UNAIDS: The First 10 Years

UNAIDS The First 10 Years262 The challenges:the need for scientific and technological innovationThe development of antiretroviral treatment has been a major breakthrough buttreatment is not a cure, it is a life-long commitment and it will take decades to stopthe spread of HIV. Thus another major challenge is to achieve more scientific andtechnological breakthroughs – such as vaccines and unobtrusive technologies includingmicrobicides for women.Scientists have been searching for a vaccine against HIV since the early days of theepidemic and numerous vaccine candidates are in various stages of development acrossthe globe. But despite the dedication of many scientists and considerable funding, thereare complex scientific problems that hinder progress such as the variability of the virus indifferent parts of the world.With over 600 000 children contracting HIV infection each year, mostly throughmother-to-child transmission, access to affordable HIV treatment represents an urgentchallenge and global health priority; similarly, accurate diagnosis of HIV infection inchildren can be difficult and expensive in resource-limited settings. Procedures andformulations of antiretrovirals suitable for use in children remain rare and tend to bemore expensive and difficult to administer than adult regimens. To overcome theseobstacles, a new method for diagnosis has been developed (dried spot testing), which mayhelp to reduce the cost and facilitate HIV diagnosis in children. With regard to treatment,some manufacturers have piloted the production of mini-pills, which are particularlysuitable for young children. However, all new products need to be properly tested,prequalified and licensed for use, and this takes time.Recently, the scientific community has confirmed that an age-old practice can helpto reduce the risk of HIV transmission. Research evidence demonstrates that malecircumcision may help to protect against HIV infection by removing cells in the innerforeskin that serve as entry points for the virus. Three trials 31,32,33 have revealed anapproximate halving of risk of HIV infection in men who were circumcised. Althoughthese results demonstrate that male circumcision reduces the risk of men becominginfected with HIV, the UN agencies emphasize that it does not provide completeprotection against HIV infection. Male circumcision should never replace other knowneffective prevention methods and should always be considered as part of a comprehensiveprevention package, which includes correct and consistent use of male or femalecondoms, reduction in the number of sexual partners, delaying the onset of sexualrelations and HIV testing and counselling.31Bailey C, Moses S, Parker CB et al. (2007) ‘Male circumcision for HIV prevention in young men in Kisumu,Kenya: a randomized controlled trial’. The Lancet, 369: 643-56.32Gray H, Kigozi G, Serwadda D et al. (2007) ‘Male circumcision for HIV prevention in young men in Rakai,Uganda: a randomized trial’. The Lancet, 369:657-66.33Auvert B, Taljaard D, Lagarde E et al. (2005) ‘Randomized, controlled intervention trial of male circumcisionfor reduction of HIV infection risk: the ANRS 1265 Trial’. PLoS Medicine, 2(11):e298.