Newsday - July 7, 2002
Laurie Garrett, Staff Corresondent

Now the cry is shifting to a call for development of health care systems capable of using those drugs. After two years of trying to distribute anti-HIV drugs in poor countries, particularly in Africa, physicians have managed to treat only 40,000 people of the 6 million targeted. And they are turning their focus to the inadequate medical infrastructures in developing countries.

Today 15,000 scientists, patients, activists and physicians are gathering here for the 14th International AIDS Conference. At past meetings fights often pitted loud activists against reserved scientists over issues generally of interest only in wealthy nations. But that dynamic began to change in Durban, and this year the major issues seem to find harmony as delegates prepare to take on a community they consider insufficiently concerned about AIDS: politicians, financiers, businessmen.

In closed meetings yesterday, scientists, activists, United Nations officials and physicians talked of the need to raise more than $30 billion a year to prevent further HIV spread, treat patients, build up health care systems in poor countries and continue an international research effort in pursuit of a vaccine, therapeutic breakthrough or microbicide, a vaginal foam or gel that can block HIV transmission.

Leaders of two organizations, the International AIDS Society and the World Health Organization, propose to form a Global Access Alliance, "creating an independent body to carry out use of anti-retrovirals in poor countries," IAS president Dr. Joep Lange of the Netherlands said in the first meeting of those interested in starting such an effort. In the room were about 60 representatives of corporations that have significant numbers of HIV-positive employees, along with the World Bank, the Rand Corp. think tank and AIDS activists and physicians who are using the drugs in Africa, India and other poor areas of the world.

The leaders of this initiative, including the IAS' Dr. Peter Hale of France, are watching as the U.S. Congress prepares to vote on a bill sponsored by Sens. Bill Frist (R-Tenn.) and John Kerry (D-Mass.) that would commit $4.5 billion to fighting AIDS in 2003. And they're awaiting U.S. Secretary of Health and Human Services Tommy Thompson, who is due to address the gathering on Tuesday.

"We need an all-out concerted effort," Hale said in an interview. "It's not the money to buy the drugs, it's the money to scale up their use. You can train a doctor. You can train a nurse. But you need to pay her enough money so she will stay."

Hale believes the alliance should stand on its own, separate from such funding drives as UN Secretary-General Kofi Annan's call for donations of $10 billion a year to the Global Fund to Fight AIDS, Tuberculosis and Malaria. And it should stand separate from an AIDS prevention call issued this week by the Gates Foundation and the UN AIDS Programme calling for $4.8 billion annually. Indeed, Hale said, it will take more money to implement treatment in countries that lack clean water or sterile syringes than will be needed to execute all other anti-AIDS efforts combined.

But Lange, for one, fears that too many AIDS programs will mean competition over resources - even as wealthy nations have been slow to meet Annan's goal.

"They are holding back their money because they see the lack of health infrastructures in these countries, the lack of trained managers," Lange said, noting that the UN General Assembly voted a year ago to set a target of having 3 million people on anti-retrovirals by 2005.

"Six million are sick now - we should treat them all," Dr. Bernhard Schwartlander, an epidemiologist with the WHO, said in an interview. "We're in treatment chaos right now. It needs to be made rational. I cannot possibly accept a situation, as we have now, that people in poor nations have to rely on recycled drugs from the rich nations."

Dr. Tomris Turmen, executive director of family health programs for the WHO, characterizes current treatment efforts as "molecules moving independently, with good intentions. But these molecules need to come together and move as one single protein, on a single path."

At this week's meeting hundreds of scientists will be presenting papers describing small-scale use of the drugs in places as far-flung as Hanoi, Hong Kong, Pretoria and Buenos Aires. The demand for treatment is growing, and is seen by many here as having the potential to become a global political issue.

"We literally have a question: Can democracy survive in the world if we \ fail to support these efforts?" Harvard University policy analyst Amir Attaran said in an interview. "This pandemic is so massive - the likes of it have literally not been seen since the inception of Western democracy.

UNAIDS director Dr. Peter Piot put his view bluntly in a discussion with a cluster of reporters yesterday: "One of my dreams is there will be a day when politicians will win or lose elections based on their performance on AIDS. I don't think that's far off."
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