A Call for Public-Private Partnerships for HIV Prevention

In the early days of the AIDS epidemic, nobody imagined the devastation it would bring -- or how relentlessly it would strike at people in the prime of their lives. However, the landscape shifted when antiretrovirals were introduced to treat those infected with HIV, and in the midst of despair, came hope. Today, promising research in HIV prevention is taking center stage, ushering in a new era in the fight against HIV and AIDS, and we have public-private partnerships to thank for many of the recent achievements.

During the past year, notable progress has been made in the field of HIV prevention. In July 2010, researchers at the Centre for the AIDS Programme of Research in South Africa (CAPRISA) demonstrated that a topical 1 percent tenofovir gel, administered before and after sexual intercourse, could reduce HIV acquisition by 39 percent in high-risk South African women. The CAPRISA 004 study demonstrates what can happen when women are able to take HIV prevention into their own hands.

Shortly thereafter, the iPrEX study found that a daily pill containing tenofovir and emtricitabine, lowered HIV infection by 44 percent in high-risk men having sex with men. The same pills were used in a third study, FEM-PrEP, but did not find the same encouraging results in high-risk women. However, this research involving 1,951 African women did highlight that product adherence -- how closely people follow directions for taking the drug -- and vaginal drug level are crucial for effectiveness.

A fourth recent study, HPTN 052, showed convincingly that early antiretroviral treatment works as prevention. This study provided antiretrovirals to the HIV-infected partner of couples with different HIV statuses and who would not ordinarily have qualified for medications using World Health Organization guidelines. Those HIV-infected persons who received antiretroviral drugs had a 96 percent lower risk of transmitting to their uninfected partner than those who did not receive drugs. So now we can "kill two birds with one stone" -- first, treat HIV-infected people to improve their personal health, and second, treat them to prevent the spread of the virus to their sexual partners.

As the scientists who led the teams that produced some of these advances, we have seen first-hand the value of close collaboration with our pharmaceutical partners. These achievements were only made possible by the partnership between publicly funded scientists and private drug companies. From the outset of all the studies, drug companies provided their drugs (or the rights to their drugs) at no cost to the study teams. For the studies of antiretrovirals as pre-exposure prophylaxis, Gilead Sciences was the key pharmaceutical player. For the study of treating HIV-infected individuals, study drugs were donated by Abbott Laboratories, Boehringer Ingelheim Pharmaceuticals, Bristol-Myers Squibb, Gilead Sciences, GlaxoSmithKline and Merck. This collaboration among six companies -- who are usually fierce competitors -- is a testimony to their interest in determining how best to prevent HIV transmission. The planet benefits from such collaboration.

Public-private partnerships are set to deliver even more in the future. For example, Gilead Sciences has made available royalty-free licenses for the gel form of their antiretroviral drug, tenofovir, which has recently been shown to reduce HIV risk in women. In South Africa, which has the world's most severe HIV epidemic, the government has acquired a royalty-free license for tenofovir gel and has partnered with a local pharmaceutical company to produce the gel locally. More governments and pharmaceutical companies must join together to ensure the availability of antiretroviral therapy for HIV treatment and prevention at the lowest possible cost in all resource-poor countries. Providing drugs for governmental use or voluntary licenses for generic versions of patented products, are a way for companies to assure adequate supply.

In addition, governments, non-governmental organizations and the pharmaceutical industry need to collaborate to train health workers to provide HIV treatment and prevention at the community level. Strengthening HIV prevention and treatment services, community outreach and literacy programs, and promoting cross-training among those providing prevention and treatment could be jointly funded by public and private resources.

The recent evidence on the use of ARV drugs for HIV prevention moves us closer than ever before to changing the course of the HIV epidemic in Africa, and indeed, globally. As the world celebrates these scientific findings, we are reminded that the public-private partnership involves being able to both "do good" and also "do well". These win-win examples demonstrate that with effective partnerships, conviction and leadership, overcoming HIV is within our grasp.