Circumcision, microbicides and drugs all offer promising new possibilities for battling the AIDS pandemic, but it will not be easy to roll out this arsenal of prevention methods, experts said on Tuesday.
And the ultimate goal of a vaccine is still far away, although vaccine researchers said they were making progress.
“An AIDS vaccine is the only tool that can end the pandemic,” Dr. Seth Berkley of the International AIDS Vaccine Initiative told a news conference.
“All evidence suggests that a vaccine is possible. There is progress being made. It’s slow but it’s steady.”
In the meantime, people need to mobilize every prevention method possible, according to the report by the Global HIV Prevention Working Group, presented to the International Conference on AIDS.
The global HIV group is in a position to make some of its recommendations happen. Its members work at the World Health Organization, Bill and Melinda Gates Foundation, European Commission and the World Bank.
“This is really putting prevention on the map in ways that it hasn’t been done before,” Dr. Helene Gayle of the aid group CARE and an organizer of the AIDS conference, said in an interview. “Research on some of these approaches, such as male circumcision and diaphragms, could show results within the next two years,” the report concludes.
No method would work on its own, but combining several could make a dent in the epidemic, the report says.
The United Nations AIDS agency UNAIDS estimates that $11.4 billion will be needed annually for HIV prevention by 2008, more than twice what is now spent.
The AIDS virus infects more than 39 million people globally, more than 60 percent of them in sub-Saharan Africa. It kills more than 4 million people every year.
Condoms and abstinence are the only reliable methods to prevent AIDS in adults, which is spread sexually and via intravenous drug use.
“Despite the fact that some new HIV prevention methods could be shown to be effective in the near future, virtually no planning or resources have been dedicated to ensuring future access to new prevention approaches,” the report says.
- Circumcision: A study in South Africa showed circumcised men were 60 percent less likely than uncircumcised men to become infected with HIV from female partners. The foreskin of the penis contains many of the cells HIV can easily infect.
- Cervical barriers: Diaphragms and similar birth control methods might block the virus from reaching the cervix, which in women is the area most susceptible to the virus.
- Pre-exposure prophylaxis with HIV drugs. Research in animals suggests taking one or two drugs a day could protect people at high risk of infection.
- Herpes suppression: The herpes virus, which infects up to 70 percent of people in some parts of sub-Saharan Africa, creates lesions that make HIV easier to acquire and transmit, but can be suppressed with several antiviral drugs.
- Microbicides: A gel or cream, perhaps containing an HIV drug, could be applied to the vagina or rectum to reduce HIV transmission. Five promising microbicides are currently in late-stage clinical trials.
Former U.S. President Bill Clinton told the meeting much progress had been made in beating down the price of HIV treatments and getting them to the people who need them most.
Four years ago, Clinton said, a course of treatment with generic versions of first-line HIV drugs cost $400 a year. “We were able to lower this price to just $140 a person a year,” Clinton said. Rapid HIV tests now cost just 50 cents, he said.
And leaders who had refused to recognize the extent of the AIDS problem have signed on to fight it, he added. “China, once in a state of denial, deserves all of our respect for turning on a dime and recognizing the problem,” Clinton said.
Revision date: July 9, 2011
Last revised: by Jorge P. Ribeiro, MD