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AIDS — a WMD that U.S. won't disarm

by THOMAS J. COATES

There is no other health conference in the world like the International Conference on AIDS. It brings together scientists of every persuasion. Policymakers and program implementers from all over the world come to learn and share, along with funders, pharmaceutical companies, non governmental organizations and charitable foundations. Add to the mix two important elements: world leaders such as Kofi Annan and Nelson Mandela and people with HIV and AIDS demanding access to services. Almost 20,000 such people gathered in Bangkok last month.

What were some of the main issues addressed and the primary lessons learned?

• AIDS is growing in Asia, a fact that was highlighted by locating the conference in Thailand. According to a UNAIDS report, more than 7 million of the 38 million people infected with HIV now live in the Asia-Pacific region, and 5.1 million of them live in India, which now has the largest number of people living with HIV, surpassing South Africa.

• Simplified drug regimens can work. Médecins sans Frontières (Doctors Without Borders) has done a study conducted in 21 countries that found that a generic antiretroviral made by Indian drugmakers Cipla and Ranbaxy Laboratories was highly effective in preventing onset of AIDS and death at a cost of $140 per day.

• Treatment and prevention need to go hand in hand. Unfortunately, the focus on treatment has eclipsed the importance of prevention. The Bill and Melinda Gates Foundation Prevention Working Group published an important report outlining what needs to be done to ensure that developing countries do not make the same mistake as developed ones as they roll out antiretrovirals. Some populations in the United States and Europe have increased risk behavior and transmission of HIV just as highly active antiretroviral therapy was introduced. We must prevent this from happening in the developing world.

AIDS is a health issue, but also a political and economic one that demands the highest response from governments in developed and developing countries. Yet funding remains woefully inadequate. Secretary of State Colin Powell called AIDS today’s worst weapon of mass destruction. But when U.N. Secretary General Annan asked the United States to show the same commitment to AIDS that it shows to terrorism, our nation refused his plea to provide $1 billion per year to the Global Fund to Fight AIDS, TB and Malaria. America’s contribution will remain at $200 million for 2004-05, down from $345 million in 2003-04. The rest of U.S. international support will be channeled through the President’s Emergency Plan for AIDS Relief. Stephen Lewis, Annan’s special envoy for AIDS in Africa, stated, “The U.S. is using the same go-it-alone strategy in AIDS that it used in Iraq.” In effect, this is an opportunity lost. This country could be leading the nations of the world by example and resources. Instead, it has chosen the path of isolation and penury, leading once again to international antipathy.

With no vaccine in sight and funding inadequate, the fight against HIV/AIDS will last a long time, certainly beyond my lifetime. One can only hope that the spirit and commitment of the delegates of this conference can continue so that some disease can be prevented and some suffering alleviated.

Coates, who attended the Bangkok conference, is professor in the Division of Infectious Diseases and an executive committee member of the UCLA AIDS Institute.