1. HIV / AIDS
A brief overview and potential insights for adolescent and adult vaccination in LICs/MICs
Arne Näveke, PhD
Executive Director – Advocacy, Policy & Communications
Planning for Adult Vaccination in Middle and Low Income Countries: HIV, TB, and Malaria Workshop
Rockville, Maryland
9 September 2013

2. What is HIV / AIDS?
Milestones
2009
RV 144 trial
results released
1998
First full-scale, Phase
II HIV vaccine trial
begins in U.S.
2011
34 million people living with HIV
2005
32 million
people living
with HIV
1990
7.5 million
people living
with HIV
1996
•IAVI is established
•Introduction of antiretroviral therapy
•20 million people living with HIV
1981
First cases of
AIDS
1992
In the U.S., AIDS becomes the
leading cause of death for men
between the ages of 24 and 44
1983
HIV discovered as the
causal agent of AIDS

3. What is HIV / AIDS?
Demographics of the AIDS Pandemic, 2011
Number of People Living with HIV
Adults (ages 15+)
30.7 million
Women
16.7 million
Children (ages 0-14)
3.3 million
TOTAL
34.0 million
People Newly Infected with HIV
Adults (ages 15+)
2.2 million
Children (ages 0-14)
330,000
TOTAL
2.5 million
AIDS Deaths
Adults (ages 15+)
Children (ages 0-14)
TOTAL
Source: UNAIDS. 2012 UNAIDS Report on the Global AIDS Epidemic. 2012.
http://www.unaids.org/en/media/unaids/contentassets/documents/epidemiology/2012/gr2012/20121120_UNAIDS_Global_Report_2012_with_annexes_en.pdf.
1.5 million
230,000
1.7 million

4. What is HIV / AIDS?
Geographics of the AIDS Pandemic, 2011
Source: UNAIDS. AIDSinfo. 2012. http://www.unaids.org/en/dataanalysis/datatools/aidsinfo/.

5. What is HIV / AIDS?
Adult Women Living with HIV, 1991
Source: UNAIDS. AIDSinfo. 2012. http://www.unaids.org/en/dataanalysis/datatools/aidsinfo/.

6. What is HIV / AIDS?
Adult Women Living with HIV, 2011
Source: UNAIDS. AIDSinfo. 2012. http://www.unaids.org/en/dataanalysis/datatools/aidsinfo/.

7. What is HIV / AIDS?
HIV Prevalence Among Sex Workers
Serbia
Lat via
Belarus
Ukraine
Romania
Bulgaria
Spain
0.4
Morocco
0.2
Armenia
Azerbaijan
Uzbekist an
Kazakhst an
Tajikst an
Kyrgyzst an
2.0
0.2
1.1
Jamaica
1.8
Hait i
0.2
0.1
0.5
0.2
0.3
0.4
1.2
0.7
2.2
1.5
4.4
3.5
2.0
HIV PREVALENCE IN
GENERAL POPULATION
Mexico
0.1 0.8
0.7 22.2
0.4 0.7
0.8 9.0
0.1 1.0
0.1 0.3
Myanmar
China
Viet Nam
Malaysia
Indonesia
4.6
1.8
Guyana
8.4
1.1 16.6
COUNTRY
Senegal
Guinea
Côt e d'Ivoir
Burkina
HIV
PREVALENCE
AMONG SEX
WORKERS
Brazil
0.3
Nigeria
0.7
1.4
3.0
1.1
18.5
32.6
28.7
16.4
3.7 24.5
DR Congo
0.6
0.1
0.5
0.4
0.3
9.4
0.3
3.0
0.3
9.0
1.3 22.1
Rwanda
Uganda
2.9 50.8
7.2 35.0
4.9
Zimbabwe 14.9 49.9
Swaziland 26.0 69.6
Madagasca 0.3 3.0
Maurit ius
1.0 31.8
Source: UNAIDS. AIDSinfo. 2012. http://www.unaids.org/en/dataanalysis/datatools/aidsinfo/; UNAIDS. HIV prevalence in adults and key populations. 2012.
http://www.unaids.org/en/resources/infographics/20121120resultshivprevalence/.
Aust ralia
0.2 0.04

8. What is HIV / AIDS?
HIV Prevalence Among Men Who Have Sex with Men
Serbia
Lat via
Belarus
Ukraine
Romania
Bulgaria
Spain
0.4
Morocco
0.2
Armenia
Azerbaijan
Uzbekist an
Kazakhst an
Tajikst an
Kyrgyzst an
13.1
0.2 17.0
Jamaica
Myanmar
China
Thailand
Viet Nam
Malaysia
Indonesia
1.8 18.2
Guyana
COUNTRY
1.1 19.4
Senegal
Côt e d'Ivoir
Burkina
HIV PREVALENCE
AMONG MEN WHO
HAVE SEX WITH MEN
0.4 12.5
2.3
2.0
0.7
1.0
1.7
1.1
1.8 37.6
Hait i
Peru
0.2
0.1
0.5
0.2
0.3
0.4
3.9
7.8
1.3
6.4
5.0
0.6
5.1
HIV PREVALENCE IN
GENERAL POPULATION
Mexico
0.1
0.7
0.4
0.8
0.1
0.1
Brazil
Nigeria
0.7 21.8
3.0 50.0
1.1 1.0
3.7 17.2
DR Congo
1.3
Kenya
0.6 7.8
0.1 6.3
1.2 20.0
0.5 16.7
0.4 1.4
0.3 8.5
31.1
6.2 18.2
0.3 10.5
Swaziland 26.0 16.7
S. Af rica
17.3 9.9
Madagasca 0.3 14.7
Maurit ius
1.0 10.3
Source: UNAIDS. AIDSinfo. 2012. http://www.unaids.org/en/dataanalysis/datatools/aidsinfo/; UNAIDS. HIV prevalence in adults and key populations. 2012.
http://www.unaids.org/en/resources/infographics/20121120resultshivprevalence/.
Aust ralia
0.2
11.2

9. What is HIV / AIDS?
HIV Prevalence Among Injectable Drug Users
Serbia
Lat via
Belarus
Ukraine
Romania
Bulgaria
Spain
Armenia
Azerbaijan
Uzbekist an
Kazakhst an
Tajikst an
Kyrgyzst an
0.4 16.4
HIV PREVALENCE IN
GENERAL POPULATION
Morocco
Mexico
0.2
0.2
0.1 2.4
0.7 11.2
0.4 17.1
0.8 21.5
0.1 1.0
0.1 7.1
0.2 10.7
0.1 9.5
0.5 8.5
0.2 3.8
0.3 16.3
0.4 14.6
11.4
Myanmar
China
Thailand
Viet Nam
Malaysia
Indonesia
7.0
Nigeria
COUNTRY
Senegal
HIV PREVALENCE
AMONG INJECTABLE
DRUG USERS
0.7
3.7
4.2
0.3
22.0
6.4
21.9
13.4
8.7
36.4
9.4
Kenya
Brazil
0.6
0.1
1.2
0.5
0.4
0.3
6.2 18.3
5.9
Madagasca
Maurit ius
0.3 7.1
1.0 51.6
Source: UNAIDS. AIDSinfo. 2012. http://www.unaids.org/en/dataanalysis/datatools/aidsinfo/; UNAIDS. HIV prevalence in adults and key populations. 2012.
http://www.unaids.org/en/resources/infographics/20121120resultshivprevalence/.
Aust ralia
0.2
1.0

10. Treatment & Prevention
Combining Complementary Options
Manage
Current
Infections
 Antiretroviral
Therapies
 Novel Treatment
Research
Prevent New
Infections
 Pre-Exposure
Prophylaxis (PrEP)
 Post-Exposure
Prophylaxis (PEP)
 Microbicides
 Voluntary Medical
Male Circumcision
 Condoms
Enact
Behavioral
Change




Sex Education
HIV Counseling
HIV Testing
Substance Abuse
Screenings
 Community
Engagement

11. How Do We Get To A Vaccine?
The Global Preventive HIV Vaccines Portfolio
Source: AVAC. April 2013 update on vaccine pipeline candidates. 2013. http://www.avac.org/ht/a/GetDocumentAction/i/49862.

12. How Do We Get To A Vaccine?
Countries Presently Conducting HIV Vaccine Trials
United Kingdom
Germany
Switzerland
France
United States
Italy
Spain
China
Thailand
Brazil
Peru
Uganda
Rwanda
Kenya
Tanzania
Mozambique
South Africa
Past / Planned Trial Site
Current Trial Site
Source: AVAC. HIV Vaccine Awareness Day 2013: the countdown continues. 2013. http://www.avac.org/ht/a/GetDocumentAction/i/50039; IAVI. Data on file; UNAIDS. AIDSinfo. 2012.
http://www.unaids.org/en/dataanalysis/datatools/aidsinfo/.

13. How Do We Get To A Vaccine?
The Scientific And Political Complexity of AIDS Vaccine R&D
CHALLENGE
Scientific
Challenges
HIV integrates; short window
HIV hyper-variability; clades
Immune correlates of protection
are still unknown
IMPACT
We are tackling an aggressive
and fast-moving target
We have to test in people early
Success will take time
HIV suppresses and kills cells
of the immune system
Relevant animal models
are lacking
Clinical trials are long and costly
Policy /
Political
Challenges
Long-term effort requires long-term,
high-level global commitment
We need sustained political
support
Market incentives for industry
activity are lacking
We need to build privatesector engagement
Ethical, regulatory,
intellectual-property issues
We need to optimize the
environment for safe,
ethical trials
Health systems challenges

14. How Do We Get There?
The Societal Complexity of AIDS Vaccine R&D And Current Options
• Ethical developed-developing world dynamics
• Cultural and religious dynamics
• Stigmatization of key populations
• Gender dynamics
Need for social sciences, close partnering
and strong environment / community work

15. Imagine a world
without AIDS