http://www.newvision.co.ug/D/8/459/719767Monday, 17th May, 2010...

http://www.newvision.co.ug/D/8/459/719767

Monday, 17th May, 2010

By Richard Hasunira

EACH year on May 18, people around the world commemorate HIV Vaccine Awareness Day. This is done to recognise and thank the thousands of volunteers, community members, health professionals, researchers and scientists who are working together to find a safe and effective HIV vaccine

People who volunteer to participate in clinical trials of AIDS vaccines and other new HIV prevention approaches have often been hailed as the heroes in the fight against the HIV/AIDS epidemic. Besides the risks and responsibilities they shoulder for the benefit of humanity, they win many auxiliary benefits for their communities.

For communities that have been devastated by HIV/AIDS, every research comes with new hope. To date, none of the research clinical trials conducted so far has delivered an effective product, be it an HIV vaccine, microbicide, or post-exposure prophylaxis (PEP, the use of ARVs for prevention). Participants and their communities have had to deal with the burden of disappointing results, save for medical male circumcision, which showed a 60% reduction in the risk of infection in men.

HIV prevention clinical trials use various approaches to involve communities as part of the ethical requirements, but also in order to recruit research participants and to create a partnership to facilitate the successful conduct of the research.

Researchers often use various approaches to recruit participants. Most trials recruit through existing health centres, and also use the same facilities during the follow-up of participants. This approach usually calls for additional investments in facilities at the participating health centres.

For example, through the microbicide trial that ended in Masaka last year, some health centres were renovated, medicines supplied and health staff trained. Trials often employ many people in various capacities, including the investigators, support staff and field mobilisers.

Up to 100 people for instance were involved in community education and voluntary counselling and testing (VCT) which took place as part of the process of preparing the community in Masaka for the research and recruitment of volunteers.

Each of the people, at their various levels, gained valuable experience that remains in the community. The senior trial staff are usually given specialised training in conducting clinical trials, including academic advancement.

One of the recognised goals of community engagement is to build capacity within the community for mobilisation, awareness and address community problems and concerns, and strengthen structures that serve the community.

It is not enough to argue for new methods, and investigators often try not to raise community expectations. In the process, they encourage people to use the known methods of HIV prevention, that is condoms, being faithful or abstinence.

According to the WHO and UNAIDS, most prevention strategies are accessible to one in every five people who could benefit from them. Only 11% of pregnant women who are HIV-positive, for example, have access to the simple drugs that could keep their babies from becoming infected.

In communities where HIV prevention research is conducted, access to counselling and other prevention messages is usually higher than the national average.

In Masaka for instance, the researchers conducted public VCT sessions, which not only allowed people who had never tested before to know their HIV status, but also provided vital HIV sensitisation.

Most research studies tend to recruit participants who are at high risk of HIV infection. In Masaka, the trial recruited sero-discordant couples, in which women were HIV-negative and their male partners, HIV-positive.

The VOICE study in Mulago is also recruiting discordant couples, while the partners study, which is taking place at various sites in Uganda, also has discordant couples as participants.

The prevalence of discordance is high in Uganda. It is estimated that about half of the people who have HIV in Uganda have an HIV-negative partner. Unfortunately, discordance does not last forever. Eventually, the negative partner also gets infected. So, people in discordant relationships are considered to be at a very high risk of HIV infection.

However, despite being at such a high risk, HIV-negative people in discordant couples that have participated in clinical trials have actually significantly lowered their risk of infection due to ready access to treatment of sexually transmitted infections (STIs), safe sex counselling and availability of free condoms.

For instance, in the Masaka microbicide trial, the final results showed that the infection rates among the women who participated was about 4.5%, which was far less than the average of over 11% for the general population in Masaka-Rakai region. This is a great contribution to public health.

Communities need to continue supporting research, because even when they do deliver an effective product, they often have many benefits to the participating communities.

Most importantly, each research widens knowledge and sets a platform for next steps. Ignoring research will not take away HIV, and the urgent need for new options is high because it is estimated that 350 people in Uganda and 7,500 worldwide get infected everyday.
The writer is an AVAC Fellow for HIV Prevention Advocacy, based at HEPS Uganda