Mail & Guardian (Johannesburg) - July 10 2000

The estimated bill is just to provide prevention methods and basic healthcare and does not include the cost of anti-AIDS drugs, said Dr Peter Piot, the executive director of UNAIDS, the UN agency charged with battling the disease.

On the eve of the 13th International AIDS Conference Piot told a press conference that a disease of this magnitude, which is killing young men and women on a scale only seen before in wars, cannot be fought without sufficient resources.

"We need for Africa alone a minimum of $3 billion a year for basic prevention and care. This is before we are even talking about antiretroviral therapy," he said.

Piot said African governments would have to provide more money for education and health and rich countries would have to contribute because it was also in their interest.

He added that UNAIDS was continuing efforts for debt relief for African nations which pay $15 billion a year, most of it in interest.

"Without the full package there is no way we can make a difference," he said, adding that the longer the world waits the more expensive it will be.

Up to 11,000 delegates from 178 countries are attending the conference, which is being held for the first time in the developing world.

South Africa, which is hosting the meeting, has the largest number of people living with HIV/AIDS with 4.2 million infected.

Piot said that in most countries in sub-Saharan Africa the epidemic was out of control. In Botswana 36 percent of adults are now infected with the HIV virus.

"HIV is not gender neutral. Twenty percent more women than men are infected with HIV in sub-Saharan Africa," said Piot. "Never before have countries experienced death rates of this magnitude among both sexes. Today we are seeing that because of AIDS," he added.

Emphasizing the devastation the disease is causing across the continent, he said the cumulative risk of 15-year-olds in some African countries of dying from AIDS is 50 percent.

Unlike other countries where the disease has spread among homosexuals and intravenous drug users, most of the infections in Africa are through heterosexual sex.

Although it is a disease of poverty, it is affecting skilled and educated people and leaving millions of children orphans. The HIV virus is also fuelling another epidemic -- tuberculosis.

"TB is the leading cause of death of people with AIDS in this part of the world," said Piot.

In addition to killing people with the HIV virus, tuberculosis is also spreading to healthy people without the virus.

Africa is short on money and also does not have enough tools to fight the epidemic. There are not enough condoms for prevention programs or enough tests to diagnose the virus or drugs to prevent mother-to-child transmission or to control the virus in infected people.

Piot applauded the news that Boehringer Ingelheim would provide its anti-AIDS drug nevirapine free in developing countries for five years but stressed that the infrastructure and health system must be in place for it to be used properly.

"The whole debate has been too focused on the price alone. The price of the drugs is a very important aspect but even at lower prices we still have the issue of who is going to pay," he added.

But Piot added that some African nations, particularly Senegal, Uganda and Zambia have made great strides in controlling the epidemic and since the last AIDS conference in Geneva two years ago there has been unprecedented political commitment to fight the epidemic.

"The challenge is to work with individual countries to improve the standard of care," he added.

Meanwhile in Washington, The World Bank announced at the weekend it was preparing a new $500 million program for fighting AIDS in Africa.

The money will be available to any African country that sets up a national AIDS program. Nearly every country would be eligible for the 40-year loans.

Callisto Madavo, World Bank vice president for Africa said: "Nearly every country in Africa will be able to access these funds. All that is needed is a sound national AIDS strategy developed in a participatory way, backed by serious government commitment."

A large share of resources will flow directly to communities to support local programs, the bank said. The new program was intended as part of the bank's long-term commitment to fighting AIDS in Africa and resources would be replenished as quickly as countries use the funds.

"Money alone is not the answer," Madavo said, because AIDS "is, above all, an issue of commitment."

"The sobering reality is that AIDS is not a health problem, but a serious development issue. Only where governments show leadership can international support be effective. We are beginning to see an upsurge of such leadership."
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