Arne Näveke, PhD

Executive Director – Advocacy, Policy & Communications

Planning for Adult Vaccination in Middle and Low Income Countries: HIV, TB, and Malaria Workshop

Rockville, Maryland

9 September 2013

HIV / AIDS

A brief overview and potential insights for adolescent and adult vaccination in LICs/MICs

7.5 million

people living

with HIV

1990

•IAVI is established

•Introduction of antiretroviral therapy

•20 million people living with HIV

1996

What is HIV / AIDS?

Milestones

First cases of

AIDS

1981

HIV discovered as the

causal agent of AIDS

1983

In the U.S., AIDS becomes the

leading cause of death for men

between the ages of 24 and 44

1992

First full-scale, Phase

II HIV vaccine trial

begins in U.S.

1998

32 million

people living

with HIV

2005

RV 144 trial

results released

2009

34 million people living with HIV 2011

Number of People Living with HIV

Adults (ages 15+) 30.7 million

Women 16.7 million

Children (ages 0-14) 3.3 million

TOTAL 34.0 million

People Newly Infected with HIV

Adults (ages 15+) 2.2 million

Children (ages 0-14) 330,000

TOTAL 2.5 million

AIDS Deaths

Adults (ages 15+) 1.5 million

Children (ages 0-14) 230,000

TOTAL 1.7 million

What is HIV / AIDS?

Demographics of the AIDS Pandemic, 2011

Source: UNAIDS. 2012 UNAIDS Report on the Global AIDS Epidemic. 2012.

http://www.unaids.org/en/media/unaids/contentassets/documents/epidemiology/2012/gr2012/20121120_UNAIDS_Global_Report_2012_with_annexes_en.pdf.

What is HIV / AIDS?

Geographics of the AIDS Pandemic, 2011

Source: UNAIDS. AIDSinfo. 2012. http://www.unaids.org/en/dataanalysis/datatools/aidsinfo/.

What is HIV / AIDS?

Adult Women Living with HIV, 1991

Source: UNAIDS. AIDSinfo. 2012. http://www.unaids.org/en/dataanalysis/datatools/aidsinfo/.

What is HIV / AIDS?

Adult Women Living with HIV, 2011

Source: UNAIDS. AIDSinfo. 2012. http://www.unaids.org/en/dataanalysis/datatools/aidsinfo/.

What is HIV / AIDS?

HIV Prevalence Among Sex Workers

Mexico 0.2 1.1Jamaica 1.8 4.6

Hait i 1.8 8.4

Guyana 1.1 16.6

Brazil 0.3 4.9

Senegal 0.7 18.5

Guinea 1.4 32.6

Côte d'Ivoir 3.0 28.7

Burkina 1.1 16.4

Nigeria 3.7 24.5

Morocco 0.2 2.0

Spain 0.4 2.0

Serbia 0.1 0.8

Lat via 0.7 22.2

Belarus 0.4 0.7

Ukraine 0.8 9.0

Romania 0.1 1.0

Bulgaria 0.1 0.3

DR Congo 1.3 22.1

Rwanda 2.9 50.8

Uganda 7.2 35.0

Zimbabwe 14.9 49.9

Swaziland 26.0 69.6

Madagasca 0.3 3.0

Maurit ius 1.0 31.8

Armenia 0.2 1.2

Azerbaijan 0.1 0.7

Uzbekist an 0.5 2.2

Kazakhst an 0.2 1.5

Tajikst an 0.3 4.4

Kyrgyzst an 0.4 3.5

Myanmar 0.6 9.4

China 0.1 0.3

Viet Nam 0.5 3.0

Malaysia 0.4 0.3

Indonesia 0.3 9.0

Aust ralia 0.2 0.04

COUNTRY

HIV PREVALENCE IN

GENERAL POPULATION

HIV

PREVALENCE

AMONG SEX

WORKERS

Source: UNAIDS. AIDSinfo. 2012. http://www.unaids.org/en/dataanalysis/datatools/aidsinfo/; UNAIDS. HIV prevalence in adults and key populations. 2012.

http://www.unaids.org/en/resources/infographics/20121120resultshivprevalence/.

What is HIV / AIDS?

HIV Prevalence Among Men Who Have Sex with Men

COUNTRY

HIV PREVALENCE IN

GENERAL POPULATION

HIV PREVALENCE

AMONG MEN WHO

HAVE SEX WITH MEN

Mexico 0.2 17.0Jamaica 1.8 37.6

Hait i 1.8 18.2

Guyana 1.1 19.4

Brazil 0.3 10.5Peru 0.4 12.5

Nigeria 3.7 17.2

Morocco 0.2 5.1

Spain 0.4 13.1

Serbia 0.1 3.9

Lat via 0.7 7.8

Belarus 0.4 1.3

Ukraine 0.8 6.4

Romania 0.1 5.0

Bulgaria 0.1 0.6

DR Congo 1.3 31.1

Kenya 6.2 18.2

Swaziland 26.0 16.7

S. Af rica 17.3 9.9

Madagasca 0.3 14.7

Maurit ius 1.0 10.3

Armenia 0.2 2.3

Azerbaijan 0.1 2.0

Uzbekist an 0.5 0.7

Kazakhst an 0.2 1.0

Tajikst an 0.3 1.7

Kyrgyzst an 0.4 1.1

Myanmar 0.6 7.8

China 0.1 6.3

Thailand 1.2 20.0

Viet Nam 0.5 16.7

Malaysia 0.4 1.4

Indonesia 0.3 8.5

Aust ralia 0.2 11.2

Senegal 0.7 21.8

Côt e d' Ivoir 3.0 50.0

Burkina 1.1 1.0

Source: UNAIDS. AIDSinfo. 2012. http://www.unaids.org/en/dataanalysis/datatools/aidsinfo/; UNAIDS. HIV prevalence in adults and key populations. 2012.

http://www.unaids.org/en/resources/infographics/20121120resultshivprevalence/.

What is HIV / AIDS?

HIV Prevalence Among Injectable Drug Users

COUNTRY

HIV PREVALENCE IN

GENERAL POPULATION

HIV PREVALENCE

AMONG INJECTABLE

DRUG USERS

Mexico 0.2 7.0

Brazil 0.3 5.9

Senegal 0.7 9.4

Nigeria 3.7 4.2

Morocco 0.2 11.4

Spain 0.4 16.4

Serbia 0.1 2.4

Lat via 0.7 11.2

Belarus 0.4 17.1

Ukraine 0.8 21.5

Romania 0.1 1.0

Bulgaria 0.1 7.1

Kenya 6.2 18.3

Madagasca 0.3 7.1

Maurit ius 1.0 51.6

Armenia 0.2 10.7

Azerbaijan 0.1 9.5

Uzbekist an 0.5 8.5

Kazakhst an 0.2 3.8

Tajikst an 0.3 16.3

Kyrgyzst an 0.4 14.6

Myanmar 0.6 22.0

China 0.1 6.4

Thailand 1.2 21.9

Viet Nam 0.5 13.4

Malaysia 0.4 8.7

Indonesia 0.3 36.4

Aust ralia 0.2 1.0

Source: UNAIDS. AIDSinfo. 2012. http://www.unaids.org/en/dataanalysis/datatools/aidsinfo/; UNAIDS. HIV prevalence in adults and key populations. 2012.

http://www.unaids.org/en/resources/infographics/20121120resultshivprevalence/.

Treatment & Prevention

Combining Complementary Options

Manage

Current

Infections

Prevent New

Infections

Enact

Behavioral

Change

Antiretroviral

Therapies

Novel Treatment

Research

Pre-Exposure

Prophylaxis (PrEP)

Post-Exposure

Prophylaxis (PEP)

Microbicides

Voluntary Medical

Male Circumcision

Condoms

Sex Education

HIV Counseling

HIV Testing

Substance Abuse

Screenings

Community

Engagement

Source: AVAC. April 2013 update on vaccine pipeline candidates. 2013. http://www.avac.org/ht/a/GetDocumentAction/i/49862.

How Do We Get To A Vaccine?

The Global Preventive HIV Vaccines Portfolio

How Do We Get To A Vaccine?

Countries Presently Conducting HIV Vaccine Trials

Source: AVAC. HIV Vaccine Awareness Day 2013: the countdown continues. 2013. http://www.avac.org/ht/a/GetDocumentAction/i/50039; IAVI. Data on file; UNAIDS. AIDSinfo. 2012.

http://www.unaids.org/en/dataanalysis/datatools/aidsinfo/.

United States

China

Thailand

United Kingdom

France

Spain Italy

Switzerland

Germany

Uganda

Rwanda

Kenya

Tanzania

Mozambique

South Africa

Peru

Brazil

Past / Planned Trial Site

Current Trial Site

How Do We Get To A Vaccine?

The Scientific And Political Complexity of AIDS Vaccine R&D IMPACT

We are tackling an aggressive

and fast-moving target

We have to test in people early

Success will take time

We need sustained political

support

We need to build private-

sector engagement

We need to optimize the

environment for safe,

ethical trials

CHALLENGE

HIV integrates; short window

HIV hyper-variability; clades

Immune correlates of protection

are still unknown

HIV suppresses and kills cells

of the immune system

Relevant animal models

are lacking

Clinical trials are long and costly

Long-term effort requires long-term,

high-level global commitment

Market incentives for industry

activity are lacking

Ethical, regulatory,

intellectual-property issues

Health systems challenges

Scientific

Challenges

Policy /

Political

Challenges

How Do We Get There?

The Societal Complexity of AIDS Vaccine R&D And Current Options

• Ethical developed-developing world dynamics

• Cultural and religious dynamics

• Stigmatization of key populations

• Gender dynamics

Need for social sciences, close partnering and strong environment / community work

Imagine a world

without AIDS