Voice of America - July 7, 2004

As the world's largest AIDS conference opens Sunday in Bangkok, Thailand - just how much progress has been made in battling the pandemic? One expert who's followed the trend of the disease says it's still being fueled by ignorance, a lack of money and weak political will.

Tony Barnett (VOA photo - J. De Capua)

Tony Barnett is co-author of AIDS in the 21st Century and a professorial research fellow at the London School of Economics. He says despite the introduction of antiretroviral drugs around 1996 - and programs like President Bush's Emergency Plan To Fight AIDS - the pandemic is not under control. In fact he says it's on the rise in Asia.

"The old thing we used to say - we social scientists years ago when the medics were totally in control of dealing with this epidemic - which is AIDS is not just about medicine and about hospitals and about doctors - is now replaced by AIDS is not just about AIDS. Because what AIDS is really showing us is the effect of poverty on a global scale," he says.

In recent years there have been successful legal battles and campaigns to lower the price of anti-retroviral drugs, ARVs, in poor countries. And there are ambitious programs to treat millions of people with the drugs to extend their lives. But Professor Barnett says without a cure or a vaccine the ARVs are just buying some time.

"First of all, I don't think anti-retrovirals are the solution to HIV/AIDS epidemics. They give us a breathing space. This is a very, very cunning adversary that we confront and confronts us. This virus is incredibly changeable. It can respond to new drugs in a number of years if the drug regimens are not fully implemented by patients or by health systems. So, realistically, I would say somewhere between five and ten years is the size of the opening that we have to benefit from these drugs. We'll need more and more and more drugs in order to keep this thing at bay," he says.

Nevertheless, he says ARV's will help keep a generation alive to raise their children, preventing AIDS orphans. Those extra years allow parents to pass along coping and survival skills and to ensure their children are educated.

But Professor Barnett does criticize drug companies that claim research and development costs are preventing them from lowering the prices of AIDS medicines.

"Drug companies benefit from public funds. They get funds from your taxpayers and from my taxpayers here. And those drug companies then claim that their research and development costs are a secret. Well, they're no damn secret. They shouldn't be a secret. This is public money and public subsidy going into their work, which they then sell back to us at extremely inflated prices. Until they are prepared to display the costs of their research and development publicly I can't take that issue seriously," he says.

At the same time, he says, the health systems of developing countries must be built or expanded - something that can have worldwide benefits.

"If you have large areas of the world where people are sick and where there are, in a sense, pools of infection, we're all going to share that in the end. It's a global problem; you can't shut yourself off. So, we need to start now with a major program, a global program, to build health systems internationally," he says.

The London School of Economics professor is critical of conservative groups that emphasize abstinence as a means of preventing HIV infection.

"The idea that abstinence is solution to a problem of this magnitude is crazy. It is so crazy that it almost doesn't bear engaging with, but I will engage with it. The conditions under which poor negotiate their sexual lives are not the same as a suburban bedroom in New York City, or in Maine, or in some other town across the United States. People actually don't have knowledge. They don't have the individual power in relation to their sexual partners always - that's particularly true of women - to be able to negotiate abstinence," he says. The latest estimate on how many people are infected with HIV, the AIDS virus, is two million lower than the last estimate… approximately 38 million compared with 40-million two years ago.

Professor Barnett says that's more a result of better reporting rather than big improvements in prevention. All estimates he says have a margin of error, but he also says many AIDS-related deaths are not recorded as such out of fear of stigma and discrimination.

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