AIDSWEEKLY Plus; Monday, May 1, 2000
Prepared by AIDS Weekly editors from staff and other reports

Directed by Nancy Padian, MPH, PhD, a UCSF AIDS researcher widely recognized for major epidemiological studies on HIV and sexually transmitted diseases, the new UCSF ARI International Research Program will collaborate with health professionals throughout the UC system and in various global sites on projects related to AIDS policy, education, prevention, testing, and treatment.

The goal, according to Padian, is to build partnerships with researchers and institutions in other countries to work collaboratively to prevent HIV/AIDS. The program will be strongly linked to the Institute for Global Health - of UCSF and UC Berkeley and directed by Richard Feachem, PhD, Dsc - bringing together the already extensive international efforts in the Schools of Medicine, Nursing, Pharmacy, and Dentistry at UCSF, and the School of Public Health and other schools at UC Berkeley. The new program also will work to develop stronger ties with the San Francisco Department of Public Health on global HIV/AIDS issues.

"San Francisco is a unique place, as we all know," said Thomas J. Coates, PhD, executive director of the UCSF ARI. "It is one place in the world where science, public health, communities, politics, and policies have worked together to provide innovation in science, prevention, and care. We want to work with investigators and public health officials in other parts of the world to help stem the tide of HIV/AIDS in those countries."

Over the past 15 years, UCSF researchers have been involved in a number of AIDS-related activities in Africa, India, Brazil, Peru, Mexico, China, and Vietnam, and the international program will focus on strengthening and building on these efforts, Padian said.

"We will look at AIDS as a global issue, but our emphasis will be on practical applications in developing countries because the populations in these areas have been devastated by HIV in disproportionate numbers to the rest of the world. This is not research for research's sake but a program that is committed to working with our international colleagues, who are experts in their own cultures, on how to stem the HIV/AIDS epidemic in their homelands," she added.

Coates emphasized that the ARI continues its commitment to HIV/AIDS issues at that local, regional, and national levels and that formalizing the international efforts of UCSF AIDS specialists strengthens all ARI programs. "The foundation of the San Francisco program is that we attend to all aspects of HIV/AIDS, from very basic molecular biology to policy sciences and application," he said.

A member of the UCSF faculty since 1988, Padian has developed and directed a number of research studies on HIV and STDs in high-risk populations. She was one of the first investigators to study heterosexual transmission of HIV in the U.S., and findings from her research projects in the 1980s and 90s are considered major works in this field. In the past few years, Padian has collaborated with the University of Zimbabwe on several projects related to female reproductive health and HIV/STD prevention.

In a series of studies, a Zimbabwe-UCSF team is investigating the safety and user acceptance of vaginal microbicides and the female condom. The microbicide studies include two types of gels applied topically that are designed to acidify the vaginal-cervical environment and/or inactivate STD pathogens including HIV.

Preliminary analysis of study results shows these methods, while not acceptable to all women, provide an important alternative to some, according to Padian. The findings are important, she added, because heterosexual transmission of HIV accounts for the majority of new HIV infections in Zimbabwe, as well as worldwide. The use of male and female condoms involves issues of acceptance, cost, availability, and effectiveness that can be politically and culturally sensitive in developing countries, and it is "urgent that more acceptable and affordable female-controlled methods, such as topical microbicides, be made available to women" in order to control HIV infection, she said.

In other research, Padian's team is collaborating with Zimbabwean colleagues on studies on the impact of oral, hormonal contraceptives, and the use of a diaphragm with spermicide on HIV acquisition in women. Both methods, Padian noted, involve critical unanswered public health questions in sub-Saharan Africa where male partners often control sexual activity and decision-making.

According to UNAIDS, a consortium of United Nations agencies, more than 33.5 million people are living with HIV/AIDS worldwide, and 1999 saw 2.6 million deaths from the disease, a higher global total than in any year since the beginning of the epidemic despite antiretroviral therapy, which has staved off deaths in richer countries. Ninety-five percent of the worldwide HIV population lives in the developing world.

This article was prepared by AIDS Weekly editors from staff and other reports.

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