The International Microbicides
Conference held in Sydney this week will be the last of its kind,
delegates were told in a closing plenary today.
From 2014 onwards, it is planned, a single biennial conference on all
aspects of HIV prevention will be held.
Globally, the two largest funders of HIV prevention research are the
US National Institutes of Health's Office
of AIDS Research and the Bill
and Melinda Gates Foundation. Gina Brown of the Office of AIDS
Research and Stephen Becker of the Gates Foundation shared the podium
to make a joint speech outlining the reasons for no longer funding
separate conferences, and instead convening a programme committee to
plan a biennial global HIV prevention conference.
They said they were proposing an "integrative prevention meeting" in
recognition of the fact that no one HIV prevention method is likely
to end the epidemic and that different methods can be synergistic.
Stephen Becker said that the demand for a more integrated approach to
HIV prevention “was being voiced from the ground up", by
community advocates and NGOs, as well as by donors who wished to see
more efficiency and less duplication of effort within the field.
Cross-cutting dialogue between specialists pursuing different areas
is more likely to generate combinations of prevention approaches than
individual approaches being pursued in neighbouring research 'silos',
There was duplication of effort in some areas. Much of
the animal-model and mucosal-immunity work being done in the HIV
prevention technologies underlay HIV vaccine development as much as
it did microbicide development. he said. And, he added, the social and
behavioural research that underpinned prevention technology research
by helping to understand which populations need what HIV prevention
methods formed the same backdrop, whether what was being developed was a
vaccine, a microbicide or the roll-out of a circumcision
Gina Brown said that a world HIV prevention conference planning
committee would be convened immediately, comprising experts from all
fields including social sciences and community advocacy. In common
with the international microbicides conferences, which have been held biennially
since 2002, the last of the the annual AIDS
Vaccine conferences, which started in 2000, will be held in 2013
in Barcelona. Other prevention conferences, such as next week's
second international Treatment
as Prevention Workshop in Vancouver, will also no longer receive
funding as separate events.
“We now know that HIV treatment and primary prevention modalities
will have to be used in an integrated manner within the field,” she
said. “It is becoming clear that there needs to be an end-to-end
plan that runs from discovery to delivery of each approach and that
this is unlikely to be achieved by the continued 'silo-isation' of
Stephen Becker implied tighter donor control of research strategy. He
said: “We are going to commercialise our approach to public health
in the sense of funding donor-co-ordinated innovative research
efforts, with the primary commitment of enabling eventual delivery
“This does not mean we are going to stop
supporting research and development for microbicides, pre-exposure
prophylaxis or vaccines,” he added. “But it does mean that, for
instance, as a Gates Foundation employee, I am no longer debarred
from talking about HIV treatment," because, he said it was recognised that what they needed to support were integrated strategies to end HIV.
Some concerns were expressed that less-well-funded fields will be "crowded out" by others. International Microbicides Conference co-chair Sheena
McCormack asked whether, as the most well-funded field, HIV vaccines
would become the focus of the majority of the conference, and
behavioural scientist Judy Auerbach said she hoped her discipline
would not be relegated to a "backdrop". Gina Brown acknowledged
this was a challenge and that fields would be funded differentially,
as they already were, but said that there would need to be ways of
structuring the meeting so that fields had some guarantee of equal
prominence "at the delivery as well as at the discovery end".
Becker finished the plenary by saying that there might need to be a
representative structure where each field had its "senators",
regardless of how much funding there was in each one.