International AIDS Conference 2008: HIV/AIDS Battle Far From Over

Day 2 of the International AIDS conference opened with feature presentations by leading global experts on their perspectives on recent advancements and challenges. Former U.S. President William J. Clinton took the stage as the keynote speaker in a session entitled "HIV/AIDS and Health System Reform: Achieving Universal Coverage." He said that the fight against HIV/AIDS is far from over. "AIDS is a very big dragon. The mythological dragon was slain by Saint George, the original knight in shining armor, but this dragon must be slain by millions and millions of foot soldiers," he added.

Clinton said that while there is no "silver bullet" to eradicate HIV/AIDS worldwide, the U.S. and other nations should reform their health systems to reach the groups at highest risk for HIV/AIDS, which have been neglected over the past 25 years. "We know there is so much yet to be done: to expand prevention, treatment and care, to strengthen undeveloped health systems." He called for a 50 percent increase in funds to reduce the price of antiretroviral drugs and keep pace with expanding antiretroviral programs. He also said that health clinics should routinely test for HIV, particularly in developing countries where 80 percent of people infected with the virus are unaware of their status.

During the session, Clinton praised legislation to reauthorize the President's Emergency Plan for AIDS Relief, signed into law last week by President Bush. "This is a stunning development for which we should all be grateful," Clinton said. He commended Mexico for legislation recently passed that will increase access to health care, adding that such legislation can help reduce new HIV cases. He also praised Mexico's policy of universal access to antiretroviral drugs for all people who need them and said he hopes the Bush administration "will follow" and provide universal access in the United States. Clinton also applauded United Nations Secretary General Ban Ki-moon and Mexican President Felipe Calderon for speaking out against discrimination during the conference.

Clinton said the United States has failed to prevent the spread of HIV among blacks, citing the recently released CDC study which found that 45 percent of new infections in the U.S. occur among non-Hispanic blacks. He said the study "should be a wake-up call" for U.S. citizens "that even as we keep working globally we need to do much more to fight AIDS at home, and I intend to do so with my foundation." Clinton cited some of the successes of his foundation, including reducing the price of some pediatric antiretrovirals from $600 annually to $60 in the previous three years. He also discussed the possibility of using pre-exposure prophylaxis to prevent HIV transmission until a vaccine is developed.

In a Washington Post interview after the speech, Phill Wilson, CEO of the Black AIDS Institute said, "I have been extremely disappointed with the Clinton Foundation, especially with it headquartered in Harlem of all places, that it has been silent" on the issue of blacks and HIV/AIDS. Wilson said that HIV/AIDS is a "direct attack on black America" and added "it is appropriate that President Clinton is committed to taking this on."

Also on Monday, experts discussed HIV vaccine research efforts. "The challenges are huge, but I have no doubt that we will live in a world without HIV some day," said Tadataka Yamada, executive director of the global health program at the Bill and Melinda Gates Foundation. He added that funding and collaboration for vaccine research needs to be increased to avoid wasted or duplicated efforts. "We need big investments for the future-not only in the basic science of HIV prevention, but also in clinical trials for an HIV vaccine." Yamada also said researcher should focus basic research to fill fundamental gaps in knowledge about how HIV attacks the immune system.

Seth Berkley, president and CEO of the International AIDS Vaccine Initiative, said although there are many biological and social challenges in developing an HIV vaccine, a vaccine is "possible." He added that scientists, corporations and governments should redouble their commitments to vaccine research rather than be discouraged by recent setbacks. According to AFP, of the 50 vaccine candidates that have been tested in humans, only two reached Phase III trials, and both of those were found to be ineffective. Approximately 30 vaccine candidates are currently in trials.