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AIDS Prevention Evolves (Again):Why we are on the verge of an era of new complexity: 

AIDS Prevention Evolves (Again): Why we are on the verge of an era of new complexity Edd Lee and Kevin Fisher AIDS Vaccine Advocacy Coalition (AVAC) edd@avac.org

The evolution of AIDS: 

The evolution of AIDS In the beginning… Focus of work: developing treatments, fighting HIV stigma and HIV/AIDS education Populations: 4H club - Homosexuals, Haitians, Hemophiliacs and Heroine addicts Then came… Focus of work: access to treatment, behavioral interventions, research to develop vaccines, the continuum of services Populations: communities of color, women, youth and the developing world/globalization

Today there are signs of more changes on the way: 

Today there are signs of more changes on the way A range of new prevention strategies in advanced stages of research Debate about how to conduct HIV testing Routine vs. mandatory Informed consent & stigma Is treatment really more available? global roll-out of treatment

Results from advanced prevention research : 

Results from advanced prevention research 2007 2008 2009 2010 2011 2013

What are the implications? : 

What are the implications? Evaluate our knowledge Need to conduct more research & make better research agendas Need to make decisions based on conclusive data Implementation How do we utilize new knowledge and interventions? Where, when, how and with whom? How do you talk about partial efficacy/disease modulation/reduction of infectiousness? Future research Trial design (size, location and incidence rate) Standard of care

Prevention Trials: 

Prevention Trials Research Question: Does this strategy decrease the risk of HIV infection more than the standard prevention package provided by the study? Current Standard of Care in research Risk reduction counseling Condoms Clean needles – sometimes!

But these new trials will bring into question… : 

But these new trials will bring into question… What should trial participants get for standard of care? How do you control for male circumcision? How many new prevention strategies do you provide to people? The better the prevention provided, the harder research becomes Informed consent since none of these strategies is likely to be 100% how do we talk about partial efficacy, disease modulation and reduction of infectiousness?

Prevention research linked to treatment advocacy: 

Prevention research linked to treatment advocacy Expansion of Prevention for Positives Offer HSV treatment, microbicides, vaccines, etc to partners, family and PLWHA? How does prevention and testing get incorporated into treatment roll-out and care? Who gets tested and how? Families, couples, individuals, routine, voluntary, in-patient? As ARV programs roll out, different countries and different clinics in the same country are providing testing in very different ways. ARV programs mean that the population being reached for prevention initiatives is different. HIV+ individuals, families, partners, etc. What’s the best prevention package to offer PWLHA? Their families? Partners?

Community Involvement : 

Community Involvement No intervention will be useful if communities do not use them. Communities have to be aware of, involved with and accepting of any interventions Communities need to help determine what are the best prevention/treatment packages for them.

Some AVAC recommendations: 

Some AVAC recommendations Convene WHO/UNAIDS/civil society-sponsored ethical consultations on issues related to introduction and evaluation of new strategies (with community involvement) Form a prevention research advocacy network to share and develop best practices and build a strong advocacy campaign for widespread access to known interventions: clean needles, male and female condoms, comprehensive sex education

AVAC commits to: : 

AVAC commits to: Create clear, user-friendly materials explaining state of research on different interventions including circumcision, PrEP, microbicides, vaccines, HPV vaccine, etc. (see www.avac.org and www.prepwatch.org for current offerings) Advocate at WHO level and elsewhere as appropriate for guidance notes on relevant topics Develop and field-test communications strategies around partial efficacy, disease modulation and reduction of infectiousness

What you can do : 

What you can do Broaden your own view of fighting HIV/AIDS Stay on top of new developments in HIV research Make sure the community gets accurate information about new research Help develop “good community practice” in research by becoming involved in research Join the Advocates’ Network at http://aidsvaccineclearinghouse.org/network.htm

To read more about these and other topics… : 

To read more about these and other topics… See the new AVAC Report http://www.avac.org/reports.htm There is a chapter on this topic, along with three more chapters on related issues:

Slide14: 

HPV Vaccines, AIDS Prevention Research, & New Opportunities for Reaching Young People of the World HPV vaccine delivery Adolescent involvement in AIDS vaccine trials The Emerging Adolescent Agenda

AIDS Vaccine Science, Strategy & Action: 

The State of the Field, the Stakes for the Future Share outputs from research on neutralizing antibodies, adjuvants, mucosal immunity assays and other work in a manner that lets us understand if and how CHAVI, CAVD and other consortia are truly adding value to the field. And don’t forget to keep thinking outside of the box! AIDS Vaccine Science, Strategy & Action

Slide16: 

Learning from Last Year’s Clinical Trials Develop a common language for talking about test of concept studies and trial sequencing decisions. Address key issues: Vaccine-induced seropositivity Incidence Reaching the “right” populations “Good Community Practice” Reports from the Frontlines

Continuum of care…: 

Continuum of care…

Comprehensive Response: 

Comprehensive Response

Comprehensive, Coordinated and Simultaneous: 

Comprehensive, Coordinated and Simultaneous Pushing for HIV testing without access to treatment or prevention resources is problematic due to HIV stigma (informed consent, mandatory, routine) Without preventing new HIV infections, we will never be able to provide treatment and care for all PLWHA Need new and better tools to prevention new infections and to keep people healthy Providers have to work with researchers to figure out the best way to introduce new resources

New Technologies: 

New Technologies New Treatments Vaccines Microbicides Male Circumcision PrEP STD Prevention Cervical Barriers

HIV/AIDS Tool Kit: 

HIV/AIDS Tool Kit Male and female condoms Anti-retroviral therapy (mother-to-child) Post exposure prophylaxis (PEP) Microbicides Cervical Barriers STD Treatment Anti-retroviral therapy Care Education & Behavioral change Therapeutic Vaccines New Treatments Education & Behavior change HIV/AIDS Vaccines Pre-exposure prophylaxis (PREP) Male Circumcision

Treatment Analogy: 

Treatment Analogy Mono-therapy vs. Combination therapy Best control of the virus

Social Justice: 

Social Justice HIV/AIDS is driven by the same socio-economic factors that put marginalized groups at risk and without needed resources The poor, people of color, women, drug users, sex workers, minorities, youth, etc Stigma for PLWHA

Slide24: 

AVAC is a non-profit, community-based organization that uses public education, policy analysis, advocacy and community mobilization to accelerate the ethical development and global delivery of vaccines against HIV/AIDS. We accept no government or pharmaceutical funding.