International AIDS Society Newsletter, no. 16

lAS
INTERNATIONAL
MOCIETY
Meeting Report
The Microbicides 2000 Conference: World
Bank Makes Unprecedented Commitment
Mark A. Wainberg, PhD

The recent Microbicides 2000 Conference that
took place in Alexandria, VA, between March
13-16, was judged to be a great success by nearly everyone who attended. The meeting was the
first-ever state-of-the-art conference on HIV
microbicides that brought together basic, clinical, and social scientists in the field. The conference was over-subscribed and the number of
registrants (620), exceeded expectations.
Scientists working in HIV/AIDS have long
understood that a fundamental reason for the
continuing spread of HIV is the lack of empowerment of women. Simply put, too many
women around the world are unable to insist
that a male partner use a condom, even if they
know that he is likely to be HIV-infected. But,
as was pointed out at the meeting, there are also
compelling reasons why HIV-infected women
might also wish to avail themselves of a successful microbicide, once developed, and there is a
need for microbicides that protect against HIV
transmission through anal as well as vaginal
intercourse.
The opening ceremony included talks by Peter
Piot of UNAIDS who spoke about global issues
of women's health in relation to microbicide
development and by Neal Nathanson of the
Office of AIDS Research, NIH, who articulated
the need for more focused, high quality research in this area. Indeed, Dr. Nathanson stressed that NIH and other granting agencies
would soon prioritize microbicide research in
unprecedented fashion. Finally, Dr. Debrawerk
Zewdie of the World Bank announced that her
agency would work together with UNAIDS to
provide funds for the purchase and distribution

of a successful HIV-microbicide product, once
one is developed.
The latter announcement was considered to be
a key breakthrough, given the relative lack of
progress in the microbicide field since the start
of the HIV epidemic. However, the absence of
a proven, effective HIV microbicide probably
has more to do with with the relatively low level
of interest in this field by the pharmaceutical
industry, rather than by an absence of scientific
knowledge.
For example, compelling rationale now exists to
develop as microbicides several compounds
that block viral entry into cells, interfere with
reverse transcriptase, or block the activity of the
viral nucleocapsid protein. Yet, little practical
progress has been made on any of these fronts.
In part, this is because the major pharmaceutical companies have long understood that the
women who might benefit most from a microbicide might also be those least able to afford
one. And, without the support and expertise of
industry in regard to the cost of product development, the formulation and synthesis of
compounds to be tested, and clinical trial
design and management, the field is unlikely to
move forward at great speed. This is why the
announcement by the World Bank was so significant. Now, for the first time, pharmaceutical
companies can decide to allocate research funds
to this area, knowing that a huge market will, in
fact, await the outcome of a successful scientific
program.
The Conference also highlighted many of the
behavioral and social issues associated with

development of a successful microbicide, including the vital issue of consumer acceptance.
Interest was also keen in regard to compounds
such as nonoxynol-9 and their potential for
microbicide development, the use of hormonal
approaches to restrict the likelihood of HIV
infection, and the secretion by lactobacilli and
other organisms of short-chain antibodies that
might neutralize HIV in the vaginal tract.
Thanks for the Microbicides 2000 meeting are
due to many individuals pharmaceutical companies, and organizations; these names were
published in the conference literature. However, the office of AIDS Research, NIH, and its
Director, Dr. Neal Nathanson, should be singled
out for having provided major support, including the underwriting of a generous scholarship program that enabled the attendance of
many delegates from developing countries.
Within OAR, Dr. Victoria Cargill worked tirelessly on organizational matters relating to the
conference and was ably assisted in this capacity by Drs. Judith Auerbach and Robert Eisinger. Mention should also be made of the leadership role of Ann Borlo of Social and Scientific Systems, that provided logistic support.
Without them, this Conference could not have
happened.
There was clear consensus at the end of the
meeting that this effort should be repeated
approximately every two years, and that the
next meeting should be scheduled for the
spring of 2002. Further details on this matter
will be provided in future issues of the IAS
Newsletter and elsewhere.

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