HIV/AIDS pioneer Kenneth Mayer heads to Australia for AIDS 2014
One of the world’s foremost experts in HIV/AIDS, Professor Kenneth Mayer, MD, arrives in Melbourne in July for the AIDS 2014 Conference. James Findlay spoke to him from his office in Boston where he’d just returned from conferences in India and Botswana.
It’s not every day when you get a direct line to a Harvard University Professor who has been working in their chosen field of expertise for their entire professional life spanning over 30 years, and been at the forefront of new, exciting developments that could potentially change the lives of millions of people.
Dr Kenneth Mayer studied the natural history and transmission of HIV, helping to lead bio-behavioral HIV prevention studies, including some of the first anti-HIV vaccine and topical and oral chemoprophylaxis trials.
He has been involved with community work since his studies and then went on to work at Fenway Health in Boston – where he was one of the first physicians to diagnose Bostonians with AIDS in the early 1980s.
“It was a crazy time,” he told MCV.
“I was reading the initial reports about this disease, and we were thinking ‘hmmm… are we going to start seeing this in Boston?’ as the first reports were in San Francisco and bigger cities,” Mayer said.
Initially Mayer saw the partners of people who were HIV positive.
“They were thinking ‘am I going to get this now?’ They would ask, ‘Can I hug my partner, can I kiss, can I do this…?’ and we wanted to give them an answer, so we started doing studies before we even knew what was causing it, to try to make sense of what was going on,” he said.
A few years later, Mayer worked on studies that followed gay couples where one partner was positive and the other was negative (now known as sero-different couples) which lead him to further research into preventative methods.
He was involved in the research for the first human study of HIV prevention known as Pre-exposure prophylaxis (PrEP) - currently one of the most talked about HIV prevention strategies.
In regards to some of the controversies surrounding PrEP, Mayer said he doesn’t believe in being “polemical” about the issue.
“People who were risky but are now using [HIV] protection, well that’s a good thing. On the other hand, community communication is so important and what people need to understand is, this prevention is only for HIV and if people are going to stop using condoms they’re potentially increasing their risk of exposure to other STIs.
“We need to look at PrEP as part of a larger frame. If a young man who is engaging in risky behaviour thinks he’s invincible and isn't visiting sexual health clinics on a regular basis but does get PrEP, has a provider who is confident and says ‘fine [you can take PrEP], but now we screen for syphilis, gonorrhoea and chlamydia’, then [the young man] might become aware that he could get those infections, however he may become more engaged in care and being treated sooner and not transmitting it to others” he tells MCV.
Dr Mayer adds:
“I understand the controversies as a clinician and a researcher. PrEP and other approaches are new tools that will benefit some people, but might not be the right thing for other people.
“The important thing is to keep refining this - what might be PrEP today might not be the same thing in 2020.”
Dr Mayer pointed out there are several studies currently looking at a range of new and different methods of prevention.
“For women, there are vaginal rings that are being developed that can be inserted once a month that slowly release different anti-viral medication. Also there are new rings that may have a dual use ability so it might be able to prevent them from HIV and pregnancy.
“There are studies looking at injectable PrEP - in theory, that’s great, but clearly something that stays in the body that long needs to be safe, and the studies are going forward but they’re being very cautious,” he said.
“The most interesting in the short run may be topical gels, which have been used in studies for women but are now being used in studies for men who have sex with men, and transgender women.
“Gel makes perfect sense for people who have anal sex because most people are using lubrication when they have anal sex. So if you had a gel that can also protect you from HIV that would be a big deal.”
However, as Dr Mayer points out, studies are not always smooth sailing. In an early study looking at the vaginal gel and its usage with men who have sex with men the gel wasn’t very well tolerated:
“It contained glycerin, which stimulates the bowel, and the feeling that you have to go to the bathroom isn’t really something you want when you’re having anal sex,” he said.
Fortunately these gels can be reformulated, and a new trial is underway and we will know more in a couple of years when the study is completed, with Dr Mayer telling MCV the “gel agenda is alive and well”.
Although to have all these studies and various prevention methods being researched, Dr Mayer highlights it’s not a walk in the park, but it’s not something the health community haven’t accomplished before.
“All this is very exciting, but it takes time, community resources and political will and that’s very important.
“This is not a totally new experience. The original contraceptive pill was high dose, had potentially more side effects, one flavour, and one choice essentially.
“Now in terms of hormone contraception there are pills, rings and all kinds of ways that women can access hormonal contraception.
“The bottom line is, it’s not one size fits all.”
Professor Kenneth Mayer, MD, speaks at the 2014 AIDS Conference on Thursday 24 July, 2014, aids2014.org