San Francisco Chronicle; Friday, July 3, 1998
David Perlman, Chronicle Science Editor

The widely proclaimed theme of the 12th World AIDS Conference in Geneva this week has been "Bridging the Gap," and nothing illustrates the width and depth of that gap more starkly than the billion-dollar -- and rising -- AIDS budget of the United States compared with the steadily declining funds to battle the epidemic in Africa and Asia -- where 95 percent of the world's people with AIDS or HIV infection now live.

Third World delegates said combinations of economic downturns in many of their nations and what they termed "donor fatigue" by wealthy countries and agencies, including international foundations and the World Bank, are making less and less money available for AIDS prevention programs and treatment.

The powerful triple combination therapies that include the new protease inhibitors are out of reach for all but the upper classes. Even the older and cheaper drugs like AZT and ddI are rarely available for poor people.

Rubarima Ruranga, for example, a major in the Ugandan army who has lived with HIV for 14 years, is a vigorous AIDS activist. He is grateful that UNAIDS, the United Nations agency, has provided funds for anti-HIV drugs and has worked out agreements with several major international pharmaceutical firms to lower their drug prices.

But Uganda, with a population of 20 million and a public health budget that comes out to about $8 per person per year, certainly cannot afford the cost of treating all its 1.8 million HIV-infected people, even though the country has one of Africa's most effective AIDS prevention programs, Ruranga said.

GLOOMY PICTURE

Southeast Asia may be in just as much trouble, according to Marina Mahathir, the British-educated director of the Malaysian AIDS Council. "Many countries in my region are now facing a situation where millions are unemployed, barely able to scrape together enough to buy food and daily necessities," she said. "And if we superimpose HIV/AIDS onto this scenario, the picture looks very gloomy indeed."

According to UNAIDS estimates, at least half of the 60 to 70 million adults who will be infected with the AIDS virus will come from South and Southeast Asia, Mahathir said. "And that was in the `good times,' " she added, "The reasons for these high numbers are plentiful: ignorance and denial in some countries, political instability in others, a relative lack of funds in still others."

PREVENTION PROGRAMS CUT

Mahathir herself is not without political power because her father, Dr. Mahathir Mohammad, is not only a noted physician but the prime minister of Malaysia.

"But that makes no difference," she said, "because our organization, the only AIDS-activist one in the country, must deal with the Ministry of Health and the ministry's AIDS programs -- including prevention programs -- which are being cut like everything else, leaving people even more vulnerable to AIDS."

"The sad irony of this situation," Mahathir told conference delegates, "is that even when the countries of Asia recover from the economic crisis in the future, as we pray they will, the impact of the crisis-boosted AIDS pandemic will act as a barrier to full economic recovery. As prevention programs are cut now, there will be more people infected who will require expensive care and treatment in the future.

"Where and how can they expect to get this in the coming years? How do we predict the future social costs of AIDS, the numbers of orphans and other survivors to care for, the depletion of human resources required to rebuild our countries?"

This international AIDS conference, with its news of fresh scientific knowledge amid continuing gloomy disease statistics, with its promising results of new drug therapies and its distant hopes for future vaccines, will end in final progress reports and ceremonies today.

980703
SC980704

Always watch for outdated information. This article first appeared in 1998. This material is designed to support, not replace, the relationship that exists between you and your doctor.

AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1980, 1998. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content. .