South African Press Association - July 15, 2004

With research over the past two years showing that an Aids vaccine is still a long way off, HIV-killing gels and creams, female condoms and diaphragms that could bolster prevention in the interim have become a priority.

"Developing an HIV vaccine is probably one of the most difficult challenges that biomedical science is confronting," vaccine researcher Jose Esparza told a plenary session at the International Aids Conference running until Friday.

It's the biggest gathering to date of Aids scientists, activists, policy-makers and HIV-infected people, also drawing international dignitaries like Mandela, the former South African president.

"The world has made defeating Aids a top priority. This is a blessing, but TB remains ignored," said Mandela, who turns 86 on Sunday.

TB is one of the most common diseases that attacks Aids patients after their immune systems have been destroyed, with the lung disease causing between 15% and 40% of the three million Aids deaths worldwide last year.

Mandela, who survived TB in prison during South Africa's apartheid era, noted that the world has known the cure for TB for more than 50 years but that too many people are not being diagnosed and treated.

Curing TB can cost as little as $10 per patient, said Dr Jack Chow of World Health Organisation.

"We can't fight Aids unless we do much more to fight TB as well," Mandela said to loud applause by scores of activists, admirers and staff at a packed news conference.

The conference also has focused on women, who are now nearly half of the world's 38-million people living with HIV, and their infection rates in many regions are climbing much faster than men's.

With many cultures denying women the power and confidence to demand that partners wear condoms, scientists are addressing ways women can protect themselves.

Vaginal gels could be such a way, and Dr Zeda Rosenberg, chief executive of International Partnership for Microbicides, urged that more resources be poured into the effort.

"Unlike vaccines, there has been virtually no private-sector investment in microbicide development," Rosenberg said. "The science is there. The technology is there, and most of all, the passion and dedication of those in the field is palpable."

These gels and creams would attack a broad spectrum of bacteria, viruses and even human cells. Among complicating factors for developers are that microbicides also can kill cells in the vagina that help block HIV, Rosenberg said.

The products could be used without a partner's knowledge, proponents say.

"Microbicides can be designed for use well in advance of sex," Rosenberg said.

Rosenberg says microbicides may initially be only about 30% effective, but that second-generation products already in early development will more specifically target HIV and be more powerful.

Much of the excitement over microbicides is premature, although they could play an important role, said Dr Frederick Altice, an infectious diseases expert at Yale University.

"It will certainly be more than 10, probably 15 to 20 years, if ever, before we have an effective microbicide," he predicted.

"People are certainly looking for any area of optimism right now, but there are still basic questions about vaginal biology that have to be answered before we can design an effective microbicide."

Some public health specialists also worry that such gels and creams could reduce the use of condoms, which are far more effective at preventing the spread of HIV.

Those same concerns apply to female condoms, although many studies have shown them to block HIV as effectively as men's condoms, said Quarraisha Abdool Karim, an epidemiologist from University of Natal in South Africa.

There has been furious criticism at the Aids conference of the policies of US President George Bush, such as his administration's insistence on abstinence -- rather than condoms -- as a primary way of battling HIV.

Critics say a vow of abstinence is difficult to maintain and, when broken, can lead to unprotected sex, raising the risk of HIV infection that could effectively be blocked by a condom.

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