Sub-Saharan Africa is getting more involved in the search for an AIDS vaccine. Scientists now realize the importance of conducting clinical trials in Africa where the strains of HIV differ from Europe and the United States. The issue was discussed at the AIDS Vaccine 2003 Conference in New York, Saturday.
There are two types of HIV: HIV-1 and HIV-2. HIV-1 is the predominant type worldwide and it has at least ten genetically distinct sub-types or clades. And it is here where geographical and often socio-economic barriers are formed when it comes to AIDS vaccine research.
For example, subtype-B is mostly found in the industrialized nations, like the United States. But three different sub-types are found in sub-Saharan Africa.
When vaccine research began, rich nations focused on subtype-B, even though it accounted for only about 12 percent of the infections worldwide. Developing countries complained that for a vaccine to be successful, it had to work on many different clades.
Dr. Cissy Mutuluuza Kityo, who is with Uganda's Joint Clinical Research Council, was one of those who pushed for clinical trials in Africa. "The area of vaccine research has changed a lot. When we compare where we are now to the early 1990s, I think we've made major strides in contributing and participating in HIV research as a continent," she said.
There were no clinical trials in Africa in the early 1990s. As of now two vaccine trials have been completed, five are in progress, and another five may start before the end of the year. Trials are underway or about to start in Uganda, Kenya, Rwanda and South Africa.
"We think this is very good," said Dr. Kityo. "We've had a lot of partnerships with international organizations that have helped us actually accelerate the research. They've helped us transfer technology very quickly. And have helped us move with our agenda very quickly."
Dr. Omu Anzala of the Kenya AIDS Vaccine Initiative notes that before vaccine trials could begin, researchers had to gain the public's trust. "Because here people will be asking you: how do you know this vaccine will work? Do you want to use us as Guinea pigs? Those words we heard and those are initial challenges. Because it means you really have to go down to the ground level and explain to all the stakeholders," he said.
Dr. Kityo emphasized that there are other "unique challenges" to wining approval for vaccine research in Africa. "We have to involve the politicians," she said. "And that may not necessarily be the case in the U.S. or European countries. We have to get consensus of the politicians before any vaccine program can go ahead in our countries."
And there are ethical and social issues that exist in poor countries. These include ensuring a high standard of care for vaccine trial volunteers; reimbursing them for the cost of transportation to the clinic; and making sure they fully understand any risks that may be involved.
It's estimated there are 44 million people living with HIV-AIDS worldwide, the vast majority are in sub-Saharan Africa. Researchers say without a vaccine, another 50 million could become infected by the year 2010.