Viewpoints / Atlanta’s AIDS conference: A regional and global perspective

A safe and effective HIV vaccine is needed now more than ever. Despite the tremendous success of AIDS therapies that have greatly extended life expectancy and quality of life for those living with HIV and AIDS, the epidemic continues to spread at an alarming rate.

Each year more than 56,000 people in the U.S. are newly infected with HIV and more than 14,000 people die from AIDS. Globally, HIV is responsible for more than 50,000 new infections each week and for more than 2.5 million new infections each year, with 33 million people now living with the disease. Since the disease was first recognized in 1981, it has claimed over 25 million lives worldwide.

The South has been particularly hard hit by HIV, with the highest proportion of new AIDS diagnoses in the country and the highest prevalence of people living with AIDS. It is the only region where the number of HIV/AIDS–related deaths has increased since 2001.

In July the U.S. government released its new “National HIV/AIDS Strategy,” which calls for a coordinated national response to the epidemic, including a commitment to reducing infections, increasing access to care, improving outcomes and reducing health disparities.

The new strategy is critically important and forward-thinking, but it is only part of the effort needed to stem the spread of this deadly disease. Just as vaccines have been the most effective public health intervention for other challenging infectious diseases, a safe, effective, accessible HIV vaccine must be a top priority in the fight against HIV and AIDS.

There have been numerous setbacks and tremendous disappointments in developing an HIV vaccine. Yet scientists are so convinced of its value that the field has never been more active and optimistic, and we have never been closer to our goal than we are today.

At AIDS Vaccine 2009 in Paris, scientists reported on RV144, the HIV vaccine regimen that demonstrated the first proof of the concept that a vaccine can confer some degree of protection against HIV in humans. This landmark result has breathed new life and new hope into vaccine research.

Here in Atlanta, scientists at the Emory Vaccine Center and Yerkes National Primate Research Center are pursuing several avenues of research relevant to an effective and safe HIV vaccine.

They have developed a promising HIV vaccine candidate that is now being developed and tested through local biotech company GeoVax Inc., with ongoing human clinical trials in Atlanta and around the United States in both uninfected and infected individuals.

Emory investigators at the Hope Clinic of the Emory Vaccine Center are participating in testing HIV vaccines as part of the HIV Vaccine Clinical Trials Network. This week’s conference will report on promising progress with these vaccines and will include updates on the RV144 vaccine trial results.

From basic science to clinical research, from public policy to funding, the scientists in Atlanta this week will be focused in a united effort to conquer one of the greatest public health challenges of our time through the development of one of the most critical public health tools of our time — a safe and effective HIV vaccine. For the benefit of the world’s populations we cannot afford to fail in our efforts to achieve this goal.

Alan Bernstein is the executive director of Global HIV Vaccine Enterprise. Eric Hunter is co-director of the Emory Center for AIDS Research.

Also contributing: James Curran, dean, Rollins School of Public Health; Carlos del Rio, chair, Hubert Department of Global Health at Rollins; and Harriet Robinson, chief scientific officer at GeoVax Inc.

Obama mustn’t retreat from Bush’s pledge to help Africa fight AIDS.

By Festus Mogae

Imagine if one in four Americans were living with HIV. That’s roughly the percentage of adults in Botswana who are infected with the disease.

Most HIV-positive people, of course, don’t live in the U.S. About 97 percent live in developing regions, like sub-Saharan Africa, where AIDS is the leading cause of death of adults.

They may not be American citizens, but they desperately need America’s help. Unfortunately, the Obama administration seems to be pulling back from the fight against AIDS at the very moment when the world has demonstrated what it is possible to achieve.

Africa is at a crossroads with AIDS — we can finish the job and win this fight with U.S. support. But if U.S. leadership wanes at this critical moment, we will see progress erode, an increase in preventable deaths and a return to the economic devastation of past decades.

Although AIDS has been converted from a killer disease to a chronic one in many of our African countries, for those without access to anti-retroviral drugs, HIV/AIDS is too often a death sentence. In Botswana, an estimated 57,000 children have been orphaned by AIDS.

The good news is that the distribution channels and public health wherewithal to defeat this disease exist — Botswana helped pioneer the provision of anti-retroviral treatment in Africa, starting its national treatment program in 2002.

Now, across the developing world, more than 5 million individuals with HIV/AIDS have seen their lives transformed by the availability of treatment. Drugs that once cost $12,000 per year can now be purchased for less than $100. As drug prices have dropped precipitously, every dollar invested can have even greater impact.

In Botswana, about 151,695 people living with HIV/AIDS have access to lifesaving drugs, and our national goal of achieving universal access has come close to being achieved. Ninety-six out of 100 Botswana infants born to HIV-positive mothers are now born AIDS-free.

A major catalyst for this success has been America’s ongoing leadership and generosity.

In 2003, President George W. Bush — with support from Republicans and Democrats alike — announced a plan to dramatically increase American efforts to fight AIDS across the globe.

As a key component of its AIDS initiative, the United States made a founding investment in the Global Fund to Fight AIDS, Tuberculosis and Malaria.

In just eight years, the Global Fund has allocated $18 billion in grants for health programs in 144 countries. Today, the fund is responsible for one-fourth of global spending to combat AIDS and two-thirds of external financing for TB and malaria. A critical portion of that investment comes from the U.S.

I know that President Barack Obama believes in these programs. While campaigning in 2008, he promised that, if elected, he would provide at least $50 billion by 2013 to fight AIDS globally, and fully fund the Global Fund. But there remains a large gap between the president’s vision, and his administration’s budget. The president’s budget actually proposed cutting America’s contribution to the Global Fund by $50 million next year at the very time when the Global Fund needs to double its resources. Health care providers in some African nations have already been forced to turn away new patients. Some find themselves unable to provide medicine.

This is no time to retreat. Experts estimate that a $6 billion, three-year commitment by the United States to the Global Fund could have a domino effect that helps turn the tide against AIDS, as well as TB and malaria.

Africa needs President Obama’s strong leadership on this issue. Recommitting to the global fight against AIDS will encourage other nations to do likewise, and bring life and hope to millions in Africa.

Festus Gontebanye Mogae, the president of Botswana from 1998 to 2008, is chair of Champions for an HIV-free Generation.