AIDS: The Elusive Vaccine


Bill Weintraub

AIDS: The Elusive Vaccine


AIDS: The Elusive Vaccine is an article by Richard Horton which appeared in the 9/23/04 edition of the New York Review of Books.

In it, Horton discusses the almost insurmountable difficulties facing those who would create an AIDS vaccine, and talks about the alternative -- which of course is prevention.

Here, for example, he looks at the science of HIV and why a vaccine is unlikely -- required reading for those of you who are still being penetrated anally:

The holy grail of AIDS prevention is a single-dose, safe, affordable, oral vaccine that gives lifelong protection against all subtypes of HIV. The first hurdle facing vaccine designers, therefore, is dealing with the extraordinary genetic complexity of the HIV epidemic.

HIV exists as two strains -- HIV-1, which dominates the epidemic, and HIV-2, which is largely confined to West Africa. So far, at least ten different patterns of HIV-1 infection have been identified. These patterns reflect particular geographic and genetic profiles of viral spread. For example, HIV-1 subtype B (there are nine genetic subtypes) is the common form of the virus in North America and Western Europe. India, by contrast, is under threat from HIV-1 subtype C. In Africa, where some two thirds of those with HIV now live (about 25 million people) and where there were three million new infections in 2003 alone, the situatin is more diverse. Southern and eastern regions of the continent face a predominantly HIV-1 subtype C epidemic. Central Africa sees a highly mixed picture -- HIV-1 subtypes A, D, F, G, H, J, and K. The implications of these differences for vaccine development remain uncertain. The best guess is that the genetic complexity of HIV will influence the effectiveness of any tested vaccine.

There are also over a dozen virus variants, called circulating recombinant forms, whose genomes have a structure that lies in between those of known subtypes. They also contribute to the difficulty of creating a one-size-fits-all vaccine. At present, scientists do not know if each subtype and every variant will need its own specific vaccine. It may well be that they will.

Worse still, a given subtype of the virus does not stay the same. HIV is continually evolving. The ingenuity of the virus in adapting to prevailing pressures in its environment -- such as the existence of a vaccine that triggers an attempt by the human body to eradicate it -- is owing to an enzyme called reverse transcriptase. This enzyme is essential for viral replication but it makes mistakes as it goes about its work. These mistakes, together with an extremely high rate of virus production, help HIV to produce an enormous family of genetically varied offspring.

Even if a vaccine were available, these different forms of HIV would almost certainly allow some of the virus to "escape" from any protective immune response that the human body mounted against it after vaccination. Some of these randomly generated "escape mutants," as they are called, would then be selected for survival in succeeding generations of the virus, since they would possess the advantage of being "fitter" -- avoiding the body's immune response -- than their nonmutated counterparts.

After further discussion of the so-far and likely to be fruitless search for a vaccine, Horton considers an alternative:

And yet the notion of a vaccine has not been entirely forgotten. A new kind of vaccine has been proposed, one that many observers believe has had a profound effect in a country long threatened by HIV. In describing how Uganda responded to AIDS in the 1980s, President Yoweri Museveni argued that "with no medical vaccine in sight, behavioral change had to be our social vaccine and this was within our modest means." He gave this comparison:

Individual behavior and personal responsibility, based on knowledge, will be our best protection against AIDS and other future epidemics. In Uganda we managed to bring the HIV sero-prevalence from 18.6 percent to 6.1 percent using just a social vaccine, a reduction close to 70 percent.... I am told by the medical scientists that a medical vaccine with 80 percent efficacy is considered a very good vaccine.

Of course most of the men on this site understand the concept of a social vaccine very well, because most of us are HIV negative due to "behavioral change."

I've read interviews with President Museveni where he says that when he first heard of AIDS, he was concerned that it was transmitted by mosquitoes or protozoans or mites -- parasites and pests which in Sub Saharan Africa are very difficult to control.

But when he learned that HIV was transmitted through sex, he says, "I thought, this isn't so bad. We can easily do something about that."

Of course Museveni is right.

HIV is a difficult pathogen to acquire; it's an easy pathogen to avoid.

Particularly among "men who have sex with men" -- MSM.

For among MSM, HIV is almost universally transmitted through anal penetration.

Indeed, most of the really serious MSM STDs are anally and/or orally vectored.

So they're easy to avoid.

Especially because there's a super hot, very low risk, and very male alternative: FROT.

And yet, as Horton goes on to discuss, there's a lot of opposition among the safer-sex boyz to the idea of a social vaccine.


Perhaps because it would put them out of a job.

For example, they say that while a "social vaccine" may have worked in Uganda, it won't in areas where women have less control over their sex lives.

But Museveni went to great lengths to strengthen the role of Ugandan women in opting whether to have sex.

And the idea that a powerless woman will be able to convince her essentially rapist male partner to use a condom -- is laughable.

Yet that's the objection the condom campaigners raise in Southern Africa -- women are too weak, so men must use condoms.

What's important to understand is that a similar and very colonial attitude prevails among AIDS prevention "experts" in the US.

Gay men are too irresponsible and too driven by lust, they tell us, to reduce their number of partners or give up anal; the best we can do is give them condoms.

Yet, as I've discussed in a number of articles, including Do Condoms Work? and Why Be Faithful?, there's abundant evidence that condoms actually increase irresponsibility and promiscuity among MSM: that they disinhibit, making gay men less choosy about their partners, more likely to have many partners, and of course most likely to do anal -- the single most dangerous vector for MSM HIV.

In addition, of course, we know that even properly used -- and it takes six separate steps to put a condom on an erect penis -- there's slippage, breakage, and leakage about 1.6% of the time.

Doesn't sound like much, does it?

Until you consider the concepts of cumulative efficacy and cumulative risk.

Because over time -- that is, cumulatively -- the risk rises.

For example, if you use a condom ten times, the cumulative breakage rate and with it risk rises to 10 X 1.6% or 16%.

Translation: the more you uses condoms, the more likely it becomes that the condom will fail, or will be used improperly, or not at all.

That's the truth about condoms, and in all the furor over barebacking, what we've lost sight of is the likelihood that many men who are sometimes "safe" and sometimes not are being infected even when they think they're being "safe."

So: these objections to the MSM social vaccines of avoiding anal, choosing Frot, and being Faithful, ones which we know work full time and all the time, are pure silliness.

But deadly.

As Charles points out in the post on this board titled ULTIMATE FRUSTRATION, the adamant refusal of AIDS Inc to consider a social vaccine like Frot leads daily to HIV infection and a subsequent lifetime of misery for those hapless gay and bi men taken in by the self-serving lies of the "safer-sex" establishment.

Guys, we have an AIDS vaccine -- and it's not elusive.

It's a social vaccine, it's called Fidelity and Frot, and it works.

And were just a tiny -- and I do mean tiny -- percentage of the tens of millions of dollars now being wasted on MSM condom campaigns diverted to the promotion of Fidelity and Frot, HIV prevalence among MSM would swiftly tumble and fall.

Remember that warrior dudes, and remember that

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