4 August, 2010

Antiretrovirals for HIV prevention: The Way Forward

Guest blog post by Salim S. Abdool Karim & Quarraisha Abdool Karim
Co-Principal Investigators of the CAPRISA 004 Tenofovir Gel trial

On July 20, we announced, on behalf of our research team from the Centre for the AIDS Programme of Research (CAPRISA) in Durban, South Africa, that a microbicide gel—containing the antiretroviral drug tenofovir—reduces a woman’s chances of acquiring HIV by 39% and the genital herpes virus by 51%. Women who used the gel most consistently showed 54% protection against HIV infection. Now, for the first time in nearly three decades of research, we have a new technology, one that women can use and control, to prevent the sexual transmission of HIV.

All of us who have a stake in HIV prevention—scientists, policy-makers, international and community advocates and funders—now have greater impetus to accelerate the research on the use of antiretroviral based strategies for prevention. More than half a dozen trials are currently investigating oral or vaginal formulations of antiretroviral drugs. Many of these will be completed within the next two or three years, and other trials are urgently needed to corroborate and extend the results of the CAPRISA 004 trial.  Specifically, additional safety information on use of tenofovir gel in pregnant women, women with hepatitis B virus infection, in women younger than 18 years and in women with renal impairment would be helpful to ease scale-up and wide-spread implementation with the eventual objective of regulatory licensure, a goal which may be another 3-5 years away.

There are many challenges as we consider the next steps including the nature of the additional research required, the considerations in designing future implementation, plans to investigate methods of reducing cost of the gel and local manufacturing, etc.  A laudable first step is the joint leadership of UNAIDS and WHO, with financial support from UNAIDS, WHO and USAID, in organizing a consultation of major stakeholders in late August, which is being hosted by the South African government, on the next steps for tenofovir gel.  The task of preparing for future implementation in a timely fashion, is daunting.  The potential of wide scale delivery of antiretroviral products for prevention will provide many challenges to scientists, public health practitioners, policy-makers and communities in considering the logistics of providing access to the most vulnerable populations. It will not be simple:  the task raises enormous ethical, medical, and economic challenges.  Small scale model implementation studies need to be initiated now to provide valuable information and guidance for expanding the future delivery of a topical or oral antiretroviral based prevention to national levels.
We are in the midst of a global economic downturn and competing priorities have diverted resources that might have expedited research on antiretroviral strategies for prevention.  Governments, communities, funders, and health experts must work together to ensure that this new way of preventing HIV attains regulatory licensure expeditiously and becomes readily available and accessible to women globally as soon as possible thereafter.

UNAIDS | Comments Off | HIV prevention, HIV treatment, Sexual transmission
23 July, 2010

Road to 2012: Two years to build on the momentum

Dear friends,

Today is the last day of the XVIII International AIDS Conference. I hope you have enjoyed following UNAIDS’ first blog, which, over the past 11 days, has provided daily updates on what we have been learning.

As the selection of posts – and the media coverage coming out of Vienna – demonstrate AIDS 2010 has harnessed the momentum that has been building around HIV prevention, including for young people who are leading the prevention revolution.

One of the highlights has been the encouraging news surrounding the CAPRISA proof of concept study that added to the growing HIV prevention results reported at the conference. The potential of having a woman-initiated and -controlled prevention option boosted visibility for all HIV prevention options.

On treatment, voices were concerted and loud. The progress we have witnessed in the past several years of now having 5.2 million people on these lifesaving drugs was noted, but it was clear at several events, from sessions to press conferences and protests, that we have to do more to ensure the 10 million people in need of treatment have access to it. UNAIDS made the case for Treatment 2.0 outlining what will be required to radically simplify the treatment platform to make it more affordable and accessible.

The conference theme of “Rights Here, Right Now” acted as a unifying element for delegates. Our vision of reaching zero new infections, zero discrimination and zero AIDS-related deaths can not be reached until we can restore dignity to people and ensure their rights to health are respected.

I spoke with many people working on the AIDS response in their own countries who are concerned about the lack of progress for most-at-risk populations. Being in the gateway city to Eastern Europe and Central Asia, I am troubled by the news that there is increasing HIV prevalence and decreasing programmes in this region. And in all parts of the world, we know that HIV services do not always reach people who need them the most: Women, injecting drug users, children and young people, sex workers, men who have sex with men, and transgender people.

The ongoing global financial crisis permeated most discussions. As we move from an era of abundance to austerity, my message throughout the conference has been that we need to ensure investments reach more people. For the first time, we have seen reductions in investments. Of particular concern is that many European countries have not met their commitments—they have given USD $600 million less than they did in 2008. It’s clear that we should not stop investments when we are showing results for people. The Global Fund needs to be fully funded. Donors must meet the 0.7% target for international aid, and the Abuja target of 15% for health must not be buried.

As this was my first International AIDS Conference as Executive Director of UNAIDS, I was especially moved—and humbled—by the support from the people I have had the honour to meet.

Thank you for sharing your stories, your challenges, and your optimism. Together, we have much work to do between now and AIDS 2012 in Washington, DC. Expectations have been set, and it is my hope that will show even more results on what has been a defining moment in the AIDS response.

Michel

UNAIDS | Comments Off | HIV prevention, HIV treatment, Men who have sex with men, sex workers and transgender people, Michel Sidibé, Punitive Laws, Women and Girls, Young People
23 July, 2010

AIDS 2010 closes with a renewed commitment to push for universal access

The XVIII International AIDS Conference has ended in Vienna after a week of intense dialogue involving 19,300 people from 193 countries engaged in the global AIDS response.

Delegates and organizers depart Vienna – where the conference opened 18 July under the theme of Rights Here, Right Now – with a renewed commitment to push for securing universal access to HIV prevention, care, treatment and support.

“Billions of people stand in solidarity with us in our drive for universal access. We must rally their support behind Michel Sidibé’s Prevention Revolution and Treatment 2.0 initiative and UNAIDS to ensure that world leaders do not turn their backs on their pledge to reach the goal of universal access,” said Dr. Julio Montaner, AIDS 2010 Chair, President of the International AIDS Society and Director of the B.C. Centre for Excellence in HIV/AIDS in Vancouver, Canada.
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UNAIDS | Comments Off | Uncategorized
23 July, 2010

“Decriminalization works, criminalization doesn’t”: Leadership panel

From left: Michel Sidibé, UNAIDS Executive Director, Joao Gulao, Gill Greer, Tim Barnett and Festus Mogae, Former President of Botswana agreeing on an anti-discrimination resolution at the Leaders on Discrimination session the 18th International AIDS Conference in Vienna, Austria on 22 July 2010.

A panel of leaders came together on 22 July at a special session to discuss the impact of criminalization of HIV transmission and of people most-at-risk of HIV infection.

Moderated by Stephen Lewis, co-founder and director of AIDS-Free World, the panel consisted of H.E. Festus Mogae, former President of the Republic of Botswana, Michel Sidibé, Executive Director of UNAIDS, João Goulão, national drug coordinator and chairperson of Portugal’s Institute on Drugs and Drug Addiction, Gill Greer, Director-General, International Planned Parenthood Federation (IPPF), and Tim Barnett, Global Programme Manager of the World AIDS Campaign.

Michel Sidibé, UNAIDS Executive Director, speaking at the Leaders on Discrimination session the 18th International AIDS Conference in Vienna, Austria on 22 July 2010.

The first panellist to speak, Mr. Sidibé told delegates that the theme of the session was probably one of the most important—and most urgent to address—at the XVIII International AIDS Conference. “If we don’t address criminalization, how can we deliver on universal access? Universal access is about ensuring the rights of all people,” said Mr. Sidibé. “Instead of embracing universal access many countries have put up universal obstacles with bad laws.”

Mr. Sidibé gave examples of countries that have moved away from punishment to provide HIV services to drug users, such as China, Indonesia and Malaysia, and stressed the importance of countries to capture data that demonstrate how decriminalization supports – and not hampers – the AIDS response.

The head of IPPF, Ms. Greer said criminalization of HIV transmission and behaviours is not the answer. “Rather than receiving support, vulnerable groups are put at fair greater risk, including their families,” she said. “Criminalization reaches beyond the individual and reaches out to entire communities. Governments should criminalize hate and violence.”

To strengthen the AIDS response, Ms. Greer said people need access to information, knowledge and services. “What is truly criminal is that people are denied this,” she added.

Festus Mogae, former President of Botswana speaking at the Leaders on Discrimination session the 18th International AIDS Conference in Vienna, Austria on 22 July 2010.

H.E. Mr. Mogae, who used several platforms throughout the conference to advocate for the human rights of people living with HIV, summarized criminalization in one word: “Futile”. He said the body of evidence on the issue indicates that decriminalization strengthens the response, especially in HIV prevention.

“The key to prevention is knowing one’s status. Knowing your status triggers access to treatment and care, and it triggers empowerment to stay HIV-free,” said H.E. Mr. Mogae. “If you criminalize HIV transmission, people will not come forward for fear of being further stigmatized and discriminated against. What we want to do is to de-stigmatize so people can come forward.”

UNAIDS | Comments Off | HIV prevention, Injecting drug users, Men who have sex with men, sex workers and transgender people, Michel Sidibé, Punitive Laws, Women and Girls, Young People
23 July, 2010

Y-PEER: Media helping empower young people to protect themselves from HIV

Y-Peer networkers event during the 18th International AIDS Conference in Vienna, Austria on XX July 2010.

Harnessing the power of the mass media and new technologies to reach young people with information about HIV and reproductive health was high on the agenda at the XVIII International AIDS conference yesterday during a series of events sponsored by Y-PEER, a youth initiative pioneered by the United Nations Population Fund (UNFPA).

According to UNFPA a youth-centred approach, such as Y-PEER, is critical to genuine engagement for change.

“If we want to engage young people on health and lifestyle issues that affect them, we need to be where they are, sharing information through platforms they are connecting to every day,” said Purnima Mane, UNFPA Deputy Executive Director (Programmes).
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UNAIDS | Comments Off | UNAIDS Cosponsors, Young People
23 July, 2010

Dr Khulood Alsaidi on HIV in the Middle East and North Africa Region

The HIV epidemic in the Middle East and North Africa region is seldom highlighted. In 2008 there were an estimated 310 000 people living with HIV, up from 200 000 in 2001. In that same year, approximately 35 000 people became newly infected with HIV in the region.

At the International AIDS Conference in Vienna, UNAIDS meet up with Dr Khulood Alsaidi from Yemen to talk about some key issues for the region:

UNAIDS | Comments Off | Uncategorized
23 July, 2010

UNAIDS speaks with Outlook’s ‘A Day In The Life’ Evgeny Pisemsky

At the XVIII International AIDS Conference, UNAIDS was pleased to meet up with Russian activist Evgeny Pisemsky who was featured in the UNAIDS Outlook 2010 report.

The interview was conducted in Russian – the English transcript is below.

What did it mean for you to be featured in Outlook 2010?
I think it is very important that activists from Eastern Europe and Central Asia learn and read stories about other activists. When I started working in the field of HIV, it was extremely important for me to know how others work with people living with HIV, to understand what their priorities were.

I do not think that I’m a special person; I am just one of many activists who are tying to stop the epidemic. Unfortunately at the conference, I did not see enough emphasis on our region. Our voice is still very weak. That is why it’s so important for me to be one of the people who speak about existing problems, to be a banner of the movement.

When I was at my first AIDS conference in Bangkok (2004) I felt confused. At the same time, this confusion has given me the strength and desire to work and help people. I saw a huge number of activists who work hard to end epidemic.

Then I was at Mexico (2008) where I felt pride on behalf of my organization for what we could do in our region. What I feel at this conference? It is anger and confusion because I think that we are doing too little. There are too many problems to which we have not even come close to solving. We’re always late, trying to catch up, but in the meantime we’re losing out against the epidemic.”

What do you think we need to do to change this?
I think it is important to create conditions for more people to become activists. In 2008, my organization won the Red Ribbon Award for what we have managed to do in the Central Federal district in Russia.

We created four new organizations and supported new activists who provide services for people living with HIV. We also direct our advocacy efforts towards the state so they can better understand the need for HIV treatment, care, support and prevention.

My strategy has not changed since then. We need to have more activists in order to strengthen our voice, and I hope that our voice will be more powerful at the next conference.

UNAIDS | Comments Off | HIV prevention, HIV treatment, Injecting drug users, Men who have sex with men, sex workers and transgender people, Punitive Laws, Sexual transmission, Social protection, Young People
23 July, 2010

Exploring combination prevention: The way forward

(from left) The session included Ms Ruth Morgan Thomas, Global Coordinator for the Network of Sex Work Projects (NSWP); Dr Bernhard Schwartländer, Director of UNAIDS Department of Evidence, Strategy and Results. Credit: UNAIDS/Anne Rauchenberger

For every two people who start on HIV treatment, five are newly infected. With the need to focus on HIV prevention becoming ever more acute, how can those at risk of contracting HIV be targeted to produce impact? What can we scale up? How to bring coordination in interventions that complement each other? These are some of the key questions explored in a UNAIDS Satellite Session at the XVIII International AIDS Conference in Vienna.

Chaired by Dr Bernhard Schwartländer, Director of UNAIDS Department of Evidence, Strategy and Results, the session attracted a broad range of speakers. These included Signe Rotberga, a UNODC Regional Project Coordinator who shared lessons about AIDS prevention and care among injecting drug users and in prison settings in the Baltic states.
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UNAIDS | Comments Off | HIV prevention
22 July, 2010

Young people interpret new UNAIDS data

A change is happening among young people across the world, especially in parts of sub-Saharan Africa. Young people are waiting longer to become sexually active, have fewer multiple partners and are increasingly using condoms among those with multiple partners. As a result, HIV prevalence among young people is dropping in many key countries according to a new analysis by UNAIDS.

Dr Peter Ghys, Chief of Epidemiology and Analysis Division UNAIDS, presented these findings together with the Vienna Youth Force today at the International AIDS Conference.

The study shows that HIV prevalence trends in 16 countries is declining among young people aged 15–24, and according to the study declines are largely due to falling new HIV infections among young people. In 15 out of 21 countries most affected by HIV in the world, a decline of 25% has been noted.

According to Dr Ghys, the results show a good concordance between trend in sexual behaviour and trends in HIV prevalence.

“UNAIDS calls on countries to implement comprehensive set of programmes to reduce the risk of young people; and young people themselves can and must be actors in these changes,” said Dr Ghys.

Young people engaged in the AIDS response in countries which are experiencing this decline were invited to comment on the new findings.

Kuena Diaho, the World Young Women’s Christian Association Lesotho, said that programmes targeting young people need to be shaped in a way so that they are not too heavy. “In Lesotho, we do edutainment; HIV prevention activates through poetry and sport.  This way, it’s a little less heavy,” said Diaho. 

“We’re a large network of young women’s organizations. We use facebook to share information, and we organize gatherings to talk about sexual and reproductive health education,” said Yvonne Akotho from the Girl scouts in Kenya.

Remmy Shawa, UNAIDS special youth fellow, from Zambia stressed that this new evidence should be used as an advocacy tool to show leaders what happens when young people are placed at the centre of the AIDS response.

Dr Ghys concluded the session noting that these encouraging results are an early return on investments made in HIV prevention. “These investments need to continue and programmes with and for young people need to be scaled up,” said Dr Ghys.

UNAIDS | Comments Off | HIV prevention, Sexual transmission, Young People
22 July, 2010

Public health leaders push ambitious agenda to stop TB deaths among people living with HIV

Global public health leaders gathered at AIDS 2010 conference have committed to an ambitious new agenda to stop these preventable deaths. A landmark document was signed today: a memorandum of understanding between UNAIDS and the Stop TB Partnership. The agreement binds the two organizations together in a common goal: to strive towards halving the number of people living with HIV who die from TB by 2015, compared to 2004 levels. Provision of life-saving antiretroviral treatment for all TB patients living with HIV is another key objective.

“We already have the tools to keep people living with HIV from dying of TB ”, said Mr Michel Sidibé, Executive Director of UNAIDS, ”We must join our TB partners to promote an evidence and human rights based approach to tackling TB and HIV. Together we can virtually eliminate TB related AIDS deaths.”
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UNAIDS | Comments Off | TB/HIV