In conversation with Mark Wainberg

Dr. Wainberg just completed a two-year tenure as president of the International AIDS Society, the world's largest organization of AIDS researchers and clinicians. He is currently director of the McGill AIDS Centre. His lab at the Jewish General Hospital's Lady Davis Institute for Medical Research, in collaboration with pharmaceutical company Biochem Pharma, was the first to identify 3TC, an important component in HIV therapy, as an effective antiviral drug. Among other projects, he is currently working on the development of an HIV vaccine. A long-time activist, Dr. Wainberg continues to speak out on issues surrounding the AIDS pandemic.

What did it mean to you to be President of the International AIDS Society?

It was the highlight of my professional life. It gave me an opportunity to have an impact, on an international scale, on the course of the disease.

It also changed my outlook. I can't just think of myself as a lab-based researcher anymore; I see myself as someone on a mission, to try to make dents in the problem on a worldwide basis.

While pursuing my lab work, I want to continue to speak out -- loudly -- to government leaders and pressure them to make a difference. For example, I met with President Daniel Arap Moi of Kenya, and I used the opportunity to tell him that his government was doing a lousy job on AIDS education. I said, "Mr. President, AIDS is your biggest enemy; it is a far greater threat than any external enemy. It is going to kill your people." He said, "You're right," and I don't know if it was my influence or not, but the Kenyan government's policy on AIDS changed by 180 degrees.

Are you still involved with the International AIDS Society?

Yes. Along with the current president, I started a program in continuing medical education in which we visit developing countries and give lectures to nurses, doctors, care givers, pharmacists and social workers.

I am also working on such issues as access to antiviral drugs for people in developing countries. There are 30 million people around the world who do not have access, and if we in the West just sit back while they slowly die, it is almost as if we are guilty of murder. I couldn't live with myself if I didn't try to help these people.

What progress has been made on this issue?

The International AIDS Society, the United Nations AIDS Program, the World Health Organization and the World Bank have been jointly lobbying the major pharmaceutical companies to reduce the price of their drugs by 80% for the Third World. If that happened, it would be an important step, but they would still be too expensive for the people of developing nations.

But we could then hopefully get third party players like the World Bank or the Gates Foundation (a charity founded by Microsoft CEO Bill Gates) to buy the drugs at the discounted price, and then either distribute them for an even lower price, or for free.

Any response from the drug companies?

They have already indicated that they are willing; we just have to work out the details. Five companies have already declared that they are on board: Glaxo Wellcome, Merck, Bristol Myers Squib, Boehringer Ingelheim, and Roche.

Overall, is the AIDS problem worse today than in previous years?

Yes, because it continues to spread at an alarming rate. The situation will get worse before it gets better, and it won't get better until everyone changes their behaviour. I often speak of the A, B, C and Ds of AIDS. A stands for abstinence; on that subject, I would say that 13- and 14-year-olds should be abstaining. I don't know what the right age to begin sexual relations is, but it's definitely not 13 or 14. Second, B stands for be faithful, for obvious reasons. If you can't do A or B, then C means use a condom. Finally -- and this is especially true in the context of developing countries -- if you don't do A, B or C, then D means you're going to be dead.

Tell me about the progress of your lab research.

We have four excellent HIV vaccine candidates now; we will test them on monkeys very soon. The way we create these candidates is by making certain constructs of vaccines with a related virus, Simian Immunodeficiency Virus (SIV). These are crippled or attenuated forms of the virus, which don't replicate anywhere near as well as virulent viruses. We hope that as it replicates -- slowly -- it will give rise to long-lasting immune responses which will protect against the real thing. So we will inject monkeys with the vaccine, and then with a virulent form of SIV, to see if they are protected.

Two years ago, you predicted you would be ready for human trials in two years.

That's true. A journalist at the recent international conference in Durban asked me, "When are we going to have an HIV vaccine?" I said, "Not for at least ten years." He said, "That's the same answer you gave me five years ago." He was right. Unfortunately, we still don't have the knowledge to create an effective vaccine, and I honestly don't know if the world will ever have one, because the problems are so great. It hurts me to say that. We're working on it, but I won't mislead people by promising a vaccine.

Is that because the virus mutates so fast?

That is one of the biggest problems. Another is that it's a sexually transmitted disease, which means that it's difficult to test the vaccine. Suppose we vaccinate 10,000 people, and then we want to see if it will work; we can't tell them to go out and have sex with as many people as possible. In fact, we have to say the opposite; we have to tell them that we have no idea whether or not it will work, so please continue to take precautions. So, for good and ethical reasons, we have to set roadblocks in the way of testing the effectiveness of the vaccine.

So how will human trials eventually be conducted?

If it works with SIV in monkeys, we will make a near identical construct for HIV. Then we will test it in groups which are already at risk -- for example, prostitutes in the Third World. And if it is proven effective, I will just give it away to the world, perhaps to the United Nations, rather than trying to patent it.

You've been very critical of people who suggest that there may be other causes of AIDS besides HIV. Is there controversy about the cause of AIDS?

Only fringe groups have articulated this idea. At the AIDS conference, we presented a list of reasons why HIV is the cause of AIDS; for example, people were dying like flies until we developed anti-HIV drugs. All the reasons added up to absolutely conclusive scientific proof. If someone says that HIV is not the cause, we should consider bringing them up on charges of endangering public health.

What about people who say that HIV is just one cause among many?

HIV is the unequivocal cause of AIDS; however, there are co-factors which contribute to the speed with which AIDS will develop, or the extent of a person's deterioration. Those co-factors could include other infections, like tuberculosis, or an already weakened immune system. But people with perfectly healthy immune systems still get AIDS because of HIV.

Is Canadian government funding of AIDS research still inadequate?

The funding situation has greatly improved, and we are not feeling the pinch the way we were a few years ago. There is still a huge gap to make up, in regard to per capita funding vis-à-vis the U.S., for example, but we have improved a lot, and we must recognize that, and thank both the Canadian government and the Quebec government for trying to make a difference.

Do you still feel that it's important to be an AIDS activist?

I am an AIDS activist, absolutely. AIDS is going to be the world's leading cause of death, so it behooves us all to be AIDS activists. At the international level, we must get that message out, and tell people that they have an obligation to protect themselves against this horrible virus. And we must keep up the pressure on the government, so that they offer more help to developing countries, through debt reduction, for example. I think we can afford it, given that we are running such great budget surpluses.

Is the world any closer to a cure?

No. We don't know how to eliminate HIV from the body of an infected individual. The best we can do is to suppress the virus, which means that the moment people go off their drugs, or develop drug resistance, there is a real good chance that the virus will begin to replicate in their bodies again, and they will go on to become ill.

People diagnosed with HIV are living longer because of the treatments available. Is there a danger of our becoming complacent?

To some extent, people have the attitude that HIV drugs are now 100% effective, so it doesn't matter if you get HIV. That's nonsense. HIV is horrible, no one wants to get it, and no one wants to take these drugs, which might not work forever, and which are hampered by problems of toxicity and potential drug resistance.

When I hear people talk about "safe sex fatigue," that makes me angry. We can't return to the unprotected sex practices of the '70s and '80s. HIV is probably here forever, and we have to deal with this new reality.

Dr. Wainberg was interviewed by Montreal freelance writer Sylvain Comeau.