The Urge for an AIDS Vaccine: Perspectives from a Developing Country

Abstract

AIDS is inexorably involving all parts of the country and all strata of society, with 10% of the urban and 3% of the rural population infected with HIV. It is increasingly a disease of women and children. The major cofactors for transmission are also sexually transmitted. For most developing countries, in spite of all education efforts, the "silent epidemic" of AIDS continues. AIDS is known but not understood; counselling modifies behavior in only 10-20% of at-risk persons. Under optimal conditions, HIV discordant females have seroconversion rates of 4.7% per year and pregnancy rates of 10.4% per year. The recent political unrest in Zaire and Haiti will further enhance the spread of AIDS in these countries. Despite these difficult periods, the work can and must continue. After all, during our 10th year of collaboration with a Haitian private research group, the Haitian government and Cornell University, Haiti has known seven different political rulers. Finally, I want to make a pledge on behalf of the millions of people who face a certain death from HIV infection and AIDS and who will never make the front page of any newspaper. For these people, you can make a difference. You must give us the tools to carry on this fight. The clinical trials must be done where they are most needed: the developing countries. Vaccines represent the only viable alternative despite the recognized obstacles of viral heterogeneity, immunogenicity, and delivery.

Successes and Challenges of HIV Treatment Programs in Haiti: Aftermath of the Earthquake

“…Throughout the 1990s, HIV prevalence remained high across the country, at one point reaching 8% in Port-au-Prince and 4% in the rural areas [11]. The highest rates were found in patients referred from other clinics for HIV testing (50% positive), hospitalized patients with TB (54% positive), sex workers on the street (from 53 to 72% positive), and patients with sexually transmitted infections (24%).…”

HIV Vaccines

“…In most developing countries, childhood vaccine coverage is substantially less. Improving the vaccine delivery infrastructure worldwide should certainly improve this situation, but it nevertheless strikes the authors as slightly ironic that, for example, in a country as poor as Haiti-in which only 28% of all children have been fully immunized-the development of an HIV vaccine is being touted as &dquo;the only viable alternative&dquo; in the fight against HIV/AIDS (Pape et al 1992). …”