From Toronto. Last night, the XVI International AIDS Conference opened in Toronto, Ontario. It is now a biennial conference and it is my sixth, having attended Florence, Amsterdam, Berlin, Vancouver and Geneva previously.
For what it is worth, like the Canadians, this conference and this venue have been totally civilized. Each conference boasts a larger and more diverse crowd, with this conference estimating approximately 24,000 people and the paper this morning saying as many as 31,000 have been here.
The opening session is often marked with protests and while there were some last night, they were rather anemic relative to years gone by. However, the stand-out moment of the evening came with the speeches of Bill and Melinda Gates, who were greeted by a standing ovation.
There were many points to the speeches, but one stood out for me as a call to action and an opportunity for the pharmaceutical industry (and a challenge for the FDA). During his talk, Bill Gates stated that even with the increases in access for people in developing nations, treatment without prevention is simply not sustainable. A prevention topic that has already achieved a high level of attention here is the exploration of using entrepreneurial medications not only as a treatment, but as a prevention measure. In outlining all the roles of the various parties to make that happen, the role of pharmaceuticals was to make available antiretrovirals to researchers who will be conducting clinical trials on the role of prevention, being performed in several countries including the United States. That is the opportunity for pharma, to develop mechanisms that enhance and encourage this research.
But there are challenges as the ramifications of such a use are huge. If the FDA has gotten so politicized over Plan B and medical marijuana, are they going to be able to respond to the development of a treatment that has profound ethical and political ramifications if a prevention pill emerges? By their recent track record, the answer is no. Hopefully, the house will be in order by time industry and researchers are ready to present the prospect of oral medication as a prevention to HIV transmission.