Newsday.com - July 5, 2002
Laurie Garrett, Staff Writer

But that grim tally - more than doubling the cumulative total of 40 million people infected with HIV since 1980 - can be averted, argue the Joint United Nations AIDS Program on HIV/AIDS and the Bill & Melinda Gates Foundation. Carefully executed prevention programs using existent, proven methods could save 29 million lives in that time at a cost of about $4.8 billion a year, they say. The Gates' Blueprint for Action is being released today in Barcelona, where about 10,000 delegates will arrive this week for the XIV International AIDS Conference July 7-12.

"These deaths are not inevitable," Dr. Bernhard Schwartlander of the World Health Organization said. "We can actually do something which can substantially decrease this epidemic."

In their exhaustive analysis, Schwartlander and his UNAIDS co-author, Dr. John Stover, assessed several points. First, they found that information about HIV is not widely disseminated: Fewer than one in five people worldwide are aware of the existence of the virus or their personal risk for becoming infected.

Next, in examining the nature of the epidemic in 85 nations, they found enormous differences. Some countries, such as the United States, have slowly spreading AIDS outbreaks more than two decades old, while in others, such as Russia, the infection is relatively small but spreading rapidly.

Schwartlander and Stover also looked at who is at greatest risk in each country, how HIV is being spread and which prevention techniques are most effective.

"We found that some 60 to 65 percent of infections could be averted with a rapid global response," Stover said. In countries where HIV is only now exploding, "We could avert 70 percent of new infection," he said.

Inaction or delay would be costly, though. "A three-year delay in response would mean we would have saved half as many lives" by 2010, or only 14 million people, Stover said. "The cost is high.... But the cost of not doing it would be even higher."

The Gates Foundation and the Henry J. Kaiser Family Foundation gathered 40 AIDS experts to evaluate the study and determine what an all-out global HIV-prevention campaign would take.

"We found that countries need combination approaches," Dr. Helene Gayle of the Gates Foundation said in an interview. "We talk in treatment about combination therapy. Now we're talking about combination prevention."

According to the foundations' report, few nations have prevention packages that have support from the highest level of government and business and involve all sectors of society.

"We have watched in Africa as the epidemic has spread north to south, west to east," said Uganda's top AIDS researcher, Dr. David Serwadda, who chaired the Gates group. "A key factor in slowing that spread is sustained political leadership."

But all possible prevention efforts - including confidential testing and treatment - must be mobilized globally, Serwadda said, "to prevent a new generation from acquiring HIV."
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