Analysis: Access Still Plagues AIDS Fight

By ED SUSMAN

For the first time in at least five years, a U.S. health official managed to address an International AIDS Society meeting without having his talk interrupted or delayed by protesters.

In the keynote address to the 4th conference of the society dealing with issues of basic science, prevention and treatment of infection with HIV, Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health, called on more than 5,000 delegates at the Sydney meeting to celebrate overwhelming advances in progress against the incurable disease.

The disease broke onto the health and political arena in 1981 and at that time, diagnosis with the disease was a virtual, rapid death sentence. Today, 26 years later, more than a score of potent anti-retroviral pharmaceuticals allow patients to survive with the infection in check for decades.

Yet, said Fauci, We’re going to be judged as a society by what we do in the next 26 years.

Discussing the actions that can be taken to change the face of the epidemic, Fauci noted that there are many proven ways to prevent HIV infections, he said — things such as access to condoms and prevention of mother-to child-transmission.

But it is quite unnerving that at most, just 20 percent of the people who could benefit actually have access to those programs, he said. We must do better than that, he said. We cannot sustain a successful effort with HIV without prevention.

Frustration with what has been seen as the United States’ slow and divisive role in supporting AIDS prevention programs without strings attached, has led to demonstrations again U.S. speakers.

In 2002 in Barcelona, the U.S. secretary of health and human services was shouted down by activists. Other American officials have experienced similar protests. That led to a virtual boycott of U.S. representation at the international meetings. In turn, the IAS has warned delegates that improper behavior toward speakers would not be tolerated. Fauci’s speech had no interruptions.

In his talk, Fauci noted that, while on one hand there are a multitude of drugs to treat HIV-infection and a robust pipeline set to spew forth more drugs in new classes to further suppress the virus, the bad news is that just 28 percent of the people who should be treated worldwide are getting benefits from these pharmaceutical advances.

If you do the math, we have a serious problem, Fauci said. At current rates, for every person started on therapy, another six become infected.

Disparities like those are a shameful failure, said Pedro Cahn, president of the International AIDS Society. Science has given us the tools to prevent and treat HIV effectively, he said, but the knowledge has not been translated into practice.

Cahn and other leading researchers — in the so-called Sydney Declaration, issued here — have called on governments and donor agencies to allocate 10 percent of all AIDS resources to research.

Good research, as we know, drives good policy, he told the opening session of the congress. And we have never been in greater need of good policy.

In another address Sunday night, Michel Kazatchkine, executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, expressed hope that the donations from wealthier countries would continue to fund treatments among people in the developing world

He said that hope is shown by the fact that when the first of these off-year meetings was held in Buenos Aires in 2001, about 100,000 people in the developing world were getting HIV therapy. Now, he said, the number is 2.2 million and growing.

At the same time, he said, the world was spending less than $2 billion a year on fighting AIDS — a number that has now increased to nearly $9 billion in 2006. However, the $9 billion figure pales alongside the United Nations’ estimate that $18 billion was needed this year for a comprehensive response to the pandemic.

Still, Kazatchkine said, the attention paid to AIDS has continued to increase, with the result that the world is coming together as never before to act on health.

Today, health is no longer seen as a happy by-product of development, he said, but rather, health is seen as a needed investment in development.