Bay Windows - National News, July 20, 2000
Beth Berlo, Bay Windows staff

Since late last year, Mbeki has drawn condemnation from the medical establishment and enraged AIDS activists from every corner of the globe with his open support for a small band of AIDS dissidents who claim that HIV is not the cause of AIDS ù a theory long ago debunked by scientists.

In addition, the South African president reportedly extended an invitation to some of the most vocal HIV denialists to participate on a panel that would re-examine the origins of AIDS in Africa. What scientists fear most is that MbekiÆs comments will fuel confusion in people ù youth in particular ù who will resume risky sexual behavior.

Sobering the more than 13,000 conference participants even more was a speech by Edwin Cameron, a South African judge, who has revealed he is HIV-positive. Cameron, 47, who is gay, learned he had AIDS after his doctor tested him without his knowledge in the late 1980s. Cameron kept the news to himself and his partner for years. Not until 1998, when Gugu Dlamini a South African woman was beat to death by several men after she revealed she had HIV, did Cameron go public with his diagnosis.

According to several news reports, Cameron accused South AfricaÆs government with being sluggish in its response to the epidemic, saying, ôIn our national struggle to come to terms with the epidemic, perhaps the most intractably puzzling episode has been our presidentÆs flirtation with those, who in the face of all reason and evidence, sought to dispute the etiology of AIDS.ö Cameron also blasted his government for not providing life-saving HIV anti-retrovirals, including AZT, to mothers and newborns in an attempt to lesson mother-to-child transmission of HIV that is decimating many families and overwhelming pediatric hospital wards and orphanages.

Despite political differences, Dr. Cal Cohen, a world renowned AIDS specialist out of the Community Research Initiative in Boston, said what he found refreshing this year was that people were able to sit and talk with their colleagues from around the world and ônot just be at the same conference,ö he said.

In regard to MbekiÆs remarks, Cohen said that, for most part, Mbeki ôskirted the issueö during the conference, and that the week ended with MbekiÆs much revered predecessor, Nelson Mandela, talking openly about HIV and criticizing Mbeki for buying into a theory largely regarded as preposterous.

ôHIV and AIDS is, right now, looking like the number-one killer which will alter the population in Africa like nothing else ever has,ö Cohen said. ôFifty percent of teenagers in South Africa are predicted to die from AIDS. ItÆs mind-numbing.ö

Members from the AIDS protest group ACT UP reportedly disrupted a media briefing held by the U.N. agency UNAIDS and the pharmaceutical industry to announce a limited access program for expensive drugs, yelling, ôYour program is appalling!ö and demanded access to cheaper drugs.

Drug companies such as Glaxo-Wellcome and Merck say they are in negotiations with various governments to reduce medication prices.

ôWhatÆs clear,ö Cohen said, ôis that when political leaders exert the will, the tools exist. In other words, there are physicians in Africa that are happy to prescribe the drugs,ö which Cohen says are there. What Cohen also sees occurring he said, ôis that the drug companies are more and more stepping up to the plate and willing to supply them.ö

Five multi-national drug companies have reportedly dropped their prices by up to 75 percent in the last few months, but activists feel the best way to provide affordable medications is with allowing other companies to develop generic drugs, and say theyÆll keep pressuring drug companies to allow licensing of their patents in developing countries.

In South Africa alone, 10 percent of the 41 million people are believed to be infected with HIV which is threatening both the life expectancy of African youth, and drastically dashing economic hopes for much of the Sub-Saharan continent.

U.S. developments

The Centers for Disease Control and PreventionÆs (CDC) key findings in the United States included data which demonstrated that the risk for developing HIV and AIDS varied dramatically by state. In addition, there was evidence presented of a resurgence of risk among many gay men and high levels of infection among young gay men.(See related story, page three.)

ôIn this third decade of the HIV epidemic, prevention approaches will have to become increasingly sophisticated,ö said Ronald O. Valdiserri, M.D., deputy director of CDCÆs National Center for HIV, STD, and TB Prevention (NCHSTP).

ôIn the United States, HIV is the epidemic, not AIDS,ö said Robert Janssen, M.D., director of NCHSTPÆs HIV Surveillance and Epidemiology Division. ôKnowing the number of AIDS cases in the United States reveals very little about the leading edge of the epidemic, while details on HIV infections give public health officials information they need to respond to the epidemic most effectively within their communities.ö

A separate CDC study showed that an increasing number of HIV-positive gay men are engaging in unprotected anal sex ù but often with other HIV-positive gay men.

In addition, the CDC found high levels of risk behavior among young men who have sex with men, many of whom have sex with women, and a low level of HIV testing, despite high risks. Scientists say young bisexual men are a ôbridgeö for HIV transmission to women, particularly given that 6.6 percent of bisexual men in one study were HIV-positive. The study included 3,492 gay and bisexual men between the ages of 15-22.

Many of the anxieties that once co-existed in men who had sex with men have waned over the years with the availability of successful treatments.

While many people on daily HIV drug regimens have experienced intolerable side effects from the medications, most at some point have stopped taking the drugs, Cohen said. What was found in the process is that a drug interruption did no harm to many of them. It minimizes toxicity and gives the body a break. ôIntially, it was discussed to see if we could tweak the immune system to help it learn to better control HIV infection,ö Cohen said. ôNow the focus has shifted only slightly. But the question is: Is there a way to use treatments as well as interruptions in a way to preserve the benefits? We donÆt know what recipe on and off will prevent side effects.ö

Many HIV infected people experience changes in their body shape as a result of the drugs. Often a combination of loss of fat in the face, arms and legs and an increase of fat in the stomach area and behind the neck, Cohen said, are likely a result from the medications, adding that it could also ôbe some role of HIV.ö He adds that the question now is: ôHow do we use these meds that keep people well and minimize side-effects? We donÆt have the answer but we know thatÆs what people want to look for. When you stop anti-virals sometimes, some people will have a rapid increase in their viral load accompanied by a sharp drop in CD4 counts ù not everybody, but the question is: Is there an approach to do this safely?ö Cohen said.

Since July 1998, the number of AIDS cases and deaths diagnosed in the United States each quarter (three-month period) has remained roughly stable, the CDC reported. During the first six months of 1999, there were 4,000 AIDS deaths and 10,000 AIDS cases diagnosed. HIV trends, the CDC says, can only be examined in the 25 states that have had HIV reporting for at least five years. The greatest declines of HIV appeared in cities such as New York, where aggressive campaigns have been implemented to provide substance abuse treatment, HIV prevention counseling and testing, access to sterile needles and risk reduction programs.
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