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REPORT FROM BANGKOK
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Reported by Jules Levin
From Jules Levin in Bangkok. Monday July 12, morning, 5:30am.
Amid the strife at Bangkok's conference regarding the importance of treatment access & prevention in the developing world & particularly Asia, this year's focus, let's not forget that at home in the USA access to care & treatment is a problem for patients who need ADAP to access HIV treatment as federal funding for ADAPs are severely restricted. There are waiting lists for ADAPs in many states. The major problem in HIV today for many patients is coinfection with hepatitis C and hepatitis B, as 30% of HIV-infected in the USA & 30% or more in Europe have HCV or HBV coinfection, but little funding attention is paid for programs needed. Arguably coinfection is the number 1 problem in HIV in the US, but who is paying attention? The 15th Intl AIDS Conference opened Sunday evening with an opening ceremony where they brought in Kofi Annan to speak. The presentation at the conference of treatment information starts Monday morning where an oral session at 2pm includes presentations on: (1) GW433908 (908)/ritonavir: 48-week results in PI experienced pents; a retrospective analysis of virologic response based on genotypic & phenotypic resistance; (2) study of 10 days monotherapy of Reverset- a new NRTI for patients with NRTI resistance; (3) update on Kaletra monotherapy with 48 week data by Joe Gathe; (4) 96 week results from TORO study of Fuzeon; (5) study of exercise and oxandrolone on lean body mass, fat distribution, blood lipids, bone density and training markers in HIV+ men & women on HAART; (6) polymethylmethacrylate (PMMA) for facial atrophy treatment: 5 years follow-up; in addition there are posters on HCV/HIV coinfection Monday. Sunday prior to opening ceremonies, which took place at 6pm, several drug companies held satellite symposiums where Roche presented results from the coinfection study of 750 patients APRICOT & talked about treatment for HCV. Abbott held a symposium where they opened where a talk about coinfection worldwide & how this is a very important concern with high rates in Europe, Russia, & the USA, and they talked about Kaletra. Boerhinger Ingleheim held a symposium where they discussed tipranavir and reviewed data presented showing the new PI to be effective for many patients with PI resistance. Of note patients with 3 or more key PI mutations (33, 82, 84, 90) may not respond well to the drug. Updated info from phase III will be presented at conferences in the Fall 2004. An Expanded Access Program is expected to begin soon, ask your doctor.
Back in the US the big news is that the LA Lakers have announced a pending deal trading Shaqille O'Neal to the Miami Heat for forwards Lamar Odom & Caron Butler, center Brian Grant, and a future first-round draft choice.
HIGHLIGHTS from BANGKOK: selected article from newswire services bringing to you the leading stories following the opening day ceremonies.
Articles below from LA Times, SF Chronicle, NY Times, Bangkok Post. More to follow.
BRIEF HIGHLIGHTS
--UN Chief Kofi Annan spoke at Opening Ceremony at the Intl AIDS Conference and said: women & girls worldwide are bearing the brunt of the AIDS crisis. Women should be empowered to care for themselves….1 in 4 infections occur in southeast Asia so its appropriate to hold this conferene here.
--Thai Prime Minister said his country would provide ART in his country & to surrounding countries
--"I think we have lost the momentum," said former Thailand Prime Minister Anand Panyarachun, in an interview published in the U.N. report.
--Thailand itself has been a showcase for successful HIV prevention. Heavy promotion of condom use in this country's commercial sex industry has reduced annual infections to an estimated 21,000 from 140,000 in 1991. But a new report by the United Nations Development Programme warns of "a possible new wave of infections" due to growing complacency.
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KOFI ANAN SPEAKS AT OPENING CEREMONY
Report from BBC Online. July 11
The UN Secretary General Kofi Annan has warned the international community it is not doing enough to fight AIDA.
Mr Annan said several of the targets world leaders set three years ago for tackling the virus had not been met.
Annan warned of dire economic consequences in the Asia-Pacific region unless leaders acted decisively to tackle Aids.
"Here in Asia, HIV/Aids is at a turning point," he said. "How you will address this challenge, will impact on the very future of the region.
He said leaders in the region had only three years to stop the crisis turning into something worse even than that experienced in Africa.
"Left unchecked, AIDS will not only devastate millions of lives, it will also impose huge burdens on the regions health systems and take up resources that are badly needed for social and economical development," he said.
Several hundred activists demonstrated outside the conference centre as delegates arrived, demanding greater availability of cheap drugs for poorer countries.
Infection rates in Asia are still much lower than in sub-Saharan Africa, but the huge populations in countries like India and China mean that even low rates produce large numbers of infected people.
Chinese Premier Wen Jiabao acknowledged on Saturday that Aids has reached every level of society in China.
Missed targets
And experts are warning that, unless more is done to combat the spread of the disease in such countries, it could cause a pandemic surpassing the scale already seen in Africa.
A report by the UN-launched Global Fund to Fight Aids, Tuberculosis and Malaria has meanwhile said that one-fifth of its initial projects failed to meet targets and are unlikely to receive further support.
The Global Fund's analysis of 25 projects, costing about $160m, blamed local bureaucracy for the failure to meet targets.
But the report said that, overall, its projects were more successful than other health programmes.
The Global Fund was conceived by Mr Annan as a means of fighting the main killer diseases. It is backed by private donors and Western governments.
Funding gap
After the last international Aids conference in Barcelona, the Bush administration pledged $15bn over five years for Aids-related programmes overseas.
Nearly 2.3 million people have benefited from the programmes, but there is still a funding gap.
The World Health Organization says less than one in 10 of those infected with HIV in the developing world have access to the drugs they need.
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Annan Challenges Leaders to Act on AIDS
By VIJAY JOSHI
The Associated Press
BANGKOK, Thailand (AP) - The International AIDS Conference opened Sunday with U.N. chief Kofi Annan challenging world leaders to do more to combat the raging global epidemic and warning that women are increasingly the unwitting victims of the disease.
Three years after world leaders pledged at the United Nations to defeat the epidemic, there has been progress on many fronts, Annan said in a speech to nearly 20,000 policy makers, scientists, activists and celebrities.
``And yet, we are not doing nearly well enough,'' he said, in the first appearance by the U.N. secretary-general at an International AIDS Conference.
``We need leaders everywhere to demonstrate that speaking up about AIDS is a point of pride, not a source of shame. There must be no more sticking heads in the sand ... no more hiding behind a veil of apathy.''
Organizers criticized a U.S. decision to send a pared-down delegation that forced some researchers to cancel presentations, with delegates saying they believed it was a message that the conference wasn't focused enough on abstinence.
The U.S. stance sends ``a strange signal'' from the largest donor nation to anti-AIDS efforts, conference co-chairman Joep Lange said. ``These ideological games are very counterproductive,'' he said.
The United States says the reason is cost cutting: It spent $3.6 million on the Barcelona trip. The bill this time is $500,000.
The conference was expected to discuss how best to prevent infections - with discussions on whether to focus primarily on condoms, as host country Thailand has done, or on abstinence, as favored by Bush.
``Bush tells lies, condoms save lives,'' read a placard held by one of an estimated 1,000 activists, many of them HIV positive, who rallied outside the venue to demand increased access to drugs, condoms and clean needles.
Thailand doled out condoms at tollbooths, hotels and the conference. The venue even had an exhibit of dresses made of condoms, symbols of the country's success in securing a sevenfold decrease in HIV infections since 1991 largely by promoting condom-only sex among prostitutes.
The emerging HIV epidemics of Asia typically have started with drug users and gay men, then progressed to sex workers and their clients, the region's main engine of transmission, said epidemiologist Tim Brown of the Hawaii-based East West Center.
The pace of the spread depends on the percent of the country's men who visit prostitutes, he said. Thailand had one of the higher percentages, about 20 percent in 1990, so its epidemic spread fast. The same pattern is happening more elsewhere in Asia - but more slowly.
``What's particularly dangerous about the slow growth is that it won't motivate the kind of aggressive response that we've seen in Thailand and in Cambodia,'' Brown said.
A UNAIDS report issued before the conference said 38 million people worldwide are infected with HIV, 25 million of them in sub-Saharan Africa and 7.6 million in Asia. A record 5 million people were infected last year.
In sub-Saharan Africa, experts are alarmed at the high rates at which HIV is spreading from high-risk groups to young women and married, monogamous housewives.
Calling it a ``terrifying pattern,'' Annan said women now account for nearly half of all adult infections, and in sub-Saharan Africa the figure is as high as 58 percent.
``And yet, one-third of all countries still have no policies to ensure that women have access to prevention and care,'' Annan said.
The theme of the 15th conference is getting more of the newly available antiretroviral drug combinations to the millions in the developing world who need them - turning AIDS from a death sentence to a chronic disease.
In a speech to open the conference, Thai Prime Minister Thaksin Shinawatra urged governments around the world to provide ARV drugs to the needy. He announced a donation of $5 million over five years to a U.N.-initiated fund to fight AIDS.
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U.S. Official May Prove Unpopular at AIDS Conference
By Mary Curtius
Los Angeles Times
July 11, 2004
WASHINGTON — As the man in charge of the Bush administration's $15-billion plan to treat millions of HIV-infected people in underdeveloped nations, Randall Tobias might expect a hero's welcome at the International AIDS Conference opening today in Thailand.
Instead, the U.S. global AIDS coordinator is likely to be greeted by the protests of activists opposed both to the administration's policies and to Tobias.
Tobias, some activists said, could expect a reception similar to the one given in 2002 to Health and Human Services Secretary Tommy G. Thompson, who was booed off the stage at the last conference, in Spain.
Since then, the administration has launched the most expensive effort ever mounted by a government to fight AIDS internationally.
Yet neither the financial commitment nor the power President Bush has given Tobias to mobilize the U.S. bureaucracy has won over critics, who charge that the administration's efforts are hamstrung by political and ideological concerns.
"He's been worse than we thought," Sharonann Lynch, of the AIDS organization Health GAP, said of Tobias. "Tobias is the front man for Bush's ideology-driven policies on prevention and on treatment" of AIDS.
Lynch said Tobias had given his critics fodder by emphasizing abstinence and faithfulness as effective ways of preventing AIDS while downplaying the role of condoms, and by failing to embrace generic drugs as substitutes for more expensive patented brands.
Conservative supporters of Bush's program argued that it was meeting with resistance because an entrenched international network of AIDS experts and activists did not like being told that their methods had failed to defeat the epidemic.
Rep. Mark E. Souder (R-Ind.), who strongly supports the president's efforts to combat AIDS internationally, said the criticism of the U.S. program was politically motivated.
"Every action taken by President Bush to elevate the fight against AIDS, both domestically and globally, has been greeted with derision … by activists who can't bear to see the president's compassionate conservative agenda achieve the results that the previous administration failed to deliver," Souder said.
The U.S. program seeks to double the number of people with access to AIDS drugs in Africa in its first year, vastly expanding treatment and prevention efforts in hard-hit African nations, the Caribbean and Vietnam. Over five years, the goal is to treat 2 million HIV-infected people with antiretroviral drugs and provide palliative care for 10 million HIV-infected people and AIDS orphans.
Tobias said his critics' vehemence mystified him.
"This program gets a lot of criticism," he acknowledged in an interview in his Washington office. Bush, he said, "is doing so much," yet "a lot of the critics are saying, 'You should do more.' "
Health GAP, or Global Access Project, opposed Tobias' appointment from the outset last year, Lynch said. Her group feared that as head of the pharmaceutical firm Eli Lilly & Co. in the 1990s, Tobias would protect drug company interests by preventing underdeveloped nations that accept U.S. money from using lower-cost generic drugs.
"He is illustrative of overall Bush policies of pandering to the pharmaceutical industry," Lynch said.
Tobias strongly rejected the charge. In an interview from Vietnam, he said his speech to the AIDS conference would urge greater unity.
"I would like to encourage everybody involved to really get focused on the fact that the enemy here is apathy, stigma and denial as opposed to each other," he said. "I would think that there are better places for people to put their energies."
In his first year on the job, Tobias, who had no background in public health, said he had been transformed by the suffering he witnessed in nations ravaged by AIDS, even as he had learned that the world of international treatment and prevention was filled with political landmines.
As chief executive of Lilly, Tobias traveled frequently to the capitals of African nations, meeting with business and government elites. He thought himself a worldly man.
But nothing in his corporate experience, he said, prepared him for the realities of AIDS that he has encountered since agreeing to come out of retirement for the administration post.
"I'm not naive," Tobias, 62, said. "But I had never sat in the dirt inside someone's home, where, because I was coming, they had swept the dirt to make this space as nice as possible."
Although Tobias said he would urge unity in Thailand, the administration's critics said the policies he was promoting provoked division instead.
The U.S. refusal to accept generic drugs approved by the World Health Organization as safe and effective angered health professionals and activists. Patented drugs are costlier, which means that governments and nonprofit organizations will be able to treat fewer people.
Activists also were angry over Thompson's decision to limit the U.S. delegation to the AIDS conference to 50 people this year — down from more than 200 at the Barcelona conference.
The administration viewed previous U.S. delegations as unnecessarily large.
"We did a re-look at whether or not this is the most efficient, effective way to use the funds available and concluded that we could do with less," Tobias said. "In previous years, there has been an awful lot of money spent in ways that may not be the most productive use of U.S. taxpayers' dollars."
But among critics, the decision to limit this year's participation was seen as evidence that the administration was less interested in multinational efforts to fight AIDS — including the global AIDS fund that the U.S. helped found — than in promoting its own program.
Thompson's decision forced U.S. scientists who had planned to attend the conference to withdraw 40 scientific papers, and caused the cancellation of U.S. seminars and workshops.
"This should be a great opportunity for the United States to provide global leadership," said Rep. Henry A. Waxman (D-Los Angeles). "Yet the way the Bush administration is handling our investment and treating the rest of the world is squandering that opportunity."
Some activist groups were willing to say the administration — and Tobias — had accomplished a great deal since Congress appropriated the first of the $15 billion in emergency funds in January. Tobias, who carries the rank of ambassador and reports to Secretary of State Colin L. Powell, has a staff of 35, operating out of a satellite State Department office.
"The man has been put into an incredibly challenging position, and we do think he has been facing it with a lot of genuine enthusiasm," said Erin Chapman, policy director for rock star Bono's nonprofit organization called Debt, AIDS, Trade, Africa.
Tobias, Chapman said, "really seems to care about this, and he's getting things done. Money is moving. Things are happening."
So far this year, the administration has released three installments of grants for the 15 targeted countries, a total of $850 million.
If the administration is having a hard time winning praise for its efforts, it is not because its programs are without merit, said one emergency fund grant recipient. Rather, the AIDS campaign is being met with hostility because the United States is held in low regard in the wake of its invasion and occupation of Iraq.
"We have to face the reality that America, in this day and age, doesn't have a great reputation in the international community," said Jack Galbraith, president and chief executive of the Catholic Medical Mission Board.
Despite the criticisms, Galbraith said, "$15 billion is a lot of money," and the U.S. deserves recognition for being willing to make that sort of commitment.
"People say we should be doing more," he said. "To be honest with you, everybody should be doing more."
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Asia on precipice of disaster
With smoldering epidemics in China and India, region at 'critical juncture'
Sabin Russell, Chronicle Medical Writer
Sunday, July 11, 2004
San Francisco Chronicle
Bangkok -- At least 12,000 delegates from around the globe are converging on this Southeast Asian capital city for today's opening of the 15th International AIDS Conference, a six-day event that organizers hope will strengthen world resolve to combat a disease that has already claimed at least 20 million lives.
A blend of political theater, medical research and social science, these AIDS conferences focus world attention on the gravity and scope of the epidemic and help to set the course of future efforts to contain it.
"This is the biggest epidemic in human history, by any standard,'' said Dr. Peter Piot, executive director of UNAIDS, the Joint United Nations Program on HIV/AIDS in Geneva. He said it will take $12 billion a year to fight the epidemic in 2005. This year's six-day meeting is likely to be dominated by discussions -- and protests -- surrounding the question of how to bring the costly combinations of antiretroviral drugs to millions of AIDS patients in poor countries.
The theme of the Bangkok conference is "Access for All," posing a direct challenge to wealthy nations to come up with strategies to provide AIDS drugs to the poor. There are 38 million people infected with HIV, the virus that causes AIDS, and nearly all of them eventually will need antiretroviral drugs to survive.
Because of its setting in Bangkok, the conference also will highlight the problem of AIDS in Asia. An estimated 7.4 million people across the giant continent are living with HIV. There were 1.1 million new infections last year in Asia alone, according to UNAIDS.
India and China, home to 2.2 billion people, are both coping with smoldering epidemics that represent less than 1 percent of their populations but add up to millions of infected people.
The conference is drawing important Asian political leaders. Chinese Premier Wen Jiabao, Thai Prime Minister Thaksin Shinawatra and India's Congress Party leader Sonia Gandhi -- who would have been named her country's prime minister had she not turned the job down -- will address the delegates.
Newly released UNAIDS estimates put HIV infections in India at 5.1 million. According to Dr. Richard Feachem, executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, India stands at a "critical juncture" that could determine the course of the epidemic.
While most health experts doubt that HIV will explode in Asia as it did in Africa -- in sub-Saharan Africa, it's estimated that 7.5 percent of adults between the ages of 15 and 49 are HIV positive -- just a small increase in the percentage of those infected in this most populous region on Earth would create a vast human catastrophe.
Thailand itself has been a showcase for successful HIV prevention. Heavy promotion of condom use in this country's commercial sex industry has reduced annual infections to an estimated 21,000 from 140,000 in 1991. But a new report by the United Nations Development Programme warns of "a possible new wave of infections" due to growing complacency.
It found that only 20 percent of young sexually active Thais are now using condoms consistently. Half of all injection drug users are now infected, compared with 30 percent 10 years ago. Infection rates among gay men have risen to 17 percent from 4 percent in the same time frame.
"I think we have lost the momentum," said former Thailand Prime Minister Anand Panyarachun, in an interview published in the U.N. report.
That may not be the kind of attention Thailand was seeking when it agreed to host the session, but it is an example of how the conference itself can spotlight problems.
"The fact that the meeting is taking place in Asia will bring the focus once again on the developing world,'' said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.
AIDS researchers no longer use the conferences to release their most important findings. There has been enormous progress in scientific understanding of HIV, but discoveries now tend to come in incremental steps, rather than major breakthroughs. "We've been studying this disease for a long time, and the low-hanging fruit has already been picked,'' Fauci said.
But he said the international conferences still provide a valuable opportunity for the global AIDS community to take stock of its successes and failures in fighting the epidemic.
Fauci will be leading a sharply curtailed U.S. government presence at this year's conference. Citing budget constraints, the Bush administration decided that only 50 scientists from the Department of Health and Human Services could travel to the Bangkok session. That compares with 236 who were sent to the last AIDS conference in Barcelona.
During the Barcelona conference, Health and Human Services Secretary Tommy Thompson was famously booed off the stage by rowdy AIDS activists, and critics of the Bush administration see the cutbacks as retaliation.
"It's outrageous that they would limit access to their scientific experts at such an important meeting,'' said Dr. Paul Zeitz, executive director of the Global AIDS Alliance in Washington, D.C. "They are undermining the whole global response to the epidemic.''
Bill Pierce, a spokesman for Thompson, acknowledged that many government researchers were displeased with the decision. However, he said the administration was in fact being flexible with a new policy that limits delegations to 40 government scientists at international conferences.
"It's a perfectly human reaction, but I would even call it a bit of whining on their part,'' Pierce said.
The United States spent $3.6 million on the Barcelona conference. The budget for Bangkok has been trimmed to $500,000. Randall Tobias, a former Eli Lilly executive who is heading President Bush's $15 billion overseas AIDS initiative, will play a prominent role at the Bangkok conference, with numerous speaking engagements to describe the U.S. program that will pay for AIDS drugs and prevention programs in the focus countries.
Although Bush temporarily hushed critics of his AIDS policies when he announced his plan during his State of the Union address in January 2003, the program is now under attack because of the time taken to implement it.
Opponents of the president's approach also complain that Tobias has put up barriers to purchasing the lowest-cost drugs made by Indian pharmaceutical- makers in favor of more expensive, branded products made by American and European firms.
Like a mountain that creates its own weather, the AIDS conferences, scheduled every two years, tend to generate surges of publicity about AIDS, particularly as it affects the developing world, and initiatives such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, and Bush's emergency plan, have often followed.
Although the International AIDS Conference tends to break no ground in science, the session has powerful symbolic importance, said Drew Altman, president of the Kaiser Family Foundation in Menlo Park.
"The event has a catalytic impact on groups and government organizations working in the field,'' he said. "Everyone gears up an initiative so they have something to announce there.'' Global spotlight
With a theme of "Access for All," the 15th International AIDS Conference is expected to focus attention on a couple of major problems:
-- How to provide expensive anti-retroviral drugs to millions of patients in poor countries.
-- How to stop the spread of AIDS in Asia, where 7.4 million people have the disease.
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HIV / AIDS
A Global Test of Willpower
HIV is a largely preventable catastrophe. But the developed world and the developing world are still not doing enough to combat the virus.
By Thomas J. Coates
Thomas J. Coates is a professor of infectious diseases at UCLA's David Geffen School of Medicine and a member of the executive committee of the UCLA AIDS Institute.
July 11, 2004
The official logo of this summer's biannual International AIDS Conference, which convenes today in Bangkok, Thailand, depicts three elephants walking forward together. They are intended to illustrate the conference's theme of "Access for All," to symbolize how communities, families and HIV/AIDS workers have successfully joined forces in the fight against AIDS.
Nothing could be further from the truth. In fact, the main lesson of this conference is that the world's response to HIV/AIDS continues to be woefully inadequate, bringing into sharp relief everything that is wrong with the world — and pointing out that our leaders are not sufficiently serious about correcting those wrongs.
It's true that many people in the United States can get the pills that fight HIV and prolong their lives. But it's important to remember that we still don't have anything that cures the disease. And those with access to medication tend to be people who are employed and have insurance that foots the bill for top-notch medical care and for the expensive medications they take every day.
That's not the case for everyone in the United States. Those who are uninsured or African American or Latino or dependent on Medi-Cal are less likely to get treatment. If they do receive medical care, it is less likely to be up to acceptable standards. The uninsured die sooner from HIV/AIDS than people with insurance. And people from poor and minority communities acquire HIV at higher rates than those who are white, affluent and insured. Where are the families and communities joining together to make sure that everyone in the U.S. has access to the same prevention techniques, drugs and standards of care?
And then there's the rest of the world. Last week, UNAIDS announced its new statistics for worldwide infections. It calculated that about 5 million people acquired HIV last year. Some have quibbled with the statistics, and the true number may be 3 million or 4 million or something in between. But even if you take the lowest estimate, 3 million new infections in a year translates into 8,200 infections a day or 342 infections in an hour. Given that HIV is lethal in about 99% of the people it infects if left untreated, that is the equivalent of a Boeing 747 crashing every hour of every day for a year.
A 747 going down is a largely preventable catastrophe. But so are most HIV infections if we really devoted ourselves to prevention. The Kaiser Family Foundation has found that we are spending only about 25% of what is needed on this epidemic, not nearly enough even to keep up with it. The Bill and Melinda Gates Foundation has documented that worldwide only 10% to 20% of individuals who need them have access to proven prevention technologies (like condoms) and fewer than 7% have access to life-extending medications. It does not need to be this bad.
There are those who say that we're moving in the right direction, that the President's Emergency Plan for AIDS Relief, or PEPFAR, the 3 by 5 program (3 million people on drugs for HIV by 2005), and the Global Fund to Fight AIDS, Tuberculosis, and Malaria are great strides forward. But those programs are better in theory than practice. PEPFAR is underfunded, covers only 15 countries and requires that recipient countries agree to prevention standards that have been proved scientifically to be useless. The World Health Organization does not have the funds to implement the 3 by 5 target and thus will fall short of its goal. Likewise, the Global Fund is already behind in what it needs and will fall terribly short of its potential in the next few years.
The leadership of the developing world cannot be exonerated either. Thaksin Shinawatra, the prime minister of Thailand, invited the leaders of nine countries and the European Commission to come to Thailand for a "Leadership Conference." Only one, President Yoweri Museveni of Uganda, accepted. President Thabo Mbeki of South Africa had the chance to lead Africa out of the AIDS epidemic just as Mandela led his country out of apartheid. He chose, instead, to argue about the causes of HIV rather than plunge into distributing medications to those who needed them.
HIV/AIDS points its finger at all that is wrong with the way we do things in this world. People are allowed to catch a totally preventable disease because we will not deploy readily available prevention resources. In some cases, the reasons are ideological. In other cases, they are financial. Either way, infections that could have been prevented are increasing and people are dying as a result.
My friends and colleagues will tell you that I'm an incurable optimist. I have been battling HIV — both personally and professionally — since the epidemic began. I do not intend to stop. It is important that we — and I mean all of us — keep trying to improve our scientific understanding of the virus and find better ways to stop it. And it is equally important that all of us in the developed and developing world continue to try to convince our policymakers that their priorities result in unnecessary deaths every day, every hour.
Morality is often invoked as a reason not to employ proven prevention strategies like providing condoms for young people or clean needles for drug users. No one can invoke the moral high ground if they permit unnecessary infections and deaths to occur. Let's devote the resources and energy necessary to prevent — and ultimately to cure — HIV, so that someone writing about this epidemic 100 years from now won't simply conclude that we lacked the will to attack the problem.
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W.H.O. Lags in Meeting Its AIDS Treatment Goal
NY Times
By LAWRENCE K. ALTMAN
July 11, 2004
BANGKOK, July 10 - The World Health Organization asserted here on Saturday that its goal of delivering antiretroviral therapy to three million people infected with H.I.V. in poor countries by the end of 2005 could still be met despite obstacles that had severely limited the number now under treatment.
The program, known as 3 by 5, has been a subject of debate since the agency's director general, Dr. Lee Jong Wook, announced it last fall. In its first progress report, issued a day before the 15th International AIDS Conference here on Sunday, the World Health Organization estimated that 440,000 people were being treated. That is about twice as many as in 2002, said Dr. Jim Kim, director of the agency's AIDS program. But the agency's goal had been to treat 60,000 more people by now.
Dr. Lee said that the United Nations agency could not let it fail because "the collective response to the H.I.V./AIDS pandemic is the benchmark by which our generation will be judged."
Critics have said the effort was too ambitious. But Dr. Lee said he wanted to set "a difficult, time-limited undertaking that would force us to change the way we work at W.H.O."
Critics also said that affected countries did not have enough workers to deliver the drugs and that the agency did not have enough money. The report was intended "to measure ourselves against specific targets to assess the progress we are making," Dr. Lee wrote. "Progress is not rapid enough," because each day 8,000 people are dying from AIDS, the report said, while asserting that the slow start still would generate enough pressure to speed the effort later.
The agency attributed slow progress to a lack of money, but that has improved through contributions from Canada, Britain and Sweden.
At a news conference here on Saturday, agency officials were long on promises but less specific about the effort that the agency, which is based in Geneva, is conducting with government and private groups.
The agency published the estimated number of people receiving antiretroviral treatment by country for 49 countries. The total was 327,000. The agency did not provide the list of countries with the remaining 113,000 people being treated.
Stephen Lewis, the special United Nations envoy for AIDS in Africa, said he felt certain from visits to a number of countries that the 3 by 5 plan would succeed in Africa.
Since December, 56 countries have asked the agency for help in developing national antiretroviral programs, more than expected. The agency said it had sent workers to more than 20 of the countries.Twelve countries have established official treatment goals that meet the 3 by 5 objective of providing treatment for 50 percent of those in need.
Only Botswana, Indonesia and Uganda have published such plans. Botswana is treating 18,000 people, with a goal of 30,000; Indonesia is treating 1,500, with a goal of 3,500; and Uganda is treating 20,000, with a goal of 55,000, said Melanie Zipperer, an agency spokeswoman.
The agency said progress has been slowed by the time it takes to develop clear, standard and simplified technical guidelines and training materials, and by the time needed to develop standards and processes to certify workers. Dr. Peter Piot, the director of the United Nations AIDS program, a partner in the 3 by 5 effort, said, "We have to be frank and admit that we have a long way to go."
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Protesters urge reforms in drug access: Warn free trade pacts will only worsen crisis
Bangkok Post - Monday, July 12, 2004
Preeyanat Phanayanggoor
About 1,000 local and international activists and delegates of the 15th International Aids Conference yesterday staged a rally in front of Impact Arena, the conference venue, calling for free access to HIV/Aids medication.
The demonstrators, many of whom are activists and delegates participating in the conference, marched from Muang Thong Thani's market, 1km away, chanting "free medication for every nation" and "access for all".
They also called for an end to Thai-United States free-trade talks, particularly the issue of protection of drug patents by US pharmaceutical companies, which they said would raise the price of HIV/Aids drugs.
They carried banners such as "Bush's free trade deals kill generic Aids drugs now" and "You talk, we die" and "FTA was an executive's fool".
Kamol Upakaew of the Network of Thai People Living with Aids said production of all HIV/Aids drugs could come under the FTA, limiting access.
The demonstrators handed a letter to the government, World Health Organisation and UNAids representatives as well as to the president of the International Aids Society, Joep Lange.
The letter demanded the Thai government ensure sustainable coverage for anti-retroviral therapy and refrain from signing FTAs, especially the one with the US.
It also called for HIV prevention policies as well as an end to the drug suppression policies that promote human rights abuses.
The government, it said, should give injecting drug users access to methadone, a substitute for heroin.
The letter also called on the WHO to include methadone on its essential drug list to make it accessible to all hospitals, so drug users would have easier access.
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