The US global Aids program may turn to new tools such as microbicide gels and pre-infection treatment to slow the epidemic in hard-hit countries, the program's director said.
Eric Goosby said the President's Emergency Plan for Aids Relief (PEPFAR) was looking closely at both the gels, which can protect women against infection during sex and "pre-exposure prophylaxis (PrEP)," which involves giving Aids drugs to people in high-risk groups before they are infected.
"We would support PrEP in terms of high risk populations," Goosby, the US Global Aids co-ordinator said.
Goosby said microbicide gels, a focus of hope since a South African clinical trial this year showed at least one version lowered HIV infection rates, could also play a part once full regulatory approval is obtained and more is understood about how they work.
"We haven't worked out the delivery system or the dosing or interval of application," Goosby said. "We are absolutely positioned to engage in it as soon as we know those."
Goosby spoke as PEPFAR signed a new five-year deal with South Africa to bolster its Aids fight, signalling a deepening co-operation between Washington and a country once depicted as representing the wrong approach to the Aids epidemic.
Turing the tide against HIV/Aids
"We are here at a moment when South Africa is turning the tide against HIV/Aids. It is exciting to see," said US Secretary of State Hillary Clinton, who signed the five-year deal with South Africa's visiting Foreign Minister Maite Nkoana-Mashabane.
Goosby said the agreement would commit the United States to working with South Africa as it identifies its own Aids-fighting priorities, with an emphasis on helping to build up the country's overall medical infrastructure.
The United States contributes around $560 million (about R3.8 billion) a year to South Africa under PEPFAR, and Goosby said funding levels were expected to remain roughly constant for the country, where 1,000 people die from Aids-related illnesses each day.
"We have developed a level of trust that is extraordinary," Goosby said. "They are revealing needs and vulnerabilities, and their ability to move forward has allowed us to have a heads up on where their areas are that we can help."
South Africa was criticised during the presidency of Thabo Mbeki, who questioned accepted Aids science and failed to make life-prolonging Aids drugs widely available.
Taking a new approach
Mbeki's successor, President Jacob Zuma, has taken a different approach, promising drugs to more people and fighting the deep social stigma attached to the disease.
South Africa has been approved for more than $300 million (about R2 billion) in support from the Global Fund for Aids, Tuberculosis and Malaria and devotes more than twice that amount from its own budget to fighting the disease.
The addition of PrEP and microbicide gels could represent a potentially large new budget item for PEPFAR, the $18.8 billion (about R127 billion) program launched by former President George W. Bush, but Goosby said new efficiencies in both care and treatment were already streamlining the overall bill.
He said South Africa had proposed using PrEP to treat uninfected inmates in South Africa's prisons a major vector for HIV while pilot projects elsewhere were looking at sex workers and men who have sex with men.
Last month researchers showed that Truvada, a once-a-day pill combining two Gilead Sciences Inc HIV drugs, markedly reduced the risk of men contracting HIV. Gilead's tenofovir was also used in the South African study that showed a microbicide gel lowered the infection rate by 30% for women.
South Africa has sought to expand its purchase of generic drugs, and Goosby said the United States actively supported efforts by developing nations to buy cheaper versions of drugs to save money.
(Reuters Health, Andrew Quinn, December 2010)