20th International AIDS Conference - Melbourne, Australia

THPL01 Stepping up the Pace: Making the Long Term Short Term
  Plenary Session
Venue: Plenary 2
Time: 24.07.2014, 08:22 - 10:30
Co-Chairs: Ian Gust, Australia (to be confirmed)
Georgie Crozier, Australia
George Ayala, United States
JoAnne Keatley, United States

Webcast provided by International AIDS Society
Award Presentation: IAS/ANRS Young Investigator Award

Stepping up the Pace on HIV Vaccine: What Needs To Be Done?
A. Lanzavecchia, Switzerland

Stepping up the Pace on New Prevention Technologies
K. Mayer, United States

Stepping up the Pace for Men Who Have Sex With Men (MSM) and Transgender: Understanding the Science
B. Grinsztejn, Brazil

Stepping up the Pace for Men Who Have Sex With Men (MSM) and Transgender: The Community Response
L. Garcia, Philippines

Powerpoints presentations
Stepping up the Pace on HIV Vaccine: What Needs To Be Done? - Antonio Lanzavecchia

Stepping up the Pace on New Prevention Technologies - Kenneth Mayer

Stepping up the Pace for Men Who Have Sex With Men (MSM) and Transgender: Understanding the Science - Beatriz Grinsztejn

Stepping up the Pace for Men Who Have Sex With Men (MSM) and Transgender: The Community Response - Laurindo Garcia
Stepping up the Pace for Men Who Have Sex With Men (MSM) and Transgender: The Community Response - Laurindo Garcia

Rapporteur reports

Track A report by Matthew Parsons

This cross-disciplinary plenary session featured four presentations delineating key priority areas in basic and clinical sciences, social research and community involvement that will be essential to eliminating HIV/AIDS.


Antonio Lanzavecchia (Switzerland) opened the session with a comprehensive overview of the current state-of-the art in HIV vaccine research. Broadly neutralizing antibodies against HIV were discussed as an essential immune response to elicit via vaccination, but the inability of previous vaccine constructs to elicit these antibodies was highlighted. Building on a presentation by Anthony Fauci (USA) earlier in the conference, Lanzavecchia reiterated the contemporary notion that broadly neutralizing antibodies might be obtainable if vaccines are designed to contain an array of envelope immunogens that elicit progressive levels of somatic hypermutation. Advances in our understanding of the HIV envelope structure were discussed in the context of contributing to immunogen design. The potential of non-neutralizing antibodies to contribute to protection through antibody-dependent cellular cytotoxicity, complement-mediated cytotoxicity and phagocytosis was also addressed. Lastly, continued study of T-cells, especially tissue-resident T-cells, was also highlighted as important moving forward.


Kenneth Mayer (USA) described the current status of HIV prevention. The extensive armamentarium of pre-exposure prophylaxis tools, including microbicides, vaginal rings, injectable agents and films were discussed.  The fruits of labour of extensive scientific research, including antiretroviral drugs and broadly neutralizing monoclonal antibodies, are now being implemented in the design of these potentially preventative technologies.   


Next, Beatriz Grinsztejn (Brazil) discussed the HIV epidemic in men who have sex with men (MSM) and transgender women. Although recent data reveal decreasing HIV incidence overall, Grinsztejn asserted that this is not the case in communities of MSM and transgender women. Strategies are urgently required to identify and provide these communities with access to HIV testing, treatment and care.


Lastly, Laurindo Garcia (Philippines) gave a moving presentation calling an end to stigma, discrimination, and violence encountered by transgender people, MSM, gay men and all minority populations worldwide. Despite our successes in biomedical prevention and treatment, Garcia emphasized that without parallel efforts to improve human rights these interventions may have a difficult time reaching the populations in greatest need.

Track D report by Martin Holt

This morning’s plenary session had four speakers tackling progress in vaccine development, other prevention technologies, and preventing HIV among men who have sex with men (MSM) and transgender women (TGW).

Antonio Lanzavecchia (Institute of Research in Biomedicine, Switzerland) spoke about HIV vaccine development. Five HIV vaccines have been tested in humans. Four of these candidates failed and the other one (the Thai trial) had a modest protective effect that faded over time. One of the current aims is to generate a vaccine that elicits broadly neutralizing antibodies (bNAbs). Many bNAbs have been identified among people with HIV, with particularly progress in the last few years in identifying highly potent versions. These very potent bNAbs are rare, so research is focusing on how they evolve and how to induce them in sufficient concentrations to confer protection. Lanzavecchia noted that researchers are also looking at whether a vaccine could generate both neutralising antibodies and a broad T-cell response to increase its chances of success. The technology to test vaccine candidates has evolved rapidly over the last decade.

Ken Mayer (Fenway Health and Harvard, Boston) spoke about developments in HIV prevention technology. He asked whether HIV treatment expansion would be sufficient to curtail the epidemic. Mayer noted that even if every HIV-positive person with a CD4 count of 500 or less was on treatment, modelling suggests that this would be insufficient to stop the epidemic and therefore we need a range of prevention options. Considering pre-exposure prophylaxis (PrEP), Mayer acknowledged patients sometimes have difficulties with adherence to a daily regime and suggested episodic, on-demand strategies or long-acting release models may be more effective or suitable. Mayer talked about microbicide candidates (topical gels or films that can be applied to the vagina or rectum to protect against HIV), intravaginal rings that slowly release antiretroviral drugs, long-acting injectable drugs and monoclonal antibodies that might offer an alternative to antiretroviral drugs. There are a number of candidates in development. Mayer also described the use of mobile phone apps to encourage people to evaluate their risk, identify protective strategies and to improve adherence to treatment or prophylactic strategies. Overall, Mayer noted that new prevention technologies will not work without also addressing social, political and economic issues, particularly community support for prevention and the cost effectiveness of new strategies.

Beatriz Grinsztejn (Oswaldo Cruz Foundation, Brazil) discussed developments related to HIV among MSM and transgender women (who are often overrepresented in HIV epidemics). Data from several countries show that while HIV incidence may be declining overall, among MSM and transgender women the epidemic appears to be worsening. MSM populations typically have much higher HIV prevalence and incidence rates, compared with their heterosexual peers, even within generalised epidemics. The situation may be even worse among transgender women (although most surveillance systems fail to provide data on this marginalised group). MSM and TGW are particularly vulnerable to HIV because of the relative ease of transmitting HIV during anal sex, high rates of untreated sexually transmitted infections, relatively high numbers of sexual partners and common experiences of stigma, discrimination and violence that prevent access to health care and prevention. Grinsztejn noted that many MSM communities display strong resilience in the face of HIV and homophobia, but many countries (particularly in Africa) criminalise homosexuality, creating hostile environments in which to tackle HIV. Grinsztejn singled out the rapidly worsening situation in Russia, which is pursuing a public anti-gay agenda that is making HIV prevention much harder. In terms of progress, Grinsztejn highlighted studies investigating the efficacy of treatment as prevention among MSM, the development of PrEP, and strategies to increase rates of HIV testing (although it is far from clear how useful these strategies will be, particularly in resource-poor settings in which there is systemic homo- or transphobia). Grinsztejn also noted that investment in HIV prevention for MSM and TGW is insufficient in most countries.

Laurindo Garcia, an HIV-positive activist from the B-Change Foundation, gave a community perspective on the response to HIV among MSM and TGW. He spoke about the fears of people to speak openly about pleasure, desire and sexual health, and that tackling moral judgments about sex and sexuality is vital for promoting HIV prevention. He noted that the last two years have seen an intensification of criminalisation, violence and hate speech against MSM and TGW. These developments stand in stark contrast to narratives of scientific progress within the HIV prevention field. Garcia suggested that developing new prevention technologies is of little use if MSM and TGW cannot access and use basic prevention services while they face an ‘epidemic of hate.’ Garcia said that he wished there was an ‘intolerance vaccine’, a ‘violence condom’ and ‘post-hate prophylaxis’ that could help people behave more respectfully to each other, protect people from violence and allow them to treat the effects of discrimination. Garcia’s point was that public health interventions are undermined by stigma, violence, criminalisation and a lack of rights for MSM and TGW. He placed the onus on health professionals and community leaders to protect and support MSM and TGW, and encouraged us all to spread empathy.


    The organizers reserve the right to amend the programme.