IAVI Report Vo. 5, no. 2

VACCNEBRE
1 t 1 1Ae r 'M i s, ~i

Uganda Canarypox Trial Completes Immunizations
Scientists from the Joint Clinical Research Centre in Uganda
reported that they have completed all immunizations of the
first HIV vaccine tested in Africa, the canarypox-based
vDP205, Each of the 40 volunteers in this Phase I trial
received four injections and will continue to be observed
for at least one year after the last injection.
"Worst Epidemic Ever" in Central America
"The HIV epidemic in Northern Honduras could approach
the catastrophe of sub-Saharan Africa," according to Carlos
Lopez, executive director of Fraternidad San Pedrana le
Lucha Contra el SIDA, Honduras' largest private AIDS
organization. Lopez estimates that 520,000 Hondurans are
now infected with HIV and that "HIV infection in the city
of San Pedro Sula alone could be as high as 240,000 - nearly
half the residents. I believe that this is the worst health
epidemic in the history of Central America," he added.
Still, doctors and officials disagree on the extent of the
epidemic, as the government did not begin to track cases
until this year. According to estimates by the Health
Ministry's AIDS program, about 40,000 Hondurans are HIVpositive.
Thailand VaxGen Trial 80% Enrolled
Researchers at VaxGen report that their Phase III HIV
vaccine trial in Thailand has enrolled more than 2,118 of
the 2,500 volunteers needed for the study. The candidate
vaccine is based on gp120 from the B and E subtypes of
HIV. It is also being tested on 5,000 volunteers in North
America and Europe.
In March, Thai Public Health Minister Korn Dabbaransi
reported that the number of HIV infections in that country
was expected to reach one million by the end of 2000.
Thailand began trials of candidate HIV vaccines in 1993 and
to date, 10 different trials have been approved in the
country.
Paying People to Get Vaccinated: One Strategy for
Reaching the "Difficult-to-Access"
As more attention is focusing on how to deliver an HIV
vaccine once it is developed, some researchers are looking
to existing vaccines for lessons. Public health officials have
long known that distributing a vaccine to high-risk adults,
even in wealthy industrialized countries, poses significant
challenges. In a paper published in the American Journal
of Public Health (March 2000), researchers from the
Intravenous Drug User Project in Anchorage, Alaska,
describe how they successfully vaccinated high-risk,
difficult-to-access groups like injection drug users (IDUs)

against hepatitis B. The researchers recruited IDUs from the
streets and referred them to vaccination centers, but only
7% of 140 users received the first hepatitis B shot.
However, when a financial incentive (US$10) was offered
for proof of vaccination, 48% of 172 users got vaccinated.
New Report on Epidemic in South Africa
More than 3.5 million people in South Africa are infected
with HIV and this number is expected to more than double
over the next decade, according to a newly-released report
commissioned by loveLife, a South African program
dedicated to adolescent sexual change behavior, and funded
by the Kaiser Family Foundation.
"The Impending Catastrophe: A Resource Book on the
Emerging HIV/AIDS Epidemic in South Africa" warns that
the country's 15-25 year olds are "the most severely
affected," with infection rates as high as 60%. It also offers
detailed analysis and data on the disease's impact on South
Africa's health, economic and social systems. The report
was prepared by Abt Associates South Africa Inc.
The executive summary and full report are available
online at the Kaiser Family Foundation website
(www.kff.org) and the loveLife website
(www.lovelife.org.za).
UNAIDS Releases Ethical Guidelines
In May 2000, UNAIDS released a guidance document,
"Ethical Considerations in HIV Preventive Vaccine
Research". The report specifically addresses issues arising
in developing countries, where many future vaccine trials
are expected to take place. Peter Piot, executive director of
UNAIDS (and a member of IAVI's Board of Directors) said,
"In the long term, a vaccine may offer the best hope of
controlling the AIDS epidemic, especially in developing
countries. It is our collective responsibility to ensure that
all vaccine trials are conducted under the strictest possible
ethical and scientific standards."
The document took more than two years to develop and
is based on a series of consultations organized by UNAIDS
with representatives from 33 countries (see IAVI Report,
April-June 1999). The most contentious issue concerned the
level of treatment that should be offered to participants who
become infected with HIV during the course of the trial.
According to the UNAIDS document, "Care and treatment
should be provided, with the ideal being to provide the best
proven therapy, and the minimum to provide the highest
level of care attainable in the host country."
The full report is available at the UNAIDS website
(www.unaids.org).