The key research findings "show incremental and great progress on a wide variety of fronts," said Constance Benson, co-chair of the 8th Annual Retroviral Conference. She spoke with the press at the Feb, 4 opening of the five-day event in Chicago. She modestly, and accurately, claimed it as "one of the preeminent conferences in the world focusing on AIDS."
"Science should determine public health policy," said Kevin DeCock, director of U.S. Centers for Disease Control and Prevention ( CDC ) in Nairobi, Kenya, in addressing the opening session. "The scientific and philosophic underpinnings of public health are epidemiology and social justice. Surveillance is both the witness and judge in any epidemic."
"Africa is a world apart in terms of scope of the epidemic," he said. With about ten percent of the world's population, "Sub-Saharan Africa accounts for 70 percent of the world's HIV-infected persons, and 80 percent of the deaths." In many of these countries, "it is destiny for a majority of 15 year olds to be dying of AIDS."
Estimates are that fewer than a million Americans are infected with HIV in a population of 270 million. What would the U.S. do with Africa's rate of infection, asked DeCock? "We cannot stay away from the issue of antiretroviral therapy in developing countries."
He argued that "we have to change the social construct through which we look at the AIDS epidemic in Africa. We have painted this epidemic in the context of human rights." That came from experience in the U.S. and in South Africa's struggle to end apartheid. "I think we need to shift that paradigm to one of the eroding public health system in Africa."
"We cannot go on dealing with AIDS in Africa through the lens of AIDS exceptionalism which derived, very understandably and perhaps appropriately, from the 1980s in the industrialized world." He argued that there cannot be credible prevention without care.
DeCock sketched out how risk factors for transmission and acquisition of HIV infection are higher in Africa than the U.S. and can interact with a multiple effect. "One can envision a high-risk environment in which a single act of unprotected sex carries a risk of HIV that is substantially higher than in the midwestern USA. Just say no is equally effective everywhere. Just saying yes, even only once, carries very different risks depending on who and where you are."
Laurie Garrett was concerned with public health implications of large-scale use of antiretroviral therapy in the less than optimal setting of Africa or other regions of the world. The journalist and author of two highly respected books dealing with public health and infectious disease feared that adequate attention was not being given to the likely emergence and transmission of strains of HIV that are highly resistant to all currently available therapies.
She pointed out that even in highly AIDS educated populations, such as gay men in the U.S., there is misconception about how HIV can be transmitted even with an undetectable viral load. Unsafe sex practices seem to be growing.
DeCock admitted that resistance has emerged to every drug used long term to treat infectious disease. But he pointed to the dramatic effect of HAART in the west and said, "Surely we cannot say this is okay for the United States but not for Africa."
MONEY TALKS
The scientists asked a practitioner of what some people have referred to the dismal science—an economist—to address them. "Science has responded brilliantly, but none of this reaches poor people," said Jeffery Sachs of Harvard University.
"The essence of Africa's crisis begins with its extreme poverty," he said. It has experienced "a virtual collapse in its public health structure," and sub-Saharan Africa has no chance of economic development without that.
"Money is the key to it all." He chastised the Clinton administration for beginning to talk the talk, but "did little, in essence." He cited the President's trip to Nigeria where a $10 million AIDS grant was announced four different times. Sachs put that sum in the context of the $25 million cost of the trip to Nigeria for the President and his entourage. He said that Clinton could have done more than three times the good by staying at home and sending a check for the amount of the trip.
Sachs claimed that the major pharmaceutical companies "are ready to deal" in providing drugs for the beleaguered continent at a price near their cost of production. He calculates that a combination of two nucleoside analogs and one non-nucleoside analog, a common initial therapy in the U.S., would run about $500 a year per person.
If the governments of the approximately 1 billion rich people of the U.S., Europe, and Japan each donated about $5 per capita, he estimates that the money would be sufficient to provide drugs for most of those in Africa who exhibit the symptoms of AIDS, as well as fund a large-scale prevention program.
Sachs is "hoping that the pharmaceutical companies will go to the Bush administration" to press for such a program. He says that the Congressmen who have traveled to Africa and seen the face of AIDS say it has "changed their lives," and support for such expenditures is growing.
But the scientists in the room were skeptical. They realize that many in Africa lack basics that we take for granted, such as clean, safe drinking water and sanitation facilities. The cost of drugs is but a small portion of the cost of creating a healthcare delivery system that must accompany those drugs.
Missing from Sachs proposal was any call for the governments of Africa to shoulder a portion of the burden. A handful of the hardest hit nations find few resources for the health of their own people yet can afford to send portions of their armies to fight in the Republic of the Congo.
South Africa, the wealthiest and most medically advanced nation in the region, until recently had refused to accept free drugs to reduce the transmission of HIV from mother to child, yet ordered a new submarine for its Navy.
The need in Africa is great and growing, the response to stem the epidemic will be complex and costly, while failure to act may prove to be even more costly.
STUDY: HIV in 30% of Young Black Gays
Thirty percent of young gay Black men are infected with HIV, according to a study of six large cities in the U.S., federal researchers reported during the 8th Retroviral Conference in Chicago, reports The New York Times.
The study, conducted by the Centers for Disease Control and Prevention from 1998 through 2000 in Baltimore, Dallas, Los Angeles, Miami, New York and Seattle, found that gay Black men in their 20s had the highest HIV infection rate of any group in that age range, the Times reported. Among young gay men, 15 percent of Hispanics, 7 percent of non-Hispanic whites and 3 percent of Asian-Americans are infected with HIV. The study found 12.3 percent of gay and bi men from 23 to 29 were infected.
The study also found that gay and bisexual men in their 20s of all races were engaging in behavior that put them at high risk for AIDS, the paper said. Of the 293 infected men in the study, only 29 percent knew they were infected. Fewer than one-fourth were receiving medical care or anti-HIV therapy, the Times said.
More of Bob Roehr's reports from the retroviral conference in upcoming Windy City Times editions.
