*EPF209 07/09/2002
Prevention and Treatment Strategies Pushed for HIV/AIDS
(Researchers outline multiple ideas for beating epidemic) (930)

By Charlene Porter
Washington File Staff Writer

Barcelona -- Ending the argument between those who emphasize the need for HIV/AIDS prevention and those who emphasize treatment of those already infected is emerging as a major theme at the XIV International AIDS Conference. Even as advocates of new strategies for prevention or treatment announce their plans, they speak of the need to pursue other strategies.

"It's clear that this debate about treatment versus prevention, should be at this point a dead debate." said Dr. Helene Gayle of the Bill and Melinda Gates Foundation at a July 8 briefing. "They have to go hand-in-hand. They are synergistic, and one can not succeed without the other," she emphasized as she spoke for the Global HIV Prevention Working Group, a broad-based panel of international HIV/AIDS specialists advocating new investments in prevention.

Technology and research, with their alluring promises of cures, are also generating considerable excitement at this meeting of more than 15,000 disease specialists. The International AIDS Vaccine Initiative (IAVI) outlined plans July 9 for multi-track research into vaccines against HIV. The coalition announced that it hopes to bring a potential vaccine into a final stage trial by 2004.

"The issue is speed," said Dr. Wayne Koff, IAVI's senior vice-president for research and development, emphasizing the urgency of the coalition's work in the face of predictions that 68 million people worldwide could die prematurely by 2020. Koff said IAVI brings together researchers from around the world in an attempt to accelerate development and testing of potential vaccines. "It's about looking at the epidemic in the developing world, and saying, 'How do you make vaccine, get that in the developing world ... as fast as possible?'"

If met, the IAVI goal to have a vaccine in final stage trials by 2004 will halve the standard time of vaccine development, Koff said.

In the more than 20-year history of the epidemic, HIV has bedeviled scientists because of its extraordinary capability to mutate. In attempting to create a vaccine, researchers run the risk that it will quickly be rendered ineffective by evolution of the target virus into a different form.

To overcome this scientific problem, scientists are searching for a vaccine that is based upon neutralizing antibodies "that block HIV (and) have been isolated from a few rare humans," said Dr. Seth F. Berkley, president and CEO of IAVI. "We just do not yet know what it takes to get the body to make them," he said describing the coalition's work to overcome that technical problem.

IAVI representatives also emphasized that while their technical work progresses on one track, efforts to contain the spread of the epidemic and diminish the numbers of further infections must be conducted simultaneously.

Existing HIV prevention strategies which are "achievable," practical," and "doable" can help avert the dramatic expansion in worldwide viral infection currently predicted by credible studies, according to the Global HIV Prevention Working Group, organized by the private, U.S-based Kaiser Family Foundation.

"The worst doesn't really have to happen," said Kaiser representative Drew Altman at a July 8 briefing outlining the findings of the working group in its new report "Global Mobilization for HIV Prevention: A Blueprint for Action."

The working group's report is released in the wake of other global demographic predictions that estimate that there could be as many as 45 million new HIV infections by 2010 if current trends continue. One study released in conjunction with the Barcelona meeting -- compiled by the World Health Organization, the U.S. Census Bureau and others -- suggests that the future infection rate could be much lower if current prevention efforts are vastly expanded. If that happens, the report says, the number of future infections could be reduced to some 16 million.

"A Blueprint for Action" calls for $4,800 million in spending on HIV prevention strategies -- a four-fold increase over current levels -- to ensure that the worst predictions do not come true. "There is clearly a major gap in access to prevention worldwide," said Gayle, a co-chair of the working group. "While we treat those infected, while we search for a vaccine, we have to embark on an unprecedented expansion of existing, proven HIV prevention programs."

"We failed to act decisively in the early stages of the epidemic in sub-Saharan Africa, and now we are paying the price," said David Serwadda of Makerere University in Uganda, a nation recognized as an exception in Africa because of its early aggressive action to contain the epidemic. Uganda has an HIV infection rate now of 8 percent. Too high, Serwadda said, but still far below the 20-30 percent infection rates that plague many nations of the region.

"A Blueprint for Action" recommends that additional funding be devoted to known prevention strategies that have been proven effective elsewhere: mass media campaigns; condom distribution, promotion and social marketing; voluntary counseling and testing programs; blood screening; and school and work-based education programs.

Peter Piot, the executive director of the Joint United Nations Program on HIV/AIDS, said, "There is not a single magic intervention that's going to fix this." Rather he said investment must be made in a broad range of programs, targeting individual vulnerable populations in multiple locales.

Gayle said the working group estimates that if the world had made greater investments in HIV prevention a decade ago, just $1,500 million, the multiple costs of the disease -- including lost work and productivity -- would be $90,000 million less today.

(The Washington File is a product of the Office of International Information Programs, U.S. Department of State. Web site: http://usinfo.state.gov)

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