[Press kit]

A graduate of Boston University School
of Law, David Gold became involved D avi
Lwith the AIDS epidemic in 1985, volunteering as a lawyer with Gay Men's Health AIDS Treatn
Crisis (GMHC) of New York and soon working with them as the Director of Medical In- Foundi lM
formation and Editor of Treatment Issues. He
has also been a member of the Treatment and Speaks out
Data Committee of ACT UP. "While working
in treatment advocacy and information, I was an IP
disturbed at how little attention was really
being focused on the area of AIDS vaccine research and development," said Mr. Gold. "Aln activist friend of min
In 1992, when the New York Blood Cen- talking to some 1lIV-infec
ter engaged in preliminary preparations for they were talking about
HIV vaccine trials, they came to GMHC. As a heart-breaking because
result, eight local community organizations got knowledgeable about tht
together to review the issues, and out of that which companies were d
came a paper, which was edited by Mr. Gold, the side effects were, yet
on some of the questions currently raised by them could obtain any o
vaccine trials. "That was really the first time lion HIV-positive people
that any community effort had taken place in them in countries where
this area," said David, "but it was still not tmynbeo$30rpe yere
enough. There was no sustained effort in this able to afford $15,000 per
regard between 1992 and 1996." and diagnostic tests is sil
In 1996, David became a founding member of the AIDS Vaccine Advocacy Coalition "Certain populations of po
(AVAC), the first community-based AIDS or- combination antiretrovir
ganization focusing on the need for an anti- extend their survival. Tb
HIV protective vaccine, or "AIDS vaccine." In 90% of the world's popul
that same year, the International AIDS Vaccine portunities to use any of
Initiative (IAVI) was incorporated [see end of never be able to stop this
article]. David currently works as the Editor we have now, given what
of the IAVI Report, a quarterly newsletter with delivery systems, means
a global orientation that focuses on AIDS vac- epidemic is with a vaccin
cine research and development. The only pub- hopefully one that we ca
lication of its kind, the IAVI Report is distrib- world."
uted to subscribers in 92 countries.--Activist D
AmFAR recently spoke with David Gold
and asked him the following questions:
1. Why do we need an HIV vaccine?
The need for an AIDS vaccine is an international issue. In a country like
Uganda, for example, if you take a hundred women and follow them for a year,
seven of them will become newly infected during that year. That equals a rate
of new infections of 7% per year. If you look at India, up until a couple of years
ago, almost none of the commercial sex workers (the population in which you
can assess the severity of an epidemic due to a sexually transmitted infection)
were infected with HIV Now, in some parts of India, up to 50% of the commercial sex workers are HIV-infected and it's estimated that India has anywhere
from 2 to 5 million HIV-infected individuals in the whole country. By the year
2000, India may have a total number of cases of HIV infection larger than all of
sub-Saharan Africa. So you have huge numbers of new HIV infections occurring in much of the world. This is particularly so in developing nations such as
India, China, Cambodia, and Viet Nam. That speaks to one of the reasons why

we need a protective vaccine.
But even here in the United States, there are, each year, significant numbers
of new infections. A major epidemic is occurring in a number of communities,
including the Latino and African-American communities, and among gay men.
I personally have stopped counting friends who have become newly infected
within the last few years.
Everything that I read and hear tells me that we can make significant progress
in reducing the number of new infections, but, by and large, because HIV disease is a sexually-transmitted infection, it will ultimately be impossible to stop
this epidemic without a protective vaccine.
2. Why is the timing right for developing a protective vaccine?
We've made progress in developing therapies that help people with HIV
and AIDS, so we're at a point, now, where we have established a base of scientific accomplishments in this area. Yet, paradoxically, these accomplishments
are pointing out the horrible inequalities in the healthcare system, not only in
the world, but also here in the United States. And, as effective as some of the
educational prevention campaigns have been, they will never stop the epidemic,
neither in the developing world, nor in the United States. We may as well face
up to it: "harm reduction" strategies are not "AIDS prevention" or "HIV prevention" because we cannot prevent all new infections. A vaccine will be the
only way to stop the epidemic from spreading.
One psychologist in the gay community pointed out that sometimes we
flippantly assume that no one's going to get infected anymore because all we
have to do is use a condom for the rest of our lives. Well, imagine if we said to
every married couple in the United States, "No big deal: just use a condom
every time you have sex for the rest of your life." It certainly might make sense,
but it's not so easy. We can tell that by the number of unplanned pregnancies
there are. We don't want to accept the fact that, until we have a
vaccine, it is very likely that we will have a sustained HIV epidemic in the United
States.
So even with advances in treatment, the only way to truly stop this epidemic is with a vaccine. I think we're also making greater progress in general in
understanding the pathogenesis of HIV disease and that, I think, gives us more
hope that a vaccine is possible.
As those who support AmFAR know, it's important to focus resources where
we think we can make a difference. For me, there are three key areas of the
epidemic where we need to focus these limited resources: (1) helping those
people who are infected stay alive and lead healthy lives; (2) finding a cure; and
(3) prevention.

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Preventing new infections is critical. One
G olway is obviously behavior modification. The
a d other way, the one that seems to be the most
it Activist an efficient and the one we've used to eliminate many other diseases, such as polio, small
tuber of AVAC, pox, and now, hopefully, Hepatitis B, is a vacthe need f r cine. So, it seems logical that we should be
1 t e need for'spending more money on AIDS vaccine
research and development. Total spending
vacc ie in this area was estimated two years ago to
have been less than $135 million worldwide,
private and public. You could argue that,ho recently visited India was perhaps general AIDS research may have impeople there. He told me that plications for a vaccine, but basically, for
)tease inhibitors, and it was research and development specifically tarpeople were extraordinarily geted to an HIV vaccine, that's all we're
fferent products. They knew spending. When you consider that the mak[oping which drugs and what ing of the new movie, Titanic, reportedly cost
re was no chance that any of $280 million, it really gives you an idea of
ese drugs. 'And, with 30 mil- our priorities as a society.
oughout the world, many of
per capita healthcare budget 3. What scientific breakthroughs give
he idea that we're going to be us promise that a vaccine can be:ient per year worth of therapy developed?
First, I should point out that AmFAR has
provided critical support for the AIDS Vacts benefit tremendously from cine Advocacy Coalition. In December 1996,
ierapy. People with AIDS can we issued our report, Industry Investment
clear from the studies. Over in AIDS Vaccine Development, which was
3n, however, will have no op- really the first comprehensive look at the
se drugs. The fact that we will reasons why the pharmaceutical and biolemic using the therapies that technology companies were not investing in
ey cost and unfair healthcare AIDS vaccine research and development. We
[ the only way to stop the HIV looked at the entire area, interviewing scind hopefully also a cure, and entists and leaders of over thirty different.ford to distribute around the companies. These companies were either
currently in the business of developing an
f Gold, Editor of the IAVI Report AIDS vaccine or had been at one time. We
asked what was missing, i.e., why were they
not in the business of developing an AIDS
vaccine, or why they thought other companies were not. Clearly, there were some very important findings. It was acknowledged that the science of HIV vaccine research is difficult, that it wasn't an easy
game, and that really spoke to the need for funding the type of projects that AmFAR
has supported in terms of basic research. There is also a need to create a better
scientific environment so that companies know how to proceed in developing an
AIDS vaccine. So we put this report together, and AmFAR helped fund that report.
Industry Investment contained several key overall recommendations, one of
which was that the President declare making the development of an AIDS vaccine
by the year 2007 a national priority. We considered it extraordinary that, fourteen
years into the epidemic, no one had even bothered to look at the reasons why
AIDS vaccine research was floundering so badly. The President did make such an
announcement and we were pleased to have such an impact.
As for scientific difficulties, we don't know exactly what type of immune.
reaction a vaccine should induce: Do we want antibodies? Or do we want cell
mediated immunity, known as a cytotoxic T lymphocyte, or CTL, response? We're
still not sure. We probably need both.
Also, we don't have a perfect animal model. Monkeys get AIDS through SIV,
which is similar to HIV, but it's not exactly the same. Chimpanzees can get
infected with HIV, but get sick from it only after a long period of time. And both
of those animals are expensive; chimps are extraordinarily expensive. So a good
animal model is lacking.
On the other hand, there have been some breakthroughs. We know that certain people are genetically resistant to HIV, which became known through some of
the chemokine research. The genetic mutations, the homozygote mutation that
some people have, seems to protect them from at least certain strains of HIV
There are also some HIV-positive individuals who have had perfectly intact
immune systems for a very long time. There may be some defect in the strain of
virus they carry that protects them. How do we take that information and
develop a vaccine perhaps that mimics that type of protection?
A group of Australians who were recipients of a common HIV-positive blood
donor appear to have remained well for a very long time. Their virus had mutations in the same key gene as that used, also in a mutated form, by Dr. Ron Desrosiers
of Harvard to vaccinate monkeys against SIV That was very exciting, seeing that
coincidence in nature and in the lab. But we now know that some of the monkeys
have developed simian AIDS from the vaccines. Nevertheless, one group has proposed the initiation of a pilot study of a live attenuated HIV vaccine in human
volunteers. However, many researchers believe that such a trial would pose far
too great a risk to participants at this time.
One way to learn more about the safety of live attenuated vaccines would be
to conduct very large and long-term animal studies of attenuated vaccines, i.e.,
studies of the kind being proposed for humans. We should also study why the
attenuated virus is protective, at least for a certain time. And, of course, we need
to study the immune response to HIV in people who are long-term nonprogressors.
Overall, there are reasons for promise, particularly with our better understanding of the pathogenesis of HIV disease. With a well-focused, well-funded and
well-conceived effort, we can have a shot at developing an effective HIV vaccine.
The International AIDS Vaccine Initiative (IAVI) was launched with the support of the
Rockefeller Foundation, the Sloan Foundation, the World Bank, the United Nations Joint
Programme on AIDS (UNAIDS), and the "Until There's a Cure" Foundation. It was established
after a series of international conferences, convened by the Rockefeller Foundation, concluded
that, given the scope of the worldwide epidemic, very little resources were being targeted to
AIDS vaccine research and development. IAVI was established as a vehicle for channeling
funds into this area and also to provide advocacy on a global level for the development of a
new vaccine.