The recent International AIDS Conference, July 7-12, in Barcelona, was perhaps one of the more political of this series of conferences, if only because several current and former heads of state were among the more than 15,000 delegates. Many people in the world will be counting on these politicians, who include Bill Clinton and Nelson Mandela, to help in the effort to bring the worldwide spread of AIDS under control.
The figures provided by UNAIDS, the United Nations agency that coordinates UN programs, are mind-numbing. Currently, there are at least 40 million people who are HIV positive, 95% of whom live in low-income countries. If current rates of infection continue, by the end of this decade we can expect the following:
It is possible, even in the absence of an effective vaccine, to slow down and eventually halt the social and economic damage caused by AIDS. Plans to do so were approved by the UN at last year's special session on AIDS in New York. To implement those plans around $10 billion U.S. per year is required. The Global Fund to Fight AIDS, TB and Malaria has been formed to help raise that money. Unfortunately, the Fund has received only $2 billion U.S. because high-income countries have not honoured their commitments. For every year of delay in implementing a comprehensive anti-AIDS plan, the UN estimates that 5 million people will die. Since its arrival in 1981, AIDS has killed 20 million people. It is not clear how many more people have to die before such a plan is given adequate funding.
Despite the disappointing level of fundraising, small projects by agencies such as Médecins Sans Frontières (Doctors without Borders) and others are helping to stem the spread of infection and bring anti-HIV drugs to low-income countries. Although a good first step, without increased funding and support, these small projects by themselves will do little to reverse projected trends.
The conference provided a forum for frontline AIDS workers to share experiences and success stories and engage in skills building. They also forged links that will be important in the years to come as it becomes clear that, given the present resources, AIDS will not go away in our lifetime. Not surprisingly, the lack of commitment to the Global Fund (and the resulting cost in human lives) angered and mobilized attendees. Indeed, activists frequently held demonstrations and "actions" to highlight important issues relating to prevention, care and treatment.
With regard to treatment, there were no major breakthroughs. For people in high-income countries, the outlook is generally good. More drugs should become licensed in the next year, including T-20 (from a new class of drugs called fusion inhibitors) and atazanavir (a new protease inhibitor). These are merely the tip of the iceberg when it comes to drugs of the future. Indeed, at one conference session, a researcher showed a slide filled with the names of new drugs at various stages in the development cycle. The rest of this issue of TreatmentUpdate will focus on selected highlights in treatment research presented at the conference.
REFERENCES
1. http://www.unaids.org/barcelona/presskit/childrenonthebrink/introduction.pdf
2. Stover J, Walker N, Garnett GP, et al. "Can we reverse the HIV/AIDS pandemic with an expanded response?", Lancet 2002 Jul 6;360(9326):73-7.
3. De Cock KM and Janssen RS. "An unequal epidemic in an unequal world.", JAMA 2002 Jul 10;288(2):236-8.
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