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Vol. LXIV, No. 3
February 3, 2012

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OBSSR Holds AIDS Commemorative Symposium

Symposium speakers included (above, from l) Dr. Robert Kaplan, Dr. Thomas Coates, Dr. David Bangsberg, Dr. Wafaa El-Sadr, Dr. Carl Dieffenbach and Dana Sampson.
Symposium speakers included (above, from l) Dr. Robert Kaplan, Dr. Thomas Coates, Dr. David Bangsberg, Dr. Wafaa El-Sadr, Dr. Carl Dieffenbach and Dana Sampson.

The Office of Behavioral and Social Sciences Research recently held a symposium commemorating 30 years since the first U.S. reported cases of HIV/AIDS. The focus was on the contributions of behavioral and social science to HIV/AIDS research.

“Since 1981, the disease has advanced in various ways—from localized outbreaks to a global pandemic, from affecting special populations to nearly every population, and from an automatic death sentence to a treatable disease,” said Dana Sampson, senior program analyst at OBSSR. Much progress has been made—including a reduction in the number of AIDS cases, lower rates of mother-to-child transmission and extended survival for those infected, she explained. Despite these successes however, the rate of new infections remains high and continues to increase in certain populations.

NIAID’s Dr. Carl Dieffenbach highlighted the numerous advances made in three decades of HIV science, from understanding the basic biology of the virus to developing and/or improving tools for diagnosis, improving treatment and developing vaccines. Biomedical approaches alone are insufficient to achieve the goal; the linkage of behavioral and biomedical research is critical to attaining viral suppression.

“The key entry point to prevention and control is testing; thus, behavioral and social science research can shed light on how to test, how to test better and how to test more regularly,” he said.

Three scientists provided an overview of their efforts to deploy behavioral and social science in expanded HIV testing, in the development and implementation of prevention tools and in boosting adherence to treatment to control and ultimately end the pandemic.

Speakers’ panel takes audience questions in a session moderated by Dieffenbach.

Speakers’ panel takes audience questions in a session moderated by Dieffenbach.

UCLA’s Dr. Thomas Coates described a community- based voluntary counseling and testing (VCT) program aimed at reducing HIV acquisition in entire communities. Due to the long latency of the HIV virus, it can spread rapidly through a community without being recognized. Said Coates, “Interventions should aim to de-stigmatize and normalize testing and work toward enhancing the disclosure of infection status.”

Coates and his colleagues tested two approaches to VCT, community-based and clinic-based, in 48 communities in Africa and Asia. Over 3 years, more than 86,000 HIV tests were performed and more than 140,000 post-test support visits occurred. The program successfully reached a relatively young group of adults, including hard-to-reach populations.

Dr. Wafaa El-Sadr of Columbia University presented data showing the growing number of people surviving with HIV/AIDS in low- and middle-income countries and explained that these successes were achieved through hard work in the face of suboptimal HIV treatment coverage. Despite widespread successes in prevention, the virus is still being transmitted. New infection rates vary by region and population, so different strategies are needed including testing, condom use, male circumcision, prevention of mother-to-child transmission, vaginal gels and anti-retroviral therapy (ART). The efficacy rates of these strategies vary wildly. In sum, even the best biomedical interventions are not 100 percent effective. El-Sadr said efficacy improves when people are offered the entire package, from pre-test counseling to ongoing support for those who test positive and retesting of those who test negative.

Harvard’s Dr. David Bangsberg focused on adherence to ART and prevention to end AIDS. Several meta-analyses of ART adherence in sub-Saharan Africa have yielded surprising results, showing rates as high as 75 percent compared to 55 percent in richer regions of the world. Even in the face of resource scarcity and obstacles to adherence, social capital plays a role in adherence. That is, people rely on relationships to overcome barriers to adherence and adherence fulfills responsibility to those who have helped an individual overcome those barriers.

OBSSR director Dr. Robert Kaplan closed the symposium by noting how much we have learned from the HIV/AIDS epidemic, from the basic mechanisms of behavior change to the importance of interventions that combine biomedical, behavioral and social components. NIHRecord Icon

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