InterPress News Service (IPS) - July 3, 1998
Dipankar De Sarkar

The conference theme, 'Bridging the Gap', recognised the fact that there are between 30 and 40 million people living with HIV/AIDS worldwide -- 90 to 95 percent of them in the developing world.

For the majority of them, access to powerful drugs that cost upward of 10,000 dollars a year per patient is impossible, though these drugs are routinely prescribed and administered in industrialised countries.

One of the major disappointments for delegates from the developing world was the conference's inability to close that gap, by persuading the massed ranks of pharmaceutical multinationals in evidence at the conference to cut their prices, if only for poor countries.

At the last World AIDS Conference in Vancouver, two years ago, drugs manufacturers lifted spirits by announcing their discover that a cocktail of drugs could make HIV/AIDS manageable, if not curable.

Yet the cost of treatment has risen as each new development has been announced since then, widening, not narrowing the so-called 'treatment gap'.

"What do I tell my patients when I go back?" asked Indian community health worker Radium Bhattacharya.

"After all the press reports about the new discoveries announced here, they will ask me 'what have you got for us? Have you got any medicines? What do I tell them? At the grassroots level, our work is very very difficult. Patients go into depression; children have to be admitted to orphanages...

Bhattacharya works with 75 HIV-positive people in the western Indian city of Ahmedabad. Every one of her patients was a professional blood donor and was infected intravenously. "My feeling is that if you can't focus on access," she said, "it's probably better not to have these conferences."

Her sentiments were echoed by a large number of delegates from the developing world.

"There's been joy and conflict and rage," Winstone Zulu, of Kara Counselling in Zambia told the conference closing ceremony. "But if we summarise it in bullet points, we lose the lives of people." Zulu said access to treatment and information must be fought for by people poor countries "and the North must show their solidarity."

"The right to health is a basic human right," said Analuisa Liguori, of the MacArthur Foundation in Mexico. "We must act now to reduce inequalities, instead of waiting for the perfect solution.

"Bridging the gap between what we know and what we must do requires activism of nuanced proportions. There are international human rights instruments, which allow us to hold nation states responsible for their action or inaction."

The gap between rich and poor countries is well marked out. AIDS is actually declining in the industrialised world. New anti- retroviral (ARV) drugs mean that transmission of the AIDS virus from infected pregnant women can be controlled while combination or multi-therapy drig treatment has dramatically reduced mortality rates in developed countries.

In contrast, the ranks of HIV/AIDS patients are increasing in the developing world. Over 21 million men, women and children, two- thirds of the global HIV population, live in Africa, south of the Sahara desert. And experts routinely describe countries in South and South East Asia as "sitting on an AIDS volcano."

There are gender, racial and information gaps to be bridged as well. The AIDS virus is mostly transmitted from men to women and there are 12.2 million such women worldwide. Yet, women face fierce discrimination when it comes to the issue of how they are treated, whether by their husbands or by the medical establishment.

Married women with HIV/AIDS all over India are routinely turned out of their homes even though they are almost always infected by their husbands.

The attitude of the medical establishment is best reflected in the continuing resistance by drug companies to seriously research and develop vaginal microbicides, which when applied externally may help prevent the transmission of HIV to women. This is in spite of the fact that a global study conducted by the European Union found a huge consumer demand for such products.

While drug companies have been energetically researching and developing treatments, there has been very little work so far on developing either a vaccine or a microbicide because they are considered less profitable.

Many observers here felt that the scientists lived in worlds of their own. "It would be so nice if the scientists could have been with us (community health workers) to hear our opinions and the opinions of people living with HIV/AIDS," said Winstone Zulu. And Bhattacharya added: "I would like to say 'thank you, Mr Scientist. We have respect for what you are doing. But we don't like you."

Richard Horton, editor of the The Lancet, a respected British medical journal, told the closing ceremony that he noticed "again and again" scientists from Europe and North America walking out of presentations by delegates from developing countries.

The next World AIDS Conference will be held in Durban, South Africa. Clarence Mini, from the Duban organising committee promised to make sure voices are heard. "The Durban conference will try to keep developing country concerns at the heart of the the proceedings," he told the audience.

Work also needs to be done to narrow the gap between private companies and government agencies. As HIV/AIDS has spread across the globe, private companies have lagged behind governments in responding to the crisis.

"The pharmaceuticals must stop the rhetoric and move to action," said the chairman of the closing ceremony, Warren Lindner. "At future conferences, they cannot just be exhibitors. They must be active players. They can no longer say there's nothing they can do."

There were 125 pharmaceutical companies involved in the conference, pooling two million dollars towards the conference costs. Horton said it seemed to him that "we don't like to bite the hand that feeds us. This betrayal gets bigger with every passing conference."

Going by facts and figures supplied by the Joint United Nations Programme on HIV/AIDS (UNAIDS), in the six days since the Geneva opened, another estimated 100,000 people worldwide have contracted the HIV virus, most of them in developing countries.

Close to 90 percent of them will not even be aware of the fact, because even testing kits are not available in these countries in sufficient numbers. It is a reality that delegates from developing countries said they knew only too well. As Winstone Zulu advised them: "take with you the images, the rage, the hopes, the despair, the sense of solidarity. They are some of the bricks that may form the bridge." (END/IPS/DDS/98)

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