Envisioning a world without AIDS is the first step
By Kelly McCann
The numbers are staggering. Since 1981, over 25 million people across the globe have died as a result of AIDS. Worldwide, it is estimated that 42 million people are currently living with HIV, and lamentably, another 14,000 become infected with HIV every day! The most heartbreaking aspect of this situation is that it doesn’t have to be this way. We know how HIV is transmitted and we know how to prevent new infections.
Since the early 1980s, educational interventions and social marketing initiatives have raised awareness of HIV and AIDS and provided specific prevention information. Over the years, effective prevention strategies—condom use, reduction in the number of sex partners, diagnosis and treatment of sexually transmitted infections—have all been shown to slow the spread of HIV. The ultimate message is a vital one: HIV is preventable.
Sounds simple enough, but existing prevention methods require us to change our behaviors. Let’s be honest—that’s never easy. Behavior change is complex and influenced by a variety of political, cultural, educational, religious, and economic factors. In addition, we humans tend to resist behavior change, especially when it comes to activities that make us feel good and appeal to our hedonistic impulses. No wonder we have such a hard time changing the behaviors that allow for transmission of HIV.
What else can be done to put an end to HIV and AIDS? Researchers are working on microbicides that can be formulated in gels, creams, films, or suppositories and applied inside the vagina or rectum to protect against HIV and other sexually transmitted infections. These substances will be particularly helpful to sex workers and women in developing countries who often do not have the option of requiring their male partners to wear a condom. Once developed, microbicides will be another useful weapon in our HIV prevention arsenal, but no panacea. What we really need is a preventive vaccine for HIV.
Such a vaccine would prepare our immune systems to recognize and protect itself against HIV. Ideally, the vaccine would be given to uninfected persons in order to keep them from becoming infected with HIV. We’ve seen preventive vaccines developed to fight other deadly diseases like smallpox and polio, so why not HIV? Sounds simple enough.
Unfortunately, traditional approaches to vaccine development have been ineffective. Creation of an HIV vaccine has proven to be an arduous task because of the nature of HIV itself. First of all, HIV mutates quickly and frequently and has a knack for avoiding detection by the immune system, all of which pose significant barriers to the development of an effective vaccine.
Another major obstacle to vaccine development has to do with HIV diversity. There are nine subtypes or clades of HIV, and those clades vary in prevalence around the world. For example, Clade B is the cause of the HIV epidemic in North America and Europe, while Clade C is the culprit in South Africa and India and is responsible for 50 percent of the HIV infections worldwide. Such diversity within HIV will require that scientists address the challenge of developing a single vaccine with a broad base of protection against multiple clades, or they must design several specific vaccines to address the various clades.
That’s no small task. It is an endeavor that will take time, money, and coordinated approach. Over the past 20 years, the National Institute of Allergy and Infectious Diseases has enrolled more than 12,000 volunteers in HIV vaccine clinical trials testing 52 different vaccine candidates. Currently, through the combined efforts of public and private entities, there are more than 30 vaccine trials under way on four continents, including a trial right here in Houston. Despite the considerable time and effort devoted to this cause, no preventive HIV vaccine is looming on the horizon. Most estimates suggest it will be 10 years and $150-$250 million before we see the development of a viable vaccine.
But don’t despair. There is much we can do in the interim. We can educate ourselves and our communities about the importance of preventive HIV vaccine research. Visit the NIAID HIV Vaccine Research Education Initiative website at www.bethegeneration.org to learn more about vaccine trials and the progress being made in the development of a vaccine. Share what you learn with others and reinforce the idea that preventive HIV vaccines are the best hope for controlling the AIDS pandemic.
Keep working on your behavior change. Be abstinent or monogamous or limit your number of sex partners. Use condoms and other barrier methods every time you have sex. Don’t share needles for any reason. It’s that simple. Stay safe so you can survive to see the creation of an effective HIV vaccine.
Then, on May 18, the 10th annual HIV Vaccine Awareness Day, show your support for HIV vaccine research by wearing your red AIDS ribbon upside down to symbolize a “V” for vaccine. And on that day, let’s all envision a world without AIDS.
Kelly McCann is the chief executive officer of AIDS Foundation Houston, which recently marked its 25th year of service. Details: www.aidshelp.org.