Vaccines -- A Community Role for HIV

While the reality of having an effective vaccine to prevent HIV infections is probably still many years away, the effort to find one is growing even as you read this article. More experimental vaccines are entering into clinical trials today, with many more products coming down the pipeline.

As exciting as it is to have a variety of different experimental AIDS vaccines in development, one of the greatest challenges still to overcome has to do with people just like you. Without the involvement of ordinary, everyday people, HIV vaccine research doesn't stand a chance. This is because the only way we will be able to discover what will protect a person from HIV is to test experimental vaccines in people.

So what are the obstacles to getting people into clinical trials? A recent study by the National Institutes of Health found that one out of five persons surveyed believed that an HIV vaccine already exists, but is being kept secret. About half of those surveyed had not heard anything about HIV vaccine research over the past year.

What does all this mean? That few people are aware of the current effort to develop an HIV vaccine, which would help to explain the challenge of finding people who are willing to volunteer to be in clinical trials. After all, how can people volunteer for something they don't even know is going on?

Ironically, a vaccine trial needs to enroll thousands of people and for more than three years, thousands more people (and more years) than is needed to bring an HIV drug to market!

Clinical Trials Around the World

More than 60 AIDS vaccines are in development right now (visit www.avac.org). More than 25 are entering or about to enter Phase I and II trials. Currently vaccine clinical trials are being conducted (or will soon be conducted) all over the world.

In the continental U.S., HIV vaccine clinical trials sites include Providence, Rhode Island; Rochester and New York City; Boston; Chicago; Baltimore; Birmingham, Alabama; Nashville; San Francisco; Seattle; and St. Louis, Missouri.

Around the world, vaccine clinical trial sites include Canada, Haiti, the Dominican Republic, Puerto Rico, Trinidad and Tobago, Peru, Brazil, Finland, the United Kingdom, the Netherlands, Belgium, Germany, France, Switzerland, Italy, Cameroon, Rwanda, Uganda, Kenya, Tanzania, Malawi, Zambia, Botswana, South Africa, Russia, India, Thailand, China and Australia.

Challenges

Current research efforts have raised issues that must be addressed today. Understanding these issues and preparing for them proactively will speed up the development of an AIDS vaccine. Here are a few issues that the public needs to be aware of.

Vaccine-induced seropositivity: HIV vaccines that teach the body to make antibodies to the virus could cause someone to test positive on an HIV test. That's because HIV tests do not actually detect HIV. Instead, they detect antibodies to HIV. (Antibodies are proteins made by a person's immune system to fight off infection.) While it is possible to tell the difference between someone who has antibodies from a vaccine versus a person who is HIV infected, most HIV testing staff have not been trained to do so. It is important that our system for HIV testing be improved to overcome this challenge.

Partially effective vaccines: It is likely that the first HIV vaccines will be less effective than treatment that is normally licensed in the U.S. (70-95% effective). Though a partially effective vaccine is not the ideal vaccine, it could be beneficial in parts of the world with high infections rates. Mathematicians estimate that a 30% effective AIDS vaccine could curb the number of new infections when used in a region of the world with a high infection rate, like southern Africa or Southeast Asia. But when the mathematicians accounted for people abandoning safe sex and needle use behaviors, they found the pandemic would actually worsen. This means any AIDS vaccine, particularly partially effective vaccines, must be provided with HIV prevention interventions in order to ensure people understand all the ways to keep themselves negative.

Disease Modulation: A preventative AIDS vaccine might not prevent infection, but instead keep an infected person from becoming sick. If this is the case, then new standards will have to be developed for treatment plans.

Accelerating vaccine development: Ever since the events of September 11, the U.S. government has accelerated the development of vaccines for anthrax and smallpox. Incentives such as guaranteed purchasing and liability insurance have helped to spark private investment in these types of vaccines. Such incentives have not been put in place for HIV/AIDS vaccines, even though 40 million people in the world live with HIV while there are zero cases of smallpox. The politics of AIDS continue to challenge efforts to end the pandemic and requires the public to overcome it. It is true the nature of vaccine research is time consuming, but we are not doing all we can to speed this process up.

Community participation and trial participant protections: Again, community participation in AIDS vaccine clinical trials is essential. Unless people are willing to participate in clinical trials, development of an effective AIDS vaccine is impossible.

But the community first requires education about clinical research and participant protections. The public must be informed about the potential of an AIDS vaccine, as well as the risks and benefits of participating in clinical research. Also, trial participants and their loved ones must be assured that their rights and health are being championed throughout this process.

Past abuses in biomedical research, such as the Tuskegee experiments, remain fresh in the memory of many people. Furthermore, examples like Tuskegee also illustrate some of the reasons certain communities have greater distrust of biomedical research than others.

After Tuskegee, several safeguards were put into place to ensure that such abuses are not repeated and that research benefits are shared equally across communities. Community involvement is one of the safeguards. This is one reason why we so urgently need to provide the community with education on clinical research.

Addressing issues of racism, sexism, ageism and classism will have a direct impact on which communities step forward to participate in clinical research. Inclusion of diverse communities will not only help ensure that an AIDS vaccine works for multiple communities, but also that diverse communities accept the vaccine because they were involved in the development of it.

Moving Forward

Making a difference in terms of developing an HIV vaccine can be as simple as sharing what you read in this article with a couple of your friends. Get conversations going so people you know are aware of current research and how to get involved.

If there are trials in your area, you or people you know could join a trial or you could join a Community Advisory Board (CAB) at the study institution and lend your knowledge and time to the effort. You could help just by making sure people know the truth about HIV vaccine research. Sometimes it is just the little things that can make a huge difference.