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I want to believe - AIDS @ 30 By Sophie Beauvais | 02 Dec, 2011

... that “an AIDS-free generation is possible.” Armed with growing evidence supporting pre-exposure prophylaxis (PrEP), a.k.a. “treatment as prevention” (https://www.ghdonline.org/hivprevention/discussion/ghdonline-expert-panel-pre...), President Obama yesterday made this statement and pledged increased support along the way, setting a new target of helping 6 million people get treatment by the end of 2013, upping the current number by 2 million (http://www.whitehouse.gov/the-press-office/2011/12/01/remarks-president-world...).

There is good reason to believe. On December 1, world leaders and organizations marked World AIDS Day, which was themed “Getting to Zero” (in-line with the UNAIDS strategy). Thirty years into the epidemic, over 65 million people have been infected with the human immunodeficiency virus (HIV), over 30 million have died, and there are currently 34 million people living with HIV/AIDS worldwide as Jennifer Weinberg recaps in the Global Pulse Journal Blog (http://www.globalpulsejournal.com/blog/). Among major milestones, the overall continued decrease in rate of new infections, deaths, and ART cost are paramount (see the UNAIDS World AIDS Day Report 2011 for more details – PDF http://www.unaids.org/en/media/unaids/contentassets/documents/unaidspublicati...).

In addition to PrEP, male circumcision for HIV prevention is seeing a rapid development (with new technologies like Prepex - http://globalhealthdelivery.org/2011/02/rwanda-male-circumcision-scale-up-wit... - which allows for the procedure without surgery) and scale-up despite critics (for example see comments here http://www.ghdonline.org/search?q=male+circumcision). There is also much hope for an HIV vaccine, which is “the biggest investment in technology” said Dr. Stefano Bertozzi, director of HIV and TB at the Gates Foundation (http://www.gatesfoundation.org/leadership/Pages/stefano-bertozzi.aspx), during a November 28 interview. The Foundation is currently working with the NIH and U.S. military, as well as Novartis and Sanofi to test a new generation of vaccine which will hopefully prove more efficacious than previous attempts.

But there is also ample reason to remain cautious, and, more importantly, to push forward in the fight. As Daniel Halperin, a researcher at the University of North Carolina, wrote in The Financial Times, “hope should not get ahead of reality.” (Available with free registration http://www.ft.com/intl/cms/s/0/7d3bc504-1a76-11e1-ae4e-00144feabdc0.html#axzz...)

Chief among current concerns is the global decrease in funding. Just last month, the board of the Global Fund to Fight AIDS, TB, and Malaria cancelled, for the first time ever, its next funding round. Many organizations are already feeling the squeeze. In a November 22 statement, MSF noted that on the ground, in hard-hit countries where they work, “the devastating effects of the overall funding crunch are becoming apparent – for example, Cameroon and Zimbabwe are facing shortfalls in the near future to support people already on treatment, and the Democratic Republic of Congo severely caps the number of people able to start on life-saving HIV treatment.” Bertozzi added that GF funds for 2012 and 2013 were actually less than what was first thought, despite current efforts to get middle income countries to increase their contributions and to get others to meet their international responsibilities despite the debt crisis. This flatline for HIV/AIDS funding should be met with continuous improvements in the delivery of existing interventions, from cost-cutting to task-shifting, he also noted, “getting everything possible out of every last dollar.”

Panelists of the AIDS@30 symposium at Harvard School of Public Health (http://www.hsph.harvard.edu/aidsat30symposium/) also agreed that with the growing evidence supporting PrEP and the success of interventions like preventing mother to child transmission (PMTCT) programs, treatment as prevention will play a large role in the future. But increasing the number of individuals on ART is, of course, not without costs or risks, and panelists spent a significant amount of time discussing the potential for significant drug-resistance to develop within populations. Sadly, many felt that it wasn’t a priority. Bob Grant, MD, MPH, a Senior Investigator at the Gladstone Institute of Virology and Immunology, UCSF, argued, “Drug resistance is a fear. It’s a concern. But we’re not seeing a whole lot of that right now. [...] Let’s focus on the problems that we are seeing.”

At the same time, panelists questioned whether drug resistance could be avoided by using different medications for treatment and prevention. Sharon Hillier, PhD, a professor at the University of Pittsburgh, highlighted some of the challenges of drug development, “You have to have a really spectacular safety profile for drugs used in prevention.” Hillier was hopeful, “I think we’re just at the earliest stages. We’re going to get to a place where we have tremendously potent agents for prevention.”

In their closing remarks for the day, speakers all highlighted critical points that should pave the way in the future of the fight against HIV/AIDS: tackling poverty and education is vital, because discrimination and stigma are rooted in poverty; we need to increase community health systems to scale up properly and empower in country practicioners to identify and implement interventions that fit communities; we need to better understand resilience and adherence in order to understand what enables patients to be successful in their drug regimens, and of course, there needs to be more financial support for the Global Fund to further this work.

As Paul Farmer pointed out, we need to look at cost effectiveness and increase metrics so that our focus can shift to equity and delivery, and ultimately see the first AIDS-free generation.

---

With contributions from Amy Scheffler and Marie Connelly reporting from the AIDS@30 symposium at Harvard School of Public Health.

Attached resource:
  • I want to believe - AIDS @ 30 (external URL)

    Link leads to: http://globalhealthdelivery.org/2011/12/i-want-to-believe/

    Summary: ... that “an AIDS-free generation is possible.” Armed with growing evidence supporting pre-exposure prophylaxis (PrEP), a.k.a. “treatment as prevention” (https://www.ghdonline.org/hivprevention/discussion/ghdonline-expert-panel-pre...), President Obama yesterday made this statement and pledged increased support along the way, setting a new target of helping 6 million people get treatment by the end of 2013, upping the current number by 2 million (http://www.whitehouse.gov/the-press-office/2011/12/01/remarks-president-world...).

    There is good reason to believe. On December 1, world leaders and organizations marked World AIDS Day, which was themed “Getting to Zero” (in-line with the UNAIDS strategy). Thirty years into the epidemic, over 65 million people have been infected with the human immunodeficiency virus (HIV), over 30 million have died, and there are currently 34 million people living with HIV/AIDS worldwide as Jennifer Weinberg recaps in the Global Pulse Journal Blog (http://www.globalpulsejournal.com/blog/). Among major milestones, the overall continued decrease in rate of new infections, deaths, and ART cost are paramount (see the UNAIDS World AIDS Day Report 2011 for more details – PDF http://www.unaids.org/en/media/unaids/contentassets/documents/unaidspublicati...).

    In addition to PrEP, male circumcision for HIV prevention is seeing a rapid development (with new technologies like Prepex - http://globalhealthdelivery.org/2011/02/rwanda-male-circumcision-scale-up-wit... - which allows for the procedure without surgery) and scale-up despite critics (for example see comments here http://www.ghdonline.org/search?q=male+circumcision). There is also much hope for an HIV vaccine, which is “the biggest investment in technology” said Dr. Stefano Bertozzi, director of HIV and TB at the Gates Foundation (http://www.gatesfoundation.org/leadership/Pages/stefano-bertozzi.aspx), during a November 28 interview. The Foundation is currently working with the NIH and U.S. military, as well as Novartis and Sanofi to test a new generation of vaccine which will hopefully prove more efficacious than previous attempts.

    But there is also ample reason to remain cautious, and, more importantly, to push forward in the fight. As Daniel Halperin, a researcher at the University of North Carolina, wrote in The Financial Times, “hope should not get ahead of reality.” (Available with free registration http://www.ft.com/intl/cms/s/0/7d3bc504-1a76-11e1-ae4e-00144feabdc0.html#axzz...)

    Chief among current concerns is the global decrease in funding. Just last month, the board of the Global Fund to Fight AIDS, TB, and Malaria cancelled, for the first time ever, its next funding round. Many organizations are already feeling the squeeze. In a November 22 statement, MSF noted that on the ground, in hard-hit countries where they work, “the devastating effects of the overall funding crunch are becoming apparent – for example, Cameroon and Zimbabwe are facing shortfalls in the near future to support people already on treatment, and the Democratic Republic of Congo severely caps the number of people able to start on life-saving HIV treatment.” Bertozzi added that GF funds for 2012 and 2013 were actually less than what was first thought, despite current efforts to get middle income countries to increase their contributions and to get others to meet their international responsibilities despite the debt crisis. This flatline for HIV/AIDS funding should be met with continuous improvements in the delivery of existing interventions, from cost-cutting to task-shifting, he also noted, “getting everything possible out of every last dollar.”

    Panelists of the AIDS@30 symposium at Harvard School of Public Health (http://www.hsph.harvard.edu/aidsat30symposium/) also agreed that with the growing evidence supporting PrEP and the success of interventions like preventing mother to child transmission (PMTCT) programs, treatment as prevention will play a large role in the future. But increasing the number of individuals on ART is, of course, not without costs or risks, and panelists spent a significant amount of time discussing the potential for significant drug-resistance to develop within populations. Sadly, many felt that it wasn’t a priority. Bob Grant, MD, MPH, a Senior Investigator at the Gladstone Institute of Virology and Immunology, UCSF, argued, “Drug resistance is a fear. It’s a concern. But we’re not seeing a whole lot of that right now. [...] Let’s focus on the problems that we are seeing.”

    At the same time, panelists questioned whether drug resistance could be avoided by using different medications for treatment and prevention. Sharon Hillier, PhD, a professor at the University of Pittsburgh, highlighted some of the challenges of drug development, “You have to have a really spectacular safety profile for drugs used in prevention.” Hillier was hopeful, “I think we’re just at the earliest stages. We’re going to get to a place where we have tremendously potent agents for prevention.”

    In their closing remarks for the day, speakers all highlighted critical points that should pave the way in the future of the fight against HIV/AIDS: tackling poverty and education is vital, because discrimination and stigma are rooted in poverty; we need to increase community health systems to scale up properly and empower in country practicioners to identify and implement interventions that fit communities; we need to better understand resilience and adherence in order to understand what enables patients to be successful in their drug regimens, and of course, there needs to be more financial support for the Global Fund to further this work.

    As Paul Farmer pointed out, we need to look at cost effectiveness and increase metrics so that our focus can shift to equity and delivery, and ultimately see the first AIDS-free generation.

    ---

    With contributions from Amy Scheffler and Marie Connelly reporting from the AIDS@30 symposium at Harvard School of Public Health.

    Source: Global Health Delivery Project

    Keywords: Media

 

This Community is Archived.

While this community is no longer active, we invite you to review and recommend past posts and resources. Membership for this community is closed, but we hope you'll join us in one of the many other communities on GHDonline.

Moderators of HIV Prevention and GHDonline staff