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The National Institutes of Health’s Fogarty International Center in collaboration with a number of other agencies sponsored the Fogarty Workshop on International HIV/AIDS Prevention Research Opportunities on April 18-20, 1998. The AIDS Research Institute at the University of California, San Francisco hosted the Workshop. The purpose of the workshop was to identify a package of effective HIV prevention interventions and develop a list of priority research goals that combine biomedical, behavioral and social interventions for HIV prevention in developing countries. The goal was to encourage research that would be feasible and relevant for developing countries with limited resources.

This monograph is based largely on presentations and discussion at the June, 1999 policy forum Primary HIV Prevention: Designing Effective Programs for People Living with HIV. The Forum was hosted by the AIDS Research Institute at UCSF and the National Association of People with AIDS. The Forum was sponsored by the National Institute of Mental Health (NIMH), the NIH Office of AIDS Research (OAR), and the Centers for Disease Control and Prevention (CDC).

In June 1996, the Center for AIDS Prevention Studies published the second occasional paper in this monograph series, entitled Sustaining Support for Domestic HIV Vaccine Research: Social Issues Over the Long Haul of Human Trials. Authored by Chris Collins, the research was supported by grants from the National Institute of Mental Health, National Institutes of Health and the University of California, San Francisco. This new report is intended to function as an update to the 1996 monograph. Most of the social and ethical issues discussed in the original paper have not changed during the past two years. Therefore, you will find many of the previously identified challenges and stages of vaccine research and development, concerns about the design of HIV vaccine efficacy trials, goals of community education, potential benefits and harms for impacted communities, and levels of industry involvement, among others, retained. As a progress report on the state of HIV vaccine research, this paper attempts to highlight, generally, both the progress and lack of progress toward the primary recommendations laid out in the earlier paper. By focusing, up front, on the latest activities of government, affected communities, and industry, a clearer landscape of the state of HIV vaccine efforts comes into view; gaps in certain areas point to the work which remains to be done.

The successful two-drug combination therapy in 1994 and protease inhibitors in 1995 set the stage for a new era in treatment of HIV disease, creating a burst of optimism over the prospect that HIV might be a controllable disease. Initial studies of protease containing triple-drug regimens suggested that these combinations could, in some cases, slow clinical progression of the disease and prolong the lives of patients. In anecdotal reports, physicians and patients described a kind of "Lazarus" effect in which previously disabled individuals found themselves regaining lost functions, returning to work and planning their futures, instead of preparing for death. There are still many unknowns about these multi-drug regimens, including their durability of effect and how many individuals for whom they will be effective. Nonetheless, the drugs have proven quite effective in clinical trials and are helping many people stay alive longer and experience better quality of life while they are alive. We thought it important to understand better why people do and do not take advantage of these therapeutic advances. Developing the medications may be only half of the battle; the other half involves making sure that HIV infected individuals have access to the drugs and that they make thoughtful decisions about whether or not to take them. If some of the barriers to taking the drugs can be addressed, they should. We conducted in-depth qualitative interviews with 114 individuals in the HIV community--75 HIV infected men and women, 18 hotline operators and supervisors, 11 case managers, and 10 physicians and nurse practitioners.