Faculty Bibliography

Experience has taught scientists that there is no guarantee of an effective microbicide. At the AIDS Conference in Durban, South Africa, in 2000, health workers had fully expected that a large trial of a spermicide, nonoxynol-9, would prove that the drug was effective. But the trial showed that nonoxynol-9 may increase the risk of HIV infection rather than protect against it. So scientists have shifted their focus to drugs that specifically aim at separate parts of HIV's life cycle. An ideal microbicide would work in three ways. First, it would kill HIV in the vagina and cervix. Second, the microbicide would prevent any virus that escapes from attaching to a woman's cells, the way HIV starts to infect. Third, for any virus that does enter cells, the microbicide would block an enzyme, reverse transcriptase, that HIV needs to replicate

A microbicide is at the top of health workers' wish list to protect the many women in poor countries whose husbands refuse to use condoms. A microbicide would also protect an infected woman's sex partners from infection. The need for a microbicide is even more urgent because there is no vaccine for H.I.V. An ideal microbicide would work in three ways. First, it would kill H.I.V. in the vagina and cervix. Second, the microbicide would prevent any virus that escapes from attaching to a woman's cells, the way H.I.V. starts to infect. Third, for any virus that does enter cells, the microbicide would block an enzyme, reverse transcriptase, that H.I.V. needs the enzyme to replicate. Viread, a drug made by Gilead Sciences that is prepared as a topical gel, is the only licensed antiviral drug being tested as a microbicide. Viread is a member of the class of drugs known as nucleoside reverse transcriptase inhibitors. The National Institutes of Health is about to begin the second of the three-stage testing system for topical Viread, Dr. [Zeda F. Rosenberg] said

Private-sector donations exceed government donations in the AIDS effort, said Hank McKinnell, the chief executive of Pfizer, who moderated the session. 'Like a flywheel gaining speed, the global donor community is now pledging, moving and disbursing funds and materials at unprecedented rates,' McKinnell said. That influx creates tensions. The government staffs of most poor recipient nations are small, yet they have to respond to myriad expectations from the donors. At the same time, donors and recipients often become overwhelmed by the massive paperwork and reporting that come with donations. Donors tend to become too involved in the day-to-day management of AIDS projects, [Biziwick Mwale] said, and 'donors want coordination, but many of them don't want to pay for it,' preferring other donors of the recipient country to meet the cost

That influx creates tensions. The government staffs of most poor recipient nations are small. Yet they have to respond to myriad expectations from the donors. At the same time, donors and recipients often become overwhelmed by the massive paperwork and reporting that come with donations. Donors tend to become too involved in the day-to-day management of AIDS projects, [Biziwick Mwale] said, and 'donors want co-ordination, but many of them don't want to pay for it,' preferring other donors of the recipient country to meet the cost. As donors compete with one another for prominence, Mwale said, 'lack of agreement on approaches and key issues among the donors themselves has also led to delays or problem in program implementation and coordination.'

The reasons vary. Some countries mistrust donor motivation in pushing co-ordination, he said. Countries may have 'real fears' that donor co-ordination could be used as 'a tool for control.'

As donors compete for prominence, said Dr. Biziwick Mwale, executive director of the National AIDS Commission in Malawi, ''lack of agreement on approaches and key issues among the donors themselves has also led to delays or problems in program implementation and coordination.'' Gregg Gonsalves of the Gay Men's Health Crisis in New York City said that scaling-up services through the public sector was essential to controlling the epidemic but that volunteer groups had ''played a key role in the response to AIDS, all too often filling in where governments have reneged on their duties'' to infected people and those at risk. Despite progress in the battle against AIDS in New York City in recent years, middle-aged black men are nearly three times as likely as other New Yorkers to be infected with the virus that causes AIDS, according to a new report by the New York City Department of Health and Mental Hygiene

Only one, President Yoweri Museveni of Uganda, accepted, said Dr. Peter Piot, the director of United Nations AIDS, an organizer of the conference. Dr. Piot's United Nations group has stressed the need to put AIDS on the agendas of political meetings like those of the Group of 8. At the same time, Dr. Piot and others have tried to get leaders to attend meetings like this one to combine politics and public policy with AIDS science. Prime Minister Manmohan Singh of India is not coming because his administration is just starting and is involved in budget debates this week, Dr. Piot said. Sonia Gandhi, the leader of the Congress Party, which leads the governing coalition in India, and Mr. [Nelson Mandela] are expected to speak at the close of the conference

Although [Kofi Annan] has attended many other AIDS meetings since April 2001, and convened the first-ever General Assembly session devoted to a disease AIDS Bangkok is the first International AIDS Conference that Annan has attended. [Peter Piot]'s United Nations group has stressed the need to put AIDS on the agendas of political gatherings like Group of Eight summit meetings. At the same time, Piot and others have tried to get heads of state to attend meetings like this one to combine politics and public policy with the science of AIDS. The AIDS virus threatens to cause large epidemics in many Asian countries. With 17,000 participants, the largest of any AIDS conference, organizers said they hoped that the meeting would focus more attention on the threat to the continent. Tim Brown, an epidemiologist from the East West Center, said that the injection of drugs has been a major force in spreading HIV in many Asian countries. Piot said drug use was 'a touchy subject for political leaders in any country or culture.' Still, he added, there was 'a timid but growing leadership on AIDS.'

Although [Kofi Annan] has attended many other AIDS meetings since April 2001, and convened the first General Assembly session ever devoted to a disease AIDS Bangkok is the first International AIDS Conference that Annan has attended. [Peter Piot]'s United Nations group has stressed the need to put AIDS on the agendas of political gatherings like Group of Eight summit meetings. At the same time, Piot and others have tried to get heads of state to attend meetings like this one to combine politics and public policy with the science of AIDS. The AIDS virus threatens to cause large epidemics in many Asian countries. With 17,000 participants, the largest of any AIDS conference, organizers said they hoped that the meeting would focus more attention on the threat to the continent. Tim Brown, an epidemiologist from the East West Center, said that the injection of drugs has been a major force in spreading HIV in many Asian countries. Piot said drug use was 'a touchy subject for political leaders in any country or culture.' Still, he added, there was 'a timid but growing leadership on AIDS.'

BANGKOK, Thailand -- The 15th International AIDS Conference began on a disturbing note here on Sunday with the cancellation of a summit meeting of world leaders invited to discuss AIDS, one of the worst epidemics in history. Only one, President Yoweri Museveni of Uganda, accepted, said Dr. Peter Piot, the director of U.N. AIDS, an organizer of the conference. Former Presidents Bill Clinton and Nelson Mandela, as well as Denzel Douglas, the prime minister of St. Kitts and Nevis, and Paul Kagame, president of Rwanda, played prominent roles in the last International AIDS Conference, in Barcelona, Spain, in 2002. Spain's prime minister did not attend. President Thabo Mbeki of South Africa spoke at the opening of the conference in Durban, South Africa, in 2000