Female-Controlled Microbicide to Prevent HIV Infection Could Be Available in Three to Four Years, Piot Says

A female-controlled, vaginal microbicide to prevent HIV infection could be available in three to four years and offers more hope in the "foreseeable future" than an HIV/AIDS vaccine, UNAIDS Executive Director Peter Piot said on Thursday, AFP/Yahoo! News reports (AFP/Yahoo! News [1], 4/14). Speaking to journalists in Geneva, Piot said that the development of a safe and effective HIV/AIDS vaccine is still not on the horizon, but a safe and effective microbicide is, "in the most optimistic scenario," three to four years away. "Conceptually, [microbicides are] straightforward, whereas with the vaccine we still don't know where to go," Piot said, adding, "We don't even know for an HIV/AIDS vaccine what are the elements in the immune response that protect us, what kind of antibodies should we try to stimulate" (Bulman, AP/Las Vegas Sun, 4/14). Microbicides include a range of products such as gels, films, sponges and other products that could help prevent the sexual transmission of HIV and other sexually transmitted diseases. HIV is transmitted primarily through heterosexual intercourse in much of Africa and Asia, but no female-controlled HIV prevention method currently is widely available (Kaiser Daily HIV/AIDS Report, 4/7). According to Piot, there are about 15 microbicides being tested worldwide, including two human trials in Thailand and the United States. "Currently, we are dealing with trials that deal with thousands and thousands of women," Piot said (AP/Las Vegas Sun, 4/14). Microbicides are necessary because of the increasing feminization of the HIV/AIDS pandemic, with more than half of new infections worldwide occurring among women, Piot said (AFP/Yahoo! News [1], 4/14). He added, "Just as the contraceptive pill is really what made a difference in terms of contraception and family planning, a product like (a microbicide) ... could make a big difference for women's lives in the AIDS epidemic" (AP/Las Vegas Sun, 4/14).

Prevention Programs "Neglected"
Piot on Thursday also said that HIV/AIDS prevention programs worldwide are being "neglected" and warned of a resulting "explosion" of new HIV cases, VOA News reports. Although it is "encouraging" that spending on prevention initiatives in developing countries has increased from $200 million to more than $6 billion over the past eight years, the "big challenge" is obtaining long-term funding commitments from donor countries, Piot said, according to VOA News. "Today, what we see often is that HIV prevention is slipping off the agenda. Among other things because it can be controversial," Piot said, adding, "But with five million new infections every year still going on, if that continues, treatment in itself will certainly not be affordable ... [w]hen you add every year so many people to the already 40 million who are infected." He added that a comprehensive prevention approach is the most-effective method, VOA News reports. "For example, for young people, postponing the age of first intercourse is not a bad thing at all. It is something that is part of the package," Piot said, adding, "You need promoting reduction of partners, being faithful. And there is a need for condom promotion."

Challenges Still Exist
Only countries with the political commitment to fight the pandemic will succeed in curbing the spread of HIV, Piot said, adding that there have been "significant breakthroughs" in India and China, according to VOA News. Although both countries previously were "in denial" about the disease, they now are addressing the issue, according to Piot, VOA News reports. African nations overall lack the infrastructures and services required to effectively use available funds for HIV/AIDS treatment and prevention programs, but there is strong political commitment in every African nation to curb the spread of HIV, Piot said. The "biggest challenges" currently are in Eastern Europe and Central Asia, which are experiencing the fastest-growing epidemics and are still "unwilling to face the awful truth about the disease," according to Piot, VOA News reports (Schlein, VOA News, 4/14).

Indian Patent Measure
Piot on Thursday also called a recently passed measure in India's parliament that would ban the production of generic versions of newly patented medicines a "major obstacle" in the fight against HIV/AIDS in the country, AFP/Yahoo! News reports (AFP/Yahoo! News [2], 4/14). The measure, which President Abdul Kalam is expected to sign into law, would prohibit the domestic production of low-cost, generic versions of patented medicines, including antiretrovirals. Under India's current patent process, the country's generic drug industry has made less-expensive medications available worldwide for more than 30 years, making it possible for many people in developing countries to receive treatment for various diseases. However, under the newly passed measure, drug makers that want to continue production of generic drugs must pay royalties to the manufacturers of the patented drugs (Kaiser Daily HIV/AIDS Report, 3/24). Although the measure would not stop the production of already-existing antiretrovirals, it could stop the future production of less-expensive versions of necessary new drugs, Piot said, according to AFP/Yahoo! News. As HIV becomes increasingly resistant to existing drugs, new drugs will be necessary to replace current generic antiretrovirals, Piot said, adding, "It is fairly predictable that we will continuously need new antiretroviral drugs." Piot also said that he sent a letter to Indian Prime Minister Manmohan Singh before last month's parliamentary vote to outline the likely consequences of the measure (AFP/Yahoo! News [2], 4/14).

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