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Excerpt
Some of the most important opportunities to emerge are political opportunities, because the best tools and interventions that scientists can develop are only meaningful if the political will exists to use them. In the last 12 months, more civil leaders and heads of states in Asia, Africa and elsewhere have recognized the risk AIDS poses to their country's development and have made commitments to tackling the epidemic. In addition, an unprecedented level of international resolve and collaboration has risen to address the AIDS epidemic. In January of this year, the United Nations (UN) Security Council discussed AIDS, making it the first health and development issue ever recognized as a priority by this body. Also, the UN recently established the International Partnership Against AIDS in Africa. Constituencies who have never worked together towards a common goal with a set of common principles and values have now united to stop this epidemic.
The attention given AIDS by these leaders and their governments has led to a second important set of opportunities: increased resources. Within the past year, resources devoted to HIV prevention and care in developing countries have doubled and tripled. While these increases are due in part to efforts by international organizations, such as the World Bank and UNICEF, many of the most affected countries have raised their commitment to preventing HIV infection and caring for those suffering from the disease.
The emerging political and resource opportunities are all the more significant given the programmatic opportunities that now exist. Scientific studies have shown that there are prevention and education measures that can reduce HIV transmission, even on a large scale and in low-income countries. With well over 16,000 new HIV infections worldwide every day and more than 30 million people now living with HIV, it is vital that proven measures for preventing and treating HIV infection and AIDS be applied. Improved access to services and to commodities that already exist could have an enormous impact in limiting the global AIDS epidemic and the suffering it causes.
While progress has been made in developing HIV vaccine candidates, there is a need for alternative and more near-term approaches to preventing HIV infection, such as microbicides. The case for microbicides is particularly compelling, given the large and growing number of women being infected through heterosexual transmission, which is the major mode of HIV transmission worldwide. In Africa, for example, there are 20 percent more women than men living with HIV infection. Though female condoms are increasingly popular, an effective microbicide that females could control would have the potential to greatly reduce HIV transmission.
Microbicide research and development have made great strides in the last five years. In 1994, there were just a dozen compounds in the preclinical stage of development, only eight ready for safety trials in humans, and only one had been evaluated in an efficacy trial, which produced unsatisfactory results. Today, there are at least 36 compounds in preclinical development, 20 ready for human safety studies, and 4 in or moving into large-scale efficacy trials. The vast knowledge acquired from research to understand HIV and develop drugs and vaccines is advancing the basic sciences of microbicides research and accelerating the development of new microbicides. Second and third generation products can be anticipated, and beyond new spermicides, there likely will be new adhesion inhibitors and antiretroviral products.
