Abstracts Vol. 1 [International Conference on AIDS (11th: 1996: Vancouver, Canada)]

Tuesday, July 9, 1996

Plenary Abstracts

Tu.06
EMPOWERMENT, COMMUNITY MOBILIZATION AND SOCIAL CHANGE IN THE
FACE OF HIV/AIDS
Parker, Richard G. Institute of Social Medicine, State University of Rio de Janeiro, Maracana,
Rio de Janeiro, Brazil
Summary: Based on recent social and behavioral research, together with r re thian a
decade of practical experience in countries around the world, an important shift has begun
to take place in models or paradigms that have been developed to understrand and
respond to the HIV/AIDS epidemic. A growing awareness of the cciplex social, cultural,
political and economic forces shaping the epidemic -and, in particular, of the link between
social injustice and increased vulnerability to HIV infection has led to the reformulation of
both theory and practice aimed at responding to AIDS and at meeting the needs of those
most affected by the epidemic. The focus of HIV/AIDS prevention efforts has increasingly
shifted from models aimed at changes in individual risk behavior to models aimed at community mobilization. An earlier emphasis on information-based educational campaigns has
given way to intervention programs aimed at enablement and empowerment in the face of
the epidemic. These developments have been linked to a new awareness of the fundamental connection between public health and human rights. and to a new understanding of
the fight against AIDS as part of a much broader process of social change aimed at redressing structures of inequality intolerance and injustice.
RG Parker, 20559-900 Rio de Janeiro, RJ Brazil Tel: 55-21I-248-0599 Fax: [phone]
E-mail: [email protected]
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PERINATAL TRANSMISSION: ASSOCIATED FACTORS AND
THERAPEUTIC APPROACHES
Bryson.Yvonne 1. Dept. of Pediatrics, UCLA Children's Hospital, Los Angeles, CA, USA
Summary: There have been major advances in the understanding and prevention of maternal fetal HIV- I transmission and in factors associated with rapid or slow progression in
infected infants. Without intervention the majority of pediatric HIV infection is acquired
from the mother either in-utero, at the time of birth, or postpartum by breast-feeding; with
transmission rates varying fi-om 13% to 40% with an average of 25% in most USA cohorts.
ZDV given to the mother during pregnancy and delivery and to the newblorn for six weeks
reduced transmission by 2/3 or < 8%. This has changed the standard of care in the US and
elsewhere and propagated recommendations for voluntary offering of HIV testing to all
pregnant women. The mechanism of protection of ZDV may be reduction of maternal
virus load and/or prophylaxis of the infant. Several studies have shown that high maternal
virus load as measured by quantitative RNA PCR is a critical risk factor associated with
transmission. Although women are more likely to transmit at high virus load, transmission
can also occur at low virus load suggesting more than one mechanis M haxiinur lowering
of maternal virus load could provide goals for targeted intervention as a model of transmission. ZDV can reduce virus load an average of 3-6 fold in drug naive women and has a
protective effect at any maternal virus load suggesting that both reduction of virus load
prior to delivery and prophylaxis of th e fetus/infant are important. Thee i s also data to
suggest that neutralizing antibody virus phenotype, and obstetrical events such as prolonged
ruptured membranes (4 hrs) and infant exposure to blood and secretions are also critical
factors. Current goals include reduction of HIV transmission to <2%. Intervention studies
are directed at both further reduction of maternal virus load and providing prophylaxis to
the newborn including the use of potent combinations of antiretrovirals, passive antibody,
and vaccines given to the mother and/or newborn infant. International studies are addressing the efficacy of shortened courses of ZDV treatment alone and in combination with
other antivirals and the individual components. The timing of transmission (ir utero and
intrapartum), the extent of early virus replication, the transmitted vir us phenotype and the
infant's immune response all seem to be important in determining the onset and course of
disease progression in the HIV infected infants. The challenge of the futur, will ie to translate the science of prevention of transmission to practical worldwide application.
YJ Bryson, Rm. 22-442 MDCC, 10833 Le Conte Ave., Los Angeles, CA 90095 USA
TI: 310-825--5235 Fax:: [phone] E-mail:: [email protected]

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FEMALE-CONTROLLED METHODS TO PREVENT SEXUAL TRANSMISSION OF HIV
Elias, Chrstopher. The Population Council, USA
Women throughout the world face a growing risk of infection with HIV. Consistent condom use, one cornerstone of primary prevention strategy, is not always feasible for many
women. Consequently women urgently need infection prevention technology that is within
their personal control. This session will review current efforts to develop and test femalecontrolled methods for preventing sexual transmission of HIV and other sexually transmitted pathogens. Both physical and chemical methods will be summarized, including recent
findings concerning the efficacy and acceptability of the vaginal pouch (female condom), as
well as an overview of research on vaginal microbicides. Data from studies of existing overthe-counter spermicides will be reviewed. The wide range of novel microbicidal products
currently being evaluated in the laboratory and early clinical trials demonstrates the breadth
of possibilities presented by chemical barrier methods. Yet formidable challenges face public
and private sector research and development efforts, and these will be outlined. The session will conclude by highlighting several issues related to the clinical evaluation and introduction of female-controlled prevention technology
C Elias, PO. Box I 2 13, Nana Post Office, Bangkok, 101 2 Thailand Tel: 66-2-25 I-4766
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HIVVACCINES: RESOLVED THAT MORE FUNDAMENTAL RESEARCH ON VACCINE
DEVELOPMENT IS REQUIRED PRIOR TO THE IMPLEMENTATION OF PHASE III
TRIALS OF CERTAIN HIV VACCINES
Moore, John P. Aaron Diamond AIDS Research Center, New York, NY USA
Society desperately needs a vaccine to slow HIV-- I spread. New drug therapies may help
richer nations, but are unaffordable to most of the world. A vaccine and increased educational interventions provide the only hope for much of Africa, Asia and South America. But
how is Western science best able to develop a vaccine? I believe candidate vaccines that
are available for efficacy trials in 1996 lack the power to intervene significantly in the AIDS
epidemic. Focussing resources on these products will not be helpful, and may actually be
counter-productive. Instead, we need to set vaccine development on a sound intellectual
and practical footing to ensure the long-term success of our endeavors. New products
must be designed and evaluated with the needs of the developing world in mind. For too
long, corporate and social pressures have pushed national vaccine programs towards efficacy trials, but judgement can often be used to assess the worth of a vaccine candidate, even
without the formal proof that an efficacy trial provides. Phase II clinical trials in humans and
tests of related concepts in animals provide evidence that can be used to form such judgements. The error part of"trial-and-error" needs to acknowledged more often than it is.
JP Moore, 455 First Avenue, 7th Floor, New York, NY I10016 USA
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HIV VACCINES: RESOLVED THAT MORE FUNDAMENTAL RESEARCH ON VACCINE
DEVELOPMENT IS REQUIRED PRIOR TO THE IMPLEMENTATION OF PHASE III
TRIALS OF HIV VACCINES
Mbidde, Edward. Uganda Cancer-Institute, Kampala, Uganda
By theY R 2000 approximately 40M people would have been HIV-infected with 90% of
them from developing countries despite the availability and use of what are considered to
be effective interventions against HIV/AIDS. These projections raise two important questions: I) why are current interventions not so effective in those societies severely affected
by the epidemic? 2) shouldn't efficacy trials of HIV preventive vaccines be accelerated for
the benefit of those societies? Ignorance, illiteracy, customs, attitudes and lack of both
huma ni and financial resources worsened by the HIV/AIDS epidemic are the major factors
responsible for the limited success observed. Subunit and live vector based HIV vaccines
have been shown in man to be safe and immunogenic but protective in animals. Given the
differences between man and other animals regarding the pathogenesis of HIV, is it not
appropriate that we learn more about these vaccines in the species for which they are
developed? Even low efficacy HIV vaccines could have tremendous positive impact in those
areas that are worst hit if used alongside known effective interventions. History clearly
documents the utility of an empiric approach in vaccine R&D. Why are we so timid in using
this approach against this "plague" of the 20th century? By using intermediate size efficacy
trials we car quickly get information that could be used in re-directing R&D in HIV vaccines
thus bringing us yet closer to our goal of HIV preventive vaccines.
E Mbidde, P.O. Box 3935, Kampala, Uganda Tel: [phone] Fax: 256-4 I -532-282
E-mail: [email protected]

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