Skip to main content
SpringerLink
Log in

Supporting Research

  • Chapter
  • First Online:
The AIDS Pandemic

  • 642 Accesses

Abstract

This chapter describes how the Global Programme on AIDS (GPA) augmented its efforts to scale up research activities in the areas of diagnostics, vaccine development, and treatment, as well as social and behavioral research to identify successful approaches to prevention. In addition, GPA sought to ensure that research in low- and middle-income countries was conducted with the highest ethical and technical standards, including addressing false claims about cures and treatments. We explain how GPA tried to negotiate with pharmaceutical companies to make early antiretroviral treatments universally affordable and accessible, and the dissapointing lack of support from Western AIDS activists to improve access in low-and middle- income countries. The chapter also details GPA’s decision to integrate the World Health Organization’s sexually transmitted disease program into GPA. In addition, we describe efforts to document success stories in HIV prevention research to define the essential elements of an HIV prevention program and demonstrate that effective HIV prevention was possible.

Within this chapter the singular pronouns I and my refer to Michael Merson alone, whereas the plural pronouns we and us generally refer to Michael Merson and Stephen Inrig jointly. Where we or us refers to Michael Merson and his colleagues at WHO, the object of the pronoun is clarified by context.

The original version of this chapter was revised to correct misspellings.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

Notes

  1. 1.

    For the purposes of this text, we will use the term AIDS to encompass both AIDS and HIV unless otherwise specified.

  2. 2.

    Jane Perlez, “In Kenya, a New AIDS Drug Gets Mired in Politics and Financial Disputes,” The New York Times, October 3, 1990, sec. World, http://www.nytimes.com/1990/10/03/world/in-kenya-a-new-aids-drug-gets-mired-in-politics-and-financial-disputes.html

  3. 3.

    D. K. Koech, A. O. Obel. “Efficacy of KEMRON (low dose oral natural human interferon alpha) in the management of HIV-1 infection and acquired immunodeficiency syndrome (AIDS).” E Afr Med J 1990;67:SS64–70; E. T. Katabira, N. K. Sewankambo, R. D. Mugerwa, E. M. Belsey, F. X. Mubiru, C. Othieno, P. Kataaha, M. Karam, M. Youle, J. H. Perriens, and J. M. Lange, “Lack of efficacy of low dose oral interferon alfa in symptomatic HIV-1 infection: a randomised, double blind, placebo controlled trial,” Sex Transm Infect. 1998; 74(4): 265–270.

  4. 4.

    “Media Reaction: W.H.O. AIDS Expert Interviewed,” October 31, 1990, 1.

  5. 5.

    For the purposes of this text, we use the term sexually transmitted disease(s) and the abbreviation STD rather than the other term sexually transmitted infection(s) or STIs.

  6. 6.

    Michael Merson, “Director’s Report, GPA Management Committee, April 26, 1990,” Geneva: World Health Organization, 1990.

  7. 7.

    Global Programme on AIDS, “The Problem, WHO Activities, and Financial Needs, June 1990,” Geneva: World Health Organization, 1990, 2.14.1, 22.

  8. 8.

    “Media Reaction: W.H.O. AIDS Expert Interviewed,” October 31, 1990, 1.

  9. 9.

    Ann Gibbons, “New Head for the WHO Global Program on AIDS,” Science, June 15, 1990; 248:1306–1307.

  10. 10.

    Michael Merson, “Director’s Report, GPA Management Committee, April 26, 1990,” Geneva: World Health Organization, 1990.

  11. 11.

    Ibid.

  12. 12.

    Michael Merson, “Report of the Director, Fifth Meeting of the Management Committee, November 26, 1990” Geneva: World Health Organization GPA/GMC (2) 90.3, 1990, 9–10.

  13. 13.

    Michael Merson, “Report of the Director: Sixth meeting of the Management Committee, Geneva, 23–24 April 1991; Provisional agenda item 3,” Geneva: Global Programme on AIDS, GPA/GMC (1)/91.3; 22 April 1991, 10–12.

  14. 14.

    Ibid.

  15. 15.

    “Romanians ban drug tested on AIDS babies,” The Toronto Star October 29, 1990, A2.

  16. 16.

    Global Programme on AIDS, “Press Release WH0/56: Clinical Trials of FLV23/A To Be Stopped,” Geneva: World Health Organization, 29 October 1990.

  17. 17.

    Rosie Waterhouse, “Drug tests on Aids babies halted,” The Independent, October 28, 1990, 1.

  18. 18.

    G. Kaiser, H. Jaeger, J. Birkmann, et al. “Low-dose oral natural human interferon-á in 29 patients with HIV-1 infection: a double-blind, randomised, placebo-controlled trial.” AIDS l992;6:563–9; M. R. Hulton, D.L. Levin, L.S. Freedman. “Randomised, placebo-controlled, double-blind study of low-dose oral interferon-á in HIV-1 antibody positive patients.” J Acquir Immune Def Syndr 1992;5:1084–90; S.J. Sperber, D.J. Gocke, C.A. Haberzettl, et al. “Low-dose oral recombinant interferon-A in patients with HIV-1 infection: a blinded pilot study.” AIDS 1993;7:693–7.

  19. 19.

    World Health Organisation. Low-dose oral interferon alfa in the management of AIDS: still an experimental drug. Press release WHO/47. Geneva: WHO, 14 September 1990.

  20. 20.

    E. T. Katabira, N. K. Sewankambo, R. D. Mugerwa, E. M. Belsey, F. X. Mubiru, C. Othieno, P. Kataaha, M. Karam, M. Youle, J. H. Perriens, and J. M. Lange, “Lack of efficacy of low dose oral interferon alfa in symptomatic HIV-1 infection: a randomised, double blind, placebo controlled trial,” Sex Transm Infect. 1998; 74(4): 265–270.

  21. 21.

    Michael Merson, “Report of the Director: Sixth meeting of the Management Committee, Geneva, 23–24 April 1991; Provisional agenda item 3,” Geneva: Global Programme on AIDS, GPA/GMC (1)/91.3; 22 April 1991, 10–12.

  22. 22.

    “Media Reaction: W.H.O. AIDS Expert Interviewed,” October 31, 1990, 4.

  23. 23.

    Stephen Inrig, In a place so ordinary: North Carolina and the problem of AIDS, 1981—1997 by Duke University, 2007, 474 pages; 3321835.

  24. 24.

    Barton Gellman, “An Unequal Calculus of Life and Death,” Washington Post, December 27, 2000.

  25. 25.

    Ibid.

  26. 26.

    Confidential memo; WHO Drug Negotions.; Jean Pierre Aboulker and Ann Marie Swart, “Letter to Lancet: Preliminary Analysis of the Concorde Trial,” The Lancet 341: 889–890, April 2 1993.

  27. 27.

    The FDA approved three other Nucleoside analog reverse transcriptase inhibitors (NARTI) in the early 1990s, including Didanosine (also called Videx, or DDI) approved in 1991; Zalcitabine (Hivid, dideoxycytidine, or ddC) approved in 1992; and Stavudine (also known as Zerit, or d4T) approved in 1994; Jean Pierre Aboulker and Ann Marie Swart, “Letter to Lancet: Preliminary Analysis of the Concorde Trial,” The Lancet 341: 889–890, April 2 1993.

  28. 28.

    Barton Gellman, “An Unequal Calculus of Life and Death,” Washington Post, December 27, 2000.

  29. 29.

    Eric Sawyer, Interview with Carlos Motta, We Who Feel Differently, March 1, 2011. http://wewhofeeldifferently.info/interview.php?interview=100

  30. 30.

    E.M. Conner, R.S. Sperling, R. Gelber, et al “Reduction of maternal-infant transmission of human immunodeficiency virus type 1 with zidovudine treatment,” New England Journal of Medicine 1994 331:1173–1180.

  31. 31.

    Report of the WHO Meeting on Prevention of Mother to Infant Transmission of HIV By Use of Antiretrovirals, Geneva, 23–25 June 1994.

  32. 32.

    N. Shaffer. et al. Short-course zidovudine for perinatal HIV-1 transmission in Bangkok, Thailand: a randomised controlled trial.” The Lancet 353(9155):773–780.

  33. 33.

    Petra Study Team. “Efficacy of three short-course regimens of zidovudine and lamivudine in preventing early and late transmission of HIV-1 from mother to child in Tanzania, South Africa, and Uganda (Petra study): a randomised, double-blind, placebo-controlled trial.” The Lancet. 2002 Apr 6;359(9313):1178–86.

  34. 34.

    Michael Merson., “Ethics of placebo-controlled trials of zidovudine to prevent the perinatal transmission of HIV in the Third World.” New England Journal of Medicine 1998 Mar 19;338(12):836.

  35. 35.

    GPA Progress Report, No 6, May 1990 WHO.

  36. 36.

    Anchalee Worrachate, “Thailand likely to become testing ground for new AIDS vaccines,” Agence France Presse, October 15, 1991.

  37. 37.

    Ibid.

  38. 38.

    Jose Esparza, Interview by Michael, Merson Seattle, WA, October, 2001; “Jose Esparza,” HIV Vaccine electronic (e) resource (HIVe), http://www.vaccineenterprise.org/hive/feature/935; David Heymann, Interview by Michael Merson, Geneva, October, 2001.

  39. 39.

    World Health Organization, “Scientific and public health rationale for HIV Vaccine efficacy trials,” AIDS 1995 9:WHO1-WHO4.

  40. 40.

    “HIV vaccines get the green light for Third World Trials,” Nature October 20 1994, 371: 844.

  41. 41.

    John Moore and Roy Anderson, “The WHO and why of HIV vaccine trials,” Nature November 24, 1994, 372: 313–314.

  42. 42.

    Jose Esparza, “A brief history of the global effort to develop a preventive HIV vaccine,” Vaccine 2013 Aug 2;31(35):3502–18.

  43. 43.

    The candidate vaccines included two different candidates based on gp 120 and one candidate based on the oligomeric V3-MAPS synthetic peptide.

  44. 44.

    Saladin Osmanov, William L. Heyward, José Esparza, “HIV-1 Genetic Variability: mplications for the Development of HIV Vaccines,” Antibiotics and Chemotherapy, 1996, 48:30–38.

  45. 45.

    Report of a Scientific meeting on unexplained Severe immunosuppression without evidence of HIV infection, Geneva, Sept 28–29, 1992.

  46. 46.

    Nicoli Nattrass and Seth Kalichman, “The Politics and Psychology of AIDS Denialism,” in Poul Rohleder, Leslie Swartz, Seth C. Kalichman, Leickness Chisamu Simbayi, Eds., HIV/AIDS in South Africa 25 Years On. ISBN: 978-1-4419-0305-1 (Print) 978-1-4419-0306-8.

  47. 47.

    Ronald Bayer, “Public health policy and the AIDS epidemic: an end to HIV exceptionalism?” New England Journal of Medicine, May 23, 1991, 324:1500–1504.

  48. 48.

    Ibid.

  49. 49.

    Ibid.

  50. 50.

    WHO consensus statement, “Sexually transmitted diseases as a risk factor for HIV transmission,” The Journal of Sex Research, 1989, 26(2), http://www.tandfonline.com/doi/abs/10.1080/00224498909551512#preview

  51. 51.

    King Holmes, Interview by Michael Merson, New Haven, CT, September, 2002.

  52. 52.

    Global Programme on AIDS and Programme of STC, “Consensus Statement From the Consultation on Global Strategies for Coordination of AIDS and STD Control Programmes, Geneva, 11–13 July 1990,” Geneva: World Health Organization, WHO/GPA/INF/90.2, 1990; http://whqlibdoc.who.int/hq/1990/WHO_GPA_INF_90.2.pdf

  53. 53.

    Ibid.

  54. 54.

    Global Programme on AIDS, 1987–1995 Final report with emphasis on 1994–1995 biennium, Geneva: World health organization, 1995, P. 50.

  55. 55.

    Ibid.

  56. 56.

    Ibid., 52.

  57. 57.

    STD Case Management Course (WHO/GPA/TCO/PMT /95.18, A-G).

  58. 58.

    Global Programme on AIDS, 1987–1995 Final report with emphasis on 1994–1995 biennium, Geneva: World Health Organization, 1995, 54.

  59. 59.

    Ibid.

  60. 60.

    Global Programme on AIDS, “Review of the Programme’s activities in sexually transmitted diseases,” Geneva: World Health Program, GPA/GMC/(10)/94.6, 1995.

  61. 61.

    Global Programme on AIDS, 1987–1995 Final report with emphasis on 1994–1995 biennium, Geneva: World Health Organization, 1995, 28.

  62. 62.

    Supanee Jivasak-Apimas, Joseph Saba, Verapol Chandeying, Chuanchom Sakondhavat, Orawan Kiriwat, Sungwal Rugpao, Wiwat Rojanapithayakorn, Arnaud L. Fontanet, “Acceptability of the Female Condom Among Sex Workers in Thailand: Results From a Prospective Study,” Sexually Transmitted Diseases, November 2001 – 28(11):648–654; http://journals.lww.com/stdjournal/Fulltext/2001/11000/Acceptability_of_the_Female_Condom_Among_Sex.7.aspx

  63. 63.

    Ibid.; Arnaud L. Fontanet, Joseph Saba, Verapol Chandelying, Chuanchom Sakondhavat, Praphas Bhiraleus, Sungwal Rugpao, Chompilas Chongsomchai, Orawan Kiriwat, Sodsai Tovanabutra, Leonard Dally, Joep M. Lange, Wiwat Rojanapithayakorn, “Protection against sexually transmitted diseases by granting sex workers in Thailand the choice of using the male or female condom: results from a randomized controlled trial,” AIDS October 1998 – 12(14):1851–1859; http://journals.lww.com/aidsonline/Fulltext/1998/14000/Protection_against_sexually_transmitted_diseases.17.aspx

  64. 64.

    “Sex and Youth: contextual factors affecting risk for HIV/AIDS; A comparative analysis of multi-site studies in developing countries,” Geneva: UNAIDS, 1999; http://cedoc.cies.edu.ni/general/2nd_Generation%20(D)/Surveillance%20Guidelines/Behavioural%20Surveillance/Behavioural%20Study%20Results/Sex%20and%20youth%20factors.pdf

  65. 65.

    Global Programme on AIDS, “Report of a Meeting on the Development of Vaginal Microbicides for the Prevention of Heterosexual Transmission of HIV, Geneva, 11–13 November, 1993,” Geneva: World Health Organization, 1993, WHO/GPA/RIC/CRD/94.1.

  66. 66.

    Global Programme on AIDS, 1987–1995 Final report with emphasis on 1994–1995 biennium, Geneva: World health organization, 1995.

  67. 67.

    J. Goeman, I. Ndoye, L.M. Sakho, S. Mboup, P. Piot, M. Karam, E. Belsey, J.M. Lange, M. Laga, J.H. Perriëns. “Frequent use of menfegol spermicidal vaginal foaming tablets associated with a high incidence of genital lesions.” J Infect Dis. 1995 Jun;171(6):1611–4.

  68. 68.

    Colposcopy Manual (RID/CRD/95.10); Report of a Meeting on the Development of Vaginal Microbicides for the Prevention of Heterosexual Transmission of HIV (WHO/GPA/RID/CRD/94.1.

  69. 69.

    Global Programme on AIDS, 1987–1995 Final report with emphasis on 1994–1995 biennium, Geneva: World health organization, 1995, 27–28.

  70. 70.

    L. Van Damme, V. Chandeying, G. Ramjee, H. Rees, P. Sirivongrangson, M. Laga, J. Perriëns. “Safety of multiple daily applications of COL-1492, a nonoxynol-9 vaginal gel, among female sex workers. COL-1492 Phase II Study Group.” AIDS. 2000 Jan 7;14(1):85–8.

  71. 71.

    Lut Van Damme, Gita Ramjee, Michel Alary, Bea Vuylsteke, Verapol Chandeying, Helen Rees, Pachara Sirivongrangson, Léonard Mukenge-Tshibaka, Virginie Ettiègne-Traoré, Charn Uaheowitchai, Salim S Abdool Karim, Benoît Mâsse, Jos Perriëns, Marie Laga, on behalf of the COL-1492 study group, “Effectiveness of COL-1492, a nonoxynol-9 vaginal gel, on HIV-1 transmission in female sex workers: a randomised controlled trial,” Lancet, 360: 971–977, 2002.

  72. 72.

    Global Programme on AIDS, 1987–1995 Final report with emphasis on 1994–1995 biennium, Geneva: World health organization, 1995, 14–15.

  73. 73.

    Michael Merson, “Director, Programme on AIDS: Global AIDS Prevention and Control.” Geneva. 5 August 1990, MHM1015, 10–12.

  74. 74.

    Michael Merson, “Report of the Director, Fifth meeting of the Management Comnittee, Provisional agenda item 3: Geneva. 26–28 November 1990,” Geneva: World Health Organization, 26 November 1990 GPA/GMC (2)90.3, 8–9.

  75. 75.

    1991 Progress Report, Global Programme on AIDS, World Health Organization, pg 91.

  76. 76.

    Michael Merson, “Report of the Director: Sixth meeting of the Management Committee, Geneva, 23–24 April 1991; Provisional agenda item 3,” Geneva: Global Programme on AIDS, GPA/GMC (1)/91.3; 22 April 1991, 8–10.

  77. 77.

    Ibid, 14–15.

  78. 78.

    Joseph Palca, “WHO AIDS Program: Moving on a New Track,” Science, October 25, 1991, 254: 512.

  79. 79.

    Michael Merson, Speech to World Health Assembly, A20/87/128, May 26–29, 1992.

  80. 80.

    Ibid.

  81. 81.

    Daniel Q. Haney, “AIDS Meeting Opens With Conflicting Visions on Stopping Epidemic,” The Associated Press, July 19, 1992.

  82. 82.

    Clare Nullis, “Health Agency Urges More Promotion of Condoms,” The Associated Press, June 22, 1992.

  83. 83.

    “WHO Gives Out Condom-Containing Key Rings,” The Associated Press, November 28, 1991.

  84. 84.

    Kevin R O’ Reilly and Peter Piot, “International Perspectives on Individual and Community Approaches to the Prevention of Sexually Transmitted Diseases and Human Immunodeficiency Virus Infection,” JID, 1996, 174 (Supplement 2), S214–S222.

  85. 85.

    Thomas Coates, Interviewed by Michael Merson, New Haven, CT, February, 2002.

  86. 86.

    Pertti J. Pelto and Gretel H. Pelto, Anthropological Research: The Structure of Inquiry. New York: Cambridge University Press, October 1978.

  87. 87.

    Manuel Carballo, Interview by Michael Merson, New Haven, CT, November, 2002.

  88. 88.

    Ibid.

  89. 89.

    Ibid.

  90. 90.

    Thomas Coates, Interview by Michael Merson, New Haven, CT, February, 2002.

  91. 91.

    Progress report April 1991; Gill Walt, Interview by Stephen Inrig, Dallas, TX, September 23, 2010.

  92. 92.

    Gill Walt, Interview by Stephen Inrig, Dallas, TX, September 23, 2010.

Author information

Authors and Affiliations

  1. Duke Global Health Institute, Duke University, Durham, NC, USA

    Michael Merson (Wolfgang Joklik Professor of Global Health)

  2. Mount Saint Mary’s University, Los Angeles, CA, USA

    Stephen Inrig (Director, Health Policy and Management Program)

Authors
  1. Michael Merson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stephen Inrig
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG

About this chapter

Cite this chapter

Merson, M., Inrig, S. (2018). Supporting Research. In: The AIDS Pandemic. Springer, Cham. https://doi.org/10.1007/978-3-319-47133-4_11

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-47133-4_11

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-47132-7

  • Online ISBN: 978-3-319-47133-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation