Report from the Durban WORLD AIDS CONFERENCE
Durban, South Africa
Monday July 10
reported by Jules Levin

Report 7

EXPOSING THE SILENCE-
GATES FOUNDATION ANNOUNCE $100 MILLION PRGOGRAM FOR BOTSWANA

In this morning's opening session, Prof Anderson from the UK talked about how serious AIDS is on a world basis and that intervention is very crucial. Its not too late in Africa. And its timely in China and India.

INTERVENTION IS NEEDED NOW

AIDS is the worst epidemic the world has ever faced. Prof. Anderson showed 8-32% in Southern Africa have HIV. Life expectancy has declined in African countries since 1996. But in Uganda life expectancy started to increase lately because of HIV programs. He made the point that even after starting prevention programs it takes a while to start a significant decline in prevalence. He also said that future infections rates will increase from here so there is still a chance in Africa to improve the situation with interventions. The lowest risk groups have yet to be affected by HIV. Interventions now could still have enormous favorable impact for these low risk groups. 

In India and China HIV is driven by heterosexual activity and at this time point intervention there can be very crucial and helpful. In Africa and sub-saharan Africa women are a main population being affected now. In Uganda, Senegal, and Thailand real successes are possible due to the government commitments. In Thailand condom use has made a difference, HIV infection and STD rates have stabilized. In Uganda prevalence rates have stabilized or improved due to intervention programs. STD intervention is considered highly desirable in stemming spread of HIV. He showed an 9% vs 18% difference in Thailand in mother to child transmission when AZT was used. He also said that HAART ought to reduce transmission although more data is needed to prove it, but it appears clear that reducing maternal viral load can improve transmission rates. He supported drug price reductions and said vaccines are crucial. Although he said vaccines in near future are unlikely. He said the world must recognize that this problem is serious and without intervention serious results can occur.

Dr Bayer from Columbia University.--a medical ethicist

He quoted Gerald Friedland that medicine is limited in its success. Talking about curing will make us feel like failures. We're not failures--doctors-- but we're limited. Herman Mendez  said he became used to death. Catherine Wofsky said "she was a travel agent for death:. She couldn't prevent death but she could help and make it easier.

Then he related the extroadinary difference that antiretroviral therapy has made. How much healthier people in general are. Dan William said AIDS is becoming a chronic treatable disease not a fatal one. Therapy has led us to dramatic decreases in death and sickness.

It makes me feel how lucky I am and at the same time feel sad for those not able to get drugs.

HIV incidence--5.6 million in SE Asia, 25 million in sub-saharan Africa, 34 million worlwide, 1 million in USA. The cost of HIV drugs will take up a large relative % of GDP of developing countries. The need to supply treatment is a moral one. Not to do so is a gross injustice. Drug prices should be slashed, he mentioned NVP offer for free should intensify the debate. But spending on AIDS should not divert money for treatment for TB and other diseases. Resources to clean blood supply is key. There has been a very poor leadership in AIDS by leader in countries in developing countries. If a vaccine becomes available it should be freely available. Microside research is crucial. History will judge is if we don't move ahead on treatment & care.

A French speaker said a World fund should be established to supply drugs to the poor. A price reduction will not solve the problem . Other issues are also key such as infrastructure. The agreement by drug companies to supply drugs must be acted upon quickly. She called for a world conference on treatment including drug companies ASOs.etc.  They will ask world leaders for a meeting.

MERCK & GATES OFFER 100 MILLION TO BOTSWANA

In a briefing following this session Jeff Sturchio from Merck discussed a program for Botswana that he and Bill gates will be offering that includes 50 million dollars. Bill Gates is donating 50 million to Botswana and Merck will match it for a total of 100 million. The question was raised about details of the program--drug prices should be slashed not just money given, where will the drugs be manufactured, where will the infrastructure come frrom? Obviously, the problem demands more than money - but money is necessary to start the process and follow-up planning is necessary so the money is effective. To the question about drug pricing Glaxo Wellcome said they have lowered prices and are in negotiations with developing countries. Jeff Sturchio from Merck said that the 5 drug companies have agreed thru the UN initiative that drug prices will be lowered. But Sturchio said they want the countries to work improving infrastructure. He was on the defensive as he felt attacked and said the companies want to help. He said we should confronting and attacking each other but we should work together, since we have agreed and want to respond to the need. He said we will have a sustainable solution to the world AIDS problem. A rep from Ghana said we need drugs but we need to be prepared to know how to use the drugs--managing side effects, etc. This follows attacks on drug companies by community & press. Stergio said his program is a 5 year commitment to see if it makes a difference. They will talk to Botswana about where the money needs to be spent.

The initial plan is to do an evaluation of care 7 treatment in Botswana now. Hopefully by the of this Summer they expect an evaluation and then make a plan. The evaluation is being done by the Health Officials in Botswana. Awareness, testing, treatments access, transmission, NGO involvement, training for medical providers & NGOs--all the issues are expected to be addressed. Botswana will have to figure out what therr needs are. Merck says they have a basic infrastructure. But better assessment of it are needed. The evaluation will hopefully identify the gaps. They have a good basic structure & care system. That's probably why they were chosen. Capacity is the issue--enough doctors, nurses properly trained. NGOs will need training. VSO (volunteer organization)of UK are & will be sending in volunteers to help train NGOs and others. They hope this will become a comprehensive. The 5 companies in the UN industry initiative will hopefully offer up drugs. As well as OI drugs.

Global health equity is a focus for the Gates Foundation. Meetings in Seattle with health officials about what to do gave birth to this idea. Merck, Gates, & Pres of Botswana met in Botswana and quickly agreed to move ahead. The Botswana Pres. made a quick commitment. In Botswana prevalence is high (29% of adults infected) but govt commitment is there, unlike other countries (South Africa). They have basic care for medical care & HIV in general