16 JULY 2010, VOLUME 11, ISSUE 25

Injecting drug users are not the only focus of the AIDS Conference in Vienna next week. One of the priorities for African delegates will be the release of the results of the CAPRISA 004 microbicide trial next Tuesday, 20 July at 1pm.

This randomised controlled trial in South Africa tested the safety and efficacy of a 1% tenofovir-gel candidate, the first to use an antiretroviral to block infection. The gel was tested among some 900 volunteers in CAPRISA's rural Vulindlela site and urban Thekwini site. Scientists and activists -- particularly in the field of HIV prevention -- are waiting in suspense to find out if this gel works. None of the six candidates tested in 11 trials over the past 15 years has been successful yet.

No big influxes of new money are coming to fight the AIDS pandemic, but some smarter targeting and using approaches that have been shown to work can still save lives, Microsoft founder and philanthropist Bill Gates said on Tuesday. Focusing more treatment on women in Africa, drug users in places where needles drive the epidemic and on gay and bisexual men where that is appropriate can go a long way to fighting the virus, Gates told reporters.

"We can focus our prevention efforts. We can look at where there is the most impact," Gates said.

Gates, whose Bill & Melinda Gates Foundation spends a large chunk of its $34 billion endowment on fighting AIDS, is influential in directing other spending as well. He has pushed governments, non-profit groups and other philanthropies to join efforts he supports.

One big goal is to extend treatment to more people. An estimated 33.4 million people worldwide are infected with the human immunodeficiency virus that causes AIDS. Only about five million people get drugs that can keep patients healthy and reduce the risk they will infect someone else.

The earlier anti-HIV treatment starts, the better, according to a randomized trial from Haiti. Early treatment reduced the risk of death by 75% and the rate of new tuberculosis diagnoses by half, according to Daniel Fitzgerald, MD, of Weill Cornell Medical College in New York City, and colleagues. The finding supports previous observational evidence that starting treatment while the immune system is still relatively robust can save lives, Fitzgerald and colleagues reported in the July 15 issue of the New England Journal of Medicine. "This is the first randomized trial comparing earlier therapy with deferred therapy," Fitzgerald told MedPage Today.

In a major observational study of a North American cohort reported last year, deferred treatment resulted in a 69% increase in the risk of death, compared with therapy started soon after diagnosis. In Haiti, however, deferring therapy quadrupled the risk of death, possibly because high rates of tuberculosis, malnutrition, and tropical diseases worsened the effect of the delay, Fitzgerald and colleagues wrote.

To read the full article, see: Severe P, Juste MAJ, Ambroise A. Early versus standard antiretroviral therapy for HIV-Infected adults in Haiti. New England Journal of Medicine 15 July 2010; 363(3):257-265.

In a bid to ease pressure on South Africa's over-burdened public health sector, the government has given hospitals and clinics permission to give patients on HIV/AIDS treatment a three-month supply of their antiretroviral medication (ARVs). In a recent memo the Department of Health said there was no legal barrier to supplying patients with multiple months of treatment, and it could lighten the burden on the health sector; an estimated 700,000 patients are currently receiving ARV treatment through monthly visits to public health facilities.

Patients could also benefit. New research from the Reproductive Health and HIV Research Unit (RHRU), in Johannesburg, found that most patients who defaulted on treatment did so because they were unable to get time off work for monthly clinic visits. Poor adherence to ARVs can lead to drug resistance, necessitating more expensive second-line treatment and limiting future treatment options. "Imagine spending one out of every 25 work days collecting tablets at the clinic," said Dr Francois Venter, president of the Southern African HIV Clinicians Society and head of RHRU's HIV management cluster.

Patients also defaulted because they had to travel long distances to reach clinics and could not afford transport costs, said Catherine Tomlinson, a senior researcher at the Treatment Action Campaign (TAC), a local AIDS lobby group. "Allowing people to get three months of medication at a time will remove these barriers to treatment and improve adherence," she told IRIN/PlusNews.

Venter said a limited amount of research had shown that decreased interaction with health workers might negatively affect adherence in a small number of patients, but most would benefit from the move. Tomlinson said selected clinics in Western Cape Province had started giving patients three-month supplies of ARVs and were seeing improved adherence.

AIDS is the world's most important health-care issue according to people all over the world who were polled for their perceptions of the AIDS epidemic in a new survey commissioned by UNAIDS. Optimism about the state of the global AIDS epidemic and progress in responding to it varied widely, often along geographical lines. In sub-Saharan Africa, where most HIV infections occur, 31 percent of respondents chose the term "getting worse" to describe the issue, while another 30 percent chose "tragic". In South and Southeast Asia participants were more likely to see the situation as "hopeful" or "manageable".

Nearly half of all respondents were optimistic that the spread of HIV could be stopped by 2015 with the proper use of resources, although pessimism reigned in some countries, including Japan, the United Kingdom and Ukraine.

While 44 percent of all respondents said the world was not responding effectively to AIDS, those in Eastern Europe, the USA and sub-Saharan Africa were most likely to express this view, yet 75 percent of respondents in the Caribbean, and 53 percent in South and Southeast Asia, believed the opposite was true.

Perceptions of country and community responses were also divided, with Senegal giving their country the highest approval rating, closely followed by Uganda and Jamaica. Less than one percent of Ukrainian respondents believed their country was responding effectively to AIDS; Russia and Latvia fared slightly better, and just 16 percent of South Africans were convinced that their country's response was effective.

The headquarters of probably the most powerful charity in the world, and one of the most quietly influential international organisations of any sort, currently stand between a derelict restaurant and a row of elderly car repair businesses. Gentrification has yet to fully colonise this section of the Seattle waterfront, and even the actual premises of the Bill & Melinda Gates Foundation, which, appropriately perhaps, used to be a cheque-processing plant, retain a certain workaday drabness. Only four storeys high, with long rows of windows but no hint of corporate gloss, its beige and grey box sits anonymously in the drizzly northern Pacific light.

There is no sign outside the building. There is not even an entrance from the street. Instead, visitors must take a side road, stop at a separate gatehouse, also unmarked, and introduce themselves to a security guard, of the eerily polite and low-key kind employed by ex-heads of state and the extremely rich. Once admitted, you cross a car park full of modest vehicles and, if you are lucky, glimpse one of the world-renowned health or poverty specialists working for the foundation, dressed in the confidently casual Seattle office uniform of chinos and rainproofs. Then you reach the reception: finally, there is a small foundation logo on the wall, and beside it a few lyrical photographs of children and farmers in much dustier and less prosperous places than Seattle. Only past the reception, almost hidden away on a landing, is there a reminder of the foundation's status and contacts: a vivid shirt in a glass case, presented during a visit by Nelson Mandela.

AIDS experts gather in Vienna on Sunday for a six-day rally on the new options emerging in a war which after nearly three turbulent decades is entering a stable, promising phase. Expected to draw more than 20,000 researchers, policymakers and grassroots workers, the International AIDS Conference is the 18th since acquired immune deficiency syndrome came to light in 1981.

For almost all this time, the conferences have been the theatre for frustration and sometimes anger. Doctors would reel off the latest setbacks in the quest to treat and prevent the AIDS virus, while activists pounded the drum for money and action by Big Pharma. Today, though, the mood is brighter than ever. Indeed, many AIDS warriors are talking cautiously of a foe that is on the way to being contained and one day will be rolled back.

"One day, we will have to turn our minds on how to wipe out the virus," Jean-Francois Delfraissy, director of France's National Agency for AIDS Research (ANRS), said in an interview. The optimism comes from the success of antiretroviral drugs, the "cocktail" of drugs that, like a boot pressed firmly on the throat of a killer, keeps HIV suppressed.

Preventing people from contracting HIV, one of the biggest obstacles in the fight against AIDS in America, is getting renewed attention from the Obama administration. On the same day that Bill Gates called for more funding and stronger leadership to combat HIV/AIDS, President Obama, in a move activists dubbed "significant," outlined a national strategy that's meant to be more comprehensive than previous measures and announced the allocation of $30 million to drive the effort.

This is not the first time this administration has tackled HIV/AIDS. Last year the government budgeted $45 million over five years to highlight the alarming rate of infection in the U.S. and to refocus attention on the issue. But that plan, called Act Against AIDS, didn't address prevention, which activists regard as essential in any anti-AIDS campaign. "We've had a broken model that doesn't fund prevention, but treatment alone," says Nancy Mahon, executive director of the MAC AIDS Fund and among those involved in discussions leading up to formulation of the new policy, which was announced by Obama on Tuesday in the East Room of the White House and spelled out in a presidential memorandum.

The policy builds on previous efforts by making a stronger attempt to tie together many levels of state, federal, and private cooperation. It will focus specifically on gay and bisexual men, black men and women, male and female Hispanics, and substance abusers. It aims, by 2015, to reduce the number of infections by 25 percent, decrease the number of people living with HIV by 30 percent, and increase the number of people aware of their positive status from 79 percent to 90 percent. "Reducing new HIV infections; improving care for people living with HIV/AIDS; narrowing health disparities -- these are the central goals of our national strategy," Obama said.

For more information on President Obama's National HIV/AIDS Strategy and Implementation Plan, see:

• National HIV/AIDS Strategy
• National HIV/AIDS Strategy Implementation Plan
• President's Memorandum for the Heads of Executive Agencies and Departments

On the eve of the world's biggest AIDS conference this month in Austria, a new research review shows many people wouldn't get inoculated against HIV even if a vaccine was developed. The authoritative review -- published in this month's edition of the journal AIDS -- was led by Peter A. Newman, associate professor at the University of Toronto's Factor-Inwentash Faculty of Social Work. Newman and PhD candidate Carmen Logie drew conclusions from 30 previous research papers involving nearly 12,000 people on the topic of HIV vaccine acceptability.

"One might assume that if an HIV vaccine was available, many people would line up to be vaccinated. However, the research strongly indicates this is not the case," says Newman, Canada Research Chair in Health and Social Justice. "The availability of a vaccine alone is not enough to ensure that people will be inoculated."

To read the full article, see: Newman PA, Logie C. HIV vaccine acceptability: a systematic review and meta-analysis. AIDS 17 July 2010; 24(11):1749-1756. 

Background The United States and international agencies have signaled their commitment to containing the human immunodeficiency virus (HIV) epidemic via early case identification and linkage to antiretroviral therapy (ART) immediately at diagnosis. We forecast outcomes of this approach if implemented in Washington DC.

Methods Using a mathematical model of HIV case detection and treatment, we evaluated combinations of HIV screening and ART initiation strategies. We define current practice as no regular screening program and ART at CD4 counts 350 cells/[micro]L, and we define test and treat as annual screening and administration of ART at diagnosis. Outcomes include life expectancy of HIV-infected persons and changes in the population time with transmissible HIV RNA levels. Data, largely from Washington DC, include undiagnosed HIV prevalence of 0.6%, annual incidence of 0.13%, 31% rate of test offer, 60% rate of acceptance, and 50% linkage to care. Input parameters, including optimized ART efficacy, are varied in sensitivity analyses.

Results Projected life expectancies, from an initial mean age of 41 years, are 23.9, 25.0, and 25.6 years for current practice, test and treat, and test and treat with optimized ART, respectively. Compared with current practice, test and treat leads to a 14.7% reduction in time spent with transmissible HIV RNA level in the next 5 years; test and treat with optimized ART results in a 27.3% reduction.

Conclusions An expanded HIV test and treat program in Washington DC will increase life expectancy of HIV-infected patients but will have a modest impact on HIV transmission over the next 5 years and is unlikely to halt the HIV epidemic.

See also: "Universal HIV testing and immediate treatment could reduce but not eliminate HIV/AIDS epidemic".

Editor's Note: All of the articles in this Supplement are are available free online and are listed below. Click titles to link to full text of each article.

HIV/AIDS, Apoorva Mandavilli
On high alert, Emma Marris
Learning from the elite, Bijal Trivedi
The primate connection, Bijal Trivedi
Dancing with an escape artist, Sarah DeWeerdt
Tiny steps towards an HIV vaccine, Cassandra Willyard
Joining forces, Cassandra Willyard
The outlook for a cure,Virginia Hughes
Forgotten lessons, Paroma Basu
Developing solutions, T. V. Padma
Fighting the monster, Amy Maxmen
Grassroots initiatives, Amy Maxmen
A call for collaboration, Unmesh Kher

Heterosexual transmission of human immunodeficiency virus (HIV-1) is the predominant mode of infection worldwide. However, the early steps of transepithelial infection still need to be clarified. Using epithelial cells, originating from the female genital tract, and peripheral blood mononuclear cells as subepithelial target cells, an in vitro dual-chamber model of the female genital tract was developed. Remarkably, an intact layer of some cell types (HEC-1A, CaSki and Ect1) served as a protective barrier against cell-free but not against cell-associated HIV-1 that crossed the epithelial barrier through transmigration. Furthermore, dysfunctions of the epithelial layers were assessed by monitoring transepithelial electric resistance and transepithelial passage of FluoSpheres[R] and HIV-1 after treatment with nonoxynol-9 (N-9). Most of the functional assays showed dysfunction of the epithelial barrier at lower concentrations compared to a widely used colorimetric toxicity assay (WST-1). Finally, N-9 treatment caused a significant increase in the production of interleukin-8 (IL-8) and macrophage inflammatory protein-3[alpha] (MIP-3[alpha]) and a decrease of Secretory Leukocyte Protease Inhibitor (SLPI) and Monocyte Chemotactic Protein-1 (MCP-1) in this model. In conclusion, this model is a useful tool to (1) study HIV-1 transmission mechanisms and (2) evaluate epithelial toxicity of candidate microbicides.

Background Intravaginal practices are commonly used by women to manage their vaginal health and sexual life. These practices could, however, affect intravaginal mucosal integrity. The objectives of this study were to examine evidence for associations between: intravaginal practices and acquisition of HIV infection; intravaginal practices and vaginal infections; and vaginal infections and HIV acquisition.

Methodology/Principal Findings We conducted a systematic review of prospective longitudinal studies, searching 15 electronic databases of journals and abstracts from two international conferences to 31st January 2008. Relevant articles were selected and data extracted in duplicate. Results were examined visually in forest plots and combined using random effects meta-analysis where appropriate. Of 2120 unique references we included 22 publications from 15 different studies in sub-Saharan Africa and the USA. Seven publications from five studies examined a range of intravaginal practices and HIV infection. No specific vaginal practices showed a protective effect against HIV or vaginal infections. Insertion of products for sex was associated with HIV in unadjusted analyses; only one study gave an adjusted estimate, which showed no association (hazard ratio 1.09, 95% confidence interval, CI 0.71, 1.67). HIV incidence was higher in women reporting intravaginal cleansing but confidence intervals were wide and heterogeneity high (adjusted hazard ratio 1.88, 95%CI 0.53, 6.69, I2 83.2%). HIV incidence was higher in women with bacterial vaginosis (adjusted effect 1.57, 95%CI 1.26, 1.94, I2 19.0%) and Trichomonas vaginalis (adjusted effect 1.64, 95%CI 1.28, 2.09, I2 0.0%).

Conclusions/Significance A pathway linking intravaginal cleaning practices with vaginal infections that increase susceptibility to HIV infection is plausible but conclusive evidence is lacking. Intravaginal practices do not appear to protect women from vaginal infections or HIV and some might be harmful.

Background For adults with human immunodeficiency virus (HIV) infection who have CD4+ T-cell counts that are greater than 200 and less than 350 per cubic millimeter and who live in areas with limited resources, the optimal time to initiate antiretroviral therapy remains uncertain.

Methods We conducted a randomized, open-label trial of early initiation of antiretroviral therapy, as compared with the standard timing for initiation of therapy, among HIV-infected adults in Haiti who had a confirmed CD4+ T-cell count that was greater than 200 and less than 350 per cubic millimeter at baseline and no history of an acquired immunodeficiency syndrome (AIDS) illness. The primary study end point was survival. The early-treatment group began taking zidovudine, lamivudine, and efavirenz therapy within 2 weeks after enrollment. The standard-treatment group started the same regimen of antiretroviral therapy when their CD4+ T-cell count fell to 200 per cubic millimeter or less or when clinical AIDS developed. Participants in both groups underwent monthly follow-up assessments and received isoniazid and trimethoprim-sulfamethoxazole prophylaxis with nutritional support.

Results Between 2005 and 2008, a total of 816 participants -- 408 per group -- were enrolled and were followed for a median of 21 months. The CD4+ T-cell count at enrollment was approximately 280 per cubic millimeter in both groups. There were 23 deaths in the standard-treatment group, as compared with 6 in the early-treatment group (hazard ratio with standard treatment, 4.0; 95% confidence interval [CI], 1.6 to 9.8; P=0.001). There were 36 incident cases of tuberculosis in the standard-treatment group, as compared with 18 in the early-treatment group (hazard ratio, 2.0; 95% CI, 1.2 to 3.6; P=0.01).

Conclusions Early initiation of antiretroviral therapy decreased the rates of death and incident tuberculosis. Access to antiretroviral therapy should be expanded to include all HIV-infected adults who have CD4+ T-cell counts of less than 350 per cubic millimeter, including those who live in areas with limited resources.

From July 18 through July 23, 2010, delegates from around the globe will convene for the biennial International AIDS Conference in Vienna. They will discuss our current risk of losing the war against the human immunodeficiency virus (HIV). Despite an unprecedented outpouring of resources and proliferation of programs, today, for every two patients who begin receiving treatment for HIV, five people are newly infected. Furthermore, new guidelines from the World Health Organization recommending that infected persons begin receiving treatment earlier will significantly increase the number of patients targeted for therapy. If we are to control this pandemic, we must recognize the urgent need to develop and deploy better prevention tools and, most important, a safe and effective HIV vaccine.

Among the most exciting developments the delegates will hear about this year are a series of recent advances that collectively represent a renaissance in HIV vaccine development. These include the first demonstration of protection -- albeit modest protection -- against HIV infection in humans through immunization, with a vaccine regimen consisting of a canary-pox-vector prime plus a protein-subunit boost in the RV144 trial in Thailand, new vaccine approaches that have significantly improved control of simian immunodeficiency virus (SIV) infection in rhesus monkeys and are now advancing to clinical trials, and the identification of novel potent and broadly neutralizing monoclonal antibodies against HIV that have revealed vulnerable targets on the virus that are now being exploited for vaccine design. In fact, just last week, a team of scientists from the Vaccine Research Center at the National Institute of Allergy and Infectious Diseases published new findings that identified the latest of these broadly neutralizing antibodies and the structural basis for its broad and potent neutralization of HIV.

Building on this progress, HIV vaccine developers in the coming era will pursue three tracks. In the short term, efforts will focus on broadening the limited protection observed in the RV144 efficacy trial, including studies aimed at elucidating the immune correlates of protection. By 2013, trials should be under way to evaluate vaccine candidates related to the RV144 vaccine. Data should also be emerging from an ongoing phase 2B test-of-concept trial assessing a regimen consisting of a DNA prime plus an adenovirus serotype 5 vector boost. By then, heterologous prime-boost regimens of different adenovirus vectors containing mosaic antigens aimed at overcoming HIV's genetic diversity will also have advanced to clinical trials, and they will reach phase 2B trials if warranted by the initial data on safety and immunogenicity.

Background Previous in vitro studies have demonstrated that polyvinylpyrrolidone coated silver nanoparticles (PVP-coated AgNPs) have antiviral activity against HIV-1 at non-cytotoxic concentrations. These particles also demonstrate broad spectrum virucidal activity by preventing the interaction of HIV-1 gp120 and cellular CD4, thereby inhibiting fusion or entry of the virus into the host cell. In this study, we evaluated the antiviral activity of PVP-coated AgNPs as a potential topical vaginal microbicide to prevent transmission of HIV-1 infection using human cervical culture, an in vitro model that simulates in vivo conditions.

Results When formulated into a non-spermicidal gel (Replens) at a concentration of 0.15 mg/mL, PVP-coated AgNPs prevented the transmission of cell-associated HIV-1 and cell-free HIV-1 isolates. Importantly, PVP-coated AgNPs were not toxic to the explant, even when the cervical tissues were exposed continuously to 0.15 mg/mL of PVP-coated AgNPs for 48 h. Only 1 min of PVP-coated AgNP pretreatment to the explant was required to prevent transmission of HIV-1. Pre-treatment of the cervical explant with 0.15 mg/mL PVP-coated AgNPs for 20 min followed by extensive washing prevented the transmission of HIV-1 in this model for 48 h.

Conclusions A formulation of PVP-coated AgNPs homogenized in Replens gel acts rapidly to inhibit HIV-1 transmission after 1 min and offers long-lasting protection of the cervical tissue from infection for 48 h, with no evidence of cytotoxicity observed in the explants. Based on this data, PVP-coated AgNPs are a promising microbicidal candidate for use in topical vaginal/cervical agents to prevent HIV-1 transmission, and further research is warranted.

Background Bacterial vaginosis (BV) has been most consistently linked to sexual behaviour, and the epidemiological profile of BV mirrors that of established sexually transmitted infections (STIs). It remains a matter of debate however whether BV pathogenesis does actually involve sexual transmission of pathogenic micro-organisms from men to women. We therefore made a critical appraisal of the literature on BV in relation to sexual behaviour.

Discussion G. vaginalis carriage and BV occurs rarely with children, but has been observed among adolescent, even sexually non-experienced girls, contradicting that sexual transmission is a necessary prerequisite to disease acquisition. G. vaginalis carriage is enhanced by penetrative sexual contact but also by non-penetrative digito-genital contact and oral sex, again indicating that sex per se, but not necessarily coital transmission is involved. Several observations also point at female-to-male rather than at male-to-female transmission of G. vaginalis, presumably explaining the high concordance rates of G. vaginalis carriage among couples. Male antibiotic treatment has not been found to protect against BV, condom use is slightly protective, whereas male circumcision might protect against BV. BV is also common among women-who-have-sex-with-women and this relates at least in part to non-coital sexual behaviours. Though male-to-female transmission cannot be ruled out, overall there is little evidence that BV acts as an STD. Rather, we suggest BV may be considered a sexually enhanced disease (SED), with frequency of intercourse being a critical factor. This may relate to two distinct pathogenetic mechanisms: (1) in case of unprotected intercourse alkalinisation of the vaginal niche enhances a shift from lactobacilli-dominated microflora to a BV-like type of microflora and (2) in case of unprotected and protected intercourse mechanical transfer of perineal enteric bacteria is enhanced by coitus. A similar mechanism of mechanical transfer may explain the consistent link between non-coital sexual acts and BV. Similar observations supporting the SED pathogenetic model have been made for vaginal candidiasis and for urinary tract infection.

Summary Though male-to-female transmission cannot be ruled out, overall there is incomplete evidence that BV acts as an STI. We believe however that BV may be considered a sexually enhanced disease, with frequency of intercourse being a critical factor.

This update includes information on biomedical prevention research-related events at the upcoming XVIII International AIDS Conference (IAC) that will take place from 18-23 July in Vienna. For those of you who will not be attending, this update describes ways to follow the news from afar.

AVAC's HIV prevention research road map identifies a range of sessions of interest to biomedical prevention research advocates. The abridged and expanded versions are both available on AVAC's AIDS 2010 webpage.

To have informal conversations, meet speakers, learn more about AVAC programs and get a range of publications and fact sheets, please visit us at the AVAC exhibition booth (E-409 in the exhibition hall) and at the Partners in Prevention Research booth (637 in the Global Village).

Also at the AVAC booth, you can get a copy of and learn more about the revised Good Participatory Guidelines, which AVAC and UNAIDS are releasing at the conference. You can also learn how to submit your comments on the new version over the coming months. There will be information about GPP and the revision process on the AVAC website at www.avac.org/gpp.
 
AVAC is collaborating in a number of events at the conference, some of which are described below. Click here for a complete list of AVAC activities at IAC.

• Satellite -- Building Young and Early-Career Investigators' Capacity to Engage Community Stakeholders and Advance HIV Prevention Research: An OCTAVE  workshop on the UNAIDS and AVAC Good Participatory Practice (GPP) Guidelines [Saturday, July 17th, 08:30-18:00, closed session]
• Satellite -- The Search for an HIV Vaccine: Where are we, where are we going and how can we get there faster? [Sunday, July 18, 11:15-13:15, Mini Room 6]
• Satellite -- The Promise and Perils of ARV-based prevention: Making it a reality on the ground [Sunday, July 18, 15:45-17:45, Mini Room 6]
• Oral poster presentation -- WHiPT Community Monitoring of Medical Male Circumcision for HIV Prevention and its Impact on Women: Findings from a five-country pilot in Kenya, Namibia, Swaziland, South Africa and Uganda [Tuesday, July 20, 13:00-14:00, Mini Room 7]
• Global Village Workshop -- Get Ahead of the Game: Your Future Prevention Choices [Tuesday, July 20, 17:15-18:30, Women's Networking Zone in the Global Village]
• Global Village session -- The Future of Sex: Lubes or Pills or Both? [Wednesday, July 21, 10:00-12:30, MSM Networking Zone in the Global Village]
• Global Village Workshop -- Get Ahead of the Game: Your Future Prevention Choices [Wednesday, July 21, 13:00-14:30, Youth Networking Zone in the Global Village]
• Workshop -- Advocating for Women-Centered HIV Prevention Technologies and Environments [Thursday, July 22, 11:00-12:30, Mini Room 8]
• WHiPT male circumcision panel and release of summary report Male Circumcision: Making it Work for Women, [Thursday, July 22, 12:15-13:30, Women's Networking Zone in the Global Village]

There are a number of ways to follow the conference news and updates:

• AVAC will provide regular updates via Twitter (@HIVpxresearch) and the Advocates' Network
• Visit the official conference blog at http://blog.aids2010.org/
• Follow NAM's scientific reporting with their coverage at www.aidsmap.com/vienna2010
• Kaiser Family Health, in partnership with conference organizer IAS, will provide daily webcasts, podcasts, live coverage and new recaps from the conference at http://globalhealth.kff.org/AIDS2010.  

AVAC will keep you in the loop with more updates as the conference gets underway, and we look forward to seeing many of you in Vienna.

Global HIV Tutorial: http://www.kaiseredu.org/tutorials/global-hiv-2010/player.html
Kim Boortz, policy analyst for the Kaiser Family Foundation, presents an overview of the global HIV/AIDS epidemic and the latest in data and trends. This narrated slide tutorial covers HIV/AIDS prevalence around the world and addresses the issue of access to Antiretroviral Treatment (ART) and prevention services in parts of the world. Key issues and challenges in addressing the global epidemic as well as global health funding are also discussed. 

Global HIV and Domestic HIV Reference Libraries: These updated reference libraries include new resources along with background information on the disease including links to an extended list of articles focusing on cost and financing. Resources on prevention services and treatment are also provided.

Reference libraries: Global HIV/AIDS: http://www.kaiseredu.org/topics_reflib.asp?rID=1&parentid=64&id=126HIV/AIDS in the U.S.: http://www.kaiseredu.org/topics_reflib.asp?rID=1&parentid=64&id=127

You are warmly invited to join a tele-briefing for Advocates hosted by the Global Campaign for Microbicides to discuss the findings of the CAPRISA 004 trial on Wednesday, 21 July 2010 at 9am Washington DC/2 pm London/3pm Vienna and Johannesburg.

CAPRISA 004 is the first trial of an antiretroviral (ARV)-containing candidate microbicide.  It is testing a tenofovir vaginal gel.  As such, it represents a historic milestone in the field of microbicide research.  To help understand the results from the CAPRISA 004 study and discuss implications for current and future microbicide research, the Global Campaign is inviting experts in the field to help provide research and advocate perspectives.

Speakers will include:

• Prof Salim Abdool Karim, Director of CAPRISA and Co-Principal Investigator of CAPRISA 004, South Africa
• Dr Gina Brown, Coordinator, Microbicides and Women and Girls Research, Office of AIDS Research, National Institutes of Health, USA
• Dr Samu Dube, Director of Africa Programmes, Global Campaign for Microbicides, South Africa
• Dr Henry Gabelnick, Executive Director, CONRAD, USA
• Dr Jim Rooney, Vice President Medical Affairs, Gilead Sciences, Inc., USA
• Mitchell Warren, Executive Director, AVAC, USA

Yasmin Halima, Director, Global Campaign for Microbicides, USA, will chair and moderate an interactive discussion with participants

1. The call aims to:
2. Share results from the CAPRISA 004 microbicide trial;
3. Provide opportunities to ask investigators, researchers, product developers, and advocates questions about the study design, findings, and implications of the results;
4. Discuss next steps for microbicide and other biomedical prevention research including oral pre-exposure prophylaxis (PrEP).

Resources

As helpful background to the discussion, GCM will provide background materials at http://www.global-campaign.org/CAPRISA004.htm <http://cts.vresp.com/c/?GlobalCampaignforMic/77361db557/d48f41f13b/92fc39918c> .

To register for this call

You must complete a registration form in advance at https://cc.readytalk.com/r/ngtj4un7h5sw <http://cts.vresp.com/c/?GlobalCampaignforMic/77361db557/d48f41f13b/7e845d0580>

Please follow all instructions carefully to ensure you are registered. Please note that if you need to have an operator call out to you and place you into the call (rather than dialing into it yourself), you must register BEFORE 7pm US Eastern Time on Monday, 19 July 2010/1am Johannesburg Time on Tuesday, 20 July 2010. After this time, it will not be possible to add you to the list of "dial-in" numbers we send to the call operators.  If there is a toll-free number available for your country (see list below), then you must dial in using that number. 

If you require assistance with registration, available toll-free numbers, or have questions, please contact us at call@global-campaign.org <mailto:call@global-campaign.org> . 

Registration Link: https://cc.readytalk.com/r/ngtj4un7h5sw <http://cts.vresp.com/c/?GlobalCampaignforMic/77361db557/d48f41f13b/c3cde26dc1>

This issue of these regularly published updates is current as of June 2010. Download it here.

A new report from AVAC surveys the state of biomedical HIV prevention research, including the first evidence of vaccine-induced protection in humans and the emergence of ARV-based prevention -- and provides strategic recommendations for moving forward in a time of constrained resources and faltering commitment to ending AIDS.

Turning the Page, AVAC's 13th annual report on the state of the HIV prevention research field, offers unique context and a timely critique for issues that will be center stage at the upcoming AIDS 2010 Conference in Vienna. These issues are also central to the AIDS response outlined in the first ever US National HIV/AIDS Strategy, released Tuesday.

As the report describes, scientific developments in several arenas of biomedical prevention research have re-energized the search for additional strategies. In the vaccine field this includes the first evidence of vaccine-induced protection and strides in identification of new potent, HIV-specific neutralizing antibodies. Antiretroviral-based prevention also shows potential, and the report provides context for the upcoming results of the CAPRISA 004 microbicide trial, the first effectiveness trial of an ARV-based prevention strategy in HIV-negative people.

The biomedical prevention research field must now develop strategies for pursuing new scientific leads and following through on promising developments without the guarantee of expanded financial resources. In addition, the implications of recent breakthroughs need to be explained clearly to diverse audiences. As the report describes, the next phase of human clinical trials will involve complex designs and questions, and their success will depend on the support of all stakeholder groups. It will be difficult to execute this ambitious research agenda in the context of fiscal constraint -- and the field needs to address this head on.

To read the full text of the AVAC's 2010 Report, visit http://www.avac.org/ht/d/sp/i/2510/pid/2510.