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Why Don’t We Have an AIDS Vaccine?

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marchers for AIDS awareness

A demonstration for AIDS advances in July 2018 in The Netherlands, with Princess Margaret Van Orange pictured at the center. (Credit: Paolo Amorim/shutterstock)

I mentioned to a friend, a gay man nearing 60, that World AIDS Day, which has been observed on Dec. 1 since 1988, was almost upon us. He had no idea that World AIDS Day still exists.

This lack of knowledge is a testament to the great accomplishments that have occurred since World AIDS Day was created 30 years ago. It is also due to an accident in the timing of his birth that my friend escaped the devastation wreaked by AIDS among gay men in the U.S., before there was antiretroviral therapy.

Many people have forgotten AIDS, but there are consequences to forgetting. The fight against AIDS is at a tipping point. Increasingly, there are signs that we may be heading in the wrong direction.

The Elusive AIDS Vaccine

I am a social epidemiologist with more than 20 years of research experience in HIV and STD prevention. I am also the founder of The Basics with Dr. Mo, a sex health communications project that translates prevention science directly for people who need it most.

It is true that global HIV/AIDS success stories abound: Mother-to-child transmission can be reduced to below 5 percent, 75 percent of people living with HIV know their status and 59 percent receive antiretroviral therapy.

Most recently, Pre-Exposure Prophylaxis (PrEP) – the use of antiretrovial drugs to prevent HIV infection among those exposed – has proved to be a successful prevention approach.

Yet the prize – a vaccine that can prevent HIV infection – remains elusive, and makes impossible the use of the only known strategy to have ever eradicated an infectious disease: widespread vaccination. That disease was smallpox, in 1980.

Seeds of Unease

Despite the lack of a vaccine, in 2016 United Nations member states adopted a political declaration on ending the AIDS epidemic by 2030.

As part of the accountability framework, interim 2020 goals set a target of 500,000 new HIV infections for that year. A review of the most recent data estimated 1.8 million new HIV infections in 2017, exactly the same number as in 2016.

Prominent scientists have already begun to question the ability to eradicate AIDS by the 2030 deadline, and concede that the situation has stagnated. The attainment of eradication looks bleak, without the aid of either an effective vaccine or the immediate large-scale promotion and utilization of existing prevention tools (i.e., condoms, voluntary circumcision and potentially PrEP). Given that the vast majority of new HIV infections are sexually transmitted and that condoms have played a decisive role in the global control of HIV transmission, ongoing condom availability and use will be essential to future eradication.

Condoms – both male and female – remain a highly effective mechanism of HIV/AIDS prevention, as well as of other sexually transmitted infections that greatly enhance the risk of HIV transmission.

Condom use is also strongly advised by global public health institutions, including the World Health Organization and the U.S. Centers for Disease Control and Prevention, in conjunction will all other HIV prevention tools including PrEP, because of their lower levels of effectiveness in preventing transmission.

Condom availability is a different matter and varies greatly from country to country. Countries with the highest levels of HIV often rely heavily on donor support. According to the most recent data, in sub-Saharan Africa in 2013, only 10 condoms were availableannually for every man aged 15 to 64 (as compared with the recommended 50 to 60), and, on average, there was one female condom available for every eight women. Funding required to maintain – let alone scale up – HIV commitments, particularly those dedicated to prevention, are increasingly uncertain.

The hydra, sprouting new heads

Even though condoms are an extremely effective barrier method, it is usage that makes condoms efficacious in preventing HIV transmission. Reported condom use varies considerably around the world, and ranges from 80 percent use by men in Namibia and Cambodia to less than 40 percent usage by men and women in other countries, including some highly affected by HIV such as Sierra Leone and Mozambique.

Age plays a role, too. Among young people aged 15 to 24, condom use at last sex varies from more than 80 percent in some Latin American and European countries to less than 30 percent in some West African countries. In the U.S., condom use is at the lower end of the spectrum: Only one-third of the population uses condoms, a number that has not changed significantly over the past two decades.

The majority – 66 percent – of the world’s HIV/AIDS cases are in sub-Saharan Africa, where there has been much progress, particularly with the provision of antiretroviral therapy.

However, there are worrying signs in other parts of the world. There has been little change in new HIV infections in countries outside of sub-Saharan Africa between 1990 and 2017.

In fact, six of the 10 most populous countries in the world have experienced 10 percent to 45 percent increases in new HIV infections since 2010: Russia, China, Brazil, Pakistan, Mexico and Bangladesh. Even in countries such as the U.S., where new HIV infections have decreased by 8 percent overall, the rates of change are unevenly distributed. For example, young African-American men who have sex with men show no decrease in new infections; African-American gay and bisexual men represent the largest percentage of new HIV infections: more than one-quarter.

The increased provision of antiretroviral therapy to people living with AIDS has had a huge impact on extending life and in preventing new HIV infections. However, there remains 25 percent of the population who live with HIV, about 9 million people, who do not know their status.

While we have been necessarily focused on the head of the hydra in sub-Saharan Africa, other hydra heads are beginning to make their presence known, many in countries ill-prepared to deal with increases in the number of new HIV infections.

In the absence of a vaccine, behavior change in the form of condom use promotion, acceptance and adoption, at a scale that many gay men utilized during the peak of the AIDS epidemic in the industrialized world, will need to occur. There are many challenges: continued stigma and gender inequality, not to mention issues of availability, distribution and proactive, nonjudgmental promotion.

We must not forget. Progress on reducing the rate of new HIV infection has been done before. It can be done again, but only if we take forceful, funded action now.

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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Ecology

Yukon and Northern BC First Nations tackle climate change using Indigenous knowledge and science

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YUKON, June 18, 2021 /CNW/ – The Government of Canada is working together in partnership with Indigenous and Northern communities in finding solutions to adapt to the impacts of climate change in the North.

Today, Minister of Northern Affairs, Daniel Vandal, along with Parliamentary Secretary to the Minister of Economic Development and Official Languages (Canadian Northern Economic Development Agency), Larry Bagnell, highlighted progress on three unique, Indigenous-led projects that are helping communities in Yukon and Northern British Columbia adapt to the challenges posed by climate change.

The Minister and Parliamentary Secretary met virtually with Carcross/Tagish First Nation (C/TFN) to learn about their community-led climate change monitoring program. C/TFN has partnered with Tsay Keh Dene Nation (TKDN) and Chu Cho Environmental of Prince George, British Columbia, to build a community-led monitoring project that examines environmental data and Indigenous knowledge to create a holistic picture of how the climate is changing across C/TFN and TKDN traditional territories. The project combines tracking of current and historical climate trends with knowledge shared by Elders while also providing opportunities for youth mentorship and climate change awareness.

The Taku River Tlingit First Nation (TRTFN) is also leading a unique project to assess the impacts of climate change within their traditional territory. Climate change is causing many of the culturally significant ice patches to melt, exposing organic artifacts to oxygen and leading to rapid deterioration. The TRTFN ice patch mapping project will involve performing archaeological assessments to prevent the degradation of artifacts. Research will be guided by traditional knowledge, Elders and oral histories, when available, and heavily involve community, Elders, youth and Knowledge Keepers.

The Pelly Crossing Selkirk Development Corporation is leading the Selkirk Wind Resource Assessment project through the installation of a Sonic Detection and Ranging (SODAR) system. The initiative includes a feasibility study leading up to the construction of a renewable energy facility, including wind, solar and battery energy storage. Expanding clean energy within the region will have direct benefits for communities, including reduced reliance on diesel, job creation and revenue generation for Selkirk First Nation. 

These projects are delivering important environmental, social and economic benefits that lead to healthier, more sustainable and resilient communities across Yukon and Northern British Columbia. They also build community clean energy capacity and help to avoid the impacts of climate change.

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Ecology

Atlantic Provinces Ready For Aquaculture Growth

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Aquaculture is an important economic driver for rural, coastal and Indigenous communities, and Atlantic Canada is well positioned to increase aquaculture production as global demand for sustainably sourced seafood grows.

That is why the ministers responsible for aquaculture in the Atlantic provinces have agreed to the ongoing development and management of their industries based on common principles. A new memorandum of understanding has been signed by the four ministers, which extends the previous agreement signed in 2008.

“In a time when food security is especially important, it is good to see our aquaculture industry has grown steadily and is poised for continued growth in 2021 based on environmentally responsible, science-based policies and practices,” said Keith Colwell, Minister of Fisheries and Aquaculture for Nova Scotia. “Our Atlantic partnership continues to help the industry grow sustainably.”

Cooperation between the provinces and the aquaculture industry has led to improvements in pest management, environmentally sustainable aquaculture methods, aquatic animal health and policies to support the shared use of marine and freshwater resources. It also aims to align regulation and policy between the provinces to make the regulatory requirements easier to understand by industry and the public.

Each province has a comprehensive and robust legislative and regulatory framework to ensure environmental sustainability, economic prosperity and public accountability. The provinces update their legislation and regulations regularly. Nova Scotia revamped its regulatory framework in 2015; New Brunswick received Royal Assent for a new Aquaculture Act in 2019 and is working on the supporting regulations; Newfoundland and Labrador completely revised its aquaculture policy in 2019; and Prince Edward Island has recently drafted a new Aquaculture Act.

The ministers have agreed to continue to use science-based evidence for management decisions, thereby increasing public and investor confidence in the Atlantic Canadian aquaculture industry.

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Ecology

COMING SOON: A Healthy Environment and a Healthy Economy 2.0

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We all want the same thing: a clean and responsible energy future for our children and future generations while continuing to enjoy a high standard of living.

On December 11, 2020, the Prime Minister announced a new climate plan which he claimed will help achieve Canada’s economic and environmental goals.

The proposed plan by Environment and Climate Change Canada (ECCC) entitled “A Healthy Environment and a Healthy Economy” will have an initial investment of $15 billion of taxpayer’s money. It is built on 5 pillars of action:

  1) Making the Places Canadians Live and Gather More Affordable by Cutting Energy Waste

2) Making Clean, Affordable Transportation and Power Available in Every Community

3) Continuing to Ensure Pollution isn’t Free and Households Get More Money Back

4) Building Canada’s Clean Industrial Advantage

5) Embracing the Power of Nature to Support Healthier Families and More Resilient Communities  

In my paper, “A Healthy Environment and a Healthy Economy 2.0” I will objectively critique each pillar in the government’s new climate plan and provide alternative solutions to the same issues.

  This is an alternative plan that supports workers, protects lower income earners and creates economic growth while respecting the environment and focusing on the dignity of work.

  This plan abandons virtue-signaling projects and relies on Canadian ingenuity to build our economy and restore Canada’s role of responsible leadership in the world.

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