PANOS London: Panos AIDS Briefing No. 3 June 1995

And the few treatments available for people with AIDS are expensive and beyond the budgets of developing countries - which account for nine-tenths of the worlds' cases of HIV.

This briefing looks at the main scientific issues the epidemic has raised so far and the challenges ahead. It reviews the basic information about HIV and AIDS and the available treatments for the disease, setting out what is known and what is still uncertain. And it analyses some of the controversies surrounding HIV.

Since 1981, when AIDS was first identified, research has moved fast but not fast enough to satisfy anyone. A scattering of antiviral drugs exist that slow down HIV's replication, but none can prevent the eventual onset of AIDS or death. Vaccines are now on trial, but even the most optimistic scientists suspect that these will at best offer only partial protection against infection. It is also unlikely a successful vaccine will be available in the next 10 years. Meanwhile, people continue to become infected at the rate of several thousand each day.

Some scientists now believe that it is now time to re-emphasise basic research, to try and answer some of the enigmas posed by HIV. For instance, how does HIV attack the immune system, the body's first line of defence against infection? Why do some people with HIV stay healthy for many years, while others develop AIDS quickly and die? Until we hold the answers to these questions, it may prove impossible to find an effective cure for the disease, or a successful vaccine.

For the short to medium term, the outlook is difficult. Few scientists believe it is realistic to expect to find an outright cure for AIDS. But many hope it will become possible to devise therapies that will dramatically slow down the disease process and buy many years of healthy life. Even that more modest goal, however, is still a long way off. Moreover, even if new therapies and vaccines are designed, will they be affordable and available for developing countries?

Beyond the biomedical problems, there are complex behavioural and social difficulties. Even though there are technically simple means such as condoms to stop the virus from spreading, those means are not available or acceptable to many. Poverty and cultural constraints continue to deprive people of control over their own lives and the power to protect themselves. It is not enough, for example, to advise people to use condoms when many women have no say in their partners' behaviour and when childbearing defines a woman's identity and status.

WATCH OUT FOR

Accurate terminology Do not confuse HIV and AIDS. HIV, the human immunodeficiency virus, is the virus which leads to AIDS, the acquired immune deficiency syndrome. The vast majority of people who are infected with HIV (also known as HIV positive) do not have AIDS and may show no symptoms of disease, although most of them will develop AIDS over a period of time. Terms such as "AIDS-infected" should be avoided - it is unclear whether this means someone infected with HIV or ill with AIDS.

Treat with scepticism any claims to have found a cure or vaccine for AIDS In many countries, physicians, traditional healers or alternative therapists have claimed to have found a cure or vaccine for AIDS. None of these claims has ever been proved, although some treatments have proved effective in relieving some of the symptoms associated with AIDS, such as diarrhoea or thrush.

If you hear of a healer or doctor in your area claiming to have found a cure for AIDS, try not to report it uncritically. Reporting such claims can give false hopes to infected or ill people, and encourage unscrupulous practitioners who stand to make money from these claims. Ask local AIDS support organisations, national or regional AIDS control authorities and respected medical or scientific sources for advice, comment and criticism to include in your articles if you report the claims.

Even minor scientific advances can be magnified by inaccurate, or ill-informed reporting. For example, claims that a new compound "destroys HIV in the test tube" is not sufficient to proclaim it as a potential cure - bleach destroys HIV in a test tube, but it is not usable as a treatment for people with HIV or AIDS.

If vaccine trials are being carried out in your country: What benefits will your country gain from participation? Are participants voluntary? Are they fully informed and do they fully understand the nature of the research? Are participants also given information on how to avoid HIV infection, for instance by using condoms? Is the strain (or subtype) of HIV the vaccine is designed for the most common in your country? If a successful vaccine is developed, has anything been done to ensure that your country can afford it? Contact your National AIDS Control Programme for information. A Panos briefing on HIV vaccine trials is available from Panos London (see below for details)

TB and STDs - HIV's dangerous associates Is investment directed at tuberculosis (TB) prevention programmes in your country? What about the prevention of sexually transmitted diseases (STDs), which increase the risk of contracting HIV?

If AIDS is not considered to be a problem in your country, is any information available on the prevalence of other STDs within the country? HIV is primarily sexually transmitted - if other STDs are present, the conditions which favour the spread of HIV are already there.

CONTENTS

1. THE CHANGING PICTURE

1995: Time to go back to basics Funding under threat Brief history of an epidemic

2. HIV: A COMPLEX VIRUS

What is HIV? How does the virus spread? The 'latent' phase is anything but Resisting illness and infection

3. HIV'S GLOBAL SPREAD

Who is affected STDs: a major factor of risk

4. DESPERATELY SEEKING ANSWERS: HIV'S MYTHS AND MYSTERIES

Where did HIV come from (and where is it going)? Polio vaccine exonerated Is AIDS a myth? Are HIV tests reliable?

5. VACCINES: WHERE ARE WE NOW?

HIV - a challenge to vaccine designers Who will foot the bill? How researchers are tackling the issue Vaccine trials: not for the faint-hearted

6. DRUG TREATMENTS: WHAT'S IN THE CUPBOARD?

Orthodox therapies Alternative therapies The cost of AIDS treatments

SOME KEY FACTS

HIV spreads from person to person through unprotected sexual intercourse, vaginal or anal, through sharing of contaminated needles or other transfusion equipment, in infected blood, and from mother to child before and during birth and through breastfeeding.

An estimated 19.5 million people have been infected with HIV since the beginning of the pandemic.

Nine-tenths of the world's cases of HIV and AIDS are in developing countries.

It is unlikely that a successful vaccine against HIV will be available in the next 10 years.

There is no cure for HIV or AIDS. The few clinically-tested treatments which are available to help treat people with AIDS are beyond the health budgets of developing countries.

The direct medical cost of treating AIDS is estimated at US$ 32,000 per capita in the United States. In Zambia, it is about US$ 374.

In the North, political commitment to tackling AIDS may be faltering. The next few years will be critical in determining whether AIDS remains high on the world's agenda or whether it is forgotten.

HIV infection dramatically increases the chances of developing tuberculosis disease, from 10% in a lifetime to 8% per year.

Sexually transmitted diseases (STDs) enhance the efficiency with which HIV spreads from person to person, partly by increasing inflammation and bleeding in the genital area.

According to a 1990 WHO estimate, there are at least 250 million new cases of STDs worldwide each year. In the developing world, STDs are among the leading causes of disease burden.

Organisations

The World Health Organization (WHO), Global Programme on AIDS, 20 Ave. Appia, CH-1211, Geneva 27, Switzerland. Tel: 41 22 791 2111

The Global AIDS Policy Coalition, 5th floor, 8 Story St, Cambridge, MA 02138, USA. Tel: 1 617 496 4370

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