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AIDS Conference Highlights Successes in Treatment, Struggles in Prevention

The conference had over 22,000 attendees, the largest AIDS conference held in a developing country, and came after a year of highs and lows for HIV/AIDS research and policy. Just prior to the conference, President Bush reauthorized PEPFAR, the President’s Emergency Plan for AIDS Relief, to provide $39 billion to fight HIV/AIDS globally in the next five years.

“Having [the conference] come on the heels of the PEPFAR authorization was really encouraging. We also know that death rates of AIDS are starting to come down and that correlates with the increase in access to treatment that people have,” Dr. Helene Gayle, president of CARE, a humanitarian organization that targets poverty and HIV/AIDS, told the Online NewsHour.

“The disappointing news is that on the prevention front some of the things we would have hoped would be reported weren’t reported,” Gayle said, in reference to set-backs with HIV vaccines, microbicides and herpes-suppression trials.

The PEPFAR funding will be integral to continuing to expand access to prevention services and life-saving antiretrovirals, an issue on the minds of many at the conference.

Global Fund chief Michel Kazatchkine told reporters that while the improvements in individual countries have been impressive and many countries are close to universal access to drugs and better care, the United Nations goal of universal coverage by 2010 is unreachable.

“When we look at global targets, none of us believes that it will be 100 percent everywhere,” Kazatchkine said.

About 33 million people around the world are infected with HIV, two-thirds of whom are in sub-Saharan Africa, according to UNAIDS. About 3 million people in the developing world are receiving antiretroviral drugs (ARVs), but millions more are not getting the treatment they need, reported the Kaiser Family Foundation.

Increasing access to ARVs will mean improving general health systems as well, conference speakers said.

Gregg Gonsalves, program coordinator at the AIDS and Rights Alliance for Southern Africa, told the conference, “The scale-up of antiretroviral therapy is the most ambitious public health undertaking of our lifetimes.”

The conference was also a chance for researchers and scientists to discuss new developments in the field.

Researcher Stephanie Planque, from the University of Texas Medical School, presented two studies indicating that certain HIV antibodies might be able to be used as a microbicide for preventing infection during sexual contact. The findings could eventually be expanded as the basis of a new vaccine, which would prompt the body to produce these antibodies on its own.

But, Planque warned the “road is long before we reach that point.”

HIV vaccine research suffered a major blow last year. A Merck HIV vaccine trial was shut down in late 2007 because it was found to not only be ineffective at preventing infections, it may have even been increasing the chance of infections. Microbicides have also hit obstacles; three recent microbiside trials have failed.

“None of those have brought the promise that we thought they might,” Gayle said, though there was encouraging research presented on circumcision helping to prevent transmission and the prevention benefits of starting patients on antiretrovirals early.

Dr. Seth Berkley, president and chief executive officer of the International AIDS Vaccine Initiative told the conference Tuesday that the setback in vaccines should not slow the research of HIV vaccines.

“Developing an AIDS vaccine may take more time and innovation than we might have once imagined, but we are confident that science will prevail. The necessary direction for the field is clear,” Berkley said, according to Reuters.

The group laid out a blueprint for vaccine researchers to proceed, saying researchers should use smaller, more focused trials and dump vaccines that do not show strong promise.

National Institute of Health HIV/AIDS researcher Anthony Fauci reiterated the importance in an editorial for CNN this week, “Many promising avenues of prevention are being discussed in Mexico City, but none is more essential than an HIV vaccine… With HIV we will have to do better than nature if we are to develop a vaccine.”

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