Miami Herald - July 11, 2004
Fred Tasker, ftasker@herald.com

AIDS, which was born in Africa and arrived in the United States as a gay men's scourge, is exploding across the globe with equal-opportunity fervor.

It's infecting a new generation of women, teenagers, minorities and gay men who are too young to know people who have died from the debilitating syndrome.

It struck more people around the world last year than in any previous year. In the United States, after eight years of decline, the number of people newly diagnosed with AIDS rose in 2002.

"We're losing the battle," said Dr. Seth Berkley, chief executive officer of the International AIDS Vaccine Initiative. "We haven't ended the epidemic anywhere."

How bad it is, and what can be done, are questions that 15,000 doctors, researchers, politicians, journalists and activists from 160 countries will debate at the 15th International AIDS Conference in Bangkok, Thailand, today through Friday.

They will hear that:

* Sub-Saharan Africa is dying. South African diamond mining companies hire two men for every job, assuming that one will soon die. South Africa, with 5.3 million people living with HIV -- the human immunodeficiency virus, which causes AIDS -- has the most infected people in one country.

* HIV is opening new fronts. It's exploding across Asia: In Vietnam, HIV infections are predicted to rise almost eightfold, from 130,000 to one million, in the next five years. In Eastern Europe, HIV infections are up by 46 percent in the past two years.

* In the Caribbean, three countries have at least 3 percent of the population infected with HIV -- the Bahamas, Trinidad and Tobago, and Haiti. In Haiti, the Caribbean's worst-infected country, the HIV rate is 5.6 percent -- a situation made worse by grinding poverty and chronic political violence.

* In the United States, AIDS, once in retreat, is fighting back. After a plunge of nearly 50 percent between 1993 and 2001, the number of people newly diagnosed with AIDS grew by 2 percent in 2002, according to the U.S. government's Centers for Disease Control and Prevention.

AIDS deaths in the United States, which peaked at more than 52,000 in 1995, dropped by 26 percent from 1995 to 1996 and by 42 percent from 1996 to 1997 with the advent of powerful anti-retroviral drugs. But the rate of decline has slowed dramatically since then; it was only 6 percent from 2001 to 2002.

"We're seeing a second flux here," said Kelly Patterson, of the Center for Positive Connections, an AIDS social services center in North Miami. South Florida has one of the highest AIDS rates in the country.

The Bush administration has greatly increased U.S. contributions, pledging $15 billion over five years to the global effort, far more than any other country. But critics say that it isn't enough, that the U.S. contribution is 22nd in the world as a percentage of gross national income, behind Norway, Luxembourg, Ireland, Portugal, Greece and others.

Others complain that the United States is giving only $1 billion to the multinational Global AIDS Fund, spending most on smaller programs in individual countries in what they call a go-it-alone posture reminiscent of the conflict in Iraq. "It's so important to move in parallel, to build sustainable health systems for poor countries," said Greg Behrman, who authored a report on U.S. aid for the Council on Foreign Relations.

In Bangkok, delegates will debate the causes and characteristics of the AIDS spread:

* More women infected: Worldwide, women make up 50 percent of those living with HIV, according to the Joint United Nations Program on HIV/AIDS. In India, 91 percent of women infected by HIV are faithful wives of cheating husbands, the report says. In the United States, women, who made up only 7 percent of new AIDS cases in 1985, make up 25 percent today, according to the Centers for Disease Control and Prevention.

* Racial disparity: African Americans make up 12 percent of the U.S. population but 50 percent of new AIDS cases, the CDC says. Hispanics are 14 percent of the population and 20 percent of new AIDS cases.

* A younger generation: Worldwide, people between ages 15 and 24 account for half of all new cases of HIV, according to the Joint United Nations Program on HIV/AIDS. In the United States, half of the 40,000 new HIV infections a year involve people under 25, the CDC says.

* Risky behavior among gay and bisexual men: In a study for the Bangkok conference, University of Miami researchers surveyed men who have sex with men in South Beach and the clubs of downtown Miami. One man said he had sex with 203 partners in the past year. Clubgoing gay male respondents in the survey claimed an average of 6.4 partners in that year.

* Lack of prevention money: "HIV is the biggest health crisis since the [bubonic plague of the] 14th century, yet AIDS vaccines account for less than 1 percent of global spending on health research," says the International AIDS Vaccine Initiative. Most money goes to drugs that fight AIDS after patients are HIV-positive.

Organizers hope the conference can set an agenda for fighting back. Expect fireworks.

Arriving delegates will be met today with a street march led by the Thai Network of People Living with HIV/AIDS, protesting U.S. trade policies that discourage cheaper generic drugs in their countries. Outside the convention hall, thousands of activists will gather in a first-ever "Global Village" for nondelegates, with speeches, AIDS poetry and art. They will even see a how-to session called "The Pleasure Project," arguing that "we can only have safer sex if we know how to have good sex."

Inside, AIDS activists from the clinics and labs of Miami, Hong Kong and Moscow will share ideas on how to dampen risky behavior -- such as by intervening in gay singles' websites to try to persuade those who seek sex partners there to be honest about their HIV status.

Longtime AIDS activists such as actor Richard Gere and singer Dionne Warwick will take part. On a recent visit to India, Gere startled prostitutes by striding into the brothels of Mumbai to grill them on whether they made their customers use condoms.

U.S. and international drug companies will attend, touting advances in anti-AIDS drugs, if any. They will contend with an uproar over Abbott Laboratories' recent quadrupling of the price of its widely used anti-HIV drug Norvir. The company cited development expenses and the importance of the drug.

Vaccine makers will be there, glumly regrouping from the failure of human trials of the AidsVax vaccine that got so much fanfare at the 2002 International AIDS Conference in Barcelona.

At some point this week, U.N. Secretary General Kofi Annan will address the conference, urging greater efforts in fighting AIDS.

In a recent BBC interview, he confessed: "I feel angry, I feel distressed, I feel helpless to live in a world where we have the means, we have the resources to be able to help all these patients, but what is lacking is a political will."

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