New Px Wire: The state of the prevention union

The new issue of Px Wire, AVAC’s quarterly newsletter on HIV prevention research and implementation, is now available.

Click here to download.

This issue goes to press as global stakeholders in the HIV prevention field are preparing for the HIV Research for Prevention (R4P) conference in Cape Town. HIV R4P is the first-ever meeting to bring together researchers, implementers, policy makers and advocates from across biomedical prevention, including vaccines, microbicides, PrEP, voluntary medical male circumcision, cure and ART in HIV-positive people.

In this issue of Px Wire, we offer a selective “state of the union” update on various areas of the prevention field—highlighting key developments, messages and areas of work that warrant particular joint attention in Cape Town and beyond.

Our centerspread looks at the targets UNAIDS announced at AIDS 2014 in Melbourne—“90- 90-90” targets calling for 90 percent of people with HIV to know their status, get initiated on ART and achieve virologic suppression. Goals such as 90-90-90 help focus the field, and treatment is crucial in ending the epidemic—but this view is incomplete. The field must have the same attention and clear objectives in preventing HIV.

The full issue of Px Wire, as well as our archive of old issues and information on ordering print copies, can be found at www.avac.org/pxwire.

Homophobic legislation and its Impact on Human Security

This report by the MSMGF explores the circumstances around the enactment of new anti-homosexual legislation in Nigeria and Uganda, examining five categories of insecurity faced by lesbian, gay, bisexual and transgender (LGBT) people in the context of these laws.

Data and Uncertainty: Understanding updates on hormonal contraceptives and HIV

AIDS 2014 featured analyses of data on the potential relationship between hormonal contraceptives and risk of HIV infection. Researchers Charles Morrison (FHI 360) and Kristin Wall (Emory University), and Mary Lyn Gaffield from the WHO discussed the newest findings and guidance.

Data Watch: Closing a Persistent Gap in the AIDS Response

In this update to the 2012 Action Agenda to End AIDS, amfAR and AVAC argue that critical and expensive decisions made with incomplete data can undermine the response to the AIDS epidemic—even as the systems for collecting these data continue to improve. The report describes the issues and identifies critical areas where better, more complete data are needed to guide the key decisions for the response to the HIV/AIDS epidemic. It also provides an update on prevention and treatment targets set in the Action Agenda.

HIV Prevention Research & Development Investment in 2013: In a changing global development, economic and human rights landscape

This annual accounting of funding for biomedical HIV prevention research tracks trends and identifies gaps in investment. The report shows that investment in HIV prevention research fell 4 percent in 2013, due to a combination of factors including declining investments by the United States and European donors, changes in the international development landscape and changes in the pipeline of HIV prevention products being tested.

When do you stop an HIV prevention trial for futility? A primer for HIV prevention advocates

This fact sheet looks at why trials are stopped early for “futility.” What does this mean, when is such a recommendation made and how does it affect other ongoing trials?

Understanding the Results of the AIDSVAX Trial

In late February 2003, the world heard preliminary results of the first large-scale human trial of a vaccine designed to prevent HIV infection. The results for the overall trial cohort were clear and disappointing. The results for a relatively small subset of trial participants are less clear, and they have sparked controversy and require further analysis. This brochure will help you understand what we do and do not know about the experimental vaccine known as AIDSVAX.

Understanding the Results of the AIDSVAX Trial (French)

In late February 2003, the world heard preliminary results of the first large-scale human trial of a vaccine designed to prevent HIV infection. The results for the overall trial cohort were clear and disappointing. The results for a relatively small subset of trial participants are less clear, and they have sparked controversy and require further analysis. This brochure will help you understand what we do and do not know about the experimental vaccine known as AIDSVAX.

Understanding the Results of the AIDSVAX Trial (Spanish)

In late February 2003, the world heard preliminary results of the first large-scale human trial of a vaccine designed to prevent HIV infection. The results for the overall trial cohort were clear and disappointing. The results for a relatively small subset of trial participants are less clear, and they have sparked controversy and require further analysis. This brochure will help you understand what we do and do not know about the experimental vaccine known as AIDSVAX.

HIV Vaccine Awareness Day: On the road to an AIDS Vaccine

Each year on May 18th, HIV Vaccine Awareness Day (HVAD), we recognize and thank the thousands of volunteers, community members, health professionals, advocates, policy makers and scientists who are working together to find a safe and effective AIDS vaccine. HVAD is a reminder that vaccine research is rarely linear, often unpredictable and always an essential component of a comprehensive response to the epidemic. It is also often a reminder that awareness of the next steps for vaccine development is limited, and HVAD is an annual opportunity to raise awareness.

The road to an AIDS vaccine is not easy. But after 30 years since HIV was identified, researchers believe we’re closer to a vaccine than we ever have been. In 2009, scientists announced that RV144, a large-scale trial in Thailand, found modest levels of protection. This was the first evidence in people, or proof of concept, that an AIDS vaccine can reduce the risk of HIV. The Pox Protein Public Private Partnership (P5) now aims to build on RV144 findings in Thailand, and to explore a modified vaccine in South Africa. Follow-on studies are starting and ongoing in Thailand; additional large-scale trials in both countries are expected to start in the next two to three years.

At the same time, the AIDS vaccine pipeline of other vaccine approaches is increasingly diverse. More than 30 AIDS vaccine clinical trials are underway, testing a variety of candidates and vaccine concepts. In the UK, funders are supporting key AIDS vaccine research though the UK HIV Vaccine Consortium, the Department for International Development, the Medical Research Council, the Wellcome Trust and the International AIDS Vaccine Initiative. The current challenge is to continue moving promising strategies forward without delay.

In this period of scientific development, while the world waits for an AIDS vaccine, we believe it is critical to:

Track Timelines and Investment

The P5 timelines have shifted, with delays that have challenged the sense of momentum and optimism. However, follow-on trials are still expected to begin in South Africa in 2015—and it is critical to support this effort, even while urging the P5 to remain transparent, efficient and accountable. Pubic sector investment and industry involvement in AIDS vaccine research are both essential and advocates should press for commitments from government and industry.

Get Engaged

Civil society input is needed to be sure that trials are acceptable, and address the concerns of the communities who might be asked to participate— and who might benefit from the research in the future.

Help Manage the Hype

There are many steps between positive animal data and trials to test efficacy in humans. Headlines that tout efficacy in small animal studies before it’s been proven in humans can over-inflate expectations.

Demand a Plan

The field has to be vigilant and selective, so that concepts advance or are set aside swiftly, with clarity about next steps.

Finally, at AVAC, we have developed a 2014 HVAD “toolkit” and will be hosting a webinar entitled Breakthroughs and Big Questions: AIDS vaccine research in 2014 on Monday, May 19 3 PM (BST) (see full information below).

Visit our HVAD page and download the toolkit.

For more on the webinar, visit here.

This post first appeared on stopaids.org.uk