AIDS Research at the NIH: A Critical Review

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conduct the program: San Diego; UCLA; Seattle; and Miami. Each program is at a NIAID-funded AIDS
Clinical Trials Unit (ACTU) site.
The International Training in Epidemiology Related to AIDS Program. program is designed to increase
foreign scientists' expertise in epidemiological research related to AIDS and its use in clinical trials and
prevention research. Ten participating US institutions train scholars from a wide array of countries,
including Zaire, Cote d'Ivoire, Caribbean lands, Brazil, China, Philippines, Singapore, Thailand, Taiwan,
Mexico, ex-USSR, Columbia, Haiti, Argentina, Uganda, Mozambique, Senegal, Dominican Republic and
Zimbabwe.
Future plans. The FIC wanted to expand both the International Training in Epidemiology Related to AIDS
and, the International Postdoctoral Research and Training in AIDS programs for FY 1993
by adding new sites and increasing funding for current sites with $2.5M in new funds. Of course, the FIC
received little more for FY 1993 in the President's budget than it was allotted for FY 1992.
Recommendations:
* The AIDS International Training and Research Program should be expanded to provide more
extensive training of foreign clinicians and health professionals in diagnosis and treatment of AIDSrelated conditions so they can bring better clinical care to the affected populations in their home
countries.
* One of the most apt criticisms of an otherwise praiseworthy program is embedded in one of the
grant applications which are part of the FIC's "Third Year Progress Report":
"The majority of the research projects initiated by our trainees in their host countries include
serosurveillance, evaluation and behavioral interventions. Training in anti-retroviral drugs and
vaccine trials, e.g. immuno-modulatory vaccines [post-infection therapeutic vaccines], have been
taught for largely philosophical purposes as most of the countries of Central America and
Caribbean have few resources for such products and must find other ways to manage the HIV-1
disease in infected individuals. Our trainees from Mexico, Argentina, and Costa Rica are now
developing a protocol to emphasize those interventions likely to be available to HIV-1 infected
individuals in Central and Latin America, e.g., affordable prophylaxis for opportunistic infections
(bactrim, dapsone, INH), nutrition intervention, exercise. psvchosocial support, etc." [emphasis
added]
* Sophisticated and technologically-driven basic scientific training of scientists and health
professionals from poorer countries may not be the most practical use of the program's resources.
While it is fine for the AITRP to help build scientific infrastructure in the developing world, FIC
should also stress training in disciplines most likely to be of use in combatting the AIDS epidemic
in countries with limited resources.
* The program should re-emphasize its commitment to developing nations.
* The new FIC emphasis on building an infrastructure for trials of preventive HIV vaccines, and the
lack of additional funding to support this work, means that the FIC will be forced to defund other
vital areas of the AITRP. The AITRP should remain a training program in epidemiology and basic
and clinical biomedical research. It should not become a vaccine development program unless
extra money is specifically allocated for that purpose. This is one of the more obscene choices
forced upon NIH by the Executive branch and Congress. While breathing down the neck of the NIH
to hurry along the vaccine effort, they provide no extra money for the endeavor.

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