Politics and Policy of HIV/AIDS » Science and Technology

Renewed institutional support for innovation in HIV prevention

Ben — Mon, 03 Sep 2007 05:04:03 +0000

This is reposted in full from the Lancet blog post of Aug 23th, “US$14 million grant for HIV prevention campaign”.

The AIDS Vaccine Advocacy Coalition is launching a new organization
to promote the development of a wide variety of HIV prevention
strategies, including microbicides and oral preventive drugs.

The launch of the new organization, called The HIV Prevention
Research Advocacy Network, was announced by AVAC Tuesdsy, Aug 21 in
Seattle at the AIDS Vaccine 2007 conference.

The initiative will be funded by five-year, US$14 million grant from the Bill & Melinda Gates Foundation

According to the press release announcing the network’s launch, the organization will:

•Develop international advocacy partnerships that support both the
needs of communities involved in research and a global advocacy
movement for HIV prevention research.

• Translate complex scientific ideas to communities AND translate community needs and perceptions to the scientific community.

• Work to hold both research agencies and advocates accountable for accelerating ethical prevention research and development.

• Help ensure that communities, policymakers, and civil society have
realistic expectations about HIV prevention research and specific
clinical trials.

• Work closely with other groups conducting HIV prevention research advocacy, including microbicide advocacy groups.

AVAC also released it annual report, which provides an overview of
the state of HIV vaccine research today. Of particular interest is a
section that looks at the slow uptake of both male circumcision as an
HIV prevention strategy and the vaccine for human papilloma Virus
(HPV). These case studies, the report argues, holds lessons for those
seeking to implement other prevention strategies.

To visit AVAC site and download the new report go to: http://www.avac.org/

To visit the AIDS Vaccine 2007 conference website go to: www.hivvaccineenterprise.org/conference/index.html

So much for not breastfeeding…

joshbusby — Sat, 28 Jul 2007 04:47:40 +0000

Turns out that it is better if kids get breastmilk, even if their mothers are HIV positive, as they are more likely to die from diarrhea than they are of contracting HIV. Here is a link to the story in the Washington Post and excerpt from the Kaiser summary report.

Providing infant formula to HIV-positive mothers might “cost at least as many lives as it has saved” because the nutrition and antibodies supplied by breastmilk are “so crucial to young children that they outweigh the small risk of transmitting HIV,” the Washington Post reports. According to the Post, CDC researchers have found that a decade-long, global initiative to provide infant formula to HIV-positive mothers has “backfired” in Botswana by causing infants to be more susceptible to other, more immediate deadly diseases. The findings join a “growing body of research” on the potential detriment of providing HIV-positive mothers with infant formula, the Post reports (Timberg, Washington Post, 7/23).

Male circumcision as foreign policy

Ben — Sun, 13 May 2007 08:46:46 +0000

The Council on Foreign Relations held its first of several rounds on the role of health technologies in US foreign policy. Laurie Garrett led the discussion with Ambassador Mark Dybul and New York Health Commissioner Tom Frieden. The full video is available on the CFR site. I’d be curious to hear what others think but I came away with the general sense that Dybul and by extension the PEPFAR program is overly cautious about male circumcision as HIV prevention. Several times Dybul pointed to slides (which hopefully the CFR video editor will post…) with WHO models that showed the HIV epidemic would not end with MC alone. Although Dybul did not mention the WHO authors, but he may have been referring to the Williams et al PLoS study published in July 2006. While not predicting the end of the epidemic, Williams et al did find that:

MC could avert 2.0 (1.1-3.8) million new HIV infections and 0.3 (0.1-0.5) million deaths over the next ten years in sub-Saharan Africa. In the ten years after that, it could avert a further 3.7 (1.9-7.5) million new HIV infections and 2.7 (1.5-5.3) million deaths, with about one quarter of all the incident cases prevented and the deaths averted occurring in South Africa.

Circumcision, like any STI control strategy, works when core spreaders at the nodes of the sexual networks are treated. There are no guarantees that high risk individuals will seek out the knife or that if they did, once cut, their new circumcised status would not affect decisions about high risk sex. But national policies to circumcise adolescents and infants, calling for safely deployed and closely monitored programs as with any public health intervention, promise to shift the epidemic curve over a few short years. New cohorts of young circumcised men, exposed to the same safe sex messages currently broadcast and presented with the same level of condom social marketing as now, will be at fundamental lower risk of HIV infection. That sounds like a worthy effort for US taxpayers to fund, certainly more than the $15 million currently available from an annual PEPFAR budget in the neighborhood of $3 billion.

Scientists Discover ‘Natural Barrier’ to HIV

Ben — Mon, 12 Mar 2007 16:57:40 +0000

‘Natural Barrier’ to HIV
March 5, 2007

By E.J. Mundell

Researchers have discovered that cells in the mucosal lining of
human genitalia produce a protein that “eats up” invading HIV –
possibly keeping the spread of the AIDS more contained than it might
otherwise be.

Even more important, enhancing the activity of this protein, called
Langerin, could be a potent new way to curtail the transmission of the
virus that causes AIDS, the Dutch scientists added.

Langerin is produced by Langerhans cells, which form a web-like
network in skin and mucosa. This network is one of the first structures
HIV confronts as it attempts to infect its host.

Clinton Foundation brokers deal to lower drug prices for tots

joshbusby — Thu, 30 Nov 2006 21:36:37 +0000

This, in the NY Times, about Clinton’s efforts to drive down drug prices for ARV therapy for kids. Got to hand it to the ex-Pres, he’s trying to make amends for having done so little as President:

MUMBAI, Nov. 30 — The cost of treating children infected with H.I.V. and AIDS is poised to plummet next year, under a deal announced today between two Indian drugmakers and former President Bill Clinton’s foundation.

Cipla and Ranbaxy Laboratories agreed to make 19 different anti-retroviral drugs designed for children available to 62 developing countries at an average price of $60 a year, which is less than half of the lowest current price, the Clinton Foundation said in a statement. Because not everyone has access to the lowest current price, the plan will actually translate into a four- to six-fold cost reduction for many children, said Stephen Lewis, the United Nations special envoy for H.I.V. and AIDS in Africa.

A $35 million grant from Unitaid, a drug-buying consortium formed in September by France, Brazil, Chile, Norway and the United Kingdom, will be combined with $15 million from the Clinton Foundation to assure the Indian drugmakers a volume of sales high enough to justify the lower prices.

However, there is a worry that the ability for generic firms to make these kinds of contributions may slow as India firms up its intellectual property rights laws:

Indian drug companies were able to produce the special pediatric drugs because they mixed together a customized combination of chemicals invented by Western companies but never patented under India’s once-lax intellectual-property protections. Yet India has recently changed its patent rules, under its World Trade Organization commitments, so as to protect Western innovations.

Thailand, however, has announced it is breaking a patent on an expensive ~~second-line~~ ARV drug (Efavirenz apparently isn’t a second-line drug but a first line drug that replaces nevirapine because of its side effects) because it is encountering drug resistance. Stay tuned. The Center for Global Development has also posted on this, suggesting the Thai government’s action may embolden others.

Health officials in Thailand announced on Wednesday that they would break a patent on the AIDS drug Efavirenz and make generic copies.

Efavirenz is a second-line AIDS treatment, made for those immune to the first generation of AIDS drugs, and it is substantially more expensive than first-line drugs.

Local practices lead to global HIV?

Ben — Wed, 22 Nov 2006 06:17:35 +0000

Behavior change campaigns for years in the African region have targeted high-risk sexual behaviors in attempts to prevent HIV infection. The discourse at times has veered into culturally naive assumptions of sexual exceptionalism. Yet, as some researchers have observed, some fundamental measures human sexual behaviors appear consistent across cultures and geographies -i.e. average lifetime number of partners. Granted, distinct regional patterns emerge on closer look – i.e. long-term concurrent partnerships and serial monogamy are alternatively dominant in different regions of the world (see April ‘06 post “Concurrency and a Campaign for Serial Monogamy”).

Other transmission routes have been largely overlooked in the mainstream discussion of HIV in Africa. This blog has mentioned before the largely unaddressed plight of MSM populations in Africa (see Feb ‘06 post “MSMs finally address”). Although blood bank management has improved since the 1980s, even in low-income countries, unclean syringe and needles have been associated with 20-40% of HIV infected cases, according to one controversial 2003 study (“HIV infections in sub-Saharan Africa not explained by sexual or vertical transmission”). Important to note that a 2004 rebuttal observed “inadequately sterilised skin-piercing instruments” likely cause no more than 2.5% of HIV-1 infections in Africa (“Transmission of HIV-1 infection in sub-Saharan Africa and effect of elimination of unsafe injections”)

In an article today (“Traditional Ways Spread AIDS in Africa, Experts Say”), The New York Times reports on local rites of passage and social behaviors that risk HIV transmission among children in Cameroon and elsewhere.

As researchers spend more time studying Africa’s overwhelming pediatric AIDS problem, they are finding that the routes of transmission may be different than in the industrialized countries, and that strategies for preventing the disease’s spread must be adapted to local realities. In developed countries, the only real risk factor for children is that they can get H.I.V. from their mothers at birth.

But here, researchers have come to agree, a host of traditional ceremonies and practices is creating transmission routes unique to Africa — dangers that have, up to now, been ignored.

In scarification ceremonies for ethnic identification and cutting for ritual healing, blades are used in sequence again and again. There is also the practice of communal breast-feeding a single baby by numerous women, common in many tightly knit villages.

In a country like Cameroon, where more than 5 percent of the population and 11 percent of pregnant women are infected with H.I.V. — the vast majority unknowingly — such practices could lead to a wildfire spread.

“If we are only biology, biology, biology, then we are only doing half of our mission,” said Marcel Manny Lobe, director of the new International Reference and Research Center for H.I.V.-AIDS in Yaoundé. “We need also to do the sociology and anthropology and then make biological interventions.”

The emphasis on locally tested interventions makes sense. And pediatric HIV prevention is certainly a critical area for HIV intervention. But consider the HIV plague at greater granularity as many epidemics – pediatric, MSM, IDU, heterosexual ’sugar daddies’ and others that at times overlap. In light of limited resource availability, I wonder if the focus on transmission due to cultural practices is where we should be placing greater attention or if, in the end, the magnitude of other HIV epidemics pulls us to where the need and risk are largest.

The answer lies in determining what is truly the largest need and risk. Without more precise measurement, we cannot do much when the fraction of HIV infections attributable to dirty needles ranges anywhere from 2.5 to 40%.

Robert Gallo praises PEPFAR, dismisses Duesberg

joshbusby — Wed, 19 Apr 2006 19:17:45 +0000

I attended a conference at Princeton this week in which eminent scientists discussed the state of efforts to develop a vaccine for the virus that causes AIDS as well as other treatment and prevention technologies like new anti-retrovirals, microbicides and male circumcision. It was a very interesting workshop, giving me a greater appreciation of the difficulties scientists have had in being able to come up with a vaccine. As I understand it, the AIDS virus is a particularly difficult kind of virus because it inserts its own genetic material into the host organism and then replicates inside the cells of that individual. Stopping that process is no easy endeavor.

The scientist Robert Gallo, who was one of the scientists who ultimately proved that HIV causes AIDS, made for a most entertaining speaker. For me, as a political scientist, his comments on PEPFAR were among the most interesting. He was effusive in his praise for the Bush Administration, suggesting that the administration had done more than any of its predecessors. He was talking mostly about treatment. I’m not sure if his enthusiasm went beyond that to prevention programs. Another prominent scientist, Emilio Emini, also supported Gallo’s comments on PEPFAR and noted that the Europeans are not doing nearly as much. I’m probing this in a new paper I’m working on for an upcoming workshop at Princeton that my blog collaborators and I have organized for May 5th on the “Politics and Policy of HIV/AIDS“.

Gallo also said some very interesting things about the infamous HIV/AIDS “denialist” Peter Duesberg whose work got some unprecedent and probably unnecessary exposure in a recent Harper’s (see Ben’s post on this.) Gallo will soon have his own reply in Harper’s Duesberg (here is a reply), but he was pretty clear that Duesberg, whom he regarded as a former friend, was promulgating disinformation and bad science in his quest to debunk the links between HIV and AIDS. Gallo described Duesberg’s stuff as off-the-wall-insane, bordering between crap and insanity, that was fueled by malignant narcissism that ought to be regarded as below the zero of knowledge. Merely mentioning Duesberg gives him more credit than he deserves. Gallo cites a 2003 New England Journal of Medicine piece in which he tries to put to bed some of the “denialist” claims. Here are some excerpts:

The year 1984 was a time of both intense excitement and harsh discussions between members of our two groups. Identifying the cause of AIDS presented a unique challenge, because unlike other viral diseases responsible for past epidemics (or, more recently, the severe acute respiratory syndrome), AIDS was characterized by clinical signs that developed years after the infection had occurred, and by then, patients usually had numerous other infections. Thus, an exceptional linkage of agent to disease had to be established. This linkage was made (particularly in Bethesda) through the repeated isolation of HIV from patients with AIDS and, more important, through the development of a readily reproducible blood test. The growth of the putative virus in T-cell lines was an enormous step, facilitating the development of a blood test for HIV, which became available in blood-transfusion centers in 1985 and produced convincing evidence of the association between HIV infection and AIDS. The blood test also helped in the cloning and molecular characterization of the genetic material of the virus at the end of 1984, which clearly proved that the new virus belonged to the subfamily of lentiretroviruses; this finding, in turn, opened the way for the design of specific drugs and vaccines.

Other indirect evidence that HIV was the cause of AIDS came from the demonstration, in 1984, of its high degree of tropism for the subgroup of CD4+ T cells, its consistent isolation from patients of different origins who had AIDS, and the isolation of similar viruses that cause AIDS in nonhuman primates (specifically, macaques). Thus, the causative relation between HIV and AIDS was accepted by the scientific and medical community in 1984 and was further verified through the later isolation of HIV type 2 in West African patients with AIDS. The relation was also supported by the clinical efficacy of drugs that specifically inhibit HIV enzymes and the demonstration that mutations in one of the co-receptors for HIV (CCR5) make some persons highly resistant to HIV infection and AIDS.

Know your enemy: Capitalizing on evolutionary origins of HIV

Ben — Fri, 17 Mar 2006 21:06:08 +0000

From the KaiserNetwork:

“[B]efore researchers can develop new drugs” to “stave off the worst that viruses” — such as HIV — and “bacteria can produce, … they must understand the evolutionary nature of individual diseases and how viruses and bacteria, in turn, shape the evolution of humans and other animals,” Boston Globe columnist Stephen Smith writes in an opinion piece. Researchers believe that HIV derived from the simian immunodeficiency virus, which has “ceased to harm [primates], in part to allow its own survival,” according to Smith. Researchers also have found that a lack of CCR5 receptors on human cells might prevent HIV from entering the cells, Smith writes, adding that a lack of such receptors appears not to have damaging effects. Smith says that some researchers have theorized the lack of CCR5 receptors is due to a regional evolutionary “artifact of the bubonic plague” that allowed people to survive the disease, adding that about 5% to 10% of people living in northern Europe are estimated to be living without CCR5 receptors. Because being without CCR5 receptors causes no harmful effects, drug companies currently are developing drugs to inhibit CCR5 receptors to prevent HIV transmission into cells, Smith writes. He adds, “This and other efforts to use evolution as a weapon against HIV are an acknowledgement that even with more than two dozen AIDS medications now available, that’s still not enough” because HIV is “especially adept at evolving to escape drugs — an evolutionary process that can take place in weeks and months” (Smith, Boston Globe, 3/13).

Microbicides – female-controlled technology for HIV prevention

Ben — Thu, 09 Mar 2006 21:28:29 +0000

The East Bay Express (8 Mar 2006, A Fresh Front in the AIDS War“) presents a narrative on the development of microbicides as seen through the eyes of African and Californian residents and the work of Bethany Young Holt, a Cal-trained epidemiologist and former Peace Corps Volunteer. The article has several threads and makes some strong accusations but interesting story and implications for HIV prevention. Lemons as a potential household microbicide are described near the end.

In 1992, Bethany Young Holt was working in the refugee camps of southern Ethiopia, where thousands of people had fled to escape the civil war in Sudan. She was a master’s student from UC Berkeley’s School of Public Health, there for an internship with the Centers for Disease Control, which was rolling out an HIV prevention program. The camps seemed like an ideal place for it — while very few of the Sudanese refugees were HIV-positive, commercial sex workers from Ethiopian cities were flooding into the camps in search of clients, and their HIV prevalence was 42 percent. It should have been a chance to avert a disaster.

Holt’s job was to teach people to use condoms. “That was just a joke,” she quickly realized. “The women all wanted them and the men wouldn’t put them on for a hundred different reasons.”…

…Holt, currently a lecturer at Cal’s School of Public Health, believed there had to be a better way to protect women. So in the late ’90s, she joined with other public-health experts and researchers who had long envisioned the next best thing to a cure or effective AIDS vaccine: something new to prevent its transmission during sex. Ideally, it would be discreet and female-controlled. It would be cheap enough that clinics in the developing world could give it away, and people in industrialized nations could buy it for about the price of condoms. Most of all, it would have to work.

After twenty uphill years, it is almost here. It’s called a microbicide, a new class of experimental drugs that kill or block HIV on contact. Most are colorless, tasteless, odor-free, and could be applied as lubricating gels, foams, suppositories, or vaginal rings. They’ve been dubbed “invisible condoms” — most likely, a sexual partner wouldn’t even know they’re there. Some can also act as contraceptives; others can kill not only HIV but a broad spectrum of sexually transmitted diseases and common vaginal infections. There are fourteen microbicides now in clinical trials and another fifteen in laboratory development, which employ a range of disease-thwarting strategies (see sidebar “Halting a Killer”). And there is yet another option undergoing preliminary safety tests. If ultimately shown to be effective, it could prove the cheapest, lowest-tech solution imaginable for impoverished women around the world. It literally grows on trees. You probably bit into it the last time you took a tequila shot.

While these anti-HIV prospects have been a long time coming, their potential to slow the global AIDS epidemic could be truly awesome: A mathematical model produced by the London School of Hygiene and Tropical Medicine estimated that if just 20 percent of women in the world’s 73 poorest countries used microbicides half the time, and if those microbicides were only 60 percent effective, it would prevent more than 2.5 million new HIV infections every three years.

…the genius of microbicides is that they put the power in a woman’s hands. Microbicide advocates are sometimes reluctant to use words like “stealthy” to describe the drugs they’re promoting, although they’re well aware that not every woman can discuss her sexual health choices with her partner. But the rising number of HIV infections among women is clearly facilitated by the idea that certain truths — drug use, infidelity, past sexual experiences, HIV status — are unspeakable, even between people who love one another. That silence, and the resulting inability of women to protect themselves against infection, are making them exquisitely vulnerable. With so many secrets working against them, it is well past time for women to have a secret weapon of their own.

New PBS Series on Global Health

joshbusby — Tue, 01 Nov 2005 14:54:26 +0000

PBS has a new special on global health airing November 1-3, 2005. It is called Rx for Survival and is narrated by Brad Pitt. Here is a description from the website.

During the twentieth century, the world lived through a golden era in public health: vaccines were discovered, diseases were cured, and the average life expectancy rose by many years. In recent decades, however, this stunning progress has declined dramatically. Although life expectancy remains high in developed nations, in many countries of the developing world it has actually fallen.

The march to better world health has been slowed by the emergence of new and devastating diseases such as AIDS, SARS and West Nile virus, by microbial resistance to many modern drugs and by a global travel network that can turn a local disease into an international outbreak in a matter of hours.

Recognizing the impact of both the slow down in medical advances and the speeding up of new and stronger diseases, the award-winning documentary team of WGBH’s NOVA Science Unit and Vulcan Productions, Inc., is co-producing a groundbreaking multimedia project to address what makes us sick, what keeps us healthy and what it would take to give good health the upper hand.

Anchored by a compelling six-hour PBS television series premiering November 1-3, 2005, Rx for Survival — A Global Health Challenge will encompass a wealth of companion elements from major media and educational partners, including TIME Magazine, NPR, Penguin Press, and Johns Hopkins University. Together these will combine to make this project the most comprehensive global health media education project ever mounted. Heightened awareness, however, is not the only goal of Rx for Survival. The ultimate objective of the project is to translate awareness into action. Because global health is such a large and complex issue, we are shining a spotlight on a single set of problems which is both critical and surprisingly easy to affect. Across the world, children from birth to age 5 need five basic health interventions (antibiotics, protection from disease-carrying mosquitoes, oral rehydration, vaccines, and vitamin A and micronutrients) to have even a chance to survive. Rx for Child Survival encourages each of us to get involved to ensure that these basic needs are delivered to children locally and globally by speaking out, volunteering time and energy, and donating to programs that are already making a difference. Many organizations are providing aid around the world. Rx for Child Survival has partnered with CARE and Save the Children to create a special fund that will help make sure that those five simple, inexpensive health interventions are delivered to some of the neediest children in the world.

Funded by the Bill & Melinda Gates Foundation and The Merck Company Foundation, Rx for Survival and Rx for Child Survival have been developed in partnership with the Global Health Council and with the advice of other leading global health experts and organizations.