San Francisco Chronicle; Monday, June 29, 1998
David Perlman, Chronicle Science Editor

There were songs of hope during ceremonies that marked the opening of this scientific conference, where nearly 12,000 epidemic fighters -- from militant activists to scientists doing basic research -- have gathered from more than 100 nations.

But there were warnings, too, that vaccines are at least 15 years away at best, that drug resistance and often unbearable side effects from the most powerful of the new drugs are causing many patients to discard them and that although prevention campaigns are succeeding in a few countries, those successes are spotty, even in so- called advanced nations like the United States.

Dr. Helene Gayle of the U.S. Centers for Disease Control and Prevention underscored the extreme disparities:

"Many of us," she said, "share the same dichotomy of emotions -- the excitement brought by the tremendous progress in prevention and treatment for many people and the overwhelming frustration and sorrow of knowing that too many have not yet felt the benefits of our advances."

Gayle is director of the federal agency's prevention campaigns against HIV -- the virus that causes AIDS -- as well as all other sexually transmitted diseases and tuberculosis.

At a briefing sponsored by the American Medical Association, Gayle reminded the world that even in America, the burden of HIV infection is borne by many who can least afford to undergo expensive treatments. African Americans and Hispanics now together account for 66 percent of AIDS cases.

She also said an increasing number of women now have AIDS, 22 percent of all reported cases. And although prevention programs have had success in some localities, including in San Francisco, Gayle reported that in 25 states, new HIV infection rates have not declined during the past four years but have remained relatively stable.

Gayle said that "continued health disparities between economic classes," the nation's failure to deal successfully with substance abuse and the "intersection between HIV and the other sexually transmitted diseases" all stand in the way of accessible and successful treatment.

As for drug abuse, Gayle said the Clinton administration's refusal to seek congressional support for needle exchange programs coupled with drug treatment and counseling amounts to a reluctance to rely on "science to guide policy decisions."

"The punishment for drug use should not be death by AIDS," Gayle said. Ruth Dreifuss, the Swiss minister of interior, health and social affairs, said drug users in Switzerland have access to free needle exchange programs that have drastically reduced the sharing of needles, a major source of HIV transmission.

AIDS IN NEWBORNS

There is at least partially encouraging information on preventing AIDS in newborn babies with the news that international funds are being mobilized to pay for administering the anti-viral drug AZT to pregnant women infected with HIV and to their newborn infants, which greatly increases the chances that the babies will remain free of the deadly virus if their mothers do not breast-feed them.

An even more successful new element in neonatal prevention was reported by French researchers who have completed a new experiment to improve the results -- for at least the most fortunate families.

In the new trial, whose results will be published this week in the Journal of the American Medical Association, the researchers administered AZT, the first anti-viral drug used against AIDS, to more than 900 pregnant women infected with the HIV during their last four weeks of pregnancy, then delivered the babies surgically by cesarean section before labor began. The drug was also given to their babies for several weeks after birth.

In Africa and Thailand, giving AZT to mothers during pregnancy and to their newborns for up to six weeks after birth had already cut the HIV infection rate in half for thousands of infants born to infected mothers.

Now, Dr. Laurent Mandelbrot of France's National Center for Health and Medical Research and his colleagues report that by performing the cesarean sections on the infected mothers before the onset of labor, they have cut the infection rate among the newborns to less than 1 percent.

In one series of 133 cesarean deliveries, for example, AZT protection plus the elective surgery resulted in only a single baby born with HIV, Mandelbrot said.

He conceded that although the procedure could be recommended in every country where access to safe surgery is widespread, most poor nations can barely afford skilled surgery for their sickest people -- let alone to protect babies from AIDS through high-tech procedures.

VACCINE RESEARCH

Before last night's opening ceremonies, leaders of the 2-year-old International AIDS Vaccine Initiative announced that they have received support from the World Bank, the British government and the Rockefeller Foundation, along with a $1.5 million grant from Microsoft founder Bill Gates, to push for more rapid vaccine research and development.

With a scientific plan and a roster of international vaccine researchers, the organization plans to enlist governments in both industrialized and less developed countries to collaborate with vaccine scientists in starting trials as soon as new vaccines are shown to be safe and to induce immune responses in laboratory animals.

With $15 million raised so far, the group said $500 million in vaccine research is needed to encourage drug companies to move toward the eventual goal of profiting from AIDS vaccines, not just drugs to treat the epidemic.

AIDS ACTIVISTS

The opening session of the conference last night was unique in one major respect. Its program -- as well all planning for the global meeting -- was shared by leaders of both the scientific community and by representatives of many of the world's community activist organizations -- the same groups that have played an effective role in prodding scientists to intensify their research, drug companies to cut their prices and governments to outlaw discrimination, promote prevention campaigns and even to legalize needle exchanges.

Unlike many previous AIDS conferences interrupted by loud and at times violent disruptions, this one was so programmed that European ACT UP leaders could share the stage for a few minutes and men and women living with AIDS from several countries could relate their experiences calmly. The only "disruption" was in the form of a few programmed moments for a noisy troop of horn- blowing protesters carrying black and white banners proclaiming:

"AIDS Treatment for All. . . . Stop Drug Company Greed."

ON THE INTERNET

Information from the AIDS conference, where major scientific reports will be presented during the next five days, will be available over the Internet in the form of "Webcasts" at www.AIDS98.ch

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