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Aids Vaccine Handbook aids vaccine handbook 2nd edition: global perspectives edited by PATRICIA KAHN aids vaccine handbook aids vaccine handbook aids vaccine handbook 2nd edition: global perspectives edited by PATRICIA KAHN May 2005 www.avac.or g aids vaccine handbook First printing. Copyright © 2005 by the AIDS Vaccine Advocacy Coalition (AVAC). All rights reserved. This book may be reproduced in its entirety or in complete articles for free distribution with written permission from the AIDS Vaccine Advocacy Coalition. No part of this work may be reproduced or transmitted in any form or by any means, electronic or mechanical, without permission in writing from the AIDS Vaccine Advocacy Coalition. When citing this book, please reference both the book and the specific article, author and source. The following is the complete book citation: Kahn, Patricia, ed. AIDS Vaccine Handbook: Global Perspectives. New York. AIDS Vaccine Advocacy Coalition. 2005. ISBN 0-9678014-1-9 The full text of this book is available online at the AVAC website: www.avac.org To order copies of this book (and other AVAC publications) or to make a tax-deductible contribution, please contact AVAC at: AIDS Vaccine Advocacy Coalition 101 West 23rd St. #2227 New York, NY 10011 USA tel: +1 (212) 367-1279 fax: +1 (646) 365-3452 e-mail: [email protected] website: www.avac.org In our effort to promote well-informed and honest dialog about AIDS vaccine research, we are pleased to send out additional bulk copies. Please contact AVAC for pricing information. Contributions will greatly facilitate this book’s distribution. AVAC is a non-profit, community- and consumer-based organization that uses public education, policy analysis, advocacy and community mobilization to accelerate the ethical development and global delivery of vaccines against HIV/AIDS. Editing by Patricia Kahn. Photo wrangling and copyediting by Michael Hariton. Book design, layout and image editing by Ann McDonald-Cacho. Immune system illustrating by Lew Long. Photography by various talent cited throughout the book. Printed in the US by Dakota Press. acknowledgments This book was made possible by the dedication and effort of many people, first and foremost those who wrote articles or gave extensive interviews to us. At all stages it has profited from the wise counsel and careful reviewing of Bill Snow and Mitchell Warren. Pat Fast, Chris Collins, Victoria Freedman, Pontiano Kaleebu, Ruth Macklin, Emmanuel Mugisha, Sarah Schlessinger and Steve Wakefield also gave valuable editorial input. AVAC gratefully acknowledges Ann McDonald-Cacho of McDonald Advertising for her imaginative and always-sharp eye and her extraordinary effort, which created the book’s design and layout. We also thank Michael Hariton for his ingenuity and hard work in bringing together this collection of photos from a wide range of people and places, for compiling the index and for his meticulous copyediting. We are also grateful to Donna Lomangino of Lomangino Studio for her assistance. For providing photos and artwork, we extend our appreciation to Michael Hoelscher, Clive Gray, Josephine Cox, Roberto Fernandez-Larsson, Lew Long, Christoph Geldmacher, the Treatment Action Campaign, Bonnie Bender, Ogun Afariogun, Trish Southwood, Charmaine da Costa Soares, Gideon Mendel and Alexandra Dupoux. We also thank Davey Mitchell, Kelley Leonard, Michelle Galloway and Laura Rabin for their help in chasing down facts and photos. Funding from the WHO-UNAIDS HIV Vaccine Initiative allowed us to extend our original plan for the book, for which we give special thanks to José Esparza and Saladin Osmanov. We are also grateful to our donors for their general support, which contributed greatly to this project. —P.K. aids vaccine handbook contents in brief the handbook is divided into the following sections: OVERVIEW The big picture of where we are now and the main 1 challenges we confront. AIDS VACCINE SCIENCE 2 A primer on vaccine research and development. CLINICAL TRIALS How AIDS vaccine candidates are tested in people and what issues arise as individuals, communities and 3 countries engage in the process. COMMUNITIES AND COHORTS Issues specific to certain highly affected and vulnerable 4 communities that are integral to the fight against AIDS. GLOBAL ADVOCACY Policy issues affecting AIDS vaccine development 5 and eventual access, and why advocacy matters. VOICES Insights from people, issues, times and places that have 6 helped shape the AIDS vaccine movement. APPENDIX Detailed listings, including information about the authors, international vaccine trials, participating research agencies 7 and non-governmental organizations (NGOs) involved with AIDS vaccines, and a glossary. NOTE: Listings of Resources and References to learn more about each subject are located at the end of many chapters. Summaries of the cited references can be found in the PubMed bibliographic database at the US National Library of Medicine: www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed Terms in bold italics are defined in the Glossary (Appendix 5). aids vaccine handbook contents FORWARD i an epidemic that rages on M. Warren iii OVERVIEW 1 1 why we need vaccine activism, still B. Snow 3 2 where are we in the search for an aids vaccine? P. Kahn 7 1 3 hiv in pictures P. Kahn/ 15 R. Fernandez-Larsson AIDS VACCINE SCIENCE 23 4 vaccine basics B. Snow 25 5 the immune system in pictures P. Kahn/L. Long 31 2 6 vaccine development: H. Collins 37 from concept to licensed product 7 aids vaccine approaches in development P. Kahn 45 8 vaccines that trigger cellular immunity R. Jefferys 53 9 partially effective vaccines E. Bass 59 10 do clades matter for aids vaccines? P. Kahn 63 11 testing aids vaccines in people E. Bass/P. Kahn 71 12 testing for immune responses to hiv: P. Kahn/M. Hoelscher 77 the science in pictures CLINICAL TRIALS 85 13 being a trial volunteer: what happens? S. Carroll/P. Kahn 87 14 is it safe? P. Fast 95 3 15 research ethics: recipe for success B. Snow 103 16 informed consent in hiv vaccine trials G. Lindegger 109 17 community advisory boards S. Wakefield 117 18 community education: working together M. Barbosa de Souza 123 19 ensuring community participation and readiness: P. Kahn 129 a conversation with janet frölich 20 vaccine trials: leaving communities better off AVAC 137 21 hiv vaccine trials in uganda P. Kaleebu 145 22 facing failure on the way towards success: R. Jefferys 153 lessons learned from the vaxgen trial 23 testing vaccines in injecting drug users: P. Kahn 161 vaxgen’s efficacy trial in thailand working with incarcerated participants M. Martin et al. aids vaccine handbook contents continued COMMUNITIES AND COHORTS 169 24 women, aids and the search for a vaccine S. Kapoor 171 25 challenges recruiting women into trials S. Wakasiaka 179 4 26 aids research with sex workers: lessons learned E. Bass 183 27 thai drug users network, aids and human rights: P. Kahn 191 a conversation with karyn kaplan 28 adolescents and aids vaccine research in the usa A. Smith Rogers 199 29 adolescents in hiv vaccine trials: T. Villafana et al. 205 perspective from botswana 30 testing std vaccines in young people: H. Collins 213 how it’s done 31 a queer eye on aids vaccine development E. Lee 219 32 aids prevention and african militaries: P. Kahn 225 a conversation with colonel deborah birx GLOBAL ADVOCACY 231 33 community matters: (re)-defining our advocacy S. Mellors 233 34 from trial volunteer to vaccine advocate P. Wetaka 239 5 35 speed and equity: C. Collins 243 why political leadership is important 36 ensuring rapid global access to aids vaccines D. Gold 253 37 just 2 drops: polio eradication in pictures P. Kahn 261 VOICES 273 38 working with communities: 1991 B. Snow 275 39 coming of age amid grief, death and aids G. Franke-Ruta 281 6 40 terms of engagement: how communities A. Menezes 285 helped shape brazil’s aids vaccine agenda 41 aids, south africa, stigma, vaccines: P. Kahn 293 a conversation with justice edwin cameron 42 going first: a conversation with anthony morris P. Kahn 299 43 going first: a conversation with mdu nkosi L. Clarke 305 contents continued APPENDIX 311 A1 the authors 313 A2 trial sites around the world 323 7 A3 ongoing clinical trials 325 A4 organizations involved with aids vaccines 329 about AVAC 343 A5 glossary 345 INDE X 363 TABLES AND FIGURES 0.1 global estimates of adults and children living with hiv (2004) vii 1.1 developing vaccines: how long it takes 8 2.1 pipeline of vaccine research and development 36 2.2 types of vaccines in clinical trials (february 2005) 47 2.3 clades / uganda 64 2.4 clades / thailand 66 2.5 clades / cameroon 67 3.1 common CAB activities 121 3.2 examples of community preparedness activities 132 3.3 critical activities of a community mobilization 134 and education strategy 3.4 race, gender and the VAX004 trial volunteers 155 3.5 VAX004 trial results: 156 infection rates in vaccine and placebo groups 5.1 annual deaths from vaccine-preventable diseases (2002) 258 6.1 milestones for community involvement with aids vaccines in brazil 290 7.1 countries conducting aids vaccine trials (february 2005) 322-3 7.2 preventive aids vaccines in clinical trials (february 2005) 324-7 aids vaccine handbook AN EPIDEMIC THAT RAGES ON AVAC forward Superman n’est pas venu. Superman never came. Ça lui aurait pris dix minutes. It wouldn’t have taken him ten minutes. Dix minutes pour apporter des médicaments. Ten minutes to bring some medicine. Mais Superman n’est pas venu. But Superman never came. L’Afrique c’était trop loin pour lui. Africa was too far for him to go. Peut-être qu’il ne connaît même pas.
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