The 18th International AIDS Conference in Vienna which ended last week brought a number of issues to the forefront, among them the need for more funding for HIV treatment. As most scientists at the conference noted, “treatment is prevention”.
This calls for promotion of universal access to treatment, prevention and care. They also stressed the need to start HIV positive individuals on anti-retroviral therapy much earlier than is the case.
But perhaps the most exciting news at the conference was the announcement of a vaginal microbicide gel from South Africa that lowers HIV infection in the case of a sexually active woman by 39%. The gel contains the antiretroviral tenofovir, which gives it a higher success rate than the six previously tried gels.
Dr. Alex Muganzi of the Infectious Diseases Institute at Mulago hospital and Africa’s representative to the International AIDS Society, who attended the conference, describes the 39% success rate as a “significant protective effect.”
However, while impressed with the research, scientists cautioned that ordinary people should get all the correct information regarding the gel.
It is feared that some individuals might think that the gel has a 100% protective rate, which might encourage reckless sexual behaviour. There are also questions regarding “bi-directionality” - does the use of the gel protect a man from contracting HIV from a female sexual partner who uses it?
In addition, there’s need for more studies to determine what the resistance patterns of the widespread use of the gel by the uninfected individuals might mean versus the infected. Could the uninfected individuals become more resistant to the gel than the infected?
As to whether the gel will be available soon in health centres and pharmacies, experts noted during a discussion in Vienna that it could take three to four years before it is on the market. It has also been said that it might never be possible to sell microbicide gels without prescription, thus ruling out the gel as an over-the-counter drug.
Despite the precautionary measures, however, the gel, to be used by squirting it into the vagina using a special applicator 12 hours before and after sex, is being lauded as one prevention measure that gives women control. The gel has the potential to lower HIV infection rates, especially in Africa.

UNIVERSAL ACCESS

In his opening speech, Dr. Julio Montaner, president of the International AIDS Society, stressed the importance of prioritising health funding and expressed “profound disappointment” with members of the G8 and G20 states for failure to take responsibility for the universal access pledge.
Many countries are cutting HIV funding, citing the economic crisis that started in 2008. Dr. Montaner says this is simply an excuse because some countries were not doing that much in the first place, citing Canada, his home country.
In an interview early this month, Dr Muganzi said most of Uganda’s funding comes from organisations like Global Fund, Presidential Emergency Plan for AIDS Relief (PEPFAR) - an initiative of the US government, and Centres for Disease Control.

EARLY ACCESS

New evidence suggests that the use of ARVs significantly reduces the rate of infection, and thus to be effective in this regard, there’s need to start early. Dr. Montaner says that individuals should start using ARVs when the CD4 count is at 350 cells/mm3. Currently, 360,000 individuals in Uganda are in need of ARVs but only 190,000 are getting the drugs.
The World Health Organisation also recommends that children should be placed on ARV treatment to improve their lives. Until recently, very few children under one year were on ARVs. This is partly because facilities for testing children have not been readily available. WHO recommends that testing of infants should be carried out four to six months after birth.
Dr Gottfried Hirnschall, WHO’s Director for HIV/AIDS says: “With early diagnosis and prompt treatment, children have far better chances of surviving.”
WHO also hopes to eliminate new HIV infections in children by reducing mother-to-child infection rates through giving the mothers ARVs. This, it is hoped, will stop transmission of HIV from mother to child during pregnancy, through breastfeeding, and at delivery.

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