Important note: Information in this article was accurate in 1998. The state of the art may have changed since the publication date.

Reuters NewMedia, Inc.; Sunday June 28 2:13 AM EDT
Jonathan Birt

Talk of dramatic breakthroughs in treatment of HIV and AIDS in Canada has given way to realization that prospects of eradicating the disease remain an elusive dream.

"This will be the conference of new realism -- of progress in prevention since Vancouver, but also of the explosion of the epidemic in new areas of the world," said Dr Peter Piot, executive director of the United Nations AIDS program UNAIDS.

"We have a more realistic appreciation of where we are in terms of treatment compared to where some people thought we were two years ago, when hubris had taken over from facts."

As more than 12,000 doctors, research scientists, activists, people with HIV, drug company representatives and journalists from all over the world gather, the meeting will be overshadowed by statistics that defy belief.

The epidemic has already claimed nearly 12 million lives since the early 1980s and is predicted to afflict some 40 million people by 2000. In at least two African states, one in four adults is thought to be affected by the virus. The theme of this year's conference, "Bridging the Gap," is a recognition of the stark fact that more than 90 percent of people afflicted by AIDS and HIV have no hope of access to more than the most modest care, let alone drugs which cost thousands of dollars a year.

The scientific aspects of the conference will be dominated by the push to make the treatments already available simpler to take and more effective. Some drug companies believe until treatment is down to one tablet a day from the current pile of up to two dozen, supplying drugs to developing countries will be a pipe dream.

Much of the conference will be given over to prevention, still the best and most economic defense in the eyes of many.

Sharp falls in infection rates in countries such as Uganda and Thailand through prevention initiatives have given some hope. But American health workers are worried by an outbreak of complacency among people at risk from HIV because of the promise of new life-saving treatments.

Data this week will continue to show a vast improvement in the outlook for a small minority of those with AIDS. In parts of the U.S. where individuals have access to recognized treatment, hospitalization and mortality rates fell by 75 percent between 1994 and 1997.

But few of those gathering on the shores of Lake Geneva expect a rapid breakthrough in the quest for a vaccine that could one day spell the end of the epidemic.

George Lundberg, editor of the distinguished Journal of the American Medical Association, said it could be "many decades, many generations" before a cure for AIDS was found.

Recalling the discovery of a vaccine against a much simpler virus, polio, in the 1950s, he noted that polio is still not eradicated around the world. " We should be hopeful but not blindly so," he said. "There will still be endemic human AIDS at the end of the 21st century I continue to fear."

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