It’s been a roller coaster of a year in HIV and AIDS. AIDS turned 30 in 2011, and with new evidence of the effectiveness of HIV treatment as prevention, experts are increasingly talking about “the end of AIDS”. At the same time, however, funding for HIV has become ever more uncertain, jeopardizing efforts to put new, life-saving science into action.
IRIN/PlusNews brings you 10 HIV-related stories that made headlines in 2011:
AIDS turns 30 – The first case of HIV was reported in 1981, and 2011 was a year of reflection on the growth of the epidemic and progress made in the fight against it.
In 30 years, an estimated 30 million people have died, another 34 million are living with the virus and an estimated 7,000 new infections occur every day. An estimated 6.6 million people were on treatment globally by December 2010, but some nine million people who qualified for antiretrovirals (ARVs) did not receive them.
ARVs as Prevention – The little pills that turned HIV from a death sentence into a chronic condition could now help us prevent new HIV infections. In May, the HPTN 052 study, a large, randomized controlled trial, found that earlier initiation of HIV treatment led to a 96 percent reduction in HIV transmission to the HIV-uninfected partner.
Activists have called on the UN World Health Organization (WHO) to rapidly develop guidelines on the use of ARVs as prevention.
AIDS funding – In November, poor funding forced a board meeting of the Global Fund to Fight AIDS, Tuberculosis and Malaria in Accra, Ghana, to cancel its 11th round of funding, which was to fund programmes from 2011 to 2013. The international financing mechanism is responsible for about 70 percent of HIV treatment in developing countries.
Earlier in the year, the Kaiser Family Foundation and UNAIDS released a report showing that funding fell from US$7.6 billion in 2009 to $6.9 billion in 2010 – the first time funding has dropped in more than a decade of tracking HIV/AIDS spending. Between 2002 and 2008, spending rose more than six-fold before levelling off in 2009.
Disappointing prevention trials – In April, a three-country study, known as FEM-PrEP, was halted after daily doses of the ARV Truvada, used as a pre-exposure prophylaxis (PrEP), failed to prevent HIV infection in the women participating.
In September, the independent Data and Safety Monitoring Board (DSMB) for the Vaginal and Oral Interventions to Control the Epidemic (VOICE) study – which aimed to test the safety, effectiveness and acceptability of the daily use of one of two different ARV tablets or of a vaginal gel – recommended that women assigned to the tenofovir tablet should discontinue use because the study would be unable to show a difference in effectiveness between the drug and a placebo.
In November, on the recommendation of the DSMP, the VOICE trial discontinued the use of the tenofovir-containing gel – and a control placebo gel – on the grounds that it was not effective in preventing HIV in the women participating in the trial.
Straight Talk with Stop TB director Mario Raviglione
Straight Talk with Stephen Lewis
Straight Talk with Elizabeth Pisani, author of The Wisdom of Whores
Heroes of HIV: The Prison Educator Gaffe-prone politicians – In November, South African media reported that Helen Zille, premier of the Western Cape and leader of the Democratic Alliance, while addressing a wellness summit hosted by the Western Cape Health department, called for people who knowingly infected people with HIV to be charged with attempted murder. She also questioned why government should foot the bill for people who contracted HIV through “irresponsible behaviour” and urged the government to shift its focus from the treatment to the prevention of diseases.
HIV activists in South Africa were angered by Zille’s remarks; rights organization Treatment Action Campaign called them “misleading and unscientific”.
Uganda’s recently appointed health minister, Christine Ondoa, was in August berated by AIDS activists for comments she allegedly made in an interview with a local newspaper on 1 August. According to Uganda’s Observer newspaper, Ondoa claimed to know three people who had been cured of HIV through prayer.
The two join a long list of blunders by African leaders on the subject of HIV.
Anti-gay legislation in Africa – As a new session of parliament began in May, MPs backing a tougher anti-gay bill – which includes a death penalty clause for repeat offenders – said they would persevere with it, despite President Yoweri Museveni’s calls for them to drop it.
In November, Nigeria’s Senate voted to criminalize gay marriage, gay advocacy groups and same-sex public displays of affection. The bill must be passed by the House of Representatives and signed by President Goodluck Jonathan before becoming law, but AIDS activists have said it can only serve to drive gay Nigerians further underground and away from HIV prevention and care services.
Western countries have responded to the growth of anti-gay legislation; British Prime Minister David Cameron has threatened to withhold aid to countries violating the rights of their gay citizens, while US Secretary of State Hillary Clinton said in December that the Obama administration would Use its foreign policy to combat efforts abroad to criminalize homosexual conduct. Following Clinton’s speech, Malawi – which in 2011 arrested gay rights activist Gift Trapence – has said it will review its anti-homosexuality legislation.
Threats to generic ARVs – According to activists, the European Union (EU) in 2011 continued to push for tougher intellectual property rules in its negotiations with India over the terms of a free trade agreement. India – known as the ‘pharmacy of the developing world’ – produces the vast majority of the ARVs used in developing countries.
Swiss pharmaceutical giant Novartis is also back in the Indian courts, challenging patent laws aimed at preventing the extension of drug patents for minor changes in existing products, a practice known as “evergreening”. If Novartis is successful, India will be forced to grant more patents on drugs than they currently do, which will keep newer drugs out of reach of those who need them the most.
In March, UNAIDS released a policy brief to help countries make intellectual property rights work for them, amid growing concerns over access to Indian generics.
Contraception and HIV risk – Helping women avoid unwanted pregnancies is an important part of prevention of mother-to-child HIV transmission, so when a study conducted in seven African countries found that women who relied on hormonal shots – many African women use the contraceptive Depo-provera – to prevent pregnancy doubled their HIV risk, HIV programmers were left confused and disappointed. Published in The Lancet in October, the study also found that in women who were HIV-positive, using “the shot” doubled the chances that they transmitted HIV to their partners.
The UN High-Level Meeting on AIDS in June adopted a declaration to end mother-to-child transmission of HIV According to Jared Baeten, one of the study’s authors, previous studies have suggested that perhaps contraception can lead to microscopic thinning of the vaginal mucous membrane and changes to the genital tract, making it easier for HIV to establish itself.
UNAIDS has called for more research and analysis ahead of a January 2012 meeting when WHO will review various st udies as it prepares to revise recommendations on HIV and contraception use.
Medicines Patent Pool – In July, Gilead Sciences became the first pharmaceutical company to sign a licensing agreement with the Medicines Patent Pool. The patent pool was established in 2010 by the international health financing mechanism, UNITAID, and aims to stimulate innovation and improve access to HIV medicines through the negotiation of voluntary licences on medicine patents that enable generic competition and facilitate the development of new formulations.
The agreement allows for the production of several of Gilead’s HIV medicines, including tenofovir and emtricitabine, as well as two integrase inhibitors, which block retroviral replication, cobicistat and elvitegravir (both still in development), and combinations that include these medicines.
The US National Institutes of Health was the first patent holder to join the pool when it licensed the life-prolonging antiretroviral (ARV), darunavir, in October 2010.
New HIV targets – “Zero new infections, zero stigma and zero AIDS-related deaths” was the bold new goal set during the UN High-Level Meeting on AIDS in June.
The meeting concluded with the adoption of a declaration that seeks, by 2015, to double the number of people on ARVs to 15 million, end mother-to-child transmission of HIV, halve tuberculosis-related deaths in people living with HIV, and increase preventive measures for the “most vulnerable populations”.
The goal appeared within reach when in December US President Barack Obama pledged to provide HIV treatment to some six million people globally by 2013, an increase of two million on the previous target.