San Francisco Chronicle - December 2, 2006
Sabin Russell, srussell@sfchronicle.com.

Because of the rule, organizers of the biannual International AIDS Conferences have not held a gathering in the United States since 1990, when San Francisco hosted the event.

The White House chose Friday, World AIDS Day, to announce that Bush would issue an executive order allowing HIV-positive people to enter the United States on short-term tourist or business visas without having to seek special permission.

"This administration is very serious about fighting discrimination on AIDS," U.S. Global AIDS Coordinator Mark Dybul said during a telephone interview after White House ceremonies marking the day.

Activists, taken by surprise by the announcement, generally praised Bush's decision but said all restrictions on immigrants with HIV should be lifted.

"It's a step away from a terribly discriminatory and inappropriate policy, but it doesn't go far enough," said Leonard Rubenstein, executive director of Physicians for Human Rights, in Washington. "This is a treatable disease. If you want to remove stigma from AIDS, you have to go the whole distance, and eliminate all restrictions on entry to the United States for people with HIV."

UCSF physician Donald Abrams, who helped organize the 1990 AIDS conference, called Bush's move "a humane and positive thing." But he was uncertain whether it would pave the way for the big international AIDS meetings to return to U.S. soil.

"It is certainly a step that will serve to bring us in line with the rest of the civilized world," he said.

Abrams said that many HIV-positive travelers entering the United States simply ignore the requirement that they declare themselves infected with the virus. But those who must also carry antiviral drugs are inevitably fearful they will be found out and turned back if customs officials find the medication, he said.

"You don't know how many people have called in their prescriptions to Walgreens because they are paranoid someone will check their bag," he said.

Mark Sawyer, a co-founder of ACT UP New York who has campaigned against the ban since it was first put in place in 1987, said Bush's plan to lift the requirement for short-term visits was not good enough.

Under the proposed new rule, HIV-positive people would receive a "categorical waiver" of the requirement on business or tourist visas for visits up to 60 days. It remains unclear whether visitors would still have to declare their HIV status, because the waiver would be granted automatically.

"We shouldn't have to get a waiver, period," Sawyer said.

International visitors to the United States who are HIV-positive have been able to obtain a special waiver for some events, such as United Nations conferences on AIDS or gay athletic events. But the process is cumbersome, and critics call it discriminatory and demeaning.

During the World AIDS Day ceremonies at the Roosevelt Room in the White House, Bush declared that "we have a duty to do something about this epidemic."

He cited his $15 billion, five-year overseas AIDS relief effort, which Dybul -- an AIDS physician who once treated patients in San Francisco -- now runs.

Dybul said the program has helped to bring antiviral drugs to 822,000 people in 15 hard-hit countries -- more than double the 400,000 counted at this time last year. "The scale-up is huge," Dybul said. "There were 560,000 just six months ago."

Although he declined to specify how many of the participants were taking lower-cost generic drugs favored by activists, Dybul said the president's program has obtained special Food and Drug Administration approval for 33 generic products, many of them made by manufacturers in India and South Africa.

Kenya has already announced it has saved 5 percent by choosing drugs from that list of approved generics, and other unspecified countries have announced plans to purchase 70 percent of their medicines from the same list, Dybul said.

The Global Fund to Fight AIDS, Tuberculosis and Malaria, a Geneva-based program linked to the United Nations, also announced Friday that it has brought treatment to 770,000 people worldwide.

Because the Global Fund and the U.S. program work closely together in many countries, there is considerable overlap in the patients counted by each. The two organizations estimate that together they have helped to bring drugs to 1.2 million people, triple the number from 2003 and twice as many as last year.

Dr. Richard Feachem, executive director of the Global Fund, said in a telephone news conference that there are now roughly 2 million people in developing countries taking AIDS drugs -- most of them through the U.S. program and the Global Fund, but others financed locally or through other relief agencies.

He estimated that 7 million people need AIDS drugs to survive, so the worldwide coverage in poor countries is roughly 30 percent. "It's still a big gap. It's still a long way to go," Feachem said.

He added that it will be difficult to achieve the target of "universal access" to AIDS drugs by 2010 without a major influx of new money -- beginning with the Global Fund's next round of grants in 2007. Feachem said that by 2010, 10 million people will need AIDS drugs.

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