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AIDSCAPTIONS. 1996 May; 3(1):34-6.The new joint United Nations (UN) Program on HIV/AIDS (UNAIDS) coordinates the HIV/AIDS activities of its six co-sponsors: the UN Children's Fund (UNICEF), the UN Development Program (UNDP), the UN Population Fund (UNFPA), the UN Educational, Scientific, and Cultural Organization (UNESCO), the World Health Organization (WHO), and the World Bank. In this interview, UNAIDS Executive Director Peter Piot discusses the program's goals and challenges. The UNAIDS program will be more multisectoral in scope than other efforts, involving all sectors of society that can affect the course of the epidemic or are affected by it. This includes the health and education sectors; ministries of trade, finance, planning, and development; nongovernmental and community organizations; people living with HIV and AIDS; research institutions; and the business sector. In each country, the UN agencies will form a "Theme Group on HIV/AIDS" to formulate intersectoral strategies.
[Unpublished] 1996. Presented at the 11th International Conference on AIDS, Vancouver, Canada, July 7-12, 1996. 12 p.Even though most people agree that a safe, effective, and available HIV preventive vaccine is needed, few agree on the characteristics of such a vaccine and how to proceed. The debate revolves around the uncertainties of the immunological correlates of protection, the antigenic significance of HIV genetic variability on vaccine-induced protection, and the biological variability of HIV and the meaning of animal protection experiments with experimental vaccines. The decision to move towards efficacy trials depends on feasibility, the science, and the vaccine. One important feasibility factor is availability of a well-characterized population with a high incidence of HIV infection, despite available interventions. A scientific factor to consider is HIV characterization (genetic variability, HIV subtypes). Current safety and immunogenicity data from phase I and II trials and ability of the vaccine to induce neutralizing antibodies and CTLs comprise some vaccine factors. Researchers have found high-risk populations willing to participate in phase III trials in Thailand. UNAIDS proposes a balanced approach strategy of conducting efficacy trials with vaccine candidates which have met minimal requirements while also conducting basic research to acquire more information on what is needed for a protective immune response. The efficacy trials may reveal some information related to such a response. Final decisions and responsibilities lie with national governments and institutions. UNAIDS is prepared to help countries in their decision making efforts. Extensive preparation and international collaboration and coordination are needed for phase III efficacy trials. Developing countries (e.g., Thailand) themselves must participate in HIV vaccine development, since most HIV infections are in these countries and these countries have the most to gain. Genetic variability of HIV and different co-factors and routes of HIV transmission indicate the need to conduct multiple efficacy trials in different areas worldwide.
SCIENCE. 1996 Jun 28; 272:1855.There are an estimated 21 million people infected with at least one of the 10 known subtypes of HIV worldwide, with more than 8500 people newly infected daily. The US Centers for Disease Control and Prevention estimate that 40,000 US citizens became infected last year with HIV. In heavily affected countries in Africa and Asia, where 33% of urban adults may be infected, AIDS deaths among young and middle-aged adults are threatening health systems, economies, and national stability. Global travel facilitates the spread of HIV worldwide. For the first time, however, a number of developing countries are registering a drop in new HIV infections, suggesting that prevention efforts focused upon safer sexual and drug-related behavior are working. Recent scientific breakthroughs are encouraging. Combination therapy with antiretroviral drugs may be able to not only defer the progression of disease and improve the quality of life, but turn HIV infection into a chronic nonprogressive condition. Furthermore, it has been determined that zidovudine can interrupt mother-to-child transmission of HIV. Research, however, remains central to preventing future HIV transmission. The development of accessible vaccines and vaginal microbicides are especially needed. The author notes that although 90% of HIV infections worldwide are in developing countries, AIDS intelligence and research and development are overwhelmingly concentrated in the industrialized world. In this context, efforts must be made to ensure the development of vaccines and therapies which are accessible and effective against AIDS in the developing world. The new Joint United Nations Program on HIV/AIDS (UNAIDS) has an important role to play in establishing a much needed partnership between developing and developed countries.