HIV prevention as treatment
Zimbabwe is one of the African countries whose Minister of Health has committed to revitalise strategies to prevent further spread of HIV amid revelations that current programming focuses more on treatment than prevention.
AT THE 21st International Aids Conference in Durban, South Africa, East and Southern Africa (ESA) ministers agreed that focus on treatment and complacency on prevention resulted in increased numbers of new HIV infections and that there was need for increased investment in HIV prevention, especially for key populations at the local level.
“What we have said is that we have forgotten about prevention, we are concentrating too much on treatment. We are saying let’s continue to concentrate on treatment but also on prevention in a very strong manner; we are saying we want to revitalise the issue of prevention to make it more alive,” Dr Parirenyatwa told The Herald during the Durban conference.
He said while the world was looking at increasing the number of people who know their status to at least 90 percent, put at least 90 percent of all those HIV positive on treatment and have at least 90 percent of those on treatment’s viral load suppressed to undetectable levels by the year 2020, popularly known as the 90-90-90 targets, focus should also be on preventing new infections.
He added there was therefore a need to establish where the new infections were coming from to effectively close the tap.
Zimbabwe is among countries that have made the most remarkable response to HIV in southern Africa. From 2004 to 2014, the number of people accessing antiretroviral therapy increased from 11 800 to 788 000. Similarly, new HIV infections declined by 46 percent between 2002 and 2014, and HIV prevalence fell from 25,9 percent in 2002 to 16,7 percent in 2014.
With a target of 80 percent coverage of treatment in six districts - including the major urban centres of Bulawayo, Chitungwiza, Harare and Mutare— by 2017, scale-up supported by the Global Fund, domestic financing raised through the AIDS levy and the efforts of other partners like Pepfar, UNAids among others, has pushed the country a step further to the desired goal.
Programmes like male circumcision, prevention of mother to child transmission are on full throttle, yet more needs to be done to scale up prevention. As Dr Parirenyatwa put it, “There is no 90 for prevention, so Zimbabwe is saying add another 90 which makes it 90-90-90-90 and to do that we need to close the new infections, that is why our slogan is close the tap of new infections.”
With more than 1 400 researchers, advocates and policy makers expected to attend the biennial HIV Research for Prevention conference (HIVR4P 2016), the premier global scientific meeting on biomedical HIV prevention, to be held October 17-21, 2016 in Chicago, United States of America, Dr Parirenyatwa’s drive is what is needed in the HIV prevention response.
HIVR4P 2016 includes the latest research updates on HIV vaccines, treatment as prevention, microbicides, pre-exposure prophylaxis (PrEP), circumcision and new and emerging HIV prevention tools such as multi-purpose prevention technologies and long-acting prevention options.
The five-day conference programme includes more than 700 scientific pres- entations across 24 oral abstract and 10 poster and poster discussion sessions, 21 satellite sessions and daily plenaries, symposia and roundtables.
“HIVR4P is a different kind of meeting, because it brings all biomedical HIV pre- vention fields together to learn from each other,” said HIVR4P Co-chair Thomas Hope of North Western University.
“By facilitating collaboration between researchers, advocates and policy makers, and between scientists focusing on vaccines, microbicides, PrEP and other forms of prevention, HIVR4P supports the collaboration and partnerships that can lead to better, faster and more comprehensive responses to the epidemic.”
Plenary speakers at HIVR4P 2016 include US Department of State Global AIDS Coordinator Ambassador Deborah Birx, European Commission Health Directorate Director Ruxandra DraghiaAkli, Bill & Melinda Gates Foundation HIV Director Emilio Emini, US National Institute of Allergy and Infectious Diseases Director Anthony Fauci, Africa Centre for Health and Population Studies Director Deenan Pillay and a host of other global experts addressing the research and implementation challenges behind efforts to slow and one day end the global HIV epidemic.
Research presentations at HIVR4P 2016 will highlight advances and challenges in every field of HIV prevention, including new and emerging forms of prevention that have the potential to transform the global epidemic.
Session topics at HIVR4P 2016 include updates on long-acting HIV prevention, new insights into HIV transmission, opportunities and challenges in delivering combination prevention, findings from PrEP access programmes in different communities around the world, perspectives on microbicide ring research, the challenges of HIV prevention access and adherence and a host of sessions on basic science issues such as insights into mucosal biology and vaccine induced immune responses.
“HIVR4P 2016 comes at a crucial time in HIV prevention research,” noted HIVR4P Co-chair Lynn Morris of South Africa’s National Institute for Communicable Diseases.
“Vaccine researchers, for example, are embarking on two large clinical trials to test the ability of different types of antibodies to prevent HIV infection. We also have a vigorous pipeline of new vaccine concepts and products, along with a more focused plan for getting them tested in humans much quicker than ever before.
“At this critical moment in HIV prevention research, HIVR4P will be an excellent conference full of new ideas, major announcements and scientific discoveries.”
The global nature of the HIV epidemic and response is reflected throughout the HIVR4P programme. More than 250 conference scholarships were provided to researchers, advocates and journalists from resource poor countries, to enhance the inclusion of global perspectives at HIVR4P and ensure that information from the conference gets back out into the communities where HIV prevention becomes reality.
HIVR4P also features the latest research on efforts to overcome stigmatization and other barriers to making effective biomedical prevention available to different populations at risk for HIV, including sex workers, people who inject drugs and women and girls.
“A global movement to crush this epidemic in women and girls requires looking at HIV prevention technologies, implementation and behavioural issues together,” said HIVR4P Co-chair Nelly Mugo of the Kenya Medical Research Institute.
“Today we have new options in female-controlled HIV prevention, such as PrEP and, perhaps soon, rings. One of our biggest remaining challenges, and one that we expect to hear a lot about at HIVR4P, is understanding how to make these new tools available to women and girls, and how to support them to use these tools and stay safe.”
“The field is realising that when it comes to HIV prevention, and to new options that can enhance both reproductive health and HIV and STI prevention, choice and flexibility are key,” added HIVR4P Co-chair Jeanne Marrazzo of the University of Alabama, Birmingham.
“Increasing access and adherence is also dependent on engaging potential users early and often as new prevention products are developed and tested, to better understand and address what they want and need to remain HIV-free.”