Pubdate: Tue, 13 Nov 2007
Source: Seattle Post-Intelligencer (WA)
Copyright: 2007 Seattle Post-Intelligencer
Contact:  http://seattlepi.nwsource.com/
Details: http://www.mapinc.org/media/408
Author: Glenda Gray And Mitchell Warren, Guest Columnists
Bookmark: http://www.mapinc.org/find?137 (Needle Exchange)
Bookmark: http://www.mapinc.org/hr.htm (Harm Reduction)

A PIVOTAL MOMENT IN HIV PREVENTION

Last week's announcement about the failure of the leading AIDS 
vaccine candidate developed by Merck & Co. is another in a series of 
disappointing setbacks in HIV prevention. How we as a global 
community choose to respond to this news, however, is the real test.

Historically, it has taken decades -- and more setbacks than advances 
-- from the discovery of a virus or bacteria until an effective 
vaccine is licensed. Typhoid was discovered in 1884, but there was no 
vaccine until 1989. Malaria, discovered in 1893, still has no 
vaccine. The measles vaccine took 42 years to develop.

In the 1930s, two experimental polio vaccines failed because they 
were determined to be unsafe, and polio vaccines were almost 
abandoned. At the time, we understood how to prevent infection by 
sanitation and avoiding public swimming areas, just as we know how to 
stop HIV infection today. We needed new tools then, and we need them now.

Today's question of how we deal with these setbacks will loom large 
in any reckoning of our response to the most severe epidemic of our time.

There are more than 4 million new infections every year. In South 
Africa, where three of this year's prevention trials have taken 
place, there are communities where nearly one-third of women between 
25 and 29 are infected with HIV. For every one individual who starts 
on life-saving antiretroviral medications, there are six others who 
are newly diagnosed.

These are mind-numbing, tragic figures. They remind us that there is 
only one viable answer to the question -- "What do we do now?" -- 
that has been posed by many observers inside and outside of the HIV 
prevention field in recent weeks.

We do more of everything.

There is a drastic shortfall in funds for implementing proven 
prevention strategies, including male and female condoms, clean 
needles, prevention of mother-to-child transmission and 
risk-reduction counseling. In December 2006, we learned that male 
circumcision showed strong protective benefits for HIV-negative men. 
This strategy must also be made available in communities where it can 
have an impact.

We must do more to bring comprehensive care, treatment and support to 
people already living with HIV worldwide. Global targets have been 
set and missed and are in danger of being missed again.

And while we do those things, we must continue to search for 
additional prevention strategies, including vaccines, microbicides, 
oral prevention or pre-exposure prophylaxis and herpes treatment.

To pit proven prevention and treatment against research is a false 
and dangerous dichotomy. The range of tools that we have today is not 
reaching every person at risk. And even if it did, it is not enough. 
Women and men, adolescents, boys and girls and infants need more 
choices when it comes to HIV prevention.

The best approach to prevention is one that provides the most 
options. There will be no magic bullet, be it a condom or a clean 
needle today or a vaccine tomorrow. There is only the ethical and 
moral imperative to develop a multi-faceted response that is a match 
for the multiple drivers of the epidemic.

In the wake of the failure of the Merck vaccine, the AIDS vaccine 
field will need to make carefully considered decisions about whether 
to move forward with planned trials of other vaccine candidates, but 
the field will keep moving forward. It must, as the history of other 
epidemic diseases tells us that an essential tool to stopping 
epidemics is an effective vaccine.

As disappointing as recent failures are, donors and advocates, 
scientists and physicians, volunteers and their families must all 
guard against "failure fatigue." We must respond loudly and clearly 
to suggestions that enough money has been spent; that it would be 
easier and wiser to move on rather than to press on.

To do so would be to ignore the reality of the epidemic today, and to 
overlook the lessons from history about the long, slow process of 
vaccine discovery. We cannot afford to walk away from science, or 
from the generations to come. Rather than giving up hope, we must 
redouble our efforts in prevention research and stand firm in our 
commitment to scientific inquiry. Millions of lives -- today and 
tomorrow -- depend on it.

Glenda Gray is the co-director of the Perinatal HIV Research Unit in 
South Africa. Mitchell Warren is the executive director of the AIDS 
Vaccine Advocacy Coalition in New York.