PARIS, Aug 7, 2006 (AFP) - The biggest-ever council of war on AIDS opens next Sunday, a quarter-century after the disease, surfacing among American gays, took its first step in a global rampage that has now claimed more than 25 million lives.
But in contrast to previous meetings where anguish, frustration and protest were often the hallmark, the six-day 16th International AIDS Conference, running in the Canadian city of Toronto, should unfold in a mood of relative optimism and serenity.
For the first time in its dreadful history, acquired immune deficiency syndrome (AIDS) appears to be marking time.
At the end of last year, 38.6 million people were living with the human immunodeficiency virus, the agency UNAIDS reported in May.
The global proportion of people infected with HIV "is believed to have peaked in the late 1990s and to have stabilised subsequently," it declared.
At the same time, the rollout of cheaper, lifesaving antiretrovirals to poor countries is pushing ahead.
And the risks of which pharmaceutical giants so vociferously warned just five years ago -- mismanagement, corruption, failure to follow a complex drug regimen -- have so far not materialised.
In December 2003, only 400,000 people out of 6.5 million badly-infected people in the developing world had access to these drugs. Two years later, the tally was 1.3 million and has surged further since then.
These encouraging events were born of tough experience and campaigning to create a political dynamism about AIDS. In turn, the politicians opened the financial spigots, leading to the more successful prevention, treatment and awareness campaigns that we see today.
"We have reached a plateau in the history of the AIDS epidemic," said Achmat Dangor, UNAIDS' director of advocacy. "It's because over the last 25 years, we've learnt some bitter lessons about what to do and what not to do."
Dangor said the optimism had to be heavily salted with caution, noting that AIDS still claimed 2.8 million lives last year and 4.1 million people became newly infected.
"It's true to say that the epidemic is slowing down globally, but we also need to be aware that in certain regions and countries it continues to expand," warned Dangor.
The search for a cure and vaccine for HIV remains beyond the horizon.
"HIV is unusually well-equipped to elude immune defences, as exemplified by its ability to vary extensively, to persist in viral reservoirs and to eventually overcome the immune system," Anthony Fauci, director of the US National Institute of Allergy and Infectious Diseases (NIAID), said in a co-authored warning marking the 25th anniversary of the first detection of AIDS.
Even so, the vaccine quest has been brightened by a huge boost by Bill Gates, whose foundation last month promised another 287 million dollars in research funds. There have been some good advances in the hunt for an HIV-killing gel, a microbicide that could be applied ahead of intercourse.
Meanwhile, a US company, Panacos Pharmaceuticals, is recruiting human volunteers for a prototype drug, PA-457, that is the first in a new class of anti-HIV treatment called maturation inhibitors. And new research says that male circumcision can significantly lower the risk of infection.
If the AIDS fighters are pausing for breath after the first 25 years of this drawn-out war, it is with the knowledge that many more battles lie ahead.
The warning lights are flashing for eastern Europe, which has the fast-growing rates of infection since sub-Saharan Africa was steamrollered in the 1990s, and for northern India and parts of China too.
In addition, the present generation of antiretrovirals being distributed in poor countries will, as all drugs, inevitably run into problems of resistance.
Will Big Pharma let their second-generation drugs be sold cheaply or copied as generics? Or will it resist such a move, as it initially did with the present frontline medications, at the cost of a media bashing?
In the past, the money question was also a rich source of protest at the once-every-two-years AIDS conference.
Today, thanks to big boosts in funding since 2003, the issue is dormant -- but maybe for not much longer.
The irony is that by saving people's lives by giving them antiretrovirals, donors become locked into an enduring commitment, for the drugs must be taken every day for the rest of one's life.
"In 2001, the world spent 1.6 billion dollars on AIDS, from all sources," said Dangor.
"In 2005, the world spent eight billion, that by any measure is a huge increase. Of course, by 2010, the world will need between 20 and 23 billion per annum, and that's significant. It means that when people make a commitment [on funding], it is a commitment that they have to see through for the next 15 to 20 years."
Around 20,000 doctors, grassroots workers, lab researchers and policy specialists have registered for the Toronto conference, whose VIP guests will include Bill Clinton, Bill Gates and the movie actor Richard Gere. The previous international AIDS conference was held in Bangkok, in 2004.
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