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The Past, Present and Future of HIV Microbicide Research Advocacy

An Interview With Polly Harrison, Founder of the Alliance for Microbicide Development

Winter 2011

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Polly Harrison founded and led the Alliance for Microbicide Development from 1998 to early 2010. She is now a senior policy advisor at AVAC. TAG worked closely with Polly in support of microbicide research and in fall 2010 TAGline interviewed her to seek her wisdom and vision for the future.

What were things like when you founded AMD?

Fairly bleak, which was why the Alliance was founded in the first place. The idea came from Mahmoud Fathalla at the Rockefeller Foundation, who provided a seed grant to form a coalition of scientists, biopharmaceutical companies and advocates to be a "catalyst" at a time when progress toward microbicides was slow, fragmented and woefully underfunded. There were just 20 of us at the first Alliance meeting in March 1998 but in a year we had almost 100 active participants, a database and regular reporting activities and busy with constituency building, outreach, media work and funding analysis. We had two staff and little money, but there was such engagement and enthusiasm that we got tons done in those early years and began to attract more funding. It's been said the Alliance "made the microbicide field" and there's truth there. People were attracted by the fact that the Alliance was a neutral convener, educator and problem-solver. The neutrality aspect caused us problems later but it's what many value and recall, rather wistfully since the Alliance no longer exists.

You asked when the "HIV microbicide" idea was first suggested. As early as 1987, the National Institute of Child Health and Development was supporting work on "contraceptive microbicides." Then in 1990 came a hugely influential article by South African epidemiologist Zena Stein that called for "HIV prevention methods that women could use."1 Zena argued that absent male concurrence with condom use, women had no way of protecting themselves from HIV infection and that AIDS was becoming a women's as well as a man's disease, not a popular concept at the time.

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The Alliance didn't arise in a total wasteland. Microbicides were in the portfolios of the NIH, Population Council and International Working Group on Microbicides, in U.S. legislative language and the International Conference on Population and Development Plan of Action, and at the 1996 Vancouver International AIDS Conference, there was the first public announcement of U.S. funding for microbicide research. Still, no one had any real money, the broader HIV advocacy community was focused on therapy and later on vaccines and the idea of something topical that could help with women's special risk was seen as scientifically and practically improbable. The failure of the UNAIDS-funded COL-1492 trial announced at the 2000 International AIDS Conference in Durban [South Africa] didn't help! COL-1492 was a commercial product based on nonoxynol-9, which was the active ingredient in topical spermicides and also showed activity against sexually-transmitted infections. However, the trial found that COL-1492 not only didn't protect against HIV infection, but might increase that risk.2 We were stunned by the results, didn't know how to handle them and for a field just getting itself organized, they were traumatic and have had a long half-life.

How have things changed since then?

A lot. Getting an advocacy movement organized and ramped up was vital. Microbicides acquired a public "personality" and some understanding of what they were and might do, and we mobilized constituencies that got successive versions of a Microbicide Development Act introduced in three sessions of the U.S. Congress. None passed but all got introduced with a lot of education, publicity and new allies and leveraged establishment of a Microbicide Branch [at the NIAID Division of AIDS, NIH] and a dedicated position for microbicides in the Office of AIDS Research. We helped establish the International Partnership for Microbicides and pushed steady increases in microbicide funding so NIH attracted more scientists, USAID raised its investment levels and more developers advanced more concepts.

What do you think are the leading questions facing microbicide research today?

If you mean challenges to advancing toward a safe and effective product with reasonable likelihood of user adherence, I'd say:

  • Funding. But not just more money. I mean funding that follows and supports some kind of rational strategy and consensus among the donors about what makes sense.
  • A distinctive collective voice speaking persistently for the special value of topical microbicides for the world's women.

Those women still don't have the kind of protection from HIV infection that they need, which is why we set out to develop microbicides in the first place!

If you mean scientific questions, then I'd say we still don't have:

  • Clear understanding of what kind of product will have enough potency for sufficient time to interrupt HIV transmission at key points in that process in ways that are safe for regular use.
  • Even one validated biomarker that can give us more assurance of product use and effectiveness than even the best adherence measures we have now.
  • A clear view of how any such product and ways to deliver it will best fit the lives of individuals and couples so they feel safer and make their own decisions about that safety.
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This article was provided by Treatment Action Group. It is a part of the publication TAGline.
 
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