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Eradication: the science and politics of a world without AIDS

Periodic Report Summary 2 - ERADICATION (Eradication: the science and politics of a world without AIDS)

What are the barriers to eliminating the transmission of HIV in human populations, now that this is technically feasible and is increasingly cited as an attainable goal?

The program of work has come to focus on a major breakthrough in HIV research announced in early 2015. This was the finding that taking antiretroviral drugs was highly effective at preventing HIV, powerfully demonstrated by two separate studies named “Proud” and “Ipergay”, conducted in the UK, and France and Canada, respectively. “PrEP” (short for pre exposure prophylaxis), as it is called, had already been under study for some time as a prevention tool, and this project had foreseen that it would play a key role in eliminating HIV transmission in combination with other strategies (such as systematic testing and treatment and targeting of epidemic “hotspots” using molecular methods). The PrEP results however were unexpected, showing 100% protection in those taking the drugs – in effect, a “magic bullet” for HIV prevention that since become a game-changer in HIV prevention. The project focuses on the making of PrEP, and its role in efforts to eliminate HIV transmission. We focus specifically on how the social and political context can contribute to making clinical trials -- and the interventions they validate -- "work" both in medical experiments and in real life. Our preliminary work indicates the pivotal role of community engagement, which enabled the recruitment of the "right" population for the study: that is, those at highest risk, and how these results have in turn generated significant traction for the goal of eliminating transmission. However it remains unclear whether the successes of PrEP can be reproduced outside of the highly specific circumstances surrounding the initial trials, particularly in areas where HIV prevalence is the highest and the epidemic the most dispersed. A key focus of our study is to examine the making of PrEP and the impact of its implementation in African contexts, where prevalence is high. Focussing on case studies in Francophone West Africa and Anglophone East Africa, we follow the "making of PrEP" as it travels along well-tread postcolonial paths from London and Paris. We examine the hypothesis that making interventions work is as much about their social and political efficacy, i.e. their ability to conjure the "right population", as their biological efficacy. Our research involves interviewing key stakeholders, community members, and people involved in the development and implementation of PrEP in Canada, the USA, France, the Netherlands, the UK, Senegal, Côte-d'Ivoire, Kenya, Uganda and South Africa, as well as experts involved responding to other epidemics. Our research illuminates how global health interventions can be made to work, and suggests that eliminating HIV may depend more on social and political arrangements than technical solutions.