Volume 18, Issue 2

Translations (pdf): Spanish  |  French  |  Portuguese

Stephaun E. Wallace, Editor-in-Chief
Stephaun E. Wallace, Editor-in-Chief Click for high-res version

Welcome to the newest edition of the HIV Vaccine Trials Network (HVTN) Community Compass.

HIV/AIDS continues to ravage families and communities. Globally, more than 36 million people are estimated to be living with HIV as of 20171. Also in 2017, around 1.8 million new HIV cases were seen, along with more than 900,000 deaths associated with HIV-related causes1.  It is also estimated that only about 75% of persons living with HIV are aware of their status1, which exponentially complicates prevention and care/treatment efforts because persons who are living with HIV and unaware of their status are more likely to transmit the virus to others. Though HIV is a major global public health issue, the continent of Africa bears the most burden of HIV disease, accounting for more than two-thirds of new HIV cases globally1. In 2017, nearly 59% of adults and 52% of children, living with HIV around the world were receiving antiretroviral therapy (ART)1, which is certainly progress but
much more is needed.

Key populations such as transgender persons, people who inject/use drugs, prison populations, men who have sex with men, and sex workers and their clients, often represent smaller proportions of the larger population. They may be more vulnerable to HIV regardless of local HIV prevention and care/treatment efforts or the local HIV epidemiology due to social and structural factors such as stigma/discrimination, heterosexism, poverty, intimate partner violence, economics, and cultural and social norms regarding gender and sex assigned at birth, sexuality, and ethnicity/race. These factors work like a cycle, reinforcing each other, ultimately resulting in decreased success at all points on the HIV care continuum and exponentially complicated prevention efforts. It is understood that HIV prevention tools do work, including one of the most recent, Treatment as Prevention, an HIV prevention strategy indicating that people who have an HIV viral load that is suppressed to undetectable levels are incapable of transmitting the virus to others. This message is gaining traction globally with campaigns like U=U (undetectable = untransmittable), particularly among advocates, activists, researchers and clinicians, as it is rooted in the science behind the results of many sources including a clinical research study, HIV Prevention Trials Network (HPTN) 052, which demonstrated that among serodiscordant couples (where one partner is living with HIV and the other is not), HIV transmission can be reduced by up to 96% when the partner living with HIV starts HIV treatment early, is adherent to treatment, and is virally suppressed (an undetectable viral load)2.  

None of these, or future advances to respond to HIV, will be effective without the community. Communities, particularly those most impacted by HIV, who serve as partners in the research enterprise and in local, national, and global responses to HIV, are critical. Moreover, communities that are well-informed about the science contribute effectively to better science. This is a core belief of the HVTN. It is demonstrated through our engagement of communities in all phases of the research process, which encourages trust, mutual respect, and understanding of the issues related to research. It also ensures that the processes and strategies that we use as a Network respect and honor the diverse values and differences of our study participants. The work of the HVTN is also informed by a model published by UNAIDS and AVAC entitled, “Good Participatory Practice: Guidelines for biomedical HIV prevention trials,” which provides a roadmap for researchers to best work and partner with communities as key stakeholders. These guidelines have been, and continue to be, a critical framework that informs our processes.

In this issue, we highlight some myths and facts about HIV vaccine research, describe important information relating to HIV testing considerations for HVTN study participants, and showcase some of the amazing people and research sites in the HVTN. We also have a special feature article on apartheid, the HVTN RAMP Scholars program, and a special award received by our very own Prof. Gita Ramjee, Director of the HIV Prevention Research Unit at the South African Medical Research Council.

Please help us ensure that this publication is representative of our entire global HVTN community! HVTN members (who have access to the HVTN member's website) can use our newly developed submission page that offers the ability to submit content and articles for inclusion in future issues. More information about this follows on page 4 under the "Meet the Community Compass Team" section.

Thank you for your continued support of the HVTN wherever you are in the world, for the work that you do in whatever role you have in the HVTN community, and the impact we have been able to make in our collective history and communities, together. Though we have come very far in response to the HIV epidemic, we have so much further to go to achieve an effective global HIV vaccine. The HVTN Community Compass team wants to be everywhere you are, so please share with us what's happening at your research sites, institutions, and in your communities, so that we can share it with the world. Please share HVTN Community Compass with your friends, family members, colleagues, and communities.

Be well,

Stephaun E. Wallace

Editor-in-Chief, HVTN Community Compass

[1] World Health Organization (2018). HIV/AIDS: key facts. http://www.who.int/en/news-room/fact-sheets/detail/hiv-aids

[2] Cohen, M.S. et al (2011) 'Prevention of HIV-1 Infection with Early Antiretroviral Therapy' The New England Journal of Medicine 365(5):493-505