Gaps and Opportunities in African HIV Research

Update on the Medical Research Council’s Sexual Health and HIV Research Committee | Slides

Caroline Stone gave an interesting overview about the Medical Research Council (MRC), its grant procedures and its Sexual Health and HIV Research Strategy Committee (SHHRSC). The MRC was established in 1913 and is one of six research councils. It has a budget of £400 million per annum. The Council is a key driver of quality science; it allocates all research, from cancer epidemiology to anti-retroviral research, from one pot of money whilst striving to maintain a balanced portfolio of medical research.

The Council has a very strong portfolio in HIV, with programmes in both developed and developing countries. The SHHRSC grants funds to epidemiological and social HIV research. Information about the strategic areas that receive priority available on the MRC website.

Stone was asked if there is any work going on trying to understand the impact of research in the field, how could one be sure Council funded research findings were being put into practice? She told delegates that the MRC doesn’t have the resources to carry out this kind of research. However, part of the funding procedure requires applicants to specify how they are going to disseminate their results.

Stone was then asked how the MRC could make it easier for African communities in the UK to get funding? Especially given the paucity of the evidence base and the difficulty researchers have qualifying for funding without an evidence base. “We are very aware of the need for more African IV research” she replied going on to say that it has been one of their priorities. The SHHRC in particular is changing and strengthening the focus of research being commissioned and has a commitment to fund projects on Black and ethnic minorities.

About Caroline Stone

Dr Caroline Stone is the Programme Manager for Public Health at the Medical Research Council. Her interests are in health services research related to molecular and cellular medicine, public health research; longitudinal studies; medical sociology; epidemiology – design, methodology; statistics; telemedicine; training in health services and public health research. She provides the secretariat for the Medical Research Council’s Sexual Health and HIV Research Strategy Committee

Review of Reviews Assessing the Effectiveness of HIV Prevention | Slides

Simon Ellis presented the results of the latest review of reviews assessing the effectiveness of interventions to reduce the risk of transmission conducted by the Health Development Agency (HDA). He confirmed the paucity of the evidence base relating to African communities when he revealed that only one review had been found. However, these alarming gaps are not limited to African communities; all the priority populations examined by the Review had little or no review-level evidence about the majority of interventions (e.g condom schemes) or intervention that address structural factors which might influence risk such as the effect of discrimination. The majority evidence found was from the United States.

The HDA are now exploring a number of ways to help develop of the African HIV prevention evidence base. The HDA plans to use the mechanisms it has in place to map ongoing and completed UK research. Additionally, as the lead agency for the NHS Public Health electronic Library, they plan to develop the “Online Database of Ongoing HIV Prevention Research” to collate ongoing African research, in liaison with the AHRF and others. The information will be available via the Public Health electronic Library and also automatically available via the AHRF website.

Finally, the HDA are exploring the feasibility of holding evaluation workshops, which will bring together people involved in intervention evaluations to share their expertise and experiences in doing evaluations and focus on finding solutions to the barriers and problems in conducting local evaluations.

About Simon Ellis

Simon Ellis is the lead for HIV prevention at the Health Development Agency (HDA) and has recently published a review of reviews assessing the effectiveness of interventions to reduce the risks of HIV transmission via sex. He also manages the National HIV Prevention Information Service (NHPIS), at the HDA, which provides various print and web resources to professionals.

African communities in the North of England | Slides

Kirit Patel gave a detailed presentation about the mapping of African populations and HIV services in the north of England. The Black Health Agency, Manchester Metropolitan University and Newcastle and North Tyneside Health Promotion department carried out the work during 2002. As this was the first mapping exercise of its kind to be carried out there were many challenges to be overcome.

Services in the North currently do not have the capacity to cope with the Asylum dispersal system. Those who fail in their asylum applications often disappear, going underground where access to healthcare is difficult.

The areas covered by the study are large, with the African communities spread far and wide. There is little funding from statutory bodies and a general feeling of disempowerment prevails.

Recommendations for the future include the launch of a seminar to disseminate findings to key takeholders and setting up a database of African Communities in the North.

About Kirit Patel

Kirit Patel was appointed in 2000 as Services Manager for the Black Health Agency. He has been responsible for managing some of the Agency’s core projects, including fundraising, delivering training as well as developing and sustaining new areas of work within the widened health remit of the organisation. He is currently an advisory member on the Management Board of the Consortium of Lesbian, Gay and Bisexual Voluntary & Community Organisations and on the Board of Trustees of the Bibini Centre for Young People (Manchester).

Microbicides and Vaccines: Research in Progress | Slides

As well as providing insight into gaps and opportunities in African HIV research, the seminar day also highlighted recent developments in Microbicide and Vaccine (V&M) research. The National AIDS Trust leads the UK and Ireland campaign for microbicides; policy development officer Rebekah Webb, introduced the subject for those delegates with limited knowledge of the mode of action of vaccines and microbicides.

Vaccine efficacy so far has been estimated at 50-60%, with the 1st generation of vaccines produced being very clade specific. It is also unlikely that one dose of vaccine will offer lifetime protection. Researchers are currently investigating the possibility of an oral vaccine, which would not have to be kept at the low temperatures normally required for vaccines. This would be ideal for developing countries both in terms of cutting storage costs and alleviating fears about the safety of needles. If funding and political interest are sustained then the first vaccines are likely to be available within a decade.

Microbicides are anything a person can use to reduce the risk of acquiring sexually transmitted infections (STI), including HIV. Both rectal and virginal microbicides in the form of gels, creams and pessaries which are non-clade specific, offer contraceptive action and bi-directional protection against STIs and are being developed. There is an amazing amount of innovation around microbicides with four Phase III trials scheduled and waiting to receive funding. The 1st generation of microbicides could potentially be available by 2008.

The NAT are now asking social research questions in preparation for the arrival of these new prevention technologies. For example, researchers are hoping microbicides will be ideal for those who are unable to negotiate condom use; women could use them in secret with their husbands. However there needs to be research into the sexual acceptability of microbicides to ensure individuals will actually use them. Data gleaned from investigations into why individuals do not use condoms should be incorporated into Microbicide development. Microbicide gels are likely to cost very little money, but access for all is down to political will and the NAT is lobbying for this now.

Recent history has shown us that technology transfer to the general public needs to be carefully monitored by advocacy groups. There are lessons about financial and sexual acceptability to be learned from the plight of the female condom. The introduction of the contraceptive pill brought about changes risk perception and risk taking behaviour; studies are needed to determine if the introduction of V&M will bring about similar changes.

Whilst neither prevention is likely to offer 100% protection from HIV, both are likely to be therapeutic to those already living with HIV. The research and development process is lengthy, possibly taking up to 20 years. This research is largely publicly funded and therefore less than 1% of HIV funding is spent on V&M. However, the patents for these technologies are held in public interest meaning that access will hopefully not be a problem in the future. Webb hypothesises that the massive under-funding is partly because of lack of interest from pharmaceuticals and partly because people do not feel they can demand something that does not exist. The NAT hopes to combat these financial and advocacy challenges as soon as possible so that vaccines and microbicides are universally available sooner rather than later.

About Rebekah Webb

Rebekah Webb is Policy Development Officer (International) at the National AIDS Trust. Her role focuses on new prevention technologies and she is the coordinator of the UK/Ireland Campaign for Microbicides. Rebekah has a background in gender and development, with a special interest in human rights.

Forming a strategic response to adverse media reporting | Slides

The recent renewed focus on migration and health in the mass media, lead the African HIV Research Forum to timetable an extraordinary session at the end of the fourth seminar day. The aim of this session was to discuss how to form a strategic response to current and future adverse media attention. Joseph O’Reilly first provided an overview of the issues as they stand and then open the discussion to the floor. Below are the key points from the discussion.

  1. There is a lot of confusion, especially in the media, about the use of certain terms; “Migrants”, ” Refugees”, “Asylum Seekers” “Visitors” are often used interchangeably by media personnel, which serves to distort the debate even further. Those in the sector need to clarify the differences for themselves and the media.
  2. Negative attitudes to migration are not a new phenomenon. This recent, renewed interest in these issues is part of a long-standing problem, which is almost as old as migration itself. Current adverse reporting should be viewed in a wider context, as part of a general sense of uncertainty in the post-cold war era. These are issues that are bound up with the security and illegality. The threat of infection, be it in the form of HIV+ asylum seekers, or part of a bio-terrorist arsenal, is portrayed as being a serious threat national security.
  3. Migrants and those who support them have taken an almost apologetic stance in this debate. There needs to be a celebration of the contribution migrants make to British and all societies. Positive stories about migrants not only provide a counter balance to negative reporting, but also allow people to take pride in their achievements.
  4. Barriers to communication within the sector need to be broken down. Providers of care for both migrants and people living with HIV, should work together to improve communication of ideas and strategies. A deafening silence is often the only collective response to new negative stories, often letting disinformation go unchecked. Networks of communication across providers will ensure that prompt reactions and timely responses will become the norm.

About Joseph O’Reilly

Joseph O’Reilly is Deputy Chief Executive and Director of Policy & Campaigns at the National AIDS Trust (NAT). He has worked internationally on HIV/AIDS and Human Rights in the Asia Pacific, Africa and the Caribbean. He has acted as an adviser to Governments and the UN on HIV and was a member of the joint UNAIDS/WHO Working Group on the Legal and Ethical Aspects of HIV Vaccine Trials. He leaves NAT at the end of May 2003 to direct Kathina, an independent management, policy and communications consulting company.

Last Updated June 9, 2006