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AIDS Vaccine 2013: HIV Vaccines Disappointing So Far But Necessary to Control Epidemic

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Since the first diagnosis of HIV in humans 30 years ago, there have been many scientific discoveries to slow and possibly curb the spread of the epidemic. However while some approaches have been highly successful, vaccines have not offered so much hope or good news.

As the AIDS Vaccine 2013 conference last week in Barcelona came to an end after a 4-day intensive of presentations and dialog on the place of vaccines in the HIV field, many questions were left unanswered.

Since the first diagnosis of HIV in humans 30 years ago, there have been many scientific discoveries to slow and possibly curb the spread of the epidemic. However while some approaches have been highly successful, vaccines have not offered so much hope or good news.

As the AIDS Vaccine 2013 conference last week in Barcelona came to an end after a 4-day intensive of presentations and dialog on the place of vaccines in the HIV field, many questions were left unanswered.

Some of the biggest questions include: How do we develop a single vaccine that will fight the many different strains of the virus? How do we deal with the technical difficulties that come with transportation, storage, and maintaining temperature? Does a vaccine really have a role to play in the final endgame of HIV?

The biggest headache for researchers at the conference was not the increasing disagreement among them about what are the best ways to develop AIDS vaccines, nor how do we report results from disappointing studies like Phambili and STEP.

The biggest dilemma is what role will vaccines play in the HIV prevention and treatment agenda? When will there be vaccines that are effective and safe enough to use? How soon will there be a vaccine on the market? Will such a vaccine be preventive, therapeutic, or even work as both?

Unlike many other HIV conferences, one particular aspect was notably missing at AIDS Vaccine 2013: There was little community visibility at the event.

In his opening address, Ntando Yola from the Networking HIV/AIDS Community of South Africa (NACOSA) said that with increasing prevention options including microbicides, voluntary medical male circumcision, and others, it can be easy to lose focus. Only through "the design, mass production, and systematic implementation of prophylactic vaccines can we eradicate the HIV epidemic," he emphasized.

However, Yola raised the need for more community engagement for vaccine awareness, warning that the success of vaccine research is dependent on community/researcher partnerships.

He suggested that his invitation to speak at the event is a sign that the scientific community is coming to terms with understanding the role of the non-scientific community in the process of conducting vaccine trials.

Yola expressed his pride in the appreciation of the role of advocates and, most importantly, the voices of the community. He pointed out that these voices should not be at the table simply to tick "donor boxes," but should be present from the start and have the power to influence the trajectory of the response to the epidemic.

Bill Snow, director of the Global HIV Vaccine Enterprise, said in his opening address to the conference that despite the fact that there are 200 HIV vaccine clinical trials ongoing, the demand for safe and effective vaccines is still one of the major challenges researchers face.

Snow stated that like clinical trials in any other area, vaccine researchers have had their own failures. His comment was based on a meta-analysis of Phambili, STEP, and the recently published HVTN505, which showed a 33% greater risk of HIV infection among people who received the vaccines.

Snow outlined the 4 key areas of focus for the conference: support diverse opportunities to facilitate learning; encourage understanding and wider use of the product development mindset and methods; identify and support advancement of intermediate questions and goals; and, finally, help funders develop better coordination of research.

Speaking to the conference via a pre-recorded presentation, Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases, called on attendees to remember the 3 P's of the conference: Progress, Partnership, and Perseverance, which should be the driving force for the 4 days of deliberation.

Fauci reminded participants that to avert a recurrence of the 4.2 million people who died of AIDS between 2002 and 2012, we need to start seeing vaccines as essential to the durable control of the HIV epidemic. Not only that, we must reduce the social and structural barriers experienced by key populations including women, sex workers, and men who have sex with men (MSM).

In concluding his speech, Fauci said that working with communities in the development of HIV vaccines would create the pathway to community ownership and eventual success.

To address the lack of community enthusiasm towards vaccine development and advocacy, AVAC-Global Advocacy for HIV Preventionorganized a community reception on October 8.

Speaking at the event, AVAC executive director Mitchell Warren said that the lack of community advocacy is due to the low level of vaccine knowledge within the community.

Laia Ruiz Mingote of Planeta Salud, the Catalan HIV organization, reminded the crowd of the need for a basic understanding and literacy around HIV vaccines. A better understanding of the science behind vaccines will help advocacy and community mobilization which in turn can drive funding and trial recruitment.

Yola from NACOSA raised the need for more community engagement towards vaccine awareness. He welcomed the follow-up to the Thai RV144 trial that will be taking place in South Africa, but said that this process should have at its heart the self-determination of South Africans who will be taking part in the trial.

Kevin Fisher of AVAC said that we should see the results of the RV144, Phambili, and STEP trials as the beginning of success, and not as failure. By looking at it this way, we can be encouraged to intensify advocacy around vaccines.

This author noted that activists and advocates have not been bold enough in promoting advocacy around vaccines, as they have done around pre-exposure prophylaxis (PreP), treatment as prevention (TasP), microbicides, Option B+, and other prevention approaches. This might be due to the not-so-promising results from many of the vaccine clinical trials to date.

As clinicians, scientists, researchers, and the few community members and advocates at the conference packed their bags to go home, many did not leave AIDS Vaccine 2013 with great excitement for the future, unlike the International AIDS Conference in 2010 where the CAPRISA 004 microbicide results were announced or the 2011 International AIDS Society conference that presented the HPTN 052 findings on treatment as prevention.

The major vaccine trial results so far have had little to offer in terms of success, and there is still visible confusion among researchers and advocates about what real role vaccines could play in the fight against HIV.

However one thing was clear: the discovery of the right safe and effective vaccine holds the key to ending AIDS. With more advocacy, funding, and political willpower, vaccines might be available earlier than expected. Until then, the search continues, and combination treatment and prevention approaches are still the best option for controlling the epidemic.

Bisi Alimi is an AVAC PxROAR (Research, Outreach, Advocacy and Representation) fellow and a long-time community advocate.