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Q&A: “The Momentum of AIDS Prevention Is Waning”

Interview with Luis Soto Ramírez, co-chair of AIDS 2008

MEXICO CITY, Aug 1 2008 (IPS) - Mexican virologist Dr. Luis Soto Ramírez, co-chair of the 17th International AIDS Conference, which opens Sunday in the Mexican capital, says that ramping up prevention efforts is the most urgent step to be taken in the fight against HIV/AIDS.

While rushing from one commitment to another in the run-up to the event, also known as AIDS 2008, which will draw 25,000 participants from 188 countries, Soto Ramírez takes time to question the way the United Nations Joint Programme on HIV/AIDS (UNAIDS) reported the conclusions of its latest global report on Tuesday.

According to UNAIDS, the annual number of new HIV infections dropped from three million in 2001 to 2.7 million in 2007.

“The announcements are accurate, but I think they lack context. In other words, great! they’re going down (the number of new infections), but this could be due to the fact that the earlier estimate wasn’t good or that some aspect of the prevention campaigns is working. But the failure to provide a context for the figures could lead people to stop protecting themselves,” he said in this interview with IPS correspondent Daniela Estrada.

Soto Ramírez, the head of the Molecular Virology Unit at Mexico’s National Institute of Medical Sciences and Nutrition, is also critical of the levels of compliance with international commitments on HIV/AIDS. “We are not going to achieve universal coverage of antiretroviral treatment by 2010,” he said.

IPS: The theme of the conference is Universal Action Now. What are the most critical aspects of the epidemic that are in need of urgent attention?

LUIS SOTO RAMÍREZ: Prevention is the most important thing. We have many problems with medical attention and treatment, because of economic reasons, and if we do not begin, or step up, prevention efforts, things will reach the point where countries, continents and humanity as a whole will be overwhelmed.

Prevention is what we have done really poorly at, with the exception of mother-child transmission.

The latest statistics show that HIV transmission has risen among men who have sex with men in the United States, even though they were the first to be affected by the epidemic, and were the ones who took responsibility, became active and spread the information. The momentum of prevention is waning.

IPS: Have the achievements of recent years, like the extension of the lives of people living with HIV, thanks to antiretroviral treatment, generated a more lax attitude towards prevention?

LSR: Of course that is what is happening, and we see it among men who have sex with men, who had earlier taken the lead in prevention and activism.

I think there are two lessons in this. The first is that prevention and awareness-raising efforts have to be constant. You don’t just throw out a message and that message stays out there for 20 years. It doesn’t work that way, unless – and this is the second lesson – you start educating people from earliest childhood, so the message is completely internalised.

We have to be very clear when talking about the good and bad aspects of the medication: about the side effects and the fact that they do not stop the spread of HIV.

IPS: In Latin America, what are the challenges in terms of prevention?

LSR: The first is to reach all people in the region, and I am not referring to numbers of people, but to all of the ethnic groups that have different languages, traditions and habits. There is a broad range of groups in the region, and it is difficult to truly reach all of them. This is a major limitation because you have to have different prevention approaches.

IPS: Will the conference have any special characteristics because it is the first to be held in Latin America?

LSR: The objectives will be very clearly oriented towards Latin America, such as for example not losing sight of a focus on men who have sex with men, or on women, who are very vulnerable to the epidemic. Latin American women are still too oppressed, too subjugated by men. The prevailing machismo must be brought to light.

IPS: What new scientific findings will be presented?

LSR: I think most of the conference will focus on prevention. Male circumcision will be debated, as will microbicides (vaginal gels designed to help protect against infection of HIV, which are still being tested), and post-exposure prophylaxis for HIV infection.

IPS: Does pre-exposure prophylaxis, taking antiretroviral pills preventively, carry risks?

LSR: How is it possible for me to think of taking a pill before having sex? It’s better for me not to have sex, or to use a condom. This is under discussion. There are many people who say “I don’t want to use condoms, I’m going to take a pill.” This occurs in small groups who have access to that information. The idea is for us to discuss at this conference the need for this practice not to become widespread.

IPS: Everyone is wondering when an HIV/AIDS vaccine will be discovered. What is your prediction?

LSR: Today I heard that the best case scenario is that a vaccine could be discovered in 25 years. I don’t even think that will happen. HIV is very different from the other viruses for which we have vaccines.

IPS: What is your opinion on the dispute over generic, cheaper drugs promoted by nations like Brazil and India vs. the rights of the big laboratories that hold patents?

LSR: That was something that was going to happen because of the sheer number of people infected. Each country has to achieve a balance. We have to buy the medications at lower prices, but we also have to provide incentives for the production of new medicines by the pharmaceutical companies.

Now, my question in Mexico and in most of the countries of Latin America is the following: are they 100 percent sure that the generic drugs work? There’s no problem; use generics in some cases and original medications in others.

I just returned from a trip to Colombia, where doctors told me about a patient taking a generic drug, who saw that the pills come out intact in his stool, and about another patient who had headaches because of a medication that produces that side effect and who started taking the generic version and no longer gets headaches. So this really alarms you. Do the countries of Latin America really have the infrastructure to carry out bioequivalency tests? I don’t think they do. I might be wrong with regard to Brazil, but even in that case I have my doubts.

IPS: What do you think about the statement by the Swiss Federal Commission for HIV/AIDS, according to which HIV positive people who are receiving effective antiretroviral treatment and have undetectable virus levels in the blood cannot transmit the disease to an HIV-negative partner via unprotected sexual contact?

LSR: That statement is completely and absolutely irresponsible. They are turning a blind eye to a phenomenon that we are seeing around the world. When you study recently infected patients, you find something very interesting: on average, 10 percent are being infected with drug-resistant HIV strains. And in some places in the United States and Brazil, the average has been found to go up to 25 and 33 percent, respectively.

This means that people who are taking antiretroviral medications are having unprotected sexual relations and are transmitting drug-resistant strains. I see the Swiss declaration as highly irresponsible. They will bring up their stance for debate at the conference, but I believe that they will come in for some severe criticism.