EDITORIAL

AIDS Response at a Crossroads

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Science  09 Jul 2010:
Vol. 329, Issue 5988, pp. 120
DOI: 10.1126/science.1193218
CREDIT: (TOP RIGHT) NATHAN GOLON; (BOTTOM RIGHT) LEO SOREL

Later this month, the XVIII International AIDS Conference will be held in Vienna, Austria. Now the largest conference dedicated to a single disease, it will bring together more than 20,000 attendees. Over the past several years, however, attendance by the basic science and clinical research communities at this conference has waned. This raises the question of whether their absence threatens the success of the overall response to AIDS.

The evolution of this conference frames a history of the AIDS epidemic and suggests reasons for the decreased interest of these scientists. The initial conferences were small, bringing together basic scientists with clinicians who were witnessing the manifestations of HIV, spurring research to understand the virus and its pathology. In the 1990s, conference themes widened as the breadth of the impact of HIV and its global dimension were appreciated. During this time, individuals living with HIV pushed relentlessly for increased funding for basic and clinical research. Key interactions between scientists and AIDS activists occurred at International AIDS Conferences, motivating a vibrant research agenda. Newly discovered protease inhibitors—the eventual cornerstone of effective therapy in the developed world—were announced at the 1996 conference, a breakthrough discovery that transformed HIV from a death sentence to a chronic and manageable condition.

The past decade of the International AIDS Conference has reflected frustration over a growing divide between those with and without access to HIV treatment, particularly as millions continued to die of HIV in Africa. The challenges of preventing mother-to-child transmission of HIV and providing mothers with lifesaving treatment were among the most critical issues debated. But during this same period of promoting wider access to treatment, basic and clinical researchers became increasingly reluctant to attend the conference. Rather, many chose to attend highly focused meetings in their specific interest areas (for example, those on HIV resistance, HIV vaccine development, or metabolic complications during HIV infection) or general meetings perceived as “more scientific,” such as the Conference on Retroviruses and Opportunistic Infections. As a result, the only forum emphasizing dialogue between those engaged in generating new scientific knowledge, those tackling the epidemic in a practical manner, and those dealing with its very personal impact, has been weakened.

CREDIT: THINKSTOCK

The response to the HIV epidemic is at a crossroads. Major scientific challenges remain. There is still no cure for HIV and no vaccine for its prevention. Although antiretroviral therapy has now reached about 40% of those in urgent need in Africa, this scale-up has generated new questions about mechanisms underlying increased early mortality after the initiation of antiretroviral therapy, diagnostics for use at the lowest health facility level, and distinguishing recent from chronic HIV infections at individual and population levels. These critical questions must be informed not only by clinical, behavioral, and operations research, but by progress in basic research. The International AIDS Conference provides the opportunity for this critical interchange. Scientists, clinicians, advocates, policy-makers, community members, and governmental leaders can sit side by side and debate issues from their own perspective and learn from each other. The basic scientists need to discern how to translate their discoveries into practice and learn of new pathogenesis dilemmas. The clinical and behavioral scientists need to recognize key challenges faced by those affected by HIV that should inform their research. The work of operation researchers should guide policy and implementation. And policy-makers and community members should express their needs and gain access to knowledge to assist their actions.

For all of these reasons, the scientists who have abandoned this conference must fully reengage, by helping to build future agendas and recruiting the most distinguished HIV scientists to present state-of-the art research that will advance the global agenda for conquering AIDS. Only by bringing science back to the center of the dialogue and bridging the divide across interests can we truly hope to achieve a world without AIDS.

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