San Francisco Chronicle - July 12, 2004
Sabin Russell, srussell@sfchronicle.com.

He addressed a packed convention hall that could not accommodate the record 17,000 delegates who registered for the biannual meeting, which has never before been held in Southeast Asia.

"One in four infections last year happened on this continent,'' Annan said. "There is no time to lose if we are to prevent the epidemic in Asia from spinning out of control.''

An estimated 38 million people worldwide are infected with HIV, the virus that causes AIDS, and the U.N. leader noted that women are increasingly bearing the brunt of the epidemic, which has claimed 20 million lives in two decades. In sub-Saharan Africa, women and young girls represent two-thirds of those infected under the age of 24.

Annan blamed "society's inequalities" for putting women at greater risk for AIDS. He cited poverty, violence and coercion by older men, as well as men having "concurrent sexual relationships that entrap young women in a giant network of infection.''

The urbane and diplomatic Annan, who won the Nobel Peace Prize in 2001, was uncharacteristically blunt in criticizing male sexual behavior.

"Leadership,'' he said, "means freeing boys and men from some of the cultural stereotypes ... such as the belief that men who don't show their wives 'who's boss at home' are not real men, or that coming into manhood means having your sexual initiation with a sex worker when you are 13."

In 2001, Annan called for a $10 billion-a-year AIDS relief effort, which led to the creation of the Global Fund to Fight AIDS, Tuberculosis and Malaria. On Sunday, he said that there has been progress, but not nearly enough.

"We need leaders everywhere to demonstrate that speaking up about AIDS is a point of pride, not a source of shame,'' he said.

Thai Prime Minister Thaksin Shinawatra brought a roar of approval from the crowd when he announced that "even though we are a small country, with a relatively small economy,'' Thailand will donate $5 million over five years to the Global Fund.

It was a purely symbolic gesture, because Thailand itself is a recipient of $5 million from the fund. It will use the grant, combined with $20 million of its own resources, to cover the cost of providing AIDS drugs to 50,000 patients in the country.

Shinawatra drew a chorus of skeptical hisses from some Thai AIDS advocates, however, when he described a new policy of "harm reduction" for dealing with injection drug users, treating them as patients rather than criminals.

Supporters of harm reduction techniques, such as needle-exchange programs, simply don't believe the pledge. They have accused the Thai government of a brutal crackdown on drug users that led, in the word of Human Rights Watch, to more than 3,000 "extrajudicial killings.''

Nevertheless, Thailand has been held up as a model for dealing with the epidemic in Asia. A nation known for its thriving commercial sex industry, Thailand suffered a frightening eruption of HIV infection among prostitutes and their clients in the early 1990s. An aggressive condom promotion campaign in red-light districts dramatically reduced the infection rate, but it did not prevent HIV from spreading to the general population.

Shinawatra asserted that "this simple program has averted more than 5 million infections."

More recently, a Thai government-owned pharmaceutical company, GPO, has produced a combination of AIDS drugs in a single pill that can treat patients for about $1 a day. Shinawatra indicated that his country will provide those drugs to neighboring nations and, eventually, outside the region.

According to a report released Sunday by the American Foundation for AIDS Research, 27 companies are manufacturing copies of anti-retroviral drugs in Asia. These companies have the potential to supply Asia's 7.4 million people infected with the virus. Fewer than 10 percent of those who need the drugs now get them, however.

Ironically, the greater availability of AIDS drugs has underscored a severe shortage of physicians qualified to prescribe them. There is only one such doctor for every 11,000 individuals with HIV in Vietnam, compared to a ratio of 1 to 24 in Japan. China has only 200 AIDS-trained physicians to treat an estimated 840,000 patients.

Kevin Frost, director of the American Foundation for AIDS Research's Treat Asia program, which released the study, said the problem could be eased with a two-month training program for doctors. "Nobody is saying we should slow down the treatment effort, but we haven't paid enough attention to the infrastructure issue,'' he said.

Much of the six-day meeting in Bangkok will be devoted to the issue of how to provide AIDS drugs at the lowest cost to the most people, and there is growing concern that the emphasis on treatment will overshadow the need for prevention.

"Our prevention responses are anemic, and we are failing to control this epidemic,'' said Tim Brown, an epidemiologist who is tracking AIDS in Asia for the Hawaii-based East-West Center.

Brown said there is ample evidence that AIDS is moving slowly but relentlessly into large populations such as those in India and China, where a 1 or 2 percent infection rate can involve millions of people -- and would represent a huge and long-term economic burden.

Meanwhile, Ambassador Randall Tobias, the global AIDS coordinator for the Bush administration, arrived at the conference Sunday amid mounting criticism of a U.S. policy restricting the number of government scientists allowed to attend it -- 50 this year, compared to 236 last year.

Conference co-chairman Dr. Joep Lange lashed out at the policy during a news conference.

"It's shameful they restricted U.S. government participation, especially when they are putting so much money in PEPFAR (the President's Emergency Program for AIDS Relief),'' Lange said.

Tobias, who is responsible for implementing the president's $15 billion plan, said later that he could not comment on Lange's criticism, as he hadn't heard it himself. But he noted that the U.S. level of support for the Global Fund represents twice the contributions of other nations combined.

Although the United States has led in contributions to the fund, the Bush administration wants to contribute only $200 million next year, compared to the $547 million authorized by Congress in the current year.

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