The personal values and moral judgments of healthcare providers are likely to interfere with the appropriate provision of HIV pre-exposure prophylaxis (PrEP), Sarah Calabrese of Yale University reported at the HIV Research for Prevention conference (HIVR4P 2016) in Chicago last week. This was one of several presentations which highlighted inequalities in access to PrEP in the U.S. In a plenary talk, Noël Gordon of the Human Rights Campaign reminded delegates that white people make up 27% of new HIV diagnoses but 74% of PrEP users. There are also inequalities in terms of age and gender.
Knowledge about and use of HIV pre-exposure prophylaxis (PrEP) has greatly increased over the past few years in San Francisco, and surveillance estimates suggest that some12,500 people are now on PrEP, according to a presentation at the HIV Research for Prevention conference (HIVR4P 2016) last week in Chicago.
Rectal microbicides that protect against HIV transmission via anal sex are a bigger technical challenge than vaginal ones. The rectal lining is more delicate than the vaginal lining, so safety has been an issue; research has shown that many of the gel formulations used in lubricants damage rectal cells and may actually enhance HIV transmission.
The HIV vaccine research field is currently going through probably its most fertile and diverse period yet. A high proportion of presentations at the second HIV Research for Prevention conference (HIVR4P 2016) in Chicago last week were devoted to a multiplicity of different approaches scientists are taking towards making an effective vaccine.
At the opening plenary, Georgia Tomaras of Duke University gave an overview of the field. It has been a long journey towards developing vaccines with even partial efficacy: the first trial of any kind was in 1987 and the first large efficacy trial -- which failed -- was in 2003. But the RV144 vaccine -- which in 2009 showed limited efficacy, reducing HIV infections among recipients by 31% (and 60% a year after its first dose) -- injected new energy into the field, not least because its effect seemed due to an unexpected kind of anti-HIV response.
At the International AIDS Conference (AIDS 2016) held in Durban in July researchers reported that a pilot study, HVTN100, of an RV144-type vaccine adapted to the strain predominant in South Africa it produced a stronger response than the original RV144 vaccine. This meant it had passed the criteria for being advanced to a large efficacy trial, HVTN 702. This will start next month -- the first HIV vaccine efficacy trial for 7 years, since HVTN 505 started in July 2009.