Letter From the Publisher

AIDS, perhaps the greatest ever world health epidemic, poses a grave threat to Africa, India and other developing countries. In Botswana, one in three adults have HIV, and 25 million of the 34 million people in the World with HIV are in sub-Saharan Africa. Although the medical infrastructures in these areas are sorely inadequate, there is enough infrastructure to begin addressing the problems. Access to treatment is generally unavailable except to those who can afford it. In South Africa, women and children are disproportionately affected. The 13th International AIDS Conference in Durban, South Africa was probably the best conference I've attended, and it has helped the world focus on this problem. More than half of the attendees were from Africa, and it was a truly unusual experience for me to meet South African and Indian doctors and health officials. While it was fascinating to be in such a distant and truly unique culture, it was also uncomfortable for me to meet individuals infected with HIV who could not access treatment. I felt very grateful for my different circumstances. Mark Wainberg, the outgoing president of the International AIDS Society, and other members of IAS, deserve much credit for having the guts to select Durban for this conference and for sticking to their guns during the attempts to boycott the conference. Those who suggested the boycott felt that holding the conference in Durban would hurt efforts to reverse the South African President's refusal to permit access to HIV medications for his people suffering with HIV. In fact, I think holding the conference in Durban was a great choice. It gave the world a chance to see the situation in the developing world on TV newscasts every night. Although much attention has now been drawn to the plight in Africa and India resulting from the meeting in Durban, there still remains controversy on how to address the problems. Let's not let the controversies delay or prevent us from providing help to the suffering. Community, industry and governments should work together to forge solutions. South African President Mbeki has so far refused HIV treatments for his people, but he can still change his mind. In his speech at the opening ceremony for the Conference, he said his advisory committee would decide on this question by the end of the year. As time separates us from the Durban experience, letís try to keep our eye on the ball and remain committed to the problems in India and Africa.

Boehringer Ingelheim has offered free nevirapine, which has been shown to be as effective in single doses to mothers and newborns as AZT in preventing mother-to-child transmission, and Glaxo Wellcome has offered deeply discounted AZT. But Mbeki's government still refuses to accept these offers. However, breast-feeding presents a problem. Unfortunately, studies reported at the conference in Durban showed that breast feeding severely lessens the reduction in transmission rates, and breast-feeding is culturally important in Africa. Recent evidence from Durban suggests, however, that in these settings, exclusive breast feeding may prevent infection; and, it is the inappropriate practice of mixed feedingóin particular the introduction of supplementary food or liquids in the first six months of life in addition to breast feedingóthat poses the greatest risk of transmission. This question remains to be resolved.

This newsletter is a selected collection of key treatment developments reported at recent HIV and liver conferences. NATAP tries to report the most comprehensive treatment information. The NATAP web site contains much more extensive treatment information from conferences, journals, and other sources.