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HEALTH: Cautious Optimism on Eve of Global AIDS Meet

Stephen Leahy

BROOKLIN, Canada, Aug 9 2006 (IPS) - The world’s largest gathering of HIV/AIDS experts and activists will meet in Toronto starting on Sunday with renewed hopes of halting the spread of this devastating disease, which an estimated 40 million people are currently living with.

Their hope arises from better treatment and prevention programmes, huge increases in funding, and data released earlier this year that the global proportion of people infected with HIV is thought to have peaked in the late 1990s and to have stabilised today, according to UNAIDS.

And so the mood of the more than 24,000 delegates to the six-day International AIDS Conference, which starts Aug. 13, may well be one of cautious optimism.

“This is one of the conferences that is going to be all things to all people,” said Dr. Mark Wainberg, director of McGill University’s AIDS Centre in Montreal and co-host of the conference.

“You have activists, you have community people, you have scientists, physicians, researchers looking for vaccines and other very basic efforts designed at trying to stem the HIV epidemic,” Wainberg said in a statement.

Former U.S. president Bill Clinton, philanthropists Bill and Melinda Gates, Princess Mette-Marit of Norway, Stephen Lewis, the U.N.’s special envoy for HIV/AIDS in Africa, and Hollywood actors like Richard Gere will also help generate media interest.

On Wednesday, the Gates Foundation pledged 500 million dollars to the Global Fund to Fight AIDS, TB and Malaria over the next five years. While the move garnered praise from an array of public health groups, they also warned that major funding increases were still needed from donor governments, which should not think that they are now “off the hook”.

Canadian Prime Minister Stephen Harper has declined to attend the conference, citing other commitments.

HIV/AIDS was first detected among U.S. men 25 years ago and remains unusually well-equipped to elude immune defences, said Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases (NIAID).

The virus has many variants and persists in viral reservoirs within the body until it eventually overcomes the immune system, Fauci said in a report.

Nearly 40 million people are infected with HIV – five times the population of Austria and several million more than live in the geographically enormous host country of Canada. Africa has about 25.3 million of those living with the disease. Since 1981, some 25 million people have died worldwide of AIDS, according to the latest U.N. figures.

However, a great deal has been learned about the virus, how it is spread and which are the most effective treatment programmes.

“The challenge today is to garner the resources and the collective will to translate that knowledge and experience into broadly available HIV treatment and prevention programmes,” said Brigitte Schmied, a doctor at the Otto Wagner Hospital in Vienna and president of the Austrian AIDS Society.

“This year’s conference theme ‘Time to Deliver’ underscores the urgency of bringing effective prevention and treatment strategies to the entire world,” Schmied told IPS.

The conference should serve as a “wake-up call for key policymakers to increase commitment and responsible action and to expand public awareness of the continued impact of and global response to HIV/AIDS,” she said.

At the conference, researchers will report fresh findings on the origins of HIV-1, and examine how select groups have managed to resist infection despite ongoing exposure to the virus. Ongoing efforts to produce an effective vaccine will be revealed, along with the results of clinical trials of microbicide gels that can be used by women to prevent HIV transmission during sex.

Scientists will also talk about the worrisome trend of drug-resistance to first-line anti-retroviral drugs that are keeping millions of people infected with HIV alive.

“The International AIDS Conference is one of the most important meetings for the discussion of key scientific developments in the fight against HIV/AIDS,” Schmied observed.

Equally important themes in the conference are the cultural and behavioural components involved in the spread and treatment of the disease.

The first hard evidence on how wider access to HIV testing and antiretrovirals affects sexual behaviour, transmission of HIV and AIDS stigma will be presented. Other research has found that empowering women and girls is emerging as a major priority to mount an effective response to the pandemic.

Several hundred AIDS experts opposed to the George W. Bush administration’s promotion, both at home and abroad, of “abstinence-only” prevention programmes will also be in attendance. Led by the Caucus for Evidence-Based Prevention, these delegates say such a strategy does more than harm than good by withholding critical information about condoms and other proven methods to block transmission of the virus.

Perhaps for the first time at these biennial conferences, funding will not be the overarching topic of discussion, as worldwide resources to battle HIV/AIDS have grown to eight billion dollars last year from 300 million dollars a decade ago.

Still, UNAIDS says much more money is needed, estimating that 15-20 billion dollars would be nearer the mark annually by 2010. And this kind of funding will need to be maintained for decades to come.

While some experts believe the fight against HIV/AIDS may have turned a corner, there are worrying signs of increased infection rates in Eastern Europe, northern India and parts of China.

Africa, hardest hit by the disease, has made gains in some areas but has a long way to go, requiring much more than money. There is poor access to care and proper diagnosis in many countries simply because there are few trained doctors and nurses left. Medical, transportation and communication infrastructure is lacking.

Many people do not have enough food and clean water, which makes them more susceptible to the virus and paradoxically unable to tolerate the anti-viral treatment programmes.

It is common for poor people in Africa to ask for food aid before agreeing to listen to health workers explain to risks of HIV/AIDS, says Stuart Gillespie of the International Food Policy Research Institute.

“Being able to get back on your feet and not have to worry about getting food for the family if you’re sick or if another adult is sick is absolutely the number one primary concern we’re seeing over and over again,” Gillespie said in a statement.

Nutritional support as part of drug treatment programmes is just one of many capacity building issues for Africa that will be addressed at the conference. Organisers recognise that ending the global HIV epidemic will take a combined effort unlike anything in history, but say: “AIDS 2006 in Toronto is a landmark opportunity to work together to review our progress and renew our energies to make it happen.”