs to be done to roll them out to every woman in need
for protection against unintended pregnancy and/or sexually transmitted
infections (STIs) including HIV. Undoubtedly more work needs to be done to
ensure there is no delay in taking research outcomes forward to yield public
Dr Anthony Fauci, Director, National Institute of Allergy
and Infectious Diseases (NIAID), National Institutes of Health (NIH), USA,
addressed HIVR4P via a video link. He said that HIVR4P is rightly
addressing all biomedical prevention options at one forum. He said that
non-vaccine prevention options and vaccine both are required to stem the
Dr Fauci underlined that non-vaccine prevention options need
to be taken regularly but vaccines once given does not have those adherence
issues. "Non-vaccine prevention options are highly effective but requires
continual adherence, whereas vaccine are often modestly effective but durable,
and does not have continual adherence issues" said Fauci.
"Foundation of HIV prevention is infact HIV testing" said
Fauci. HIV testing connects to two streams: if the test is positive then person
should be connected to care continuum and if negative, then to prevention
He said that there are gaps in care continuum and we must
find ways to fill these gaps. Referring to prevention continuum, Fauci said
that if the test is negative then the person is encouraged for counselling and
risk stratification, and provided tailored prevention services from the
Fauci was referring to a range of HIV prevention options
that have been proven to work effectively such as: HIV testing and counselling,
treatment as prevention, voluntary medical male circumcision (VMMC), treatment
of STIs, rectal and vaginal microbicides (both are currently under research),
prevention or treatment of drug and alcohol use, provision of clean needles and
syringes, education, behaviour modification, male and female condoms, blood
supply screening, antiretroviral drugs for prevention of mother to child
transmission of HIV (PMTCT), Post-Exposure Prophylaxis (PEP), and Pre-Exposure
Prophylaxis (PrEP). Vaccines will also get added to this 'toolbox' once proven
to be safe and effective in ongoing research studies, said Fauci. There is no
effective HIV vaccine available today. Yet a safe and effective vaccine is
critical to the control of HIV globally.
He also stressed to fashion combination prevention for
'hotspots' of HIV infection. He gave an example of Lake Victoria area in Kenya
which has HIV rates comparable to places in Africa with highest HIV prevalence.
This area is also known to have low male circumcision rates and unsafe sex work
associated with fishing community is also reported. But rest of the Kenya does
not have that high HIV rates. Combination prevention needs to be tailored in
unique contexts and realities and if we do so, we could prevent "600,000 new
HIV infections by 2030" said Fauci.
Ref: Bobby Ramakant, Citizen News Service