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Public Acceptance Of Future HIV Vaccines

March 15, 2011

On the eve of the world's biggest AIDS conference this month in Austria, a new research review shows many people wouldn't get inoculated against HIV even if a vaccine was developed.

The authoritative review - published in this month's edition of the journal AIDS - was led by Peter A. Newman, associate professor at the University of Toronto's Factor-Inwentash Faculty of Social Work. Newman and PhD candidate Carmen Logie drew conclusions from 30 previous research papers involving nearly 12,000 people on the topic of HIV vaccine acceptability.

"One might assume that if an HIV vaccine was available, many people would line up to be vaccinated. However, the research strongly indicates this is not the case," says Newman, Canada Research Chair in Health and Social Justice. "The availability of a vaccine alone is not enough to ensure that people will be inoculated."

Newman and Logie's meta-analysis of existing literature identified several factors that could influence people's willingness to be inoculated with an HIV vaccine. Among them:

    * The effectiveness of a vaccine: The research showed people would be far less likely to take an HIV vaccine if it was only 50 per cent effective in protecting against HIV infection:
      If a vaccine was 50 per cent effective in protecting against HIV, only 40 per cent of people said they would accept it
      If a vaccine was 100 per cent effective, 74 per cent of people said they would accept it
    * Risk perception: The research showed many people do not see themselves as being "at risk" of contracting the disease - even if they are - and so would not consider being inoculated against HIV.
    * Structural factors: The research showed that factors such as cost and access to vaccines would prevent some people from seeking inoculation.

Additional but less influential factors included fear of side effects and fear of vaccines.

"If we want a future HIV vaccine to be acceptable and accessible to people, we need to address these factors now, before the vaccine is publicly available," says Newman. "Otherwise, we'll get to the point where we've got a safe and reasonably effective vaccine but the public is not prepared or able to receive it."

Logie says the research indicates a growing need for public education. People need to understand what scientists mean when they talk about a vaccine's efficacy, she says.

"The research shows that some people are highly suspicious of vaccines that are less than 100 per cent effective, but the fact is, not every vaccine is 100 per cent effective. That's something the public needs to understand," she says.

There must be more education and awareness around the benefits of vaccines and the continuing risk of HIV, particularly in young people, says Newman. "It's a challenge to have people weigh the very miniscule risks of getting a vaccine against the far greater risks of HIV." And governments need to consider what can be done to address "structural barriers" such as cost for vaccines and making them easily accessible.

"The research has clearly identified factors that would influence people's decisions around HIV vaccinations," says Newman. "Now, we have to ask ourselves, 'which of those factors can we begin to address, and how?'"

Source:
April Kemick
University of Toronto



More Than Five Million People Receiving HIV Treatment

March 01, 2011

An estimated 5.2 million people in low and middle-income countries were receiving life-saving HIV treatment at the end of 2009, according to the latest update from WHO.

WHO estimates that 1.2 million people started treatment in 2009, bringing the total number of people receiving treatment to 5.2 million, compared to 4 million at the end of 2008.

"This is the largest increase in people accessing treatment in a single year. It is an extremely encouraging development," says Dr Hiroki Nakatani, WHO Assistant Director-General for HIV, Tuberculosis, Malaria and Neglected Tropical Diseases.

At the XVIII International AIDS Conference, WHO is calling for earlier treatment for people with HIV. The objective is to begin HIV treatment before they become ill because of weakened immunity.

"Starting treatment earlier gives us an opportunity to enable people living with HIV to stay healthier and live longer," says Dr Gottfried Hirnschall, WHO Director of HIV/AIDS.

Estimates developed through epidemiological modeling suggest that HIV-related mortality can be reduced by 20% between 2010 and 2015 if these guidelines for early treatment are broadly implemented.

Earlier treatment can prevent opportunistic infections including tuberculosis (TB), the number one killer of people with HIV. Deaths from TB can be reduced by as much as 90%, if people with both HIV and TB start treatment earlier.

The strength of a person's immune system is measured by CD4 cells. A healthy person has a CD4 count of 1000 - 1500 cells/mm3. WHO previously recommended starting HIV treatment when a person's CD4 count drops below 200 cells/mm3 but now advises starting HIV treatment at 350 cells/mm3 or below.

"In addition to saving lives, earlier treatment also has prevention benefits," Dr Hirnschall says. "Because treatment reduces the level of virus in the body, it means HIV-positive people are less likely to pass the virus on to their partners."

WHO's treatment guidelines expand the number of people recommended for HIV treatment from an estimated 10 million to an estimated 15 million. The cost needed for HIV treatment in 2010 will be about US$ 9 billion, according to the Joint United Nations Programme on HIV/AIDS (UNAIDS).

"The investments we make today can not only save millions of lives but millions of dollars tomorrow," said Dr Bernhard Schwartlander, Director, Evidence, Strategy and Results, UNAIDS. "People with weaker immune systems who come late for treatment require more complex and costly drugs and services than those who start treatment earlier and are healthier."

Since 2003 - which marked the launch of the historic "3 by 5" initiative to provide access to HIV treatment to 3 million people living in low- and middle-income countries by the end of 2005 - the number of people receiving HIV treatment has increased 12-fold.

At AIDS 2010, WHO is releasing the 2010 guidelines on Antiretroviral treatment of HIV infection in adults and adolescents - public health approach.

Source:
WHO



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