Newsday - February 4, 2001
Laurie Garrett

Top North American and European AIDS scientists will convene in Chicago tonight for the annual AIDS Conference on Retroviruses and Opportunistic Infections-where the political issues that rocked last summer's World Conference on AIDS in South Africa are expected to take a back seat to talk of progress in treating HIV patients living almost exclusively in wealthier sections of the world.

Six months ago at the conference in Durban, South Africa, science nearly disappeared from the agenda, overshadowed by the debate over which of the planet's HIV patients deserved access to the expensive drug cocktails used to treat infections in the United States, as well as what sorts of political and economic schemes might best improve HIV treatment in hardest-hit Africa.

The five-day Chicago meeting will have hints of that debate, and activists say they will push for greater attention to getting cheaper HIV drugs to people in developing countries. But the bulk of the discussion will focus on issues highest on the American HIV agenda: Improvement in the use of available drugs, concerns about rising levels of drug resistance, new anti-HIV drugs and the search for an AIDS vaccine.

"I know that people are always looking for a big buzz and a dramatic new highlight or finding to focus on," Dr. David Ho, director of the Aaron Diamond AIDS Research Center in Manhattan, said in a press briefing last week. "But ... there isn't one thing that's happening. If you kind of look for what's the biggest splash, I think there are trends in transmission and risk behaviors."

Ho also said he expected HIV transmission related to drug resistance, the development of treatments targeting drug resistant viruses and development of new drugs to get attention.

At this conference, politics and issues of the social impact of HIV customarily form a polite backdrop to discussions of data on clinical trials and laboratory research. Some participants question whether HIV science can ever return to the less confrontational state that existed before the dramatic scenes in Durban.

Among the keynote speakers will be Harvard economist Jeffrey Sachs, who brought Durban attendees to their feet when he called for billions of dollars to combat HIV in Africa.

The United Nations AIDS Programme went into the Durban meeting hoping to rally the scientists for a global call for $1 billion to combat the spread of HIV in Asia, Africa and the former USSR. That sum would be more than four-fold the agency's entire 2000 budget. The ante was upped, and by the time Sachs spoke, he told the crowd that three billion dollars, annually, wasn't enough to stop HIV. He told the enthusiastic crowd to shoot for $10 billion a year, or, "a movie ticket and a box of popcorn" from each American and Western European.

According to his staff late last week, Sachs was still planning his remarks for Chicago.

Scientists from the U.S. Centers for Disease Control and Prevention, New York City Department of Health and other local health agencies will present evidence that 5 to 10 percent of new infections involve viruses that are already resistant to one or more of the drugs in use. Such primary resistance generally complicates treatment, researchers will say.

And the CDC's Dr. Kevin DeCock, who is based in Kisumu, Kenya, will report that AIDS has now killed more than 22 million people worldwide, and 37 million more are living with HIV disease. In his address to the Durban gathering DeCock said, "The World Bank sees AIDS as a development issue, but should our response be a development or emergency response? A frequently used word is sustainability. To talk of a sustainable response to the biggest public health crisis ever in this [African] fragile continent seems unrealistic at best."

Recent donations to the HIV battle include a promised $100 million from Microsoft chief executive Bill Gates last week to the private International AIDS Vaccine Initiative; the Internet company Yahoo! offered another $5 million. Since last January numerous countries, including the United States, have promised to increase their donations both to UNAIDS and to other anti-HIV efforts.

But sources high in the U.S. government tell Newsday that the Clinton Administration's promised sum was held up in State Department accounts for more than 12 months, reaching Geneva only after the end of the U.S. fiscal year. Several European countries are more than two years in arrears on their promised donations, and UNAIDS operates on a shoestring of actual cash reserves.

The Bush Administration has not yet indicated what its policy will be in the global battle against HIV. Last week, the administration indicated it will revoke a 2000 executive order allowing AIDS- plagued African governments to import cheap, generic versions of anti- HIV drugs.

AIDS patient advocates said last week that they were also concerned about two other Administration moves. Just two days after his inauguration, President George W. Bush reinstated a rule forbidding U.S. government officials involved in any aspect of implementation of the $425 million foreign aid budget from discussing abortion or the use of abortion-inducing drugs overseas. And Sen. Jesse Helms (R-N.C.) has put forward a proposal to eliminate the U.S. Agency for International Development, funneling foreign aid dollars instead through religious and humanitarian private foundations.

Planned Parenthood of New York has decried such a move, noting that such religious groups were historically reluctant to support condom distributions to combat sexual spread of HIV.

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