13 Oct 2011

U.S. Global AIDS Coordinator Eric Goosby: There is political support in U.S. to partner with Russia on HIV prevention and treatment strategies

U.S. Global AIDS Coordinator Eric Goosby, who attended an international conference on ways to prevent AIDS in Moscow on October 10-12, told Interfax in an interview about the role this forum could play in combating HIV, about prospects of developing anti-HIV drugs and about Russian-American partnership in this area.

Question: What role could this forum play in combating HIV?

Answer: I think the world was thrilled when the Russian government decided to convene a discussion on how to address the fight against infectious diseases - HIV, TB and malaria. So we came and we were very interested in supporting the Russian government‘s substantive discussion of these issues.

Q.: What could the United States offer Russia fr om its practical experience in dealing with this problem and what could the U.S. probably borrow fr om Russia?

A.: I think the United States has gone its way in understanding how best to respond to this epidemic.
We, too, had to learn that you needed to understand how the virus moves through an individual and how it functions, but also how the virus moves through a population, to position the response as the government, the Department of Health, faces this challenge and to develop the surveillances, so you are aware of where the virus is, geographically and by population.
Once you understand where and how the virus is moving through the population you then position your prevention interventions by targeting individuals and groups that are at highest risks of transmission of that virus.
In every country, including the United States, once that is understood, you have to have political leadership to decide that you are going to engage in responses that target high-risk populations in a respectful, fair but effective manner.
So, the political leadership, matched with the science and the surveillance to know wh ere the virus is, allows the government and the medical institutions to deliver effective antiviral therapies to prevent the movement of the virus through the general population.
In the United States and in every country in which we worked - in Africa, in Southeast Asia, Eastern Europe - every pattern that has been successful required or had political leadership at the top, defining the problem, prioritizing the approach and implementing it through prevention at district levels of systems of care.
The unusual challenge with HIV is that it always highlights the most vulnerable populations - marginal groups, injection drug users, men who have sex with men who are very vulnerable. Women in general are very vulnerable. And this requires that governments and leaderships protect those groups.
The reason that the leadership must assert itself is that populations participating in high-risk behavior have a greater chance of developing HIV and getting infected . But ignoring these high-risk populations inevitably leads to the virus moving to the general population, to people who are not at high risk, who are not using drugs.
So we know how the virus moves through populations. We know how to position our prevention programs. We also have drugs that are very effective in treating people who are HIV positive. Indeed, we are talking about individuals who take anti-HIV drugs and die of something else. People are living 20-30 years after the initiation of the therapy, routinely.
What have we learned from Russia? We have learned its ability to scale-up testing . People know their HIV status. Twenty million people have been tested in Russia over the last year or so. An extraordinary number! Of those, 60 thousand have been identified as HIV positive and all those individuals are being given a treatment. That testing strategy of identifying individuals and their treatment are of interest to the world.

Q.: Are there effective drugs that could slow HIV progressing? Do you think a drug could be developed that would cure HIV patients? Or is it a naive idea? Do you think advanced know-how would help develop an effective medication to combat HIV?

A.: Drugs slow down the virus progression in an individual almost to the point wh ere there is no progression. They are very effective. Individuals who started the anti-viral therapy get to a normal immune function and the majority of them continue to work and care for their families Taking an anti-viral therapy is like being a diabetic or a person with high blood pressure. You take the medicine for the rest of your life, but if you take it you don‘t have the complications of those diseases. HIV is the same. It is very effective although not curative.
The other effect of this therapy is that by taking the therapy you drop the amount of the virus in your blood to when it cannot be found and the ability to infect other people through sex or blood drops almost to zero. So treatment becomes highly effective indeed and becomes a prevention.
So we, for the first time in the history of 30 years of responding to this epidemic, we are in a position to actually put all tools together, we have the tools to stop new infections by treating people aggressively, by treating pregnant women who are HIV positive and using other prevention interventions for high-risk behavior, such as drug therapy for people addicted to drugs and who use needles, which causes the transmission of HIV and hepatitis. These known interventions, these effective interventions now can be deployed effectively in combination with the anti-viral therapy, and stop the spread of HIV.

Q.: Are there plans to organize Russian-American joint research, given the role our countries play in developing advanced medical know-how, and create an effective HIV drug? If such plans exist what their budget could be and is there political support for such initiative?

A.: There is strong political support in the United States to partner with Russian scientists and to better understand prevention strategies, as well as treatment strategies. We have developed a partnership between the National Institute of Health and the Russian Foundation for Basic Research, that is new and will take effect next year. That will allow this type of opportunities to be joined. Co-investigators will move forward with therapies, prevention and treatment.
The other relationship that we have had with Russian scientists for ten or eleven years is the National Institute of Health bringing Russian scientists to all international meetings on HIV. So we have been talking to each other for a very long time on prevention, care, treatment and research efforts.