Sharing Patents to Wipe Out AIDS

Via the New York Times, by Tina Rosenberg.

Not since the announcement in 1996 that antiretroviral therapy could effectively control H.I.V. has there been a season of AIDS news as hopeful as this one.  Trials of a new microbicide have brought positive results; ongoing studies of circumcision are showing that it gives strong, lasting, protection; a man has been cured of H.I.V. infection and new animal and clinical trials are raising hopes that he won’t be alone.

The research with the most immediate and dramatic impact, however, examines two novel ways to use those antiretroviral drugs.  People with H.I.V. who start their antiretroviral therapy as soon as they are diagnosed, instead of waiting for their immune systems to degrade, have a near-zero chance of passing the virus on to their sexual partners. This is the AIDS vaccine we’ve been waiting for — a 96 percent drop in infection rates is far better protection than any actual AIDS vaccine could  provide.  It has also now been shown that giving one antiretroviral pill a day to people who don’t have H.I.V. but are at very high risk for catching it can reduce their risk by two-thirds or more.

Taken together, these two methods of using antiretroviral drugs not just to treat AIDS, but also to prevent its spread, offer real hope of ending the epidemic.  But there’s a catch:  they require providing these drugs to millions, perhaps tens of millions, more people than are getting them now.  Someone has to pay for all this.

That’s why it matters that last week, Gilead Sciences, one of the most important manufacturers of AIDS drugs, became the first drug maker to join something called the Medicines Patent Pool, a two-year-old organization that was established by Unitaid, an international body dedicated to buying AIDS drugs. In joining the patent pool, Gilead agrees to let generic pharmaceutical companies copy four of its drugs for sale at very low prices in poor countries.  Gilead will get a small royalty for every copy sold.

Read the rest here.

[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

How Sexy Sex Can Help Prevent HIV Transmission

Last month, a special supplement of Health Research Policy and Systems featured an article written by Anne Philpott and Wendy Knerr of The Pleasure Project. The write-up, ‘Strange bedfellows: bridging the worlds of academia, public health and the sex industry to improve sexual health outcomes’, discusses the public health community’s approach to HIV prevention, which is mostly focused on disease and the negative outcomes of sex. The authors make a case for an alternative approach based on the positive, liberating and pleasurable aspects of safer sex. The Pleasure Project, a largely volunteer-run organisation based in India and the UK, is a programme that adopts exactly such an approach. Their tagline says it best: ‘Putting the sexy back into safer sex’.

Mapping Pathways checked in with Anne Philpott to get her thoughts on how such an approach can help prevent HIV. “We believe you can have safer sex if you know how to have good sex. Pleasure is the primary reason people have sex” explains Anne, “yet it is almost completely absent in the public health domain – in programming, education and research. Since HIV is spread mainly through sexual transmission, efforts to prevent HIV need to consider the role that sexual pleasure and desire play in sexual behaviour.”

Anne’s personal ‘light-bulb moment’ took place at a microbicides session during an HIV/AIDS conference. “The speaker kept using terms like ‘insertive probe’ and ‘receptive cavity’, and for the longest time I thought he was discussing the technical cellular dynamics of microbicides or something like that. Turned out he was trying to talk about penetrative sex – for me, that was a moment of total frustration with the public health world. Why can’t we just say ‘penis’ and ‘vagina’?”

The Pleasure Project carries out advocacy about the importance of pleasure in sexual health, trains health professionals and educators about the eroticisation of safer sex, conducts research to build the evidence base, and pushes for safer sex in the erotic media industry. It sees itself as a bridging organisation – bringing pleasure into the world of public health and bringing public health into the world of pleasure – and works to make sure that the lessons are learned across the two different worlds.

What is one of the key lessons for the public health community? “Sex sells. People in the commercial world use sex to sell things like cars, toothpaste, pens…almost anything! Why not use sex to sell safer sex?” says Anne. “While working at a firm that made female condoms, I noticed how women would bring up the positive elements of the condom and how it actually increases sexual pleasure. We need to focus on things like that along with conveying the message of protection. That’s what will help motivate more and more people to practice safe sex – fear tactics only work up to a point.”

The Female Health Company, which manufactures markets and sells female condoms, seems to agree wholeheartedly. The company has provided key support to organisations advocating for a more positive, pleasure-focused approach to the female condom. “The innovative approach of eroticising the female condom is already having an impact,” says Robbie Nelson, the company’s programme and sales director. “The NGOs we work with, which have had pleasure trainings from The Pleasure Project, are not only making it easier for people to talk about condoms, but they are showing people how sex can be fun with condoms.”

The Pleasure Project’s strategy certainly seems to be working: Their website gets more than 5,000 unique visitors each month – interestingly enough, there’s been a recent surge in hits from Turkey and countries in the Middle East. The Global Mapping of Pleasure (‘A directory of organizations, programmes, media and people who eroticize safer sex’) has been downloaded more than 20,000 times. The organisation is now also pushing for greater research into the pleasure potential of new HIV-prevention products like microbicides. Numerous other initiatives, such as LifeLube, are also attempting to combine the idea of pleasure with HIV prevention. Together, these organisations may kickstart something of a sexual revolution in the public health community’s efforts to combat HIV.

[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

ARV Access Fears Across the World

A slew of recent articles have appeared in the news lately which express concern over the availability and accessability of many countries including Swaziland (PlusNews), Indonesia (Jakarta Globe), and middle-income countries around the world (below). This comes on the heels of the Ranbaxy-Gilead deal which has the potential to greatly increase the supply of these life-saving drugs.

Bad News for Drug Prices in Middle-Income Countries

Middle-income countries with large numbers of people living with HIV will no longer benefit from preferential pricing when buying antiretroviral drugs from large pharmaceutical companies, according to the annual Médecins Sans Frontières drug pricing report, Untangling the Web of ARV Price Reductions.

“The main bad news in the study is the fact that a number of pharmaceutical companies will no longer be providing preferential pricing to middle-income countries like Brazil, China, India and Thailand,” Nathan Ford, medical director at MSF’s Campaign for Access to Affordable Medicines, said at the launch of the report at the 6th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention in Rome.

According to the report, pharmaceutical firm ViiV Healthcare – owned by Pfizer and GlaxoSmithKline – no longer offers reduced prices to middle-income countries, even when their programmes are fully funded by the Global Fund to fight HIV, Tuberculosis and Malaria.

Merck has also ceased to offer discounted prices to all lower middle- and upper middle-income countries, proposing instead to negotiate discounts on a case-by-case basis. Previously, Merck offered middle-income countries discounts that were still up to 10 times the price of generic versions. Of particular concern is the price of UN World Health Organization-recommended third-line drug, raltegravir – an integrase inhibitor that blocks retroviral replication – which costs up to US$5,870 per person per year in Brazil, compared with $675 in sub-Saharan Africa.

Janice Lee, pharmacist at MSF’s Campaign for Access to Essential Medicine, noted that drug company discount programmes were not a long-term solution, and governments would have to start using trade-related aspects of intellectual property rights (TRIPS) measures to override patents; in the past, Brazil and Thailand have used compulsory licences – when a government allows someone else to produce the patented product or process without the consent of the patent owner – to lower prices in their countries.

The report notes that Abbott excludes low- and middle-income countries from differential prices for the standalone heat-stable ritonavir 100mg tablet. It blocks the enzyme protease, required by HIV to make new viruses. A spokesman for Abbott said the company’s long-standing pricing policy would protect the poorest people living with HIV.

"Abbott’s preferential pricing policy for ritonavir has been in place, unchanged, for a decade,” Dirk van Eeden, director of HIV communication and policy at Abbott, told IRIN/PlusNews via email. “It includes all African and least developed countries, where the outright majority of patients with HIV live.”

ViiV Healthcare also defended its pricing policy, saying it was committed to ensuring access to its medicines.

Read the rest here.

Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

Capitalizing on Scientific Progress

A report released this morning by HIV Vaccines and Microbicides Resource Tracking Working Group at the IAS conference in Rome "found that overall investment in HIV prevention R&D had actually increased, with the modest exception of a one percent decline in vaccine R&D. The report documented a total US$1.19 billion investment in research and development (R&D) for four key HIV prevention options: preventive vaccines, microbicides, pre-exposure prophylaxis (PrEP) using antiretroviral drugs, and operations research related to medical male circumcision.":

"2010 has been a year of retrospection, a time for looking back over the 30 years since the first published report of the mysterious illness that would come to be known as AIDS. As sobering as this anniversary has been, it has also been a time for some optimism and calls to end the epidemic. These calls may not be simply wishful thinking, fueled as they have been by promising research results over the past two years in vaccines, microbicides, pre-exposure prophylaxis using antiretrovirals (PrEP), and antiretroviral treatment as prevention—results that have energized the entire HIV prevention field.

The first good news came at the end of 2009, when researchers in the RV 144 Thai vaccine trial reported that a vaccine combination had reduced risk of infection by 31 percent—the first clinical evidence that a preventive AIDS vaccine would be possible. Then, in July 2010, the CAPRISA 004 trial team announced its findings–that use of 1% tenofovir (TDF, also known as Viread®) vaginal gel reduced women’s risk of HIV infection by 39 percent—providing the first proof that a microbicide would be possible. This news was followed in November 2010 by the announcement from the iPrEx trial team that daily oral tenofovir/emtricitabine (TDF/FTC, also known as Truvada®) had reduced risk of HIV infection by an estimated 44 percent overall in men who have sex with men (MSM) and transgender women, and proved for the first time that HIV prevention using PrEP would be possible. And finally, in early 2011, the HIV Prevention Trials Network (HPTN) 052 trial established that use of antiretroviral therapy (ART) by HIV-positive individuals reduced transmission to their partners"

Source: HIV Vaccines and Microbicides Resource Tracking Working Group

[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

IAS 2011: The Conference So Far

As you probably know, Mapping Pathways is in Rome this weekend for IAS 2011, the 6th IAS Conference on HIV Pathogenesis, Treatment and Prevention. We are very excited to be there, but in case you couldn't join us here is what has been happening the last few days:

Every day the conference is in session, the International AIDS Society releases a press release describing details and highlights from each day. The first three can be found here, here, and here. Another important press release from the conference discusses treatment as prevention.

Lancet has published several articles about the conference and treatment as prevention as well.

Science Speaks: HIV & TB News along with several other sources including IAS itself are live-blogging the event or publishing frequent updates. Keep an eye out here and elsewhere for more exciting news from Rome.

[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]