Mapping Pathways is a multi-national project to develop and nurture a research-driven, community-led global understanding of the emerging evidence base around the adoption of antiretroviral-based prevention strategies to end the HIV/AIDS epidemic. The evidence base is more than results from clinical trials - it must include stakeholder and community perspectives as well.

20 December 2012

The prevention revolution is underway: In conversation with Linda-Gail Bekker

Original content from our Mapping Pathways blog team

"We have to continue to advocate and do the implementation science so that we can show policymakers what is feasible."

In the third of this five-part series, Linda-Gail Bekker of the Desmond Tutu HIV Centre, a Mapping Pathways partner organisation, speaks about the AIDS 2012 conference and her thoughts on the FDA approval of Truvada for PrEP. Read parts one and two

MP: What were some of the conversations around the AIDS 2012 conference?

LGB: AIDS 2012 confirmed that the prevention revolution is currently underway. The energy around prevention was palpable. AIDS 2012 had me running around between presentations on microbicides to PrEP to treatment as prevention (TasP) and back again to microbicides. Since I am involved in both treatment and prevention, I am usually very torn in conferences on what to attend. This time, I did one talk on treatment of HIV-infected adolescents but everything else was related to prevention, PrEP and microbicides. This is great because this is where the science is at the moment.

I also participated in some very important and in-depth conversations about some of the studies where the results have looked less than ideal. There were conversations about what actually happened in the FEM-PrEP trial and the VOICE trial. Those conversations are ongoing and data is beginning to filter through and things are becoming clearer.

MP: The U.S. Food and Drug Administration (FDA) approval of Truvada for PrEP was another major event this year. What is your reaction to that and how does that change things?

LGB: I attended this FDA meeting and it was absolutely thrilling. Gilead and the key scientists did a great job presenting the science and I thought the discussions were very robust and thorough. I came away from the process very impressed with the way drugs are reviewed. I also subsequently read the statements from people on the panel about why they voted the way they did and felt their opinions were informed, valid and thoughtful.

However, we are now in an era where we need to be practical while still doing the science. In that sense, I’m not sure how much the FDA approval changes things in the South African context. I would be delighted if Gilead takes this forward locally (in terms of an application to the SA Medicines Control Council) because I think it would give us impetus to move forward with prevention, but clearly much will depend on our policymakers and their thoughts about cost and and further decisions of key population implementation versus a generalised population implementation.

We have to continue to advocate and do the implementation science so that we can show policymakers what is feasible and what the impact in the public sector may be so that they can understand what the logistics are.

Linda-Gail Bekker is deputy director of the Desmond Tutu HIV Centre at the Institute of Infectious Disease and Molecular Medicine, University of Cape Town. She also serves as the chief operating officer of the Desmond Tutu HIV Foundation, a Mapping Pathways partner organisation. 

Stay tuned to the blog as we bring you part four of our conversation with Linda-Gail, where she speaks about her involvement in the HPTN 067 study and about issues that make HIV the complicated problem that it is. 

Stay tuned for the Mapping Pathways monograph, coming in early 2013

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