Nevertheless, vaccines could significantly reduce HIV transmission.

Nevertheless, vaccines could
significantly reduce HIV transmission.
Simulation modelling studies have
investigated the potential impact of AIDS
vaccines in a variety of developing
countries6 . While their results focus
on individual countries and are based
on specific assumptions, these studies
generally find that:
�� even vaccines that are only partially
effective (30-50%) could significantly
reduce the number of new
infections; and
�� effectively protecting a quarter of the
adult population with a vaccine could
reduce HIV prevalence – the
number of HIV-positive people – by
more than half over 20 years.
Effectively protecting half of the
adult population could reduce longterm
HIV prevalence by 80%.
Therefore, there is considerable value
in investing in AIDS vaccine research
and development even as HIV prevention
and AIDS treatment, care and support
programmes continue to expand.
Without new preventive technologies to
complement and go beyond existing
HIV prevention methods, AIDS
treatment can be expected to absorb an
ever-increasing proportion of aid,
competing with other important poverty
reduction programmes. One of the
starkest realities is that in the long-term
such levels of spending are not
sustainable. Current HIV prevention
approaches are clearly not enough.
Interventions that depend upon
sustained behaviour change have had
limited success. There is a need to be
thinking much more about long-term
responses, while doing everything
possible to mitigate the impact of the
current AIDS epidemic in the short-term.
Improved prevention would also help
sustain access to antiretroviral therapy
for those who need it by reducing the
total number of people living with HIV.
Current efforts
The International AIDS Vaccine Initiative
(IAVI) is fostering a new type of
partnership between health researchers
and institutions from developed and
developing countries. Medical research
has been taking place in developing
countries for decades, but what is
happening today is different. The current
wave of vaccine and drug research is
based on a deeper and more long-term
relationship between national and external
researchers with a greater focus on local
capacity building and increased involvement
of communities, national level stakeholders
and political leaders. As a result, African
and Asian researchers are now actively
participating in defining the scientific
hypothesis to be tested and in managing
the trials themselves.
The new-style AIDS vaccine research
partnerships are also starting to provide
benefits beyond the immediate circle of
scientists and trial volunteers, by
improving health infrastructure and
standards of care. One example is the
United States Military HIV Research
Program (WRAIR) in East Africa, which
provides ‘wrap-around’ HIV prevention
and treatment services to communities
located near trials sites. This means
setting up laboratory infrastructure,
training clinicians and counsellors, and
providing antiretroviral dugs and other
supplies. Trial participants are HIVnegative
so do not need antiretroviral
therapy; however, the WRAIR programme
now provides more than 10 000 people
with antiretroviral therapy in Kenya,
Tanzania and Uganda.