Science & Medicine

Washington Post Examines Experts' Questions on Basis of HIV Vaccine Research, Funding Strategies

[Mar 21, 2008]

The Washington Post on Friday examined how many experts are "questioning both the scientific premises and the overall strategy of the nearly $500 million in AIDS vaccine research funded annually by the U.S. government." The questions come after two HIV vaccine trials were halted in September 2007 because they did not protect participants from contracting HIV and "may actually have put them at increased risk of becoming infected," according to the Post. The "multiple surprises" in HIV vaccine research "have reminded researchers how much they still do not know about HIV's biology" and has "focused attention on questions" that were never previously considered, the Post reports.

According to the Post, scientists are trying to "make sense" of the trial failures and "assess whether they should have seen it coming" (Brown, Washington Post, 3/21). Merck in September 2007 announced it had halted a large-scale clinical trial of its experimental HIV vaccine after the drug failed to prevent HIV infection in participants or prove effective in delaying the progression of the virus to AIDS (Kaiser Daily HIV/AIDS Report, 9/24/07). Also in September, the company announced that it was halting a similar trial in South Africa. Seven other trials of similar vaccine candidates have been "stopped or put off indefinitely," the Post reports, adding that some might be "modified" or "canceled outright."

The vaccine candidate could not have caused HIV infection because it contains three HIV proteins and not the entire virus, the Post reports. According to the Post, the "working hypothesis for what went wrong" in the Merck trials is that the vaccine candidate "somehow primed the immune system to be more susceptible to HIV infection." However, people for years have been contracting immune-activating infections and receiving vaccines, and there has "never been evidence that those events increased a person's risk of acquiring HIV," the Post reports, adding that the vaccine trials "would be odd places to first notice such a thing." In addition, participants in the Merck trials who received the vaccine did not have increasingly activated CD4+ T cells compared with people in the placebo group. According to Merck vaccine executive Mark Feinberg, this fact is "kind of an interesting and unexplained observation." Anthony Fauci, director of NIH's National Institute of Allergy and Infectious Diseases, said that "something very, very peculiar" is happening in the trials.

Many researchers and HIV/AIDS advocates are wondering what "effect this near-worst-case scenario" will have on future vaccine trials, according to the Post. NIH next week is scheduled to meet to examine its HIV vaccine program. The agency's budget for HIV vaccine research is $497 million this fiscal year, the Post reports. In addition, Merck has spent an undisclosed sum to develop vaccine candidates and manage trials.

Mark Harrington, head of the Treatment Action Group, said the HIV research community "can't afford to have any more trials" like the ones that were halted, adding that researchers "have to stop and reassess and recommit to basic science, or people will begin to lose faith." Ronald Desrosiers, a molecular geneticist at Harvard University, added that NIH has "lost its way in the vaccine arena" and said the agency should redirect HIV funding to basic research.

John Moore -- a virologist at Weill Cornell Medical College who has criticized the vaccine trials -- said he does not "think that what happened" in the Merck trial "is an example of scientists blindly rushing into dangerous things." He added that he does not know "anyone" in the HIV vaccine research community "who said this was going to happen." Although there are no "obvious villains," some experts are "questioning the wisdom" of the trials' strategy because asking "millions of people to take an AIDS vaccine that probably would not protect them from the virus ... would be a hard and confusing task, even in places where the epidemic still rages," according to the Post (Washington Post, 3/21).

Link to this story.

Global Challenges

Papua New Guinea Officials Discuss Strategies To Integrate HIV/AIDS Services Into Agricultural System

[Mar 21, 2008]

Officials from Papua New Guinea's National Agricultural Research Institute recently met with a representative from the global health firm Options to discuss ways to integrate HIV/AIDS services into agricultural research programs, Papua New Guinea's Post-Courier reports.

According to Rachel Grellier, a social development consultant at Options, if the spread of HIV is not contained in Papua New Guinea, the country's agricultural system will face food and labor constraints because the system is dependent on labor. Grellier said the meeting aimed to discuss the situation with stakeholders and to develop ways to address the impact HIV/AIDS is expected to have on the agricultural system.

Grellier said that it is important to determine which agricultural systems are already experiencing the effects of HIV/AIDS and which aspects of each system are most vulnerable, adding that it will help stakeholders develop recommendations to address the situation. According to Grellier, strategies that aim to counter the effects and to address likely responses should be developed (Laraki, Papua New Guinea Post-Courier, 3/20).

About 1M STIs Diagnosed Annually in Papua New Guinea, WHO Says

In related news, the World Health Organization has estimated that about one million curable sexually transmitted infections are transmitted annually in the country, Manish Jain, Save the Children Fund's program director in Papua New Guinea, said Tuesday, PACNews/Marianas Variety reports.

Jain said the country's STI prevalence is among the highest in the world. According to a report recently released by the National AIDS Council, people living with STIs are 40% more vulnerable to HIV than people without an STI. He added that HIV is spread quickly and easily in areas with high prevalence of other STIs.

A Papua New Guinea Institute of Medical Research study conducted among people at high risk of HIV in the country's Eastern Highlands province found a 21%, 19%, 24% and 51% incidence of gonorrhea, chlamydia, syphilis and trichomoniasis, respectively. In addition, 74% of people had at least one STI and 43% had more than one; however, less than 1% of the people were receiving treatment, Jain added.

Jain on Tuesday signed a memorandum of understanding with the Eastern Highlands provincial government to implement a program aimed at improving STI clinics and bolstering STI prevention and treatment programs (PACNews/Marianas Variety, 3/19).

Link to this story.

Thailand Recording High Number of New HIV/AIDS Cases, Survey Says

[Mar 21, 2008]

Thailand is recording a high number of new HIV/AIDS cases, primarily because of the prevalence of high-risk sexual activities in the country, according to a recent survey released by the Population and Community Development Association, the Bangkok Post reports. According to the survey, at least 40 people newly contract HIV in Thailand each day.

According to PCDA Chair Mechai Veravaidya, new HIV cases are mostly being recorded among teenagers ages 15 to 19. The survey found that this group tended not to use condoms and had casual sex with multiple partners. Mechai said a lack of condom use promotion has made the disease "very serious again," the Post reports. He added that the country needs to renew a campaign that promotes condom use to fight the spread of HIV or the virus will begin to affect Thailand's health care system.

According to the Post, an estimated 500,000 people are living with HIV/AIDS in the country, and more than 80% of people living with the disease are in need of antiretroviral drugs (Treerutkuarkul, Bangkok Post, 3/20).

Link to this story.

Legal Group Calls Namibia's New Budgetary Allocations for Health Sector Inadequate

[Mar 21, 2008]

The Namibian government has not allocated enough money in its new budget to address problems facing the Ministry of Health and Social Services, such as providing sufficient treatment access to people living with HIV/AIDS, the Nambian Legal Assistance Centre said recently, the Namibian reports.

The government has allocated 6.4 billion Namibian dollars, or about $730 million, for health sector programs in fiscal year 2008, the Namibian reports. According to LAC, the allocation is a 26% increase from last year. In a statement issued last week, Amon Ngavetene, project coordinator of LAC's AIDS Law Unit, said that 9.5% of the total budget is allocated for the health sector -- significantly less than the 15% target set by a conference of African health ministers in April 2007.

LAC "does not believe" that the allocation is "enough to meet the perennial challenges besieging" the health ministry -- particularly the programs for antiretroviral drug access, infrastructure deterioration and general improvements in working conditions for staff -- the center said. "We hope that with this allocation tied with responsible and accountable spending," the health targets in the United Nations Millennium Development Goals will have a "chance to be progressively realized as we move" toward the MDG 2015 deadline, Ngavetene added (Namibian, 3/19).

Link to this story.

Botswana Officials Encourage Youth To Receive HIV Tests

[Mar 21, 2008]

Botswana officials speaking at a recent event in the capital of Gaborone encouraged young people to get tested for HIV and to abstain from high-risk behavior, Botswana's Mmegi reports. According to Mmegi, the event marked the commemoration of the Month of Youth Against AIDS in Gaborone.

Senior Superintendent Kabo Marage at the event said that people most affected by the disease are between ages 14 and 49, adding that it is imperative for young people in the country to know their HIV status and to use available resources to reduce the spread of the virus. Oaitse Mbaiwa of the Botswana National Youth Council called on young people to take responsibility by knowing their HIV status. He added that these events are held to increase awareness among young people and for them to take the lead in the fight against HIV/AIDS. Mbaiwa also encouraged young couples to get tested for HIV together.

The event, themed "Commit to Zero Transmission Lifestyle: Youth Leading in HIV/AIDS Management and Wellness Promotion," was attended by police officers and students from Gaborone, Mogoditshane and Tlokweng, Mmegi reports (Mosokwane, Mmegi, 3/19).

Link to this story.

Opinion

'National Silence' on Sexual Behavior, Race, Poverty Contributes to High Rates of HIV, Other STIs, Opinion Piece Says

[Mar 21, 2008]

The "national silence" on issues such as sexual behavior, race and poverty has contributed to the high rate of HIV and other sexually transmitted infections among teenagers in the U.S., Robert Fullilove, associate dean at Columbia University's Mailman School of Public Health, Adaora Adimora, associate professor of medicine at the University of North Carolina-Chapel Hill, and Peter Leone of the North Carolina Division of Public Health write in a Washington Post opinion piece.

According to the authors, a CDC study released earlier this month that found that about 25% of U.S. girls and young women ages 14 to 19 have at least one of four common STIs is "already old" news for people who work in public health. They add that public health workers "fear this latest study will have its 15 minutes in the spotlight and also fade from view," just like a similar study released 10 years ago by the Institute of Medicine did. The "taboo" of talking about sexual behavior, poverty and race is one "obvious reason" that rates of STIs remain high, the authors write, adding, another is "that the incidence of [STIs], particularly HIV, is concentrated in poor, segregated neighborhoods that are characterized by high rates of incarceration." The "shift" in marriage and courtship patterns that results from men being incarcerated, as well as an increase in the number of "multiple concurrent sexual partnerships," also are contributing to the problem, according to the authors.

HIV/AIDS and other STIs cost the U.S. "tens of billions of dollars" annually, "but with the exception of HIV infection, [STIs] remain the elephant in the room when it comes to the national conversation about health and health care," the authors write. They add, "We can no longer have effective [STI] prevention campaigns in poor communities of color if they treat one person at a time or ignore social conditions underpinning high rates of HIV and other" STIs. "Simply put, we will never rid the U.S. of HIV and other [STIs] if our only weapon is medical treatment," the authors write, concluding, "And if we are unable to engage in a national dialogue about the sexual health of our youths and the social dynamics that drive [STIs], this epidemic will go largely ignored, and many more lives will be lost" (Fullilove et al., Washington Post, 3/21).

Link to this story.