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Proven interventions and research-based efforts offer hope for HIV/AIDS prevention
XV International AIDS Conference Press Release. 15 July 2004.
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Community leaders and scientists at the XV International AIDS Conference today called for substantially increased investment in proven HIV prevention efforts and scientific research to develop new prevention technologies, including a female-controlled method of prevention and an HIV vaccine.
It is estimated that global resources required to mount comprehensive HIV prevention will increase from less than US$5 billion in 2004 to just under US$10 billion in 2007.1 HIV prevention is highly cost-effective. Yet, less than one in five people worldwide has access to HIV prevention services.
Condoms: Cost-Effective Prevention
?“One simple message repeated by scientists and leaders at the Conference is that condom use is one of the least expensive, most cost-effective methods for preventing HIV transmission. Consistent, correct use of condoms significantly reduces the risk of HIV and other sexually transmitted infections,?” said Dr. Joep Lange, Conference Co-Chair and President of the International AIDS Society.
In a number of Conference venues, implementation of the so-called ABC approach (Abstinence, Be Faithful, Use Condoms) to HIV prevention was hotly debated. While there is general agreement that young people should be encouraged to delay sexual debut until they are physically and emotionally able to deal with the responsibilities and consequences of sexual activity, there is considerable disagreement about the relative emphasis on abstinence. Some ABC proponents argue that to be effective, such programs must focus largely or exclusively on abstinence. Opponents contend that such approaches are overly simplistic, supported by little scientific evidence of effectiveness, and could even undermine effective HIV prevention by failing to provide information on effective condom use. They also point to the fact that emphasising faithfulness among married women does not necessarily protect them from the risk of infection due to their husbands?’ unfaithfulness, which they cannot control.
Success stories such as Thailand?’s ?“100% condom programme,?” which changed levels of risk behaviour and brought Thailand?’s HIV/AIDS epidemic to heel in the 1990s were cited as sources of inspiration for current and future prevention programs. Dr. Siripon Kanchana, director of the bureau of health promotion at the Thai Ministry of Health, today shared new developments in Thailand?’s prevention efforts, including reduction of mother-to-child transmissions. She said that ?“the proportion of women giving birth who are HIV positive has declined slightly during these three years,?” since Thailand has been collecting data on its national prevention of mother-to-child transmissions (PMTCT) program.
Meanwhile, Dr. Quarraisha Abdool Karim, adjunct associate professor at the Mailman School of Public Health, Columbia University and at the Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, presented evidence on the effectiveness of male and female condoms as future prevention strategies. ?“The promotion of male condoms to reduce HIV is effective in both research and real world settings and it can play a critical role in prevention of heterosexual HIV transmission in developing countries. The introduction?…of female condoms, in addition to male condoms, can increase overall condom use?…thereby reducing HIV transmission,?” she said. ?“Preliminary data suggest that antiretroviral prophylaxis, herpes simplex virus control and male circumcision may reduce HIV transmission,?” she added.
Microbicides offer tremendous hope and promise for millions of women who are unable to insist that their partners use a condom. These substances will represent a major breakthrough in the fight against AIDS, by substantially reducing transmission of sexually transmitted infections, either by destroying the microbes or preventing them from establishing an infection. A safe and effective microbicide has not yet been found, but nearly a dozen have now entered human testing.
Dr. Zeda Rosenberg, CEO of the International Partnership for Microbicides (IPM), said, ?“a 60% efficacious microbicide introduced into 73 low income countries and used by only 20% of women would avert 2.5 million HIV infections over 3 years in women, men and infants.
With...leadership, sufficient financial resources, collaborative efforts and product development expertise, we are confident that women in developing countries should have access to safe and effective microbicides within the next five to 10 years.?”
Progress in HIV Vaccine Development
Only a vaccine to prevent HIV has the capacity to completely end the pandemic. Global investment in HIV vaccine research has been estimated at just under US$500 million per year, with trials of 30 vaccine candidates currently spanning 19 countries on all continents, but it is likely that a successful vaccine is still a number of years away.
In his plenary speech, Dr. José Esparza, Director for HIV Vaccines at the Bill & Melinda Gates Foundation, reported to Conference delegates on the latest vaccine initiatives. ?“Very importantly,?” he said, ?“vaccine research and development is being positioned as part of a comprehensive global response to HIV/AIDS, together with other prevention efforts, especially microbicides, and in the framework of increased access to treatment?…More basic research is needed to produce the new scientific knowledge that we need to more rationally develop new generations of more potent candidate vaccines.?” |
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