San Francisco Chronicle - August 11, 2004
Diane V. Havlir, Robert M. Grant

Is there an inkling of hope in this abysmal situation? There were some surprising answers at the conference. Only five years ago, lifesaving therapy for HIV was not even mentioned on the global agenda. Antiretroviral therapy was too expensive and complicated to administer in poor countries. AIDS was a fatal disease, period. Then at the XIV World AIDS Conference in Durban, South Africa, passionate calls for treatment access were finally heard. The conference theme of "Break the Silence" became a reality when the World Health Organization officially endorsed HIV treatment for all persons in need. And in short time, a number of large, ambitious treatment programs sponsored by WHO, the U.S. government and others were launched.

"Access for All" was a gutsy meeting theme for the organizers of the Bangkok conference. Millions of persons need HIV treatment. Delivering treatment is no easy task. It requires the commitment of world leaders, the necessary financial resources and a solid scientific and public health anchor. It requires a global social and political movement.

The juncture the global community faces with AIDS is reminiscent of what San Francisco faced more than 20 years ago. The obstacles to slowing the epidemic, reducing stigma and treating the disease seemed insurmountable back then. We began to gain the upper hand on the epidemic only through commitment, contributions and cooperation among politicians, activists, health-care providers, industry and scientists. In one sense, San Francisco's story is a tale of heroes; in another, it was a painful journey with too many lives lost along the way.

The beauty of Bangkok lay in this visible evolution of a social and political movement to treat HIV, with a leadership and following that may have a chance to succeed. U.N. Secretary-General Kofi Annan, Dr. Peter Piot of UNAIDS and Jim Kim of WHO all gave inspirational speeches on global commitment. Leaders from the major treatment initiatives discussed plans and problems. Activists catalyzed productive dialogue; program managers networked and the pharmaceutical industry actively participated despite the attacks on drug pricing.

Several important scientific contributions also premiered at this meeting. Just a few examples:

-- A new strategy was unveiled for preventing drug resistance while using antivirals to prevent mother-to-child transmission.

-- Some "microbicides," lubricants that inactivate HIV, were shown safe.

-- Sustained effectiveness for our most important drugs against HIV was demonstrated.

Although most news about the spread of HIV was grim, clear success stories, including Thailand and Uganda, were notable. Analysis of HIV control in these areas revealed a blend of political leadership, public discussion and individual changes in behavior. Most important, the meeting was an incubator for young scientists from all over the world. Science was not center stage, but this was science in action -- the application of important breakthroughs on a global scale.

The road ahead will no doubt be uphill in the global response to HIV, but the urgency is great. We believe that the 15th International AIDS conference in Bangkok provides insight into a better approach to human disease. While basic science drives the development of new drugs, scientists are often inspired by observations made by clinicians, who deal directly with patients, or public-health officers who observe population trends, or political leaders who create policy. As our experience in San Francisco showed, we learn to use new drugs through extensive collaborations between laboratory scientists, clinicians, the patients themselves and their community organizations. In Bangkok, we could see how discussion across these particular points of view can be difficult, yet how it frequently gives rise to new approaches to therapy and prevention. We glimpsed how the human community could work together to combat a difficult global problem.

Dr. Diane V. Havlir is a professor at UCSF School of Medicine and chief of the HIV/AIDS Division and Positive Health Program at San Francisco General Hospital. Dr. Robert M. Grant is an associate investigator at the Gladstone Institute of Virology and Immunology and associate professor at UCSF School of Medicine.

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