Update: 2010 International AIDS Conference
Tales From Vienna: The World's AIDS Community Converges Upon Vienna for the International AIDS Conference
More than 16,000 delegates traveled to Vienna, Austria for the 18th International AIDS Conference held in July. Abstracts (summaries) and many webcasts are available at www.aids2010.org.
Leading the news from the conference: the first ever antiviral-based gel to show effectiveness in preventing HIV in women.
Doctors don't usually get a standing ovation when presenting data from a study, but Dr. Quarraisha Abdool Karim did.
She presented study results showing a 39% decrease in HIV infections in women using a vaginal gel containing tenofovir, an anti-HIV medication. The gel was used up to 12 hours before sex and again afterwards.
Moreover, in women who used the microbicide (germ-killing) gel in 80% of the incidences of sexual intercourse, there was a 51% reduction in infection. These women made up the majority of the participants using the gel.
A smaller group of women using the gel less than half the time had a lower success rate, a 28% reduction in infection, but this is still one in four women remaining uninfected.
In addition, the gel prevented herpes infection in 54% of women.
After years of disappointing results with microbicide research, advocates around the world expressed elation. "Goooooal!" wrote Science reporter Jon Cohen.
Nearly 900 women participated in the study at the Centre for the AIDS Programme of Research in South Africa (CAPRISA), with the major funder being USAID (U.S. Agency for International Development).
The U.S. and South African governments were the primary forces behind the study. Dr. Abdool Karim is with Columbia University and associate director of CAPRISA, where her husband, Dr. Salim S. Abdool Karim is director. He is also a vice-chancellor at the University of KwaZulu-Natal (UKZN) in South Africa.
In a UKZN press release, Dr. Quarraisha Abdool Karim says that, "Tenofovir gel could fill an important HIV prevention gap by empowering women who are unable to successfully negotiate mutual faithfulness or condom use with their male partners. This new technology has the potential to alter the course of the HIV epidemic, especially in southern Africa where young women bear the brunt of this devastating disease."
A YouTube video of interviews with some of the women and medical providers in the study, entitled "Gabi's Gift," is available, along with other information on the results, at www.caprisa.org. In it, Gabi Nxele explains that a friend died of AIDS and participating in the study was her gift to the women of the world.
A mathematical model presented at the conference estimated that "a vaginal microbicide with an efficacy of 40% to 50% could prevent between 271,000 and 602,000 new HIV infections in 10 years [in South African women] depending on coverage." This depends on the gel's effectiveness being confirmed in further research. For example, a tenofovir gel combined with pills is being studied by the Microbicide Trials Network (MTN). The model also depends on the gel becoming available within five years.
In the CAPRISA study, usage fell off over time. There was a 50% prevention rate in the first year, which went down to 39% for the entire two and a half years of the study. The success rate was compared against women who were given a placebo gel (no active substance).
Tenofovir is available as an HIV drug called Viread, and is in the HIV medications Truvada and Atripla, both best-selling compounds. It is also being studied as a prevention pill for HIV-negative people at high risk of infection. There's long been hope and excitement for tenofovir, and Truvada, to help in the prevention of HIV during sexual encounters. Newer HIV drugs are also being studied for this purpose.
Two U.S.-based organizations, FHI (Family Health International) and CONRAD (Contraceptive Research and Development Program), collaborated with CAPRISA. MTN reported that Gilead Sciences, which makes tenofovir, initially created the gel and granted a royalty-free license for it to CONRAD and to the International Partnership for Microbicides. Gilead provided tenofovir for free to MTN.
CONRAD is a division of the Department of Obstetrics and Gynecology at Eastern Virginia Medical School, with a mission to help rapidly develop safe, affordable, and effective products for contraception and prevention of sexually transmitted HIV and other infections.
CONRAD offered to lead the movement to have the gel released as soon as possible if it continues to show effectiveness. Advocates noted that government regulations around the world prevent the availability of products for years after they are found to be effective.
The study publication is available free online at www.sciencemag.com.
It's time to stop the harmful laws and discrimination associated with the international war against drugs, according to doctors, researchers, and advocates who created the Vienna Declaration. The statement urges the promotion of syringe exchange and other proven methods of protecting health.
"The criminalization of illicit drug users is fuelling the HIV epidemic and has resulted in overwhelmingly negative health and social consequences," they wrote. "A full policy reorientation is needed."
The declaration goes on to briefly review the history of this war on drugs and discuss its failings.
Among the problems discussed is a high rate of HIV among injection drug users (IDUs) in areas of the world where the virus is "spreading rapidly." In Eastern Europe and Central Asia, as many as 70% of IDUs become infected, and in some areas, more than 80% of this group acquires HIV.
"In the context of overwhelming evidence that drug law enforcement has failed to achieve its stated objectives, it is important that its harmful consequences be acknowledged and addressed," the declaration continues.
The following points, taken directly from the declaration, represent some of the consequences of the war on drugs:
"Unfortunately, evidence of the failure of drug prohibition to achieve its stated goals, as well as the severe negative consequences of these policies, is often denied by those with vested interests in maintaining the status quo," the declaration says. "This has created confusion among the public and has cost countless lives. Governments and international organizations have ethical and legal obligations to respond to this crisis and must seek to enact alternative evidence-based strategies that can effectively reduce the harms of drugs without creating harms of their own." The document goes on to make several recommendations.
The declaration also notes that, "Basing drug policies on scientific evidence will not eliminate drug use or the problems stemming from drug injecting. However, reorienting drug policies towards evidence-based approaches that respect, protect, and fulfill human rights has the potential to reduce harms deriving from current policies and would allow for the redirection of the vast financial resources towards where they are needed most: implementing and evaluating evidence-based prevention, regulatory, treatment and harm reduction interventions."
Individuals and organizations are invited to sign the Vienna Declaration at www.viennadeclaration.com.
This article was provided by Test Positive Aware Network. It is a part of the publication Positively Aware. Visit TPAN's website to find out more about their activities, publications and services.
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