Q: What were some research highlights from the conference?
A: Two major research advancements drew much attention at the conference: 1) treatment as prevention and 2) pre-exposure prophylaxis, known as PrEP. In the first case, a large, randomized study showed that when people living with HIV begin antiretroviral (ARV) treatment before they normally would, their chances of transmitting the virus are reduced by an astounding 96%. The second breakthrough involved two randomized studies among heterosexual couples in Botswana, Kenya, and Uganda, which showed that a daily dose of ARV drugs for HIV-negative men and women reduced the risk of contracting HIV by 60-70%.
Another interesting study addressed male circumcision for HIV prevention, one of EngenderHealth’s HIV focus areas. A study from South Africa showed for the first time that male circumcision reduced the number of new HIV infections within a population. Among 15- to 34-year-old men, there was a 76% reduction in new HIV infections between 2007 and 2010 in the Orange Farm area outside of Johannesburg.
Q: What are the key issues emerging in light of the recent findings involving HIV treatment for prevention?
A: Treatment as prevention took center stage at this year’s IAS conference in Rome. While everyone seems very excited about these amazing results, many debates have surfaced about the practical issues that must be addressed before this approach can become a reality.
Currently, in Africa, as in other parts of the world, many people need treatment now, yet are unable to get it because of lack of availability and resources. How can we begin giving anti-HIV drugs to people who do not need them yet clinically, even though we know that doing so will decrease the chances of passing HIV to others? Treatment-as-prevention approaches are extremely expensive, and stigma is an obstacle to getting tested and accessing treatment. There are also concerns about human rights issues surrounding drug distribution in limited resource settings. These are only a few of the many issues that complicate this discovery.
It is also important for people to keep in mind that treatment as prevention and PrEP have a major behavioral component. People actually need to take the drugs. With past prevention measures (condom use, reduction in sexual partners, safe drug injection practices), we have seen that behavior change is not easy. We must not be lulled into thinking that these prevention approaches using ARV drugs will be any more likely to succeed without significant efforts.
The ethics of using placebos in future HIV research were also debated at the conference, particularly with regard to developing an HIV vaccine. How ethical will it be to give placebo medication in place of other near effective biomedical approaches such as treatment as prevention and PrEP when researching effectiveness?
Q: What new HIV-related research did EngenderHealth present at the conference?
A: EngenderHealth gave two poster presentations on our male circumcision work in Kenya, both of which were very well-received. One demonstrated that male circumcision provided by non-physicians (nurses and clinical officers) is safe, effective, and acceptable, when the providers are well trained and facilities have the required equipment and supplies. The second confirmed the safety and acceptability of the Shang Ring, a novel device for adult male circumcision that EngenderHealth is researching in Africa. Participants were eager to use the findings as a lobbying tool to push their governments to support male circumcision.
Q: What role do you think this and similar conferences play in knowledge sharing and advancement?
A: Scientific conferences are crucial for knowledge sharing. They provide a forum for presenting the latest developments and advances in the field, for exchanging ideas about projects, and for immersing oneself in the latest work in many different subfields of HIV research. Conferences allow researchers to present their data and solicit input from others, as well as provide input on others’ work. They allow for critical discourse, discussion and debate that help to move the field forward and provide an opportunity to network with colleagues and to develop new collaborations with people from around the world.
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