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World AIDS Conference Hits Hopeful Note

MED’s Samet points to strides in treatment access, prevention

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Jeffrey Samet, a School of Medicine professor of internal medicine and an AIDS prevention researcher. Photo by Vernon Doucette

The news from Vienna is not all gloom and doom. As 25,000 representatives from the fields of health care, research, business, government, and human rights converged on the Austrian capital for the 18th International AIDS Conference this  week, there has been much to celebrate, despite a worldwide increase of nearly 3 million HIV-infected people each year.

The conference, dubbed “Rights Here, Rights Now,” opened with the encouraging news that use of an antibacterial vaginal gel laced with the retrovirus-fighting drug tenofovir reduced HIV transmission in a large group of South African women by nearly 40 percent. And though there is no vaccine or cure for the AIDS-causing HIV virus 30 years into the global epidemic, drug treatments are allowing patients to live extended and in many cases normal lives, in a growing portion of the developing as well as the western world.

With participants from more than 100 nations, the biannual conference attracted luminaries including former President Bill Clinton and philanthropist Bill Gates. “It’s just enormous,” says Jeffrey Samet, a School of Medicine professor of internal medicine and an AIDS prevention researcher, who was in Vienna last week dashing from presentations to keynote addresses to meetings with email collaborators he’d never met face to face. BU Today caught up with Samet Tuesday evening to speak with him about the mood of this year’s conference and the knowledge and inspiration he’ll be bringing home to BU.

BU Today: This is a huge event. Can you describe the scope of the conference?
Samet:
It’s really something akin to a water hose in your mouth. It’s the whole range of HIV issues coming at you; it’s just enormous. The meeting covers everything—I attended a session on innate immunity and there were 1500 people there. A lot of basic science happens here, and so does clinical science, a lot of drug trials, and [discussion of] the economics of the epidemic.

What’s the big news coming out of the conference?
The vaginal microbicide gel that significantly reduces the rate of HIV transmission versus placebo. This is a major success in a prevention trial of something researchers have been hoping to achieve for 25 years. The announcement preceded the presentation of the data, and it was really exciting. I wasn’t at that session, but I was told that people stood up and applauded like they were at a concert, something that just doesn’t happen at scientific conferences.

Tell me about the so-called Vienna Declaration and how it relates to AIDS policy in the United States.
The Vienna Declaration is a pretty big deal here. I was asked to sign it a few months ago. [More than 12,000 health practitioners have signed.] It seems straightforward. It says that public policy should be based on scientific evidence. But that said, needle exchange for IV drug users in the United States was just endorsed for the first time, by the Obama administration. Our public policy didn’t include it because it seemed too politically toxic. In some countries, like Russia and Ukraine, where police often harass drug users, addicts use dirty needles to avoid calling attention to themselves. So some people are calling for an end to police harassment, and that gets controversial.

Where are conference-goers predicting the next surge in AIDS cases will occur?
Eastern Europe, especially Ukraine, is a site that has taken off. Russia, where I do my prevention research, has gone from thousands of cases a year to millions; since 2001, HIV prevalence in Russia, Eastern Europe, and Central Asia has nearly doubled. People are keeping an eye on India, China, and southeast Asia. No place in the world has escaped, but the reasons for the increase are different. In Eastern Europe and Vietnam, transmission is mainly through drug use; in India it’s prostitution.

What recent findings will you present in your poster session this week?
I’ve spent the last 10 years doing work in Russia, looking at HIV-infected alcohol users. We did a prior prevention study to assess risk of sexual transmission. We’d looked at so-called narcology hospitals—the Russian equivalent of rehab—and now we’re looking at infectious disease hospitals. We’re trying to reduce the sexual spread of the disease. What we’re presenting here is a study of 700 people with HIV who also have been treated for sexually transmitted diseases such as gonorrhea, syphilis, and chlamydia. By using the recurrence of these as a marker in HIV-infected subjects, we can measure how many are practicing safer sex.

What are some promising advances in HIV prevention?
From the prevention research perspective, I get moved about pragmatic structural, as well as behavioral, interventions. Prevention isn’t going to be a matter of one microbicide gel—it’s going to require strong structural intervention, which means we have to change the way normal activities are done so they’ll be less risky. For example, if you have men going into a bar that’s close to where they get paid on Fridays, with a hotel next door that rents rooms by the hour, and there are sex workers at the bar, drinking will easily flow into high risk sex. You can’t interrupt this flow, but you can add a piece to it, by handing out a condom with every drink at the bar. There are all sorts of levels and varieties of structural intervention.

What will you take away from this year’s conference?
It’s a good time for people to be reminded that there are still 40 million people with HIV out there, and more than a million are infected every year. Yet it’s remarkable that people get treatment and live long lives. That’s not happening everywhere, but it’s happening more and more places—in Nepal, in Peru, in Rwanda, in Korea. This is the best thing that came out of the [George W.] Bush administration, that HIV treatment should be seriously funded worldwide.

Any other high points in addition to the announcement of the South Africa prevention study?
When Bill Clinton gave his keynote speech about the need to use AIDS funding more wisely, someone I know who has been to nearly all of these conferences came out crying. He’s just such an amazing speaker.

Will you be at the 2012 World AIDS Conference in Washington, D.C.?
Yes, and I want to pass along that it’s a fascinating volunteer opportunity for clever students. Any BU students who want to be involved in HIV work on any level can learn a lot just by helping out at the conference.

Susan Seligson can be reached at sueselig@bu.edu.

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