Efforts to increase prevention, treatment and care for the communities most vulnerable to HIV and AIDS were the main focus of the American Foundation for AIDS Research’s (amfAR) 17th National HIV/AIDS Update Conference (NAUC) held in Oakland April 10-13.

About 2,000 healthcare professionals, service providers, prevention and addiction specialists, community advocates and others from around the country came together to learn about the latest research and development in the struggle to combat the HIV/AIDS epidemic.

Congressmember Barbara Lee, who represents California’s 9th District that includes the cities of Oakland and Berkeley and most of Alameda County, reflected upon the disproportionate amount of HIV/AIDS cases occurring among African Americans in Alameda County and the U.S. during a press conference proceeding the opening plenary session. Lee stressed funding for Alameda County is not adequate to meet the needs of people affected by the HIV/AIDS crisis.

According to amfAR, in 1998 Alameda County was the first county in the U.S. to declare a public-health state of emergency due to its disproportionate number of African-American AIDS cases.

Lee, who also chairs the Congressional Black Caucus (CBC) Task Force on Global HIV/AIDS, said funding on a national scale related to minorities should be increased, and highlighted President Bush’s failure to adequately address the issue thus far.

“This year, however, one of the efforts we’re mounting is to try to get the president to put $610 million into the budget for the minority AIDS initiative,” she said. “If you remember the president during the State of the Union address, he talked about HIV and AIDS and its disproportionate impact on the African-American community, yet when you saw the budget, the money wasn’t there, so it leaves the real rhetoric of that speech.”

A lower socioeconomic status and access to healthcare are other factors that contribute to higher HIV/AIDS rates, she added.

“We begin to understand that you can’t just look at a medical model and address this epidemic in any community. You have to look at the most vulnerable, the most marginalized people and how socioeconomic conditions play into their vulnerability,” she said.

According to Lee, a lack of healthcare accessibility in the U.S. due to the absence of a universal healthcare system is another reason minority populations are more severely affected by HIV and AIDS.

“We’ve got an environment in our country that is not conducive for those who are marginalized … We have to really look now and redefine this epidemic and look at how the socioeconomic factors really play into exacerbating this disease,” she said.

Dr. Mervyn Silverman, conference chair and an amfAR board member, said that federal funds budgeted for prevention must be spent properly.

“One-third of the president’s money for prevention internationally has to be for abstinence-only. In most countries in sub-Saharan Africa, the highest risk for a woman getting infected is being married. You’re going to talk about abstinence in that situation? It makes no sense,” he said.

Silverman does not believe abstinence education should be a priority right now, as HIV infection rates continue to rise among young people each year.

“Studies have shown, domestically and internationally, [that] though abstinence is the first part of any health-education regimen, it doesn’t work in isolation – not here, not anywhere,” he said.

Over 50 smaller concurrent sessions and roundtables were offered during the four-day conference in addition to larger plenaries and symposiums. Topics centered around six different areas: public policy and funding, mental health and addiction, prevention and harm reduction, treatment and research, and vulnerable communities.

Edd Lee, director of community education and outreach for the AIDS Vaccine Advocacy Coalition (AVAC) in New York City, co-presented a session on HIV vaccines and vaccine development with Jen Sarche, director of community education at the San Francisco Department of Public Health’s HIV research section.

Lee stressed that not all vaccines are 100-percent effective against infection (most range from 70-95 percent effectiveness) and none are 100-percent free from side effects and/or adverse reactions.

Sarche said it’s important to realize HIV vaccines do not contain “whole-killed” or “live-attenuated” (weakened pathogens) like a vaccine for measles, rabies or rubella would. Instead, HIV vaccines are recombinant vaccines, which are man-made, synthetic pieces and parts of HIV that come together in different ways to try to create a good immune response.

“A whole-killed or a live-attenuated virus, there could be manufacturing errors that would pass on the virus in which the vaccine does not completely kill it, which is why people can get a little bit sick after they get a vaccine,” Sarche explained. “It’s really important to understand that when using a recombinant vaccine, you cannot become infected with HIV.”

Lee said there are two types of vaccines in the process of being developed: Therapeutic vaccines are designed for people already living with HIV and are considered an immune-based therapy, while preventative vaccines target those not infected with HIV and are meant to elicit an antibody and/or a cellular immune response that would prevent infection and possibly slow down disease progression.

“Because we don’t have a vaccine yet, it’s unclear what our vaccine will actually do once it is developed, but one side is that it would provide sterilizing immunity – it would prevent infection all together,” Lee said.

Preventative vaccines would have two different immune responses, Sarche explained. During a humoral immunity response, an antibody would attack and neutralize the HIV virus or infected cell, while cellular immunity would activate killer T-cells that attack virus-infected cells.

“The idea of cellular immunity is that HIV has already infected that cell, but the immune system would be trained how to kill that off better, faster,” Sarche said, “Either keep the person from progressing to AIDS or perhaps keep that person from transmitting the virus to somebody else.”

Vaccine trials are categorized into three different phases with varying levels of intensity. When a trial is in the Phase III level, the most extensive stage of research is conducted on thousands of participants during the course of three to four years, and it attempts to measure the efficacy of preventing HIV infection.

Today there are 35 ongoing HIV vaccine trials occurring in 23 countries. Currently there are 27 Phase I trials, three Phase II and one Phase III being conducted.

Lee explained there are also Phase IIB trails, or “proof-of-concept” trials, which are not as long as Phase III.

“These trials will give us an idea about whether or not this concept of the vaccine works,” he said. “What we will get out of a Phase IIB trial is if the product works really, really well or not at all; we will be able to kind of calculate that.”

Sarche and Lee are excited about The Step Study, the latest proof-of-concept vaccine trial, which was formed by a partnership between the HIV Vaccine Trials Network (HVTN) and Merck Pharmaceuticals. Conducted in six countries with 16 study sites within 13 U.S. cities, researchers are using an adenovirus vector (cold virus) to transport genetic information about HIV in order to induce an immune response.

“The adenovirus can’t reproduce, but it’s really good about getting into the system to deliver this information about HIV and hopefully train the immune system to fight off the virus,” Sarche said.

According to HVTN, the Phase III trial, launched in the fall of 2003, is testing a “prime-boost,” or combination regimen, of vaccines on 16,000 uninfected people in Thailand. The results from this trial, which will run for three years, are not expected to be available until 2007 or 2008.

Lee said that although trails have not been successful at finding an HIV vaccine yet, they are crucial to understanding more about the virus.

“Each trial is very important because it gives us a little bit more information that hopefully will begin to give us a little bit more of a clue about what it is we have to do in order to get people’s immune systems to protect them from HIV,” he said.