AIDS Vaccine 2013: “We’re going backwards” trial enrollment should include couples counseling

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aidsvaccine2013Science Speaks is live-blogging from AIDS Vaccine 2013 this week. Meeting in Barcelona, Spain, with the theme “Progress, Partnership and Perserverance,” from Oct. 7 to Oct. 10, this event brings together a history of hope, and an update on opportunities that have shown themselves in recent years.

TSHIRT

Dr. William Kilembe, of the Emory Universtiy affiliated Rwanda Zambia HIV Research Group, models his t-shirt calling for HIV prevention clinical trial protocols that offer couples counseling and testing. (click on image to enlarge).

The t-shirt Dr. William Kilembe and a few like-minded people brought to Barcelona and wore at Monday’s AIDS Vaccine Conference opening events doesn’t rely on a clever slogan or eye-catching cartoon to make its point about the epidemic that brought roughly 1,000 generally like-minded people here. Rather, it spells out what they say is a point of contention, in painstaking detail, their view that something essential is missing from HIV prevention research protocol.

“The largest burden of the HIV epidemic is in sub-Saharan Africa,” he explains. The largest transmission there, he goes on, is between married or cohabitating couples. TshirtfrontFor that reason, he continues, the World Health Organization issued guidelines recommending that HIV testing and counseling be offered to couples, wherever HIV testing and counseling is available. That includes antenatal clinics. And it should, Kilembe said, include clinical HIV prevention trials. But it seldom does, he said.

“It is the prevailing standard of care,” said Kilembe who has traveled across Africa training programs that provide HIV testing to incorporate couples counseling, in his role overseeing the Couples’ Voluntary Counseling Testing program in Lusaka and Southern Provinces of Zambia for which the Emory affiliated research group has been recognized as a center of excellence. “We see an increase in condom use when a couple is given couple counseling,” he said, “And we see a lowering of HIV incidence where there is couple counseling.”

PhiriAndKilembeFor that reason, Dr. Mannasseh Phiri, a physician and long time AIDS response advocate points out, if you are in a relationship and seek HIV testing in Zambia, you will advised to bring your spouse or partner as well. If you enroll in an HIV prevention trial, however, it is unlikely that you will be. Instead of research bringing progress in that regard, Phiri says, “We’re going backwards.”

“It should be a requirement that as a standard of care, anyone who is participating in any HIV prevention research needs to be offered couples counseling,” Kilembe said.

Yes it will slow enrollment down, at a time when urgency to pick up the pace of clinical trials has grown. But, he added, leaving it out is counterproductive. “HIV is a sexually transmitted problem,” he observed. “But we’re not interested in finding out the status of partners?”

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