Richard Wolitski, Ph.D., acting director for the CDC's HIV/AIDS Prevention Division, muses about next steps following the 2008 International AIDS Conference in Mexico City.
Now—of course, the feminista in me always comes out, especially at a conference where there are so many opportunities to learn about what experts are doing at the policy and programmatic level to address gender inequities. read more »
The field is finally moving toward consensus around the definition of a topical microbicide. In every presentation I attended during AIDS 2008 that provided a definition of a topical microbicide, they all stated the exact same definition and it included the word "rectal." It's about time!
I attend a HIV, STI, or microbicide conference nearly every quarter and this is the first time I have heard the definition articulated in a consistent way across presentations made by researchers from different organizations with different research agendas. Researchers from the Microbicide Trials Network (MTN), Center for the AIDS Programme of Research in South Africa (CAPRISA), and the International Partnership for Microbicides (IPM), for example, were all on the same page with regard to the definition of a topical microbicide. While these researchers and organizations may all have different strategies, plans, and foci for the development of a microbicide, it was great to finally see consistency and the word "rectal" included in the basic definition of the concept.
For the record, at least for the time being, let's use this basic definition when we describe the concept of a topical microbicide: a product that can be applied to the vaginal and rectal mucosa with the intention of preventing the transmission of sexually transmitted infections, including HIV.
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Around the world (including the United States), thousands of HIV-negative people are enrolled in clinical trials to determine whether taking anti-retroviral drugs could reduce the risk of being infected with HIV. This strategy is called pre-exposure prophylaxis, or PrEP.
By the middle of next year, more people will be enrolling in PrEP trials than in all HIV vaccine and microbicide efficacy trials combined. Advocates will need to weigh in now, as results from current efficacy trials may become available beginning as early as 2009. There is a role for prevention research advocates to seek answers to questions that can help to determine the next steps in the PrEP research program, to prepare for the trial results, and to ensure access to PrEP if proven effective.
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In response to this challenge, the Prevention Research Advocacy Working Group (PRAWG) of HIV/AIDS Mobilization Project (CHAMP) recently formed a PrEP Committee. The PrEP Committee is composed of researchers and community advocates, including representatives from AIDS Vaccine Advocacy Coalition (AVAC), Global Campaign for Microbicides & Project Inform. It is focused on identifying questions that must be answered, fostering discussions in and beyond our communities about the opportunities and challenges of this potentially successful intervention, and preparing for advocacy efforts to ensure access to PrEP if proven effective.
~ Declare That People with Disabilities Get HIV Due to
Discrimination and Exclusion ~
~ Demand Immediate Inclusion in HIV/AIDS Research and
Programming to End A Generation of Neglect ~
Today people living with
disabilities - including people living with HIV/AIDS and disabilities - and
allies will convene at an historic AIDS2008 satellite session to demand that
international AIDS community end decades of neglect of this population, who lives at
heightened risk of HIV acquisition and morbidity. AIDS-Free World and Disabled Peoples'
International will call for immediate inclusion in HIV/AIDS research agendas,
data collection and programming for prevention, treatment and care.
At an August 4 press conference organized by AIDS-Free World
and Disabled People's International, activists and researchers laid out the
context that makes people living with disabilities especially vulnerable to
HIV. At least 10% of the world's population
- 650 Million people - has a disability affecting their daily lives. Globally, most people with disabilities face
poverty, stigma, social isolation and marginalization, and 80% dwell in rural
areas of developing countries.
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New Frontiers in Harm Reduction. Sounds exciting, doesn't it? Unfortunately, after attending this "symposia," I was making the same complaints I've been making throughout this conference. Perhaps I've made some poor choices, but I've been underwhelmed by the depth and creativity of presentations. Some of the valuable chestnuts I've "learned" here: Prevention is good. Stigma is bad. Harm reduction is good. Punishing injection drug users is bad. Hmm. It really...um...makes you think?
But I left this symposia (I still can't figure out why we use the plural here) on Harm Reduction a little bit more angry. Two of the speakers basically stood up and said, My program is great, My organization is doing something really new and important, I work really hard, Here's a photo of us working. Yes, she actually shared a photo of her staff sitting around a table in her 12-minute presentation.
She made what felt to me a stark distinction between harm reduction and prevention. I don't understand the value in this. Isn't prevention based on the principles of harm reduction? Isn't harm reduction... prevention?
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Women of the world unite for their rights! The past few days have demonstrated the power and visibility of women at the International AIDS Conference, with hundreds of women and girls’ rights activists leading the charge by marching to the Zocalo (the historic city square) to the beat of “all rights for all women.” Women, men, transgender persons, sex workers, lesbians, adolescents, and gender equality advocates are demanding the fundamental human rights of women and young women: the right to live and make decisions without fear of violence, coercion, stigmatization or discrimination; the right to a free, healthy and safe sex life; the right to dignified work; the right to comprehensive information and services regarding prevention and sex education; the right to life-saving treatment… With women comprising 60% of adults living with HIV and AIDS in many regions of the world, women’s lives hang in balance in the absence of these rights.
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The venerable medical journal the Lancet dedicated its pre-IAC issue to HIV-prevention, what editor Richard Horton called “the neglected issue in the AIDS response.” On Wednesday, contributing authors called for a reinvigorated movement for prevention that demands a comprehensive, multifaceted approach, including structural change. Mirroring the Caucus for Evidence Based Prevention critiques of narrow definitions of evidence, the distinguished panel also called for investment in flexibile, realistic monitoring and evaluation mechanisms.
Jeffery O’Malley, director of the HIV and AIDS group at the UN Development Program, opened with the history of HIV-prevention, urging us to remember when prevention and epidemiology were all the AIDS community had enough information talk about. In the early 80s, he recalled, “gay men and drag queens invented safe sex, and they still haven’t been given the Nobel Prize.”
So I went to the Lancet
session on prevention, and what a change from two years ago!
In Toronto 2006 the big
buzz of the conference was prevention, but a specific kind of prevention,
namely the New Prevention Technologies (NPTs). Oh yes! Bills Gates and Clinton
were in full agreement. Let's pour shedloads of money into microbicide research
and vaccines and, though it's a ‘challenge' because you always have to say
that, one day we'll have a nice easy to use prevention method that will mean
everyone's protected, or at least more than they are by Condoms and Being
Faithful.
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This year? Every single
speaker, and we're talking about people like Peter Piot of UNAIDS and Tom
Coates, one of the foremost NPT proponents in the world, stressed that there
was "no magic bullet". HIV prevention had to be and would always have to be a
combination phenomenon.
Prevention works – if you ask people what they want to prevent
So get this. The results of a randomised controlled trial of an HIV prevention method were presented on Monday and they produced a 57% reduction in the risk of HIV infection.
So was this some study of circumcision in Africa or PrEP in Peru you’ve unaccountably missed? No. It was a behavior-change programme for gay men at the Boston Fenway HIV clinic and while it was too small to show differences in HIV incidence it produced dramatic cuts in the amount of risky sex guys were having.
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CDC's Richard Wolitski on Turning IAC Rhetoric into Action
