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Teaching the Body to Combat a Chameleon
12/29/2002

A new HIV vaccine is about to enter into a data analysis phase. It is wonderful that progress is being made in this area, primarily for regions of the world in which HIV has infected large portions of the population, such as the 30% in some African countries. However, I find pitches such as the following worrisome:

If Vaxgen can show that the infection rates among the vaccinated groups are anything between 45 per cent and 65 per cent lower than in the unvaccinated group, the company should be able to persuade the world that the trial has been a resounding success.

Don Francis, the president of Vaxgen, said that even a 30 per cent reduction in infection rates would be deemed an important step forward because some epidemiologists believe that such a partially effective vaccine could eventually curb the epidemic if it were used for mass vaccination.

The idea of mass vaccination to slow the spread of HIV by 30% strikes me as dangerous, not only because of any inherent dangers of the vaccine, but also because people may see it as more of a protection than it is. Add to this the mutable nature of HIV and the variety of different strains, and I think it would be a mistake to call anything that is currently feasible a "resounding success."

Also consider this statement: "Without an effective vaccine, there is little hope of containing the spread of HIV, which has already reached levels of 30 per cent among the general population of some African countries." In the entire Independent article, there is not a single mention of abstinence or changing behavior, even though the subject of HIV is inextricable from the subject of its behavioral transmission.

In Uganda, the percentage of pregnant women with HIV dropped from 21.6% to 6.2% in a little over a decade. The country achieved this by searching its culture for strategies via which to make a strong push for abstinence. Even a moderately effective vaccine would be wonderful, but there is no indication that any strategy to end the HIV epidemic can succeed without a behavioral component.

There is also no indication that this message is getting through to "the world" that is soon to be presented a campaign to "persuade" it that a vaccine is its only hope.

Posted by Justin Katz @ 10:09 PM EST