New York, NY – An international coalition of scientists and activists today launched a common platform for ending the AIDS epidemic. Thirty years into the epidemic, as world leaders come together at the United Nations to recommit to a global AIDS response, the broad-based international coalition issued a statement calling for world leaders to support a rational, evidence-based approach to responding to AIDS. The group also calls for additional signatories to the declaration.

“As at so many other critical points in the epidemic, we have the opportunity now to use the fruits of science and research to show the way forward. Putting more people on AIDS treatment will save lives and prevent new infections, and will also help build and strengthen platforms for delivering comprehensive health services in resource-poor settings,” said Paul Farmer, Harvard University Professor and co-founder of Partners In Health. “We have the knowledge and the tools to reverse the epidemic—and we must not fail to use them.”

The declaration, “We Can End the AIDS Epidemic,” argues that highly-active antiretroviral treatment (ART) for HIV positive people is a preventive strategy that is a cornerstone to ending the epidemic.

The founding group of signatories includes African Services Committee, AIDS Foundation of Chicago, AIDS United, amfAR, AVAC, ATHENA Network, Black AIDS Institute, Canadian HIV/AIDS Legal Network, Fenway Health/The Fenway Institute, GIV, Health GAP, HIV Prevention Justice Alliance, International Community of Women Living with HIV, International Rectal Microbicide Advocates, International Treatment Preparedness Coalition, New HIV Vaccine and Microbicide Advocacy Society, Open Society Public Health Program, Partners In Health, Project Inform, Treatment Action Campaign, Treatment Action Group, and the Wits Institute for Reproductive Health and HIV, and more than two dozen leading the global AIDS researchers and advocates.

“This statement represents the common vision of scientists and activists to halt the epidemic. For the first time in three decades, we now have the real potential to end the AIDS epidemic. The question now is will we?” said Mitchell Warren, AVAC executive director. “Recent breakthroughs in AIDS vaccine, PrEP and microbicide research suggest powerful, additional tools for the future. Right now, the scientific evidence that treatment is prevention must serve as a clarion call to funders, policy makers and program implementers to move forward boldly and quickly to capitalize on the conclusive evidence provided by the clinical trial HPTN 052.”

HPTN 052 found that earlier initiation of antiretroviral treatment provides a health benefit to HIV-positive people, and is a highly powerful tool for preventing transmission to sexual partners.

The statement calls for:

• World leaders to adopt ambitious treatment and prevention targets.
• Donors, including PEPFAR and the Global Fund to Fight AIDS, Tuberculosis and Malaria, to evaluate existing and new funds with core activities including antiretroviral treatment for individuals with CD4 cell counts at 350 or above
• All working on the AIDS response to end non-integrated, artificially-separated approaches to funding and delivering treatment and prevention services.
• Donors, communities, implementers, industry and researchers to map and execute an implementation research agenda for ART as part of combination prevention strategies.

“The most expensive, least effective strategy is to continue spending on AIDS the way that we are today,” said Nono Eland of South Africa’s Treatment Action Campaign. “We need more resources and better strategy. Funds need to be aligned with what is known to work—and reprogrammed where needed. We have no time to waste. World leaders at the UN this week should make clear commitments to the platform outlined in this statement.”

According to the declaration, and consistent with a new investment framework from UNAIDS published last week in the Lancet, funding needs to be directed to evidence-based strategies with combination ART as a cornerstone of a set of proven strategies to prevent and treat HIV, including male and female condoms, male circumcision, prevention of vertical transmission, behavior change programs that target social norms as well as individual risk, and activities addressing key populations including sex workers, men who have sex with men and harm reduction programs for injecting drug users. Funds that are not aligned with these core activities need to be justified and, where applicable, reprogrammed.

“The scientific evidence is clear. We know that early treatment has health benefits for HIV-positive people, and we now know that treatment also provides clear benefit for prevention,” said Kenneth H. Mayer, M.D. of Fenway Health. “As we work to scale up HIV treatment programs, we must also scale up and sustain research that builds on important proof of concept for biomedical prevention options, including pre-exposure prophylaxis, or PrEP, microbicides and vaccines to prevent HIV. Widespread treatment access coupled with new prevention options will be essential as we move to end this epidemic.”

The declaration grew out of a think tank on optimizing the potential of ARV-based prevention convened by AVAC with support from the John M. Lloyd Foundation. The meeting brought together 25 HIV experts to discuss the way forward capitalizing on mounting evidence of the broad benefit of widespread access to antiretroviral treatment.

The full text of the declaration, along with a list of signers, is available at www.avac.org/endtheepidemic, where additional individuals and organizations can also sign on.

Contact:
Mitchell Warren, [email protected], +1-914-661-1536
Kay Marshall, [email protected], +1-347-249-6375

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About AVAC: Founded in 1995, AVAC is a non-profit organization that uses education, policy analysis, advocacy and a network of global collaborations to accelerate the ethical development and global delivery of AIDS vaccines, male circumcision, microbicides, PrEP and other emerging HIV prevention options as part of a comprehensive response to the pandemic.

New York, May 12, 2011 – Today the sponsors of a randomized clinical trial known as HPTN 052, which is evaluating combination antiretroviral therapy for HIV prevention, announced that randomization would halt due to overwhelming evidence of benefit.

“We now have evidence from a randomized trial confirming what has been seen in observational settings: ARV treatment is prevention,” said AVAC Executive Director Mitchell Warren. “These data must serve as a clarion call to funders, policy makers, civil society and implementers. HPTN 052 shows a prevention benefit that must be translated into programmatic reality. If deployed effectively, efficiently and ethically, early initiation of treatment will be fundamental to turning the tide of the epidemic.”

HPTN 052 is a large, multi-site, randomized trial designed to determine whether antiretrovirals, medicines currently licensed to treat HIV infection, can prevent the sexual transmission of HIV among couples in which one partner is HIV-infected and the other is not (serodiscordant couples). Nearly 1,800 of these HIV-serodiscordant couples from four continents are participating in the trial. At the time of enrollment, the HIV-positive partners had CD4 cell counts between 350 and 550 cells/cubic millimeter and so were not eligible for ARVs based on most national guidelines. Couples who enrolled were randomly assigned to one of two groups. In one group, HIV-positive partners received antiretroviral therapy immediately. In the other group, HIV-positive partners deferred initiation of ARV treatment until they had the clinical or laboratory findings indicating ARV eligibility based on national guidelines.

In a scheduled review of interim data, the trial’s independent Data Safety and Monitoring Board (DSMB) found clear evidence that providing immediate antiretroviral therapy to the HIV-positive partner significantly reduced the risk of transmitting HIV to their HIV-negative partner. The trial team has used viral genetic analysis to establish which new infections were linked to the HIV-positive partner. They reported that there was one such linked HIV infection in the immediate treatment group versus 27 infections in the group that began treatment according to national guidelines.

Based on this indication of a clear benefit, the DSMB recommended that the trial halt randomization. The trial team announced today that it would do so, and begin offering immediate treatment to all HIV-positive partners. All couples will continue to be followed until the protocol-defined end of the trial.

“We congratulate the trial sponsors, scientific collaborators and partners who conducted this landmark global trial. We especially want to thank the nearly 1,800 HIV-serodiscordant couples from four continents whose commitment as trial volunteers made this effort possible,” Warren said. “As the global community reflects on the prevention and treatment implications of this trial, we must also consider current and future trials working with serodiscordant couples, and civil society voices must contribute to the way forward.”

“Today’s result should be viewed in light of other recent findings from trials using ARVs for prevention,” said Warren. “The recent results from the iPrEx trial showed that PrEP is effective in gay men and transgender women, while the CAPRISA 004 microbicide trial showed that 1% tenofovir gel is effective at reducing HIV risk for women.”

“Together, these results allow us to imagine a world in which men and women seek HIV testing with the knowledge and confidence that they will receive a range of highly effective options for staying healthy and protecting themselves and their partners—whatever the test result,“ Warren added. “The results of the study require us to rethink how we structure the delivery and funding of HIV services overall.”

“The financial, human and technical resources needed to translate the HPTN 052 trial finding into a public health breakthrough on a national or global level will not come overnight. And ARVs alone will not solve the epidemic,” said Warren. “Existing prevention tools including male and female condoms, syringe exchange, male circumcision, behavior change programming, prevention of vertical transmission, and HIV testing, remain critical as do structural interventions, stigma reduction initiatives and comprehensive care and treatment programs. We also still need to maintain and build on the momentum of other recent positive results from vaccine, microbicide and PrEP research.”

“Realizing this vision will require substantial resources,” said Warren. “The upcoming UN High Level Meeting on AIDS should set treatment and prevention targets that take the HPTN 052 results into account,” Warren said. “We need to start critical discussions and come to quick decisions about where and how to deploy treatment as prevention in the short-term. Government and international normative agencies now have a critical mass of data to publish guidelines for appropriate implementation of treatment as prevention in concert with other prevention methods.”

“Now is the best time to invest in an expanded response to the AIDS epidemic. AVAC stands with the global community of advocates for HIV prevention, treatment, research and implementation to expect and demand an extraordinary response to this unprecedented epidemic,” Warren added.

Contact:
Mitchell Warren, +1 914-661-1536, [email protected]

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About AVAC: Founded in 1995, AVAC is a non-profit organization that uses education, policy analysis, advocacy and a network of global collaborations to accelerate the ethical development and global delivery of AIDS vaccines, male circumcision, microbicides, PrEP and other emerging HIV prevention options as part of a comprehensive response to the pandemic.