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', Becker added.
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 programme.
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 the field.”
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 and access.
“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.
Brown G, Becker S The future of HIV biomedical prevention conferences. International Microbicides Conference, Sydney, closing plenary, 2012.