25 April 2012 (Sydney) – The conclusion of the 2012 International Microbicides Conference, a gathering of researchers, advocates and funders in the HIV prevention field, wrapped up three days of discussion focused on access to prevention technologies, adherence in clinical trials, innovative financing, dual prevention technologies and new methods of preventing rectal transmission of HIV. Conference organizers also presented the top awards in the microbicide field: the Lifetime Achievement and the Omolulu Falobi Award.
Since the first microbicide conference was held in 2000 near Washington, D.C., the biennial gathering has expanded to include hundreds of top scientists in the HIV prevention field and the advocates from around the globe who have fueled this new science. Only two years ago, the HIV prevention field had scant evidence and hope that a product used before sex could prevent HIV. Since then, the CAPRISA 004 trial proved the concept that a gel applied in the vagina before and after sex can reduce HIV infection, and several trials have shown that a tablet taken orally can reduce HIV infection. These successes have opened the door to complex challenges that were examined during the Sydney conference.
Global Fund Deputy Executive Director Debrework Zewdie provided a detailed look at global resourcing for new HIV prevention technology and discussed various methods of innovative financing. She pointed out the delay in implementation following the male circumcision trials and proof that mother-to-child transmission of HIV can be prevented. She also challenged the microbicide community to prepare now for implementation.
Milly Katana, Public Health Specialist with John Snow Incorporated, Uganda said, "It is criminal to deny women access to protective products simply because they cannot afford the fee for them. We can't let that happen with a microbicide. We have to start thinking about access now, while research is going on. Then we will be prepared to ensure women have access to safe and effective microbicides as soon as they are introduced."
Other presentations focused on the challenges of adherence in clinical trials and the need for science and real world behavior to go hand in hand. Many presenters noted that the only products that work are the ones that people will use.
Real world sexual behavior has also brought to light the need for rectal microbicides. These products in development continue to gain recognition as a much needed prevention technology for men as well as women. IRMA (International Rectal Microbicide Advocates) released On the Map: Ensuring Africa's Place in Rectal Microbicide Research and Advocacy. This strategy document, developed by African advocates, researchers, and global allies outlines, priority actions to ensure Africa fully engages in rectal microbicide research and advocacy activities, including the integration of safe anal-sex messaging into HIV prevention programs.
"For far too long the operating principle concerning the HIV epidemic in Africa has been that it is solely heterosexual, and that sexual transmission is entirely driven by unprotected vaginal intercourse between men and women," said Jim Pickett, IRMA chair. "But an increasing body of evidence tells us quite clearly that unprotected anal intercourse is happening all across the continent – amongst heterosexuals as well as gay men, other men who have sex with men (MSM), and transgender individuals. Unprotected anal intercourse is not uncommon in Africa," he continued, "and compared to unprotected vaginal intercourse, it is 10 to 20 times more likely to result in HIV infection. We absolutely need to be concerned about this." For a copy of On the Map, go to: http://rectalmicrobicides.org/ProjectARMreport2012.pdf
Researchers at the University of Pittsburgh have developed a rectal-specific microbicide gel that contains two different antiretroviral (ARV) drugs: tenofovir and griffithsin. Tests of the combination gel indicate that it has acceptable physiochemical characteristics and stability for its further development as a rectal microbicide as a way to help prevent HIV infection transmitted through unprotected anal sex. Additionally, they evaluated the rectal safety of a reformulated version of tenofovir gel and found it was both safe and acceptable. The results of the study, which included 65 HIV-negative men and women who used the gel rectally once a day for one week, represent another important step forward in the effort to develop a rectal microbicide to prevent HIV through anal sex.
Dual purpose technologies, also known as multi-prevention technologies, or MPTs, are moving to the forefront in research, as well as advocacy. Dr. Henry Gabelnick, Executive Director of CONRAD, spoke about the need for products that prevent pregnancy as well as HIV infection. "Improved prevention technology should be developed more vigorously but it is severely dependent on funders recognizing that not only HIV prevention but broad spectrum microbicidal activity as well as contraception are necessary."
Anna Forbes, a long-time microbicide advocate, received the third Omololu Falobi Award for Excellence in HIV Prevention Research Community Advocacy. Forbes was honored for her significant contributions to microbicides advocacy over a long career devoted to fostering civil society engagement in HIV care, treatment and prevention and women's rights. She has been involved in the fight against AIDS for almost three decades and was an early champion for microbicides when the field had few strong advocacy voices. She is currently working to promote female condom access through the Paper Doll campaign and for more information, please go to: www.condoms4all.org.
Lut Van Damme, M.D. and Gita Ramjee, M.D, two of the field's long time principal investigators, were honored with the conference Lifetime Achievement award. Conference Co-chair John Kaldor said, "This award should not be thought of as something that is given to someone at the end of their career, but rather an acknowledgment that they have already accomplished so much. Both Drs. Ramjee and Van Damme led the COL-1492 clinical trial, the first to test whether a vaginal gel can reduce HIV infection.
Notably, the conference closing session ended with a presentation by Gina Brown with the National Institutes of Health's Office of AIDS Research and Stephen Becker with the Bill and Melinda Gates Foundation who announced their decision to being planning a biennial global HIV prevention conference. The Sydney 2012 Microbicides conference was the last event funded by NIH and the Gates Foundation that will focus on microbicides and going forward, the two funders will jointly plan an integrative approach that will combine vaccines, microbicides and oral PrEP .
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