11 July 2002 Edition

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AIDS crisis outstrips even worst-case scenarios

In the next 60 seconds, at least four people will have died of AIDS in Africa, the world's poorest continent.

In diamond-rich Botswana, Southern Africa, a staggering 39 percent of adults are infected with HIV, with rates over 50 percent in the northeast and among urban expectant mothers, and the pandemic is still outstripping all efforts to control it.

Botswana's government goes so far as to say that the population is facing extinction from the disease. Life expectancy for the 1.6 million Botswanans has fallen below 40 years for the first time since 1950. Studies suggest it could dip below 30 if the spread of the virus is not reversed.

South Africa, Africa's economic powerhouse, has the highest number of people living with HIV-AIDS - an estimated 4.74 million or one in nine people; Ivory Coast tops the list in West Africa with an infection rate of around 10 percent; Zimbabwe has 2.3 million people infected; in Nigeria, Africa's most populous country, some 3.5 million of its 120 million people are infected with HIV.

"Africa has never known anything like this in its history. It is the worst nightmare that we can imagine. It is worse than a nuclear bomb," says Bunmi Makinwa, head of UNAIDS in Eastern and Southern Africa.

With more than two thirds of the world's AIDS sufferers living in Sub-Saharan Africa, scientists say costly HIV drugs are not being made available where they are most needed. A UN report says that rich western countries are the least affected, while dozens of other countries are in the grip of an AIDS/HIV epidemic. And it adds that the scale of the epidemic now outstrips even the worst-case scenarios of a decade ago.

Estimates of the number of cases at the end of 2001 showed that as many as 40 million people worldwide were infected with HIV/AIDS, but more than 28 million of those cases were reported in the Sub-Saharan African region.

That compares with almost 3 million in the whole of the Americas and just over half a million in Western Europe. Australia and New Zealand had the lowest number of cases - just 15,000.

The gulf between the world's richest and poorest countries has never been more evident than when looking at access to AIDS prevention and treatment.

For $10 billion a year, AIDS experts are convinced they can launch a credible response to the epidemic with improved prevention against new infections and antiretroviral drugs for at least 2 million people already living with HIV/AIDS in developing countries. Many HIV-positive Africans are too poor to afford treatment and so far, less than a third of the necessary funding is available. "The G8 have not put their money where their mouth is," said Zachie Achmat, chairman of South Africa's anti-AIDS Treatment Action Campaign (TAC).

"The response of donors to date is appalling. The $10 billion a year needed to combat AIDS is equivalent to just four days global military spending or what rich countries spend on agricultural subsidies in ten days," said Oxfam's Mogha Smith.

Visas denied to some delegates

But to donor states and pharmaceutical companies, the lives of millions of people affected by AIDS in developing countries are not as important as political power and revenue. An example was the attitude of the Spanish government, which denied visas to some of the delegates travelling from Third World Countries to the UN sponsored XIV International AIDS Conference taking place in Barcelona from 7 to 12 July.

At the opening ceremony, activists kept up a chorus of jeers and whistles that drowned out the words of Spanish Health Minister Celia Villalobos. Some among the 15,000-strong audience walked out.

AIDS activists protested against the Spanish government's refusal of visas to a number of people from developing countries who planned to attend the conference.

Activists said the government wanted to keep out people from the developing world with the virus that causes AIDS - a charge Madrid denied.

"If you are HIV positive and you can't provide proof you have medical insurance you were banned from coming," said David Miller, from the New York branch of AIDS activist group Act-Up.

Activists march in Barcelona demanding aid for developing countries in their fight against AIDS, Sunday, 7 July. More than 15,000 people from around the world gathered for a conference in Barcelona to spend a week looking for solutions to an epidemic that now infects 40 million worldwide, more than half of them in Africa

Political will

The most emotional moment of the opening ceremony came when the lights dimmed and the audience held up thousands of candles in memory of those who have died of AIDS, as cellist Damian Martinez played a wistful tune.

Peter Piot, head of the UN AIDS agency, UNAIDS, said the world must not allow the AIDS crisis in Africa - where more than 30 percent of people in some countries carry HIV - to be repeated in other continents.

"The world stood by while AIDS overwhelmed sub-Saharan Africa. Never again," Piot said.

UNAIDS warned last week that the AIDS epidemic was still in its infancy and could kill 70 million people over the next 20 years as it spreads deeper into Asia and Eastern Europe.

Piot dismissed the argument that it is not technically feasible to bring sophisticated antiretroviral treatment to millions of people in some of the world's poorest countries. "It's not knowledge that's the barrier. It's political will," he said.

Outside the conference, some 500 activists took to the streets to echo Piot's call, demanding cuts in the price of AIDS drugs in rich countries and universal access to generic, cheaper versions of these drugs in poor countries.

Scientists say that scaling-up interventions could prevent 29 million new adult infections worldwide by 2010. Without any intervention, almost double that figure could become infected.

Pressure groups are calling for a global response to the problem, including the promotion of the use of condoms, mass media campaigns and schools programmes.

Billions of pounds are needed for vaccine research, including the cost of expensive anti-HIV drugs and supplying them to poorer countries. Campaigners are urging political leaders to become involved in strategies to prevent the spread of HIV.

New hopes for AIDS vaccine

Drug resistance has returned as a problem in HIV/AIDS treatment, after a brief lull in the late 1990s, according to new figures.

The introduction of triple-drug therapies in the mid-1990s revolutionised the treatment of the killer disease for thousands of those infected in Western countries, allowing them to return to relatively normal lives.

But the virus is fighting back by evolving new ways to circumvent medicines. A growing number of people are being infected with strains that are already resistant to one or more of the three widely used classes of antiretroviral drugs.

A revolutionary AIDS drug that stops the HIV virus from entering cells may offer new hope to thousands of patients resistant to current therapies.

Data released on Monday by drug makers Roche Holding AG of Switzerland and US biotech firm Trimeris showed T-20 slashed the amount of virus in the blood of many patients running out of treatment options.

The injectable drug, which could reach the market in the first quarter of 2003, is the first in a novel class of medicines known as "fusion inhibitors" that work in a completely new way to outwit HIV, the virus that causes AIDS.

Results of two clinical trials released at the world AIDS conference showed twice as many patients achieved a reduction of HIV in their blood to undetectable levels when taking T-20 plus older drugs as those given conventional therapy alone.

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