Scientific Advances and the Fight Against AIDS

Posted by Eric Goosby
July 16, 2011
A Health Worker Tests Blood for HIV

This week, I am in Rome, Italy, for the International AIDS Society's Conference on HIV Pathogenesis, Treatment, and Prevention. This gathering of researchers caps a year of incredible scientific announcements, and I anticipate even more at this meeting.

Last summer, the PEPFAR-funded CAPRISA study of a tenofovir-based microbicide demonstrated successful proof-of-concept for this female controlled prevention method. The study showed that women using the microbicide gel had an average of 39 percent fewer HIV infections and 51 percent fewer genital herpes infections compared to women who used a placebo gel. The results of this study were clear evidence of the importance of U.S. investments -- across multiple agencies -- in microbicides. And through PEPFAR, our country teams will be working to create the regulatory path and client demand for these products when they are ready to be marketed, so that this innovation can be quickly brought to bear in order to save lives.

In May, a National Institute of Health (NIH) randomized control trial confirmed earlier observational evidence and clearly documented that treatment also worked as an extraordinarily effective tool for the prevention of sexual HIV transmission. Initiation of antiretroviral treatment (ART) by HIV-infected individuals substantially protected their HIV-uninfected sexual partners from acquiring HIV, with an astonishing 96 percent reduction in risk of HIV transmission. By lowering the viral load of HIV, ART greatly reduces the risk of sexual transmission of HIV to an uninfected partner.

And just this week, two studies have confirmed an initial proof-of-concept trial demonstrating the use of pre-exposure prophylaxis (PrEP) against HIV infection. In these studies, individuals taking a daily tenofivor or tenofovir/ emtricitabine combination experienced infection rates more than 60 percent lower than those on a placebo. This finding further advances potential options in prevention for couples where one partner is infected with HIV and for other high-risk populations.

I expect additional innovations to be announced at this meeting, creating momentum around “what's possible” in fighting HIV/AIDS. Nearly a decade after the creation of PEPFAR and the Global Fund helped begin to restore hope to hard-hit nations, these new research achievements are bringing a second wave of hope to communities impacted by AIDS. They are creating a mood of optimism and promise as we turn our attention to next year's International AIDS Society meeting in Washington, D.C.

Many of these advances have benefited from the funding and expertise found throughout the U.S. government. They have the potential to radically change the way we think about HIV/AIDS in the developing world, and help to prevent millions of new infections worldwide. We will work with the World Health Organization and others as they develop the normative guidance that will allow us to partner with countries to translate these scientific findings into effective, lifesaving programs.

In order for us to fulfill the promise of these findings, we will continue to foster shared responsibility among all parties. We will continue to work with our partners in national and local governments, enabling them to create the policies and systems that allow innovations to be rapidly implemented and scaled up at the country level. We need to work with ministries of finance and other donors to coordinate and complement financing, so that we get the maximum life-saving impact for every dollar spent. And we will continue to make sure that these efforts build upon and help to strengthen the health systems that deliver care in the developing world.

It's a tall order, but I believe we can achieve amazing things over the next few years. I am honored to lead a program that is at the forefront of putting scientific advances into practice to save lives, and look forward to reporting back from Rome.



July 17, 2011

Djriad in Bangladesh writes:

hi. i miss you. Usa

Paul W.
United States
July 17, 2011

Paul W. in USA writes:

Bravo Eric! Keep up the good work.

George C.
New York, USA
July 17, 2011

George M.C. in New York writes:

While the new PrEP data are moderately encouraging, I would urge you to look more closely at the CAPRISA data. In the published results, the benefit was only seen among rural women. Among urban women, there was no difference in either arm.

Further, the absolute risk reduction is nominal, leaving a large "number needed to treat" of around 45. That is, 45 HIV- people need to be on this costly, toxic drug for a year to prevent one infection. So far, the studies have not been conducted long enough to determine what impact on bone morphology or kidney function such use may have.

More practically speaking, due to the high costs of the drugs, there are some 10-15 million HIV+ individuals who are CURRENTLY clinically eligible for treatment but unable to be receive it. Yet we know that treating patients ALSO inhibits the spread of HIV.

One might be led to believe that Gilead's only interest is in opening up a new and very lucrative market among the worried well in wealthy lands.

Perhaps Ambassador Gooseby might comment also on issues such as a) the high price of drugs, the proximate cause of the ADAP crisis in the US; b) the efforts of the US Trade Representative and the EU in prosecuting TRIPS-Plus trade agreements, throwing in things like data exclusivity, that assure blocking access to generic ARV and other OI medications? Or perhaps on the need to end the bloody, racist, failed drug war that only fosters a festering HIV pandemic? The need for harm reduction programs and needle access? These, along with condoms, counseling and care, more nurses and doctors from rural Mississippi to Lusaka, Zambia to Uzbekistan are the kind of robust, vigorous, global initiatives that we need to end the HIV pandemic. What do you think?

tsigie t.
July 19, 2011

Tsigie in Ethiopia writes:

Thank you for your update about HIV.

Marc A.
California, USA
July 20, 2011

Marc A. in California writes:

There is research showing female circumcision also reduces the changes of contracting HIV. But even the least intrusive form of female circumcision is illegal to perform on an infant girl. A sexist double standard.

The few studies in Africa that found male circumcision reduces HIV are contradicted by other research and experts. ""

For example, see ""

This recent study found no association between circumcision in Kenya and HIV rates. ""

This recent report in Uganda says circumcisions are increasing HIV rates because the men think it makes them immune. ""

This is exactly what renowed Jewish physician Dr. Dean Edell warned about when he called the African/HIV conclusions "silly" and warned, "it will backfire." He recognized the gender double standard, the loss of sensation in the penis, how condoms and education are the solution, etc. ""

The South African Medical Association just denounced infant male circumcision as unethical and illegal and expressed "serious concern that not enough scientifically-based evidence was available to confirm that circumcisions prevented HIV contraction and that the public at large was influenced by incorrect and misrepresented information. The committee reiterated its view that it did not support circumcision to prevent HIV transmission."""

The President of Uganda has rejected male circumcision as a way to prevent HIV and declared the studies misleading.

The Dutch Medical Association's May 2010 report, backed by 7 other national medical associations, concluded:

"Contrary to what is often thought, circumcision entails the risk of medical or psychological complications.""Non-therapeutic circumcision of male minors conflicts with the child's right to automony and physical integrity.""There are good reasons for a legal prohibition of non-therapeutic circumcision of male minors, as there is for female genital mutilation.""There is no convincing evidence that circumcision is useful or necessary in terms of prevention or hygiene."""

British Columbia College of Physicians and Surgeons' 9/09 report declared:

"There is no evidence to support routine circumcision of newborn and infant males.""The stated benefits of protection against urinary tract infection are marginal, and do not justify mass circumcision. Our changing understanding of the relationship between urinary tract infection and chronic renal disease further weakens the case for routine circumcision.""There is evidence that circumcision does result in memory of painful experiences, and is not quite as simple and low risk as your report suggests."""

Australian College of Physicians' 9/09 report declared:

"The benefits of infant male circumcision that have been promoted over time include the prevention of urinary tract infections and sexually transmitted diseases, and the reduction in risk of penile and cervical cancer. Current consensus of medical opinion, including that of the Canadian and American Paediatric Societies and the American Urological Society, is that there is insufficient evidence that these benefits outweigh the potential risks. That is, routine infant male circumcision, i.e. routine removal of normal tissue in a healthy infant, is not recommended."""


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