Anso Thom

22 July 2009
Cape Town — Scientists have renewed the call for more immediate and urgent effort to be directed towards HIV prevention amid the dominance of treatment interventions and the world-wide search for a quick fix vaccine, which many agree, is years away.

Speaking at the plenary session of the 5th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2009) yesterday (Tuesday) Professor Bruce Walker of the Harvard Medical School put a slide up at the end of his technical talk on understanding the immune responses of long-term HIV survivors in the absence of treatment.

It showed that at a KwaZulu-Natal clinic 0% of 15 year-olds tested were HIV positive, by the time they were 16 around 10% were infected and by the time they turned 22 a staggering 66% of these young women were HIV-positive.

"This is absolutely horrifying and unacceptable and more efforts must be turned towards prevention," said Walker, who works in close collaboration with the Doris Duke Medical Centre at the University of KwaZulu-Natal.

Dr Stefano Bertozzi, Executive Director at the Center for Evaluation Research and Surveys at the National Institute of Public Health in Mexico started his plenary talk by expressing shock at the KwaZulu-Natal slide.

Bertozzi made a plea for scientists and researchers to not only think about "more money for AIDS", but more importantly "less AIDS for the money".

"We are not managing to get less AIDS for the money and we need to ask ourselves whether we need strategies for improved efficiency in the light of figures showing we had 2,7-million new infections in 2007 and that twice as many people die of AIDS compared those who start on treatment," said Bertozzi.

Bertozzi said greater emphasis needed to be placed on getting value from investments amid the threats to AIDS funding brought on by the financial crisis. He said this required a shift in thinking from a short-term emergency response to a more efficient, long-term approach.
"We need to stop spending billions implementing large-scale interventions without measuring effectiveness," he said citing the example of the billions that was spent on abstinence campaigns without any measure whether these campaigns held any value in preventing HIV.

He said there was also a critical need to focus on interventions where the maximum benefit could be derived. For example in Russia where HIV infection is predominantly among injecting drug users, very little is spent on targeting this group.

Dr Robert Gray at the Johns Hopkins Bloomberg School of Public Health in the US revealed that of the 28 completed biomedical prevention trials (which are hugely expensive and take very long), only four, including three trials of male circumcision, have reported significant efficacy. Gray argued for conducting fewer trials, but with a greater investment in rigor and quality.
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