Miami Herald - July 10, 2002
Fred Tasker, ftasker@herald.com

"HIV infection rates will drop when we implement programs based on sound scientific research and when prevention has the full backing of national leaders and is funded with adequate resources," Dr. Helene Gayle, director of the HIV-AIDS program for the Bill & Melinda Gates Foundation, told delegates Tuesday at the 14th International AIDS Conference here.

On Monday, the World Health Organization announced that at present rates of infection, the number of people living with AIDS or HIV, the human immunodeficiency virus that causes AIDS, could near 85 million worldwide by 2010. Currently, an estimated 40 million people worldwide live with AIDS or HIV.

FUNDING NEEDS

Programs as simple as distributing free condoms could dramatically slash HIV infections and their soaring attendant costs, Gayle said. One study indicated that condom distribution cost only $11 to $17 for each HIV infection prevented.

"But in poor countries, only one of five people at risk of infection are reached by such methods," she said. "We will pay now or pay later, but the longer we wait the [more] monetary and human costs will escalate."

Gayle said a new Global HIV Prevention Working Group of 37 leading world experts, funded by the Gates Foundation and Henry J. Kaiser Family Foundation, estimates that total spending on prevention by all public and private sources needs to be $4.8 billion a year by 2005 -- compared with today's $1.2 billion.

The funding discussions started with a hitch Tuesday morning, however, when protesters drowned out U.S. Health and Human Services Secretary Tommy Thompson, who attempted to speak about American contributions to global AIDS programs.

"I understand that people are passionate about this and want to blame the United States," Thompson said. "But the United States under President Bush has doubled the amount of resources it provides for the fight against AIDS."

Last month, President George W. Bush announced a five-year, $500 million initiative to stem transmission of HIV from mother to child in Africa and the Caribbean.

AIDS activists complain that Bush is ignoring people already living with the disease. They want the United States to contribute more to the United Nations-backed Global Fund to Fight AIDS, Tuberculosis and Malaria. The United States has pledged another $500 million to that fund.

Thompson said that 45 percent of worldwide money going to HIV programs comes from the United States, and that the U.S. contribution to the Global Fund represents 25 percent of the total money given so far.

ACADEMIC CRITIC

Jeffrey Sachs, a Columbia University economist who chaired a WHO committee studying what's needed for a major attack on AIDS, said the United States has not contributed its fair share and that it should be donating $2.5 billion a year to the fund.

The United States ranks 18th in the world in the percentage of gross domestic product pledged to the U.N. Global Fund.

"Secretary Thompson was probably surprised at his reception today," Sachs said. "He should not be surprised. It is a reflection of the utter confusion within the United States government of what they are actually doing."

Advocates call funding of preventive measures essential in saving lives and money.

Gayle told the delegates about ongoing studies by public and private U.S. groups testing new methods of prevention, including:

ò Treating non-HIV sexually transmitted diseases more aggressively. In Tanzania this resulted in a 40 percent reduction in HIV infection, although the medical reasons are unclear, she said.

ò Promoting circumcision of men. Studies show this reduces the risk of HIV infection by half, even though, again, it is not clear whether the reason is biological or because it induces safer sexual behavior.

ò Promoting use of diaphragms by women. Studies show that the cervix is more biologically susceptible to HIV than vaginal tissue, so protecting it might inhibit infection.

ò Experimenting with post-exposure prophylaxis (PEP). Studies in San Francisco and Brazil suggest that taking certain anti-retroviral drugs after unplanned sexual exposure to HIV -- through sexual assault, condom breakage or other causes -- might inhibit infection.

ò Investigating pre-exposure prophylaxis. Studies are under way to see if taking anti-retroviral drugs before HIV exposure might help prevent infection.

"However," Gayle cautioned, "none of these new technologies will likely be 100 percent effective in preventing transmission.

Therefore we must maintain a balance between biomedical options and behavioral prevention."

This report was supplemented with material from The Associated Press

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