San Francisco Chronicle; Tuesday, April 21, 1998
David Perlman, Chronicle Science Editor

In virtually every country outside the industrialized West, the experts agreed, the most desperate needs are abundantly clear.

-- Nationwide centers for confidential counseling and testing for HIV, the AIDS virus, are lacking everywhere.

-- Supplies of the AIDS drug AZT, now proven to prevent transmission of HIV from most infected pregnant women to their unborn infants, are unaffordable in virtually every poor nation.

-- Kits to test national blood supplies before transfusions are virtually unobtainable within the meager health budgets of most of the nations.

--Condoms, the best physical barrier against the virus, must be marketed far more aggressively, although ample supplies are too often unavailable.

Yet all these needs, the prevention experts agreed, cost money -- and the developed world's financial help is sorely lacking. Increased taxes on wealthy individuals and multinational corporations may be needed, the experts said.

The 200 prevention experts had gathered in San Francisco over the weekend for a specialized workshop seeking practical measures for combatting the epidemic. Hosts were the AIDS Research Institute of the University of California in San Francisco and the Fogarty International Center of the National Institutes of Health in Bethesday, Md.

The meeting's background was ominous indeed: The latest United Nations figures show that more than 30 million people are now living with HIV infections or with AIDS itself -- 90 percent of them in the developing world

--and nearly 12 million have died since the global epidemic emerged in the late 1970s.

In the epidemic's newest surge, women account for more than 40 per cent of the victims, and already 8.2 million children have been orphaned by the disease, the UN figures show.

To Thomas J. Coates, director of UCSF's AIDS Research Center, the major goal for the world must lie in prevention -- "to save the next generation and the generation after that," as he put it. It is useless, he said, to think of an affordable, effective AIDS vaccine for at least two generations, and drug treatments, no matter how effective, are far beyond the capacity of most poor nations.

Elizabeth Ngugi, an AIDS specialist at the University of Nairobi in Kenya, voiced the concern typical of all the experts when she said: "We don't have voluntary testing centers in my country, we don't have AZT, we don't have drugs for treating other sexually transmitted diseases that open the way for AIDS infections, so how can we protect the next generation when our women cannot protect themselves?

"Where is the partnership between our developing countries and the superpowers? It doesn't exist."

And from Martha Bulter deLister of the Dominican Republic, came this complaint: "President Clinton has been in South America to lead the nations toward a new free market, but health was not even on the agenda, AIDS was not on the agenda."

The international experts noted that test kits for screening blood supplies cost only 50 cents each, while administering AZT to an HIV-positive pregnant woman costs only $50. That is cheap prevention, they agreed -- and certainly far cheaper than the $37,000 a year it costs to run a clinical trial on a new triple-combination drug treatment in a developing nation where prevention is so far more important to saving future lives.

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