Finding a Way Forward
It's never easy to hear that a major scientific endeavor did not produce the results it was hoping to produce. Last week the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, announced it would stop administering injections in its HVTN 505 clinical trial of an investigational HIV vaccine regimen. An independent data and safety monitoring board (DSMB) found during a scheduled interim review that the vaccine being tested did not prevent HIV infection, nor did it reduce the amount of HIV in the blood of those participants who became infected with HIV. While the early closure of a trial is always a hard experience, we do go forward from here. This result opens a conversation -- a place to discuss where we are in the development of a vaccine and what we understand about the science of HIV prevention. It helps to remind us that in the thirty years we have known HIV, nothing about this virus has been easy. Yet, we are stronger for the struggle. Our experience as gay men throughout the history of HIV/AIDS has proven that we surge forward after setbacks.
Although we did not find a vaccine from this trial, we did learn. And because of that learning I remain hopeful about our search for a vaccine. From this trial we took away victories that can help change the face of research and its relationship to our community. This trial showed us how researchers and communities can work together to recruit under-represented populations that have not been engaged in HIV vaccine research. The trial offered a model for how research can be more reflective of the communities that carry the highest burden of HIV and could most benefit from an effective vaccine. We learned how to work with a disengaged population to help them see (again) why an HIV vaccine matters to them.
These are lessons that will help inform the science of HIV prevention as it moves forward. More importantly, these lessons reassure highly affected communities that the research landscape is trying to do better and address past wrongs that have contributed to a culture of mistrust and disengagement from research. If a solution to the HIV puzzle is to be found, it must come from community members and researchers working together. Preconceived notions that each of these groups may have about the other serves to only stifle an essential dialogue. To truly build momentum that will lead to the end of the epidemic will require both sides to be open to understanding each other, and to appreciate what they each bring to the work. It is through the collective actions that synergy happens. Ultimately, success means a vaccine for all of us.
The gay community must work to maintain the engagement that this trial has started. We need to build upon our unique knowledge and experience of HIV and bring that expertise to the table.
At the end of the day, these results do not change the fundamental truth that an HIV vaccine remains critical to any long-term strategy to end the AIDS epidemic in our community and around the world. Although it's a bit of a cliché, we have to remember that it's not how many times you fall down; it's how many times you get back up, something our community has always done.
Matthew Rose is a long-time HIV/AIDS advocate. For the last three years he has been a member of Prevention Research, Outreach, Advocacy and Representation (PxROAR), a domestic program created by AVAC to offer training for advocates in biomedical HIV prevention research education. Previously Matthew spent two and a half years with the National Coalition for LGBT Health overseeing its HIV/AIDS policy work. Matthew is a member of the Capital Area AIDS Prevention Effort; sits on the ethics working group for the HIV Vaccine Trials Network; serves on the national steering committee of the Black Treatment Advocates Network; and is chair of the policy committee and a member of the organizing committee of the Young Black Gay Men's Initiative.