OUAGADOUGOU, Dec 14 (AFP) - When walking up a mountain, it's usually best to keep your eyes firmly on the ground and concentrate on moving forward, step by step, rather than look to the distant summit and suddenly feel your morale plummet.
Doctors, scientists, policymakers and community workers who attended the AIDS in Africa conference have just taken that peek.
They have given themselves the chance to see where they are in the fight against the greatest health threat to the continent.
But at the same time, they have become terribly aware of how far they have yet to go.
Sub-Saharan Africa became a sitting duck for AIDS after the disease was first identified 20 years ago.
Poverty, ignorance and sexual promiscuity have now combined to make the continent home to more than 70 percent of the 40 million people AIDS or its precursor, the human immunodeficiency virus (HIV).
The five-day conference in Ouagadagou, capital of the western African state of Burkina Faso, wrapped up Thursday with a statement reasserting the will to pursue the fight and appealing for international mobilisation to cut the cost of drugs.
This is a snapshot of the AIDS war today and the challenges ahead, as perceived at many of the presentations and workshops at the conference:
- ANTI-RETROVIRALS: The cost for Africans of these wonder-drugs, which can suppress the spread of HIV although not eliminate it, has plummeted, by 85 percent on average over the past year.
The reason: a public outcry and the post-September 11 anthrax scare, which caused the US, in need of an antibiotics stockpile, to weaken its support for the pharmaceutical industry's rigorous defence of its drug patents.
Many voices at the conference demanded that the prices fall further or the drugs be offered for free.
But concern is also emerging that lower prices are not enough. Only 30,000 Africans now get the retrovirals. For millions to get them, countries must urgently build a proper medical infrastructure to ensure that the powerful drugs are not misused and cause resistance to them to build up.
- PREVENTION: Growing emphasis is being put on preventing HIV infection among people who do not have it, as compared with treating people who already do.
According to one study released at the conference, counselling prostitutes and dishing out free condoms to them is the most cost-effective way to combat AIDS -- a dollar spent here is 2,000 times more efficient in saving lives than a dollar spent on anti-retrovirals.
However cheap the drugs become, there are big fixed costs in building a network of clinics, staffed with doctors, health workers, technicians and epidemiologists, to administer these treatments.
- WORK ON VACCINE: Arguably the most depressing aspect of the pandemic. No vaccine has yet emerged from the research pipeline, and only one is in Phase III trials, the biggest and longest part of the testing process.
Worse, vaccine work is overwhelmingly focussed on subtype B of the HIV-1 viral strain, which is prevalent in North America but not in Africa. No-one can tell whether a vaccine engineered for one subtype will work on another.
Another problem is the growing evidence of viral mutations, as genetic portions of the various HIV types mix and match, raising the fear that vaccine designers are facing a shifting target.
- POLITICS: After years of neglect and indifference, some African governments are now working hard to combat the AIDS crisis.
Cote d'Ivoire, Senegal, Rwanda and Uganda were widely named by delegates as being ahead of the field, introducing initiatives that have apparently caused the rate of infections among adults to stabilise or even fall. Botswana, where more than a third of adults have the virus, is also belatedly working hard.
But South Africa, whose president, Thabo Mbeki, has questioned the clinical causes of AIDS and resisted importing anti-HIV drugs, left many to shake their heads in despair.
Even though African leaders have declared AIDS their most urgent priority, not one of them, with exception of the host, Burkinabe President Blaise Compaore, attended the conference. That lack of top-level support was regretted by many here.
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