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HIV / AIDS
A brief overview and potential insights for adolescent and adult vaccination in LICs/MICs

Arne Näveke, PhD

Ex...
What is HIV / AIDS?
Milestones
2009

RV 144 trial
results released

1998

First full-scale, Phase
II HIV vaccine trial
beg...
What is HIV / AIDS?
Demographics of the AIDS Pandemic, 2011
Number of People Living with HIV
Adults (ages 15+)

30.7 milli...
What is HIV / AIDS?
Geographics of the AIDS Pandemic, 2011

Source: UNAIDS. AIDSinfo. 2012. http://www.unaids.org/en/dataa...
What is HIV / AIDS?
Adult Women Living with HIV, 1991

Source: UNAIDS. AIDSinfo. 2012. http://www.unaids.org/en/dataanalys...
What is HIV / AIDS?
Adult Women Living with HIV, 2011

Source: UNAIDS. AIDSinfo. 2012. http://www.unaids.org/en/dataanalys...
What is HIV / AIDS?
HIV Prevalence Among Sex Workers

Serbia
Lat via
Belarus
Ukraine
Romania
Bulgaria

Spain

0.4

Morocco...
What is HIV / AIDS?
HIV Prevalence Among Men Who Have Sex with Men

Serbia
Lat via
Belarus
Ukraine
Romania
Bulgaria

Spain...
What is HIV / AIDS?
HIV Prevalence Among Injectable Drug Users

Serbia
Lat via
Belarus
Ukraine
Romania
Bulgaria

Spain

Ar...
Treatment & Prevention
Combining Complementary Options
Manage
Current
Infections

 Antiretroviral
Therapies
 Novel Treat...
How Do We Get To A Vaccine?
The Global Preventive HIV Vaccines Portfolio

Source: AVAC. April 2013 update on vaccine pipel...
How Do We Get To A Vaccine?
Countries Presently Conducting HIV Vaccine Trials

United Kingdom

Germany
Switzerland

France...
How Do We Get To A Vaccine?
The Scientific And Political Complexity of AIDS Vaccine R&D
CHALLENGE

Scientific
Challenges

...
How Do We Get There?
The Societal Complexity of AIDS Vaccine R&D And Current Options

• Ethical developed-developing world...
Imagine a world
without AIDS
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  1. 1. HIV / AIDS A brief overview and potential insights for adolescent and adult vaccination in LICs/MICs Arne Näveke, PhD Executive Director – Advocacy, Policy & Communications Planning for Adult Vaccination in Middle and Low Income Countries: HIV, TB, and Malaria Workshop Rockville, Maryland 9 September 2013
  2. 2. What is HIV / AIDS? Milestones 2009 RV 144 trial results released 1998 First full-scale, Phase II HIV vaccine trial begins in U.S. 2011 34 million people living with HIV 2005 32 million people living with HIV 1990 7.5 million people living with HIV 1996 •IAVI is established •Introduction of antiretroviral therapy •20 million people living with HIV 1981 First cases of AIDS 1992 In the U.S., AIDS becomes the leading cause of death for men between the ages of 24 and 44 1983 HIV discovered as the causal agent of AIDS
  3. 3. What is HIV / AIDS? Demographics of the AIDS Pandemic, 2011 Number of People Living with HIV Adults (ages 15+) 30.7 million Women 16.7 million Children (ages 0-14) 3.3 million TOTAL 34.0 million People Newly Infected with HIV Adults (ages 15+) 2.2 million Children (ages 0-14) 330,000 TOTAL 2.5 million AIDS Deaths Adults (ages 15+) Children (ages 0-14) TOTAL Source: UNAIDS. 2012 UNAIDS Report on the Global AIDS Epidemic. 2012. http://www.unaids.org/en/media/unaids/contentassets/documents/epidemiology/2012/gr2012/20121120_UNAIDS_Global_Report_2012_with_annexes_en.pdf. 1.5 million 230,000 1.7 million
  4. 4. What is HIV / AIDS? Geographics of the AIDS Pandemic, 2011 Source: UNAIDS. AIDSinfo. 2012. http://www.unaids.org/en/dataanalysis/datatools/aidsinfo/.
  5. 5. What is HIV / AIDS? Adult Women Living with HIV, 1991 Source: UNAIDS. AIDSinfo. 2012. http://www.unaids.org/en/dataanalysis/datatools/aidsinfo/.
  6. 6. What is HIV / AIDS? Adult Women Living with HIV, 2011 Source: UNAIDS. AIDSinfo. 2012. http://www.unaids.org/en/dataanalysis/datatools/aidsinfo/.
  7. 7. What is HIV / AIDS? HIV Prevalence Among Sex Workers Serbia Lat via Belarus Ukraine Romania Bulgaria Spain 0.4 Morocco 0.2 Armenia Azerbaijan Uzbekist an Kazakhst an Tajikst an Kyrgyzst an 2.0 0.2 1.1 Jamaica 1.8 Hait i 0.2 0.1 0.5 0.2 0.3 0.4 1.2 0.7 2.2 1.5 4.4 3.5 2.0 HIV PREVALENCE IN GENERAL POPULATION Mexico 0.1 0.8 0.7 22.2 0.4 0.7 0.8 9.0 0.1 1.0 0.1 0.3 Myanmar China Viet Nam Malaysia Indonesia 4.6 1.8 Guyana 8.4 1.1 16.6 COUNTRY Senegal Guinea Côt e d'Ivoir Burkina HIV PREVALENCE AMONG SEX WORKERS Brazil 0.3 Nigeria 0.7 1.4 3.0 1.1 18.5 32.6 28.7 16.4 3.7 24.5 DR Congo 0.6 0.1 0.5 0.4 0.3 9.4 0.3 3.0 0.3 9.0 1.3 22.1 Rwanda Uganda 2.9 50.8 7.2 35.0 4.9 Zimbabwe 14.9 49.9 Swaziland 26.0 69.6 Madagasca 0.3 3.0 Maurit ius 1.0 31.8 Source: UNAIDS. AIDSinfo. 2012. http://www.unaids.org/en/dataanalysis/datatools/aidsinfo/; UNAIDS. HIV prevalence in adults and key populations. 2012. http://www.unaids.org/en/resources/infographics/20121120resultshivprevalence/. Aust ralia 0.2 0.04
  8. 8. What is HIV / AIDS? HIV Prevalence Among Men Who Have Sex with Men Serbia Lat via Belarus Ukraine Romania Bulgaria Spain 0.4 Morocco 0.2 Armenia Azerbaijan Uzbekist an Kazakhst an Tajikst an Kyrgyzst an 13.1 0.2 17.0 Jamaica Myanmar China Thailand Viet Nam Malaysia Indonesia 1.8 18.2 Guyana COUNTRY 1.1 19.4 Senegal Côt e d'Ivoir Burkina HIV PREVALENCE AMONG MEN WHO HAVE SEX WITH MEN 0.4 12.5 2.3 2.0 0.7 1.0 1.7 1.1 1.8 37.6 Hait i Peru 0.2 0.1 0.5 0.2 0.3 0.4 3.9 7.8 1.3 6.4 5.0 0.6 5.1 HIV PREVALENCE IN GENERAL POPULATION Mexico 0.1 0.7 0.4 0.8 0.1 0.1 Brazil Nigeria 0.7 21.8 3.0 50.0 1.1 1.0 3.7 17.2 DR Congo 1.3 Kenya 0.6 7.8 0.1 6.3 1.2 20.0 0.5 16.7 0.4 1.4 0.3 8.5 31.1 6.2 18.2 0.3 10.5 Swaziland 26.0 16.7 S. Af rica 17.3 9.9 Madagasca 0.3 14.7 Maurit ius 1.0 10.3 Source: UNAIDS. AIDSinfo. 2012. http://www.unaids.org/en/dataanalysis/datatools/aidsinfo/; UNAIDS. HIV prevalence in adults and key populations. 2012. http://www.unaids.org/en/resources/infographics/20121120resultshivprevalence/. Aust ralia 0.2 11.2
  9. 9. What is HIV / AIDS? HIV Prevalence Among Injectable Drug Users Serbia Lat via Belarus Ukraine Romania Bulgaria Spain Armenia Azerbaijan Uzbekist an Kazakhst an Tajikst an Kyrgyzst an 0.4 16.4 HIV PREVALENCE IN GENERAL POPULATION Morocco Mexico 0.2 0.2 0.1 2.4 0.7 11.2 0.4 17.1 0.8 21.5 0.1 1.0 0.1 7.1 0.2 10.7 0.1 9.5 0.5 8.5 0.2 3.8 0.3 16.3 0.4 14.6 11.4 Myanmar China Thailand Viet Nam Malaysia Indonesia 7.0 Nigeria COUNTRY Senegal HIV PREVALENCE AMONG INJECTABLE DRUG USERS 0.7 3.7 4.2 0.3 22.0 6.4 21.9 13.4 8.7 36.4 9.4 Kenya Brazil 0.6 0.1 1.2 0.5 0.4 0.3 6.2 18.3 5.9 Madagasca Maurit ius 0.3 7.1 1.0 51.6 Source: UNAIDS. AIDSinfo. 2012. http://www.unaids.org/en/dataanalysis/datatools/aidsinfo/; UNAIDS. HIV prevalence in adults and key populations. 2012. http://www.unaids.org/en/resources/infographics/20121120resultshivprevalence/. Aust ralia 0.2 1.0
  10. 10. Treatment & Prevention Combining Complementary Options Manage Current Infections  Antiretroviral Therapies  Novel Treatment Research Prevent New Infections  Pre-Exposure Prophylaxis (PrEP)  Post-Exposure Prophylaxis (PEP)  Microbicides  Voluntary Medical Male Circumcision  Condoms Enact Behavioral Change     Sex Education HIV Counseling HIV Testing Substance Abuse Screenings  Community Engagement
  11. 11. How Do We Get To A Vaccine? The Global Preventive HIV Vaccines Portfolio Source: AVAC. April 2013 update on vaccine pipeline candidates. 2013. http://www.avac.org/ht/a/GetDocumentAction/i/49862.
  12. 12. How Do We Get To A Vaccine? Countries Presently Conducting HIV Vaccine Trials United Kingdom Germany Switzerland France United States Italy Spain China Thailand Brazil Peru Uganda Rwanda Kenya Tanzania Mozambique South Africa Past / Planned Trial Site Current Trial Site Source: AVAC. HIV Vaccine Awareness Day 2013: the countdown continues. 2013. http://www.avac.org/ht/a/GetDocumentAction/i/50039; IAVI. Data on file; UNAIDS. AIDSinfo. 2012. http://www.unaids.org/en/dataanalysis/datatools/aidsinfo/.
  13. 13. How Do We Get To A Vaccine? The Scientific And Political Complexity of AIDS Vaccine R&D CHALLENGE Scientific Challenges HIV integrates; short window HIV hyper-variability; clades Immune correlates of protection are still unknown IMPACT We are tackling an aggressive and fast-moving target We have to test in people early Success will take time HIV suppresses and kills cells of the immune system Relevant animal models are lacking Clinical trials are long and costly Policy / Political Challenges Long-term effort requires long-term, high-level global commitment We need sustained political support Market incentives for industry activity are lacking We need to build privatesector engagement Ethical, regulatory, intellectual-property issues We need to optimize the environment for safe, ethical trials Health systems challenges
  14. 14. How Do We Get There? The Societal Complexity of AIDS Vaccine R&D And Current Options • Ethical developed-developing world dynamics • Cultural and religious dynamics • Stigmatization of key populations • Gender dynamics Need for social sciences, close partnering and strong environment / community work
  15. 15. Imagine a world without AIDS
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