13 August 2008
Experts Target Prevention to Slow Global AIDS Epidemic
AIDS 2008 meeting closes with call for universal access to treatment
Washington -- Acquired immunodeficiency syndrome (AIDS) is a global epidemic of the greatest urgency. Over the past 25 years, more than 25 million people have died of AIDS-related illnesses, and an estimated 33 million people now live with the precursor to AIDS, human immunodeficiency virus (HIV).
The theme of the 17th International AIDS Conference (AIDS 2008), Universal Action Now, emphasized the global need for timely ways to reduce the number of new HIV infections and treat all those already afflicted.
Hundreds of the world’s top AIDS researchers and policymakers spoke at the August 3-8 meeting in Mexico City, which had roughly 25,000 attendees.
Among the attendees was Dr. Mark Dybul, U.S. global AIDS coordinator for the Department of State, who discussed the U.S. renewal of the President’s Emergency Plan for AIDS Relief (PEPFAR) in an interview with the Kaiser Family Foundation. PEPFAR was initiated in 2003 as a five-year, $15 billion program and reauthorized July 30 for $48 billion over five years.
“The most important thing is that [the PEPFAR renewal] sends the signal that the American people are going to stay in this for the long term,” Dybul said. “I think that is how we will change things.”
PEOPLE WITH HIV/AIDS
A critical issue at AIDS 2008 was that of children and HIV. In an August 6 plenary session, Linda Richter of South Africa’s Human Science Research Committee said nearly 2.1 million children are infected with HIV and 90 percent were exposed to the virus through mother-to-child transmission. The needs of HIV-positive children are often overlooked, she said, and she called for an increase in family-centered services such as child care and economic assistance.
Elisabet Fadul of the Dominican Republic’s World Food Programme and Global Youth Partners also spoke about youth and AIDS. Her approach to stemming the growing prevalence of AIDS in young people between ages 15 and 24 focused on policies and actions that engage at-risk and infected youths by making them partners in programs that address their needs.
Zonibel Woods of the Ford Foundation presented the Roadmap for Action on Women with HIV, which targets the reduction of violence against women with HIV. According to Woods, fear of violence is a main reason that women with HIV avoid treatment. Other aspects of the road map include protecting women’s sexual and reproductive rights and investing in women’s support organizations.
DEVELOPING NATIONS
Much of the burden of the AIDS epidemic has fallen on low- and middle-income countries. On August 7, Morolake Odetoyinbo, chief executive officer of Positive Action for Treatment Access in Nigeria, addressed the heavily burdened health systems in these countries and how people living with HIV may be able to reduce the burden.
Odetoyinbo said people living with HIV already act as peer educators and spokespeople but could also serve as advocates, monitors and managers. People living with HIV, she added, should be included in groups that make decisions about HIV prevention and treatment programs.
Tuberculosis (TB) is another disease that has ravaged the developing world, Dr. Chakaya Jeremiah Muhwa of the Ministry of Health in Kenya said in his August 7 address. AIDS can significantly increase a person’s risk for TB, the leading cause of death for those infected with HIV.
Muhwa described how progress is being made by testing people with TB for HIV and implementing preventive therapy for HIV-positive TB patients. However, he said, new drug-resistant TB strains are now affecting patients in South Africa.
INTO THE FUTURE
Treatment is important, Dr. Myron Cohen of the University of North Carolina said August 5, but the world cannot treat its way out of the AIDS epidemic. Cohen highlighted a potential prevention strategy called anti-retroviral therapy (ART) that has shown promise in laboratory animals at preventing HIV infection before and even after exposure to the virus.
If a cure for AIDS is even possible, scientists agree, patients have a long wait. A strategy called highly active anti-retroviral therapy (HAART) can effectively stop HIV reproduction in the body, said Dr. Robert Siliciano, professor of molecular biology and genetics at the Johns Hopkins University School of Medicine, but HAART cannot eliminate the virus from the body.
The virus hides itself away in an immune system cell called a CD4 T cell. For HIV to be eliminated from the body, Siliciano said, it would be necessary to identify these HIV-reservoir CD4 T cells and find ways to eradicate them.
Researchers are pursuing these reservoirs and, once they are found, can begin the process of screening drug candidates to destroy them. Three steps -- stopping viral reproduction and finding and vanquishing reservoirs -- would effectively eliminate HIV from the body and cure the disease, Siliciano said.
“In the past few days we have learned many, many things,” said Luis Soto-Ramirez, head of the Molecular Virology Unit at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, and AIDS 2008 co-chair.
“The fact that last year more than 2 million people were newly infected with HIV, an infection that is entirely preventable, is simply unacceptable,” he added. “Despite the progress we have made, we are not on course to meet universal access targets. Our failure to meet those commitments will have an impact on millions of lives. It is time to bring drugs to everyone in need. It is time for universal access now.”
More information about AIDS 2008 is available at the meeting Web site.
