There is now an unprecedented opportunity to curb new HIV/AIDS infections, save lives, and set the world on a path toward eliminating the AIDS epidemic, according to AVAC’s annual update on HIV prevention research. In AVAC Report 2011: The End?, the advocacy group provides a three-part, science-based agenda for ending the AIDS epidemic in our lifetime, including a playbook which focuses specifically on the next 12 months.
According to the report, strategically and synergistically implementing recent breakthroughs in combination prevention methods can allow for a sustained decline in new HIV infections, currently at 2.7 million per year. The report calls for scaling up implementation of several “game-changers” in HIV prevention research: voluntary medical male circumcision (VMMC), pre-exposure prophylaxis (PrEP) to include topical microbicides, HIV treatment as prevention, and an AIDS vaccine. In addition to scaling up successful prevention methods, the report makes the argument that global response to the epidemic needs a coherent, long-term plan to capitalize on opportunities.
The report’s three-part agenda for ending the epidemic sets out to:
1. Deliver today’s proven strategies at scale for immediate impact.
- Testing is the most important step towards ending AIDS because there are a growing number of treatment and prevention methods tailored to an individual’s status.
- VMMC is a largely unutilized tool that reduces an HIV-negative man’s risk of acquiring HIV through vaginal sex by approximately 60 percent. Achieving and maintaining 80 percent VMMC coverage by 2015 would avert more than 20 percent of projected new infections in Botswana, Lesotho, Malawi, Namibia, Rwanda, Swaziland, Uganda, Zambia, and Zimbabwe.
- HIV/AIDS treatment as prevention is one of the most effective prevention interventions available to countries, communities, and individuals living with HIV. The HIV Prevention Trials Network (HPTN) 052 study found that earlier initiation of antiretroviral therapy (ART) reduced transmission within discordant couples – where one partner is HIV infected and the other is not – by 96 percent. There were also significant reductions in cases of extrapulmonary TB in individuals who started ART early.
2. Demonstrate and roll out newly available HIV prevention tools, including PrEP and microbicides.
- The global community needs to swiftly implement PrEP pilot programs in countries and communities where oral PrEP is relevant; and
- Develop a clear and accelerated product development pathway for clarifying the effectiveness of tenofovir gel as topical prophylaxis, in light of the results of the VOICE trial.
3. Develop long-term solutions, including an effective vaccine and cure.
- The global community must maintain funding to build on recent breakthroughs in HIV vaccine development, while connecting the vaccine agenda to combination prevention interventions; and
- Identify and close funding gaps in Thai vaccine trial follow-on trials while prioritizing evaluation of the hypothesis generated by trial results. In 2009 the RV-144 clinical trial demonstrated that an HIV vaccine is possible reducing the rate of HIV infection of those in the trial by about 31 percent.
By implementing the strategies laid out in the report over the next decade, AVAC says there will be many fewer infections while people infected with the disease will live longer, healthier lives. The global response to the epidemic requires strong political leadership and commitments to implement what we know works, according to the report, to finally bring an end to the disease.