Breakthroughs Blog: HIV/AIDS

George Fistonich is a recent graduate of the University of Southern California with a Master of Public Health degree, and currently serves as a research and policy fellow at amfAR, The Foundation for AIDS Research. He wrote this guest post about a new amfAR analysis that details the human impact of possible federal budget cuts on global health programs. amfAR recently released a new analysis that outlines the potential effects of budget sequestration on global health programs, using updated figures to reflect recent and accurate estimates. As our analysis illustrates, cutting funding for global health programs—including those that support access to lifesaving HIV and AIDS, tuberculosis (TB), and malaria tools and programs that fund research for the next generation of global health products—would barely make a dent in reducing the US federal deficit. However, cuts to global health and health research programs would have a crippling impact on people around the world. “Sequestration” is a fiscal process by which automatic, indiscriminate, across-the-board cuts would be made to most budget line-items at a certain set percentage. This process was included as a provision in the Budget Control Act of 2011, which would trigger sequestration at the start of the 113th Congress in January, unless Congress is able to pass $1.2 trillion in deficit reductions by the end of this year. The Center on Budget and Policy Priorities estimates that sequestration would lead to an 8.4 percent reduction in funding for non-entitlement federal programs, including all global health and health research and development programs. Under the rules of sequestration, a total of $109.4 billion would be cut for fiscal year 2013, of which nearly $690 million would be taken from global health programs. This cut to global health represents a negligible 0.6 percent of the total deficit reductions for that year, but would lead to devastating human impact worldwide. Secretary of State Hillary Clinton and President Obama both set an ambitious goal last year by announcing the United States’ intent to create an AIDS-free generation. Sequestration would not only undermine this achievable goal, but would undermine the progress we have made so far in providing treatment and care for millions of people worldwide, restrict funding for groundbreaking AIDS research, and ultimately result in thousands of unnecessary deaths in the next year alone. amfAR’s analysis estimates that an 8.4 percent cut to bilateral funding through the President’s Emergency Plan for AIDS Relief (PEPFAR), the President’s Malaria Initiative (PMI), and TB programs would lead to the following in 2013: 273,000 fewer people receiving AIDS treatment. 62,000 more AIDS-related deaths. 122,500 more children becoming orphans. 111,000 fewer HIV-positive pregnant women receiving services to prevent mother-to-child transmission. 21,000 more infants being infected with HIV. 354,000 fewer children receiving food, education, and livelihood assistance. 2.2 million fewer insecticide-treated nets procured. 3.7 million fewer people receiving malaria treatment. 6,000 more malaria-related deaths. 65,000 fewer people receiving TB treatment. 8,000 more TB-related deaths. Sequestration would also lead to the following in 2013 alone due to cuts in multilateral investments: 1.2 million fewer pentavalent vaccines procured through the GAVI Alliance, leading to 13,000 child deaths due to diphtheria, tetanus, pertussis, Haemophilus influenza type B, and hepatitis B. 2.8 million fewer insecticide-treated nets procured; 7,500 more malaria deaths; 102,000 fewer people receiving TB treatment; 12,000 more TB deaths; and 114,000 fewer people receiving AIDS treatment through the Global Fund to Fight AIDS, Tuberculosis, and Malaria. Sequestration would not only limit access to currently available treatment and prevention tools, leading to an increase in HIV and AIDS, TB, malaria, and childhood deaths—it would also hinder research into new tools that are critically needed to fight these diseases. Cutting these programs would do nothing to reduce the federal deficit, and Congress must therefore work to prevent sequestration and protect funding for global health and research and development. Full text of the analysis, including methods for determining these estimates, can be found here.

Yesterday, the International AIDS Society (IAS) and the University of California-San Francisco released the Washington, DC Declaration ahead of this month’s XIX International AIDS Conference. The declaration aims to build support for efforts to end the HIV and AIDS pandemic, and lists nine priorities that are needed to achieve this goal. Accelerated research for new HIV and AIDS prevention and treatment tools is included among the priorities listed in the declaration as necessary to finally end the pandemic. Recent years have seen game-changing research results for new treatment and prevention products—from microbicides to vaccines to using treatment as prevention—that are leading many to believe that research is contributing to a watershed moment in HIV and AIDS. "We want to make sure we don't overpromise," Anthony Fauci—head of the National Institute of Allergy and Infectious Diseases—said in a recent Associated Press article. But, he added, "I think we are at a turning point." It seems that the conference organizers couldn’t agree more about the role of science and research in this metamorphosis in the pandemic. “In a scenario unthinkable just a few years ago, we now have the knowledge to begin to end AIDS in our lifetimes,” said Elly Katabira, president of IAS and international chair of AIDS 2012, when releasing the declaration. And as we recently noted, research is shaping up to be a central theme of the conference overall. Accelerated research for new HIV and AIDS prevention and treatment tools is included among the priorities listed in the Washington, DC Declaration as necessary to finally end the pandemic. Photo credit: PATH/Evelyn Hockstein At the same time that science is leading to hope that the end of HIV and AIDS is within reach, countries around the world are dealing with budget constraints and the effect of a global economic crisis. “Yet, at this moment of extraordinary scientific progress and potential, the global response to AIDS faces crippling financial challenges that threaten past success and future progress,” Katabira said. “Through this declaration, we stand together to call on world leaders across all sectors to provide increased resources, visionary leadership, and a full-fledged commitment to seize the opportunity before us.” It’s heartening that this year’s International AIDS Conference will be held in the United States for the first time in more than 20 years. When the conference last took place in the United States (in San Francisco in 1990), an HIV diagnosis was still equitable with a death sentence. But research soon led to life-saving antiretroviral drugs that, for many, have made HIV and AIDS a chronic and manageable condition. It’s almost overwhelming to think about what the next generation of HIV tools will bring. As Congress and other US policymakers continue the federal appropriations process and the country heads into a presidential election, we hope that US leaders listen to the 25,000 researchers, advocates, people living with HIV, and others attending the conference and calling for much-needed new ways to prevent and treat the disease.

In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week. A recent article in VOA News reveals that a research team at Monash University has discovered a viral protein that may be used to develop an alternative to antibiotics. In a recent study in Nature Genetics, researchers say they have unraveled the genetic codes of four parasite strains responsible for the bulk of malaria cases outside Africa. The findings could have implications for malaria vaccine research and development. The military’s Defense Advanced Research Projects Agency has announced a new program to speed the development of a tool that integrates 10 human “organs-on-a-chip” to study complex human physiology outside the body. The international development network site Devex provides a sneak peek at the plans for the International AIDS Conference scheduled for 2014 in Melbourne, Australia. Researchers and policymakers recently gathered in London to champion affordable, innovative solutions to the world’s biggest health issues, such as maternal health.The meeting stemmed from a new partnership between the Qatar Foundation and Imperial College London.

Dr. Bríd Devlin is the executive vice president of product development of the International Partnership for Microbicides (IPM), a GHTC member. In this guest post, she writes about a new study IPM launched last week that will look at a new HIV prevention option for women. Last week, IPM announced The Ring Study, a Phase III efficacy trial to determine whether a monthly antiretroviral (ARV)-containing vaginal ring can safely and effectively help prevent HIV infection in women. This product could provide women with discreet, long-acting, and easy-to-use protection. In my role, I oversee IPM’s drug development projects. After working on a variety of drug delivery technologies for over 18 years, I cannot overstate how excited I am about a ring for prevention of HIV—this could be a real game-changer. The ring is a platform technology that has been used successfully for other medical purposes for decades. IPM has adapted the ring to potentially stem the spread of HIV to women in sub-Saharan Africa, the epicenter of the epidemic and where our studies show high acceptability for such a product. While highly effective, current HIV prevention options often cannot be used by women who are disproportionately vulnerable to infection. The ring is a promising way to expand women’s prevention options on multiple levels. First, several studies have shown that the same types of ARV drugs that successfully treat HIV may also protect against infection before it has a chance to take hold. In addition, by offering women sustained, monthly protection, it could overcome the burden of adherence, which is crucial to achieving the protective benefit offered by ARV-based prevention. As Sarah Boseley of The Guardian wrote in her recent blog, it’s a tool that “women can wear and forget about—at least for a month at a time.” The ring is also female-initiated and discreet. This means women can control their own HIV prevention without having to rely on a male partner’s cooperation or action. IPM has announced The Ring Study, a Phase III efficacy trial to determine whether a monthly antiretroviral (ARV)-containing vaginal ring can safely and effectively help prevent HIV infection in women. Additional studies in the field are looking at other approaches to female-initiated prevention, such as gels used around the time of sex and daily pills. It is important for women to have a range of options so that they can choose a product that best meets their needs and preferences. This year, IPM celebrates its 10th anniversary and a decade of progress in helping to advance HIV prevention for women. We have not arrived at this milestone alone. Partnership is at the core of our business model and mission. By working with partners across the public and private sectors, we amplify our individual resources and scientific ingenuity to help meet the health needs of women everywhere. For instance, the National Institutes of Health-funded Microbicide Trials Network will begin a larger Phase III “sister” study of the ring called ASPIRE in the coming months. Given its promise as a delivery mechanism, IPM is adapting the ring to meet the unique needs of women. With funding from the US Agency for International Development, we are developing a dual-purpose prevention ring designed to provide both HIV protection and contraception in a single product. We are bringing together global leaders to talk about the urgent need for multipurpose prevention technologies at Advancing the Integration of HIV and Sexual and Reproductive Health, a satellite session IPM is cohosting with Women Deliver at the upcoming International AIDS Society (IAS) conference. In late July, thousands of HIV scientists, policymakers, and activists will descend on Washington, DC, for the IAS conference. The theme is “turning the tide together” and one topic that will be highlighted is promising developments in HIV prevention. IPM looks forward to the ring being part of that conversation.