Gates urges collective effort to speed up research on microbicides

Speaking at the opening plenary of the 16th international conference on HIV/AIDs on 13 August, Mr Gates said that the world was doing more than ever before to tackle the disease which infects 90 million people in Africa alone. He cited the work of the Global Fund, which he commended for scaling up access to treatment and preventive tools, but stressed that more funding must be found, particularly for preventative medicine.

"We have to understand that the goal of universal treatment - or even the more modest goal of significantly increasing the percentage of people who get treatment - cannot happen unless we dramatically reduce the rate of new infections," said Mr Gates.

One of the most widely practiced approaches to prevention is the ABC programme, "Abstain, Be faithful, use Condoms". But this approach has its limits, said Mr Gates. Abstinence is often not an option for poor women and girls who have no choice but to marry at an early age. Being faithful will not protect a woman whose partner is not faithful. And using condoms is not a decision that a woman can make by herself.

Another approach is male circumcision, and Mr Gates referred to research findings which suggest that it could significantly reduce the spread of HIV. "This is exciting - and if male circumcision truly is effective, we should make it widely available," said Mr Gates. "But, like using condoms, circumcision is a procedure that depends on a man."

Instead, more research on microbicides should be undertaken. Microbicides are formulated as foams, gels, creams, impregnated sponges, suppositories, and films. Designed to be inserted into the vagina prior to sexual intercourse, such products have the potential to be female-controlled, enabling women at risk of HIV to protect themselves without partner consent. And while there is promising research to report, Mr Gates said that the world has not done nearly enough to discover these new tools - "and I include our foundation in that assessment."

"All of us who care about this issue should have focused more attention on these tools, funded more research, and worked harder to overcome the obstacles that make it difficult to run clinical trials. Now we need to make up for lost time," he added.

Also speaking at the open plenary was Melinda Gates. She too highlighted the need to accelerate research in this area. "When it comes to stopping this disease, there is no silver bullet. We need to be much more aggressive about getting all of today's prevention tools to everyone who needs them. And we need a constant stream of new innovations - especially those that put the power to prevent HIV in the hands of women," she said.

Mrs Gates continued by saying that while the Gates Foundation would continue to invest in research on microbicides and other preventive tools, and do what it could to remove the roadblocks that stand in the way of trials, it could not go it alone: "We all have a role to play."

She called on AIDS activists to use their influence to push for more research into prevention and to insist on bringing the tools already available to the people who need them. "Nobody has the power you have to focus attention, apply pressure, and get action," she added.

Governments too should make the search for new prevention tools, such as microbicides, more of a priority for funding. They should also host clinical trials, and use their influence to ensure that the trials run smoothly. The WHO, UNAIDS, and other organisations should also help develop common ethical standards for clinical trials so they can start faster and run without interruption.

Turning to industry, Mrs Gates called upon pharmaceutical companies to invest more in research and development for preventive tools, including microbicides, and to do more to share treatment drugs with researchers who want to test whether they can also be effective for prevention.

"Researchers can help test the drugs more quickly by developing novel trial designs, finding faster ways to analyse data, and coming up with biomarkers that can help test a hypothesis without needing a clinical trial of 10,000 patients. They should also make sure that when clinical trials are run, they benefit those who are in greatest need," she said.

"If all these players do their part, we will move forward, as fast as science can take us, to discoveries that can help block the transmission of HIV. This goal is worth our greatest efforts; it could very well be the turning point that leads to the end of this disease," she concluded.

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