THE DELIVERY QUESTION

New Ways to Prevent HIV Are on the Way, but Will They Get to the People Who Need Them?

In 2006, more than 4 million people worldwide became infected with HIV—the equivalent of nearly 11,000 people every day. “The harsh mathematics of this epidemic proves that prevention is essential,” Bill and Melinda Gates told delegates to the International AIDS Conference in Toronto last August. And, they added, we must “put the power of prevention in women’s hands” by expanding access to current prevention strategies and developing effective new prevention methods.

In conjunction with the conference, the Global HIV Prevention Working Group, a panel of 50 experts convened by the Gates and Kaiser Family foundations, released a report on promising HIV prevention research titled New Approaches to HIV Prevention: Accelerating Research and Ensuring Future Access.

According to the report, several innovative HIV prevention methods are in the late stages of clinical research and could show results within the next few years. (With our partners, we are funding some of this research.) Among the new prevention tools are oral prophylaxis drugs and topical microbicides—gels and creams that, if applied to the vagina, may reduce the transmission of HIV to women. If proven effective and used in combination with existing strategies, oral drugs and microbicides could help avert millions of HIV infections among women.

But the report also issued an urgent warning: “Virtually no planning or resources have been dedicated to ensuring future access to new prevention approaches,” it said, which means “we risk letting new prevention methods sit idle while 4 million people become infected every year.” Even now, fewer than one in five people at high risk for HIV have access to current prevention methods such as condoms and education.

Part of the equation is ensuring that the world commits the necessary financial resources to delivery of new prevention methods. But there are other questions as well. For example: What is the best strategy for making sure that introducing new prevention methods doesn’t lead to an increase in high-risk behavior? How do countries and health agencies gauge the demand for new products to provide an adequate supply? How should the regulatory process evolve so that new products are approved without unnecessary delays?

New prevention methods could give the world a historic opportunity to slow, and ultimately reverse, the global HIV/AIDS epidemic. Making the most of this opportunity will require global commitment to guarantee rapid access to new tools as soon as they are proven effective.