KHOPOTSO: The 20-year old ABC strategy of HIV prevention has shown that preventing infection is not as easy as Abstaining, Being faithful and Condomising. That was the general feeling at the last biennial International AIDS Conference, in Toronto, Canada. A renewed and sustained focus on prevention, which includes devising new technologies is just what is needed to potentially save hundreds of thousands of people per annum around the world from getting infected. Dr Francois Venter works with Wits University’s Reproductive Health & HIV Research Unit, in Johannesburg.
Dr FRANCOIS VENTER: I think it’s good that we’ve started to push prevention to the front. I think we’ve got very, very effective therapy ‘ but we can’t have this huge number of people entering the system forevermore. It just is wrong.
KHOPOTSO: Billionaire AIDS philanthropist Bill Gates, perhaps summed it up best when he said that ‘today we can get 450 000 people on treatment’¦ but at the same time that’s happening four million new infections occur’. That 10:1 ratio he discussed is the fundamental reason why the world has to get back to prevention and improve on the existing interventions. Male circumcision, cervical barriers such as the diaphragm and prevention using ARVs are some of the additional prevention methods scientists and researchers are excited about. These have implications for governments.
Dr MANTO TSHABALALA-MSIMANG: We also have to encourage innovation and research into additional tools for response, including vaccines, microbicides, traditional medicines and other forms of therapies.
KHOPOTSO: Minister of Health Dr Manto Tshabalala-Msimang. Male circumcision is being punted as a potential barrier that will reduce men’s risk of HIV infection. A study conducted in Orange Farm, south of Johannesburg, shows that circumcised men have a 60% less chance of contracting HIV. Engaging the subject for the first time publicly, this is what the Minister had to say:
Dr MANTO TSHABALALA-MSIMANG: As a policy-maker, you never place your policy or develop policy on one study’¦ You need multiple studies that will inform your policy so that you don’t make mistakes. And, therefore, we are waiting for the results of Uganda and Kenya.
KHOPOTSO: She continues.
Dr MANTO TSHABALALA-MSIMANG: But having said so as well, I just wanted to say’¦ that it is also absolutely critical to take into account people’s cultures. What do they see of themselves? What is their dignity; because you can’t impose on them? You can only just make information available. You can imagine if I were to go around the whole of South Africa and say ‘all African men must come for circumcision’. I don’t know what would become. But I can make the information available as long as that information which was generated in Orange Farm is substantiated by other information.
KHOPOTSO: Dr Francois Venter.
Dr FRANCOIS VENTER: I agree with the Minister in terms of saying we must wait for, the studies that, hopefully, will be released in December’¦ I think what the Department of Health and all of us need to start talking about is if this thing does turn out to be as effective as the Orange Farm study suggested’¦ what are we going to do about it? We don’t need to wait to have those discussions. If at the end of this year or early next year we get results and they tell us, ‘no, it didn’t work’, then we can go back to the drawing board. But, if this does work we should very quickly say, ‘do we want to do it or don’t we’? And that I would disagree with the Minister – I would say that we can start hoping, in fact, anticipating the results will be positive because if they are we should be moving quickly.
KHOPOTSO: Until recently, the world’s hope for HIV prevention was pinned on the development of a vaccine. To date, only one vaccine has completed a Phase III trial to test for efficacy. It was found that it doesn’t work. Two more candidate vaccines are currently in efficacy trials. Results of one of these are expected in 2008. The painfully slow process of developing a vaccine has somewhat shifted the interest of most researchers and scientists from this particular intervention. Dr Seth Berkley is the President and CEO of the International AIDS Vaccine Initiative (IAVI).
Dr SETH BERKLEY: It’s the greatest scientific challenge that probably exists in the world today. On the other hand, this epidemic is the worst epidemic since the 14th century. So, creating a tool to solve that – rightfully so – is going to be one of mankind’s greatest endeavours. And when the world succeeds it will become one of the great chapters of this century. One of the things we have to think about in the future about all of our interventions is not about one intervention is going to be right for everybody. What we need is a toolkit of interventions, just like we have in family planning.
KHOPOTSO: Male circumcision, cervical barriers, preventative ARVs, microbicides and vaccines are still subject to laboratory and trial tests. The world’s immediate challenge is to strengthen the ABC of HIV prevention and to make the most basic preventive method of all- male and female condoms – more available to all.