Day of reckoning
At an international conference on HIV/AIDS, it transpires that the struggle against the pandemic is hampered by severe cash shortages and a lack of political will, writes Negar Azimi
Chronic cash shortages and concerns born of research surrounding the resistant nature of the HIV virus to drugs marked this year's conference of the International AIDS Society, held in Paris last week.
The focal point of funding shortfalls is the Global Fund to Fight AIDS, Tuberculosis and Malaria, established three years ago at Okinawa's G8 conference of industrialised nations, and is the broadest financial commitment to combating the epidemic made by the world's most powerful governments to date.
United States Secretary of Health and Human Services Tommy G Thompson, who currently chairs the Fund, announced that the Fund is now facing a budget shortfall of up to $800 million, but most figures confidently place it between $400 million and $600 million.
A shortfall will translate into a significant truncation of crucial treatment and prevention projects already approved by the Fund around the world. By conference closing, no announcement of major new contributions to the Global Fund had been made, although small- scale pledges came from Ireland, Greece and China.
During the closing ceremony, activists attacked G8 nations' commitment to the Fund, chanting "Prodi, Thompson, Chirac, the G8 must pay" and "Donors lie, we die, fund the Fund now," finally disrupting the address of French President Jacques Chirac.
The protests came on the heels of a speech by Romano Prodi, chairman of the European Union, at the end of a day-long donors' conference for the Global Fund. Prodi, for his part, tried to intercede on behalf of the angry protesters.
"Sometimes we are like the tortoise in the fable, advancing one step at a time. But like the tortoise we get there in the end," he said about the EU's commitment to fighting the epidemic.
Former South African President Nelson Mandela called upon European governments to match the commitment of US President George W Bush, who signed a law this past spring to provide $15 billion in AIDS funding over the next five years.
Though the Bush plan and his recent five- day trip to Africa have been attacked as mere public relations stunts by AIDS activists, the gesture remains an important one.
United Nations Secretary-General Kofi Annan, Chirac and British Prime Minister Tony Blair had joined Mandela in urging European governments to promise $1 billion a year to the Global Fund. Nevertheless, nothing has come of those calls, while diplomatic sources told Reuters that Germany, Denmark and the Netherlands had effectively blocked the prospect of increased funding.
Sharoann Lynch of US-based activist collective Health GAP (Global Access Project) expressed frustration with the lack of commitment to the Global Fund from European governments.
"During the G8 Summit in Evian we were told to wait until the EU summit for donors to make good on their promises. At the EU summit in Greece we were told to wait until the Donors Conference [in Paris]. Now the Donors Conference has come and gone, and once again the G8 countries have betrayed people with AIDS," she told Al- Ahram Weekly.
The US-based Bill and Melinda Gates Foundation for its part outdid most governments, donating an immediate $100 million -- making it a larger donor that either Britain or Germany, who pledged between $40 million and $48 million. In the meantime, scientific findings presented at the conference on the nature of the virus were equally as discouraging as funding shortfalls.
The largest study on resistance to HIV/ AIDS drugs to date, led by researchers at the University of Utrecht in the Netherlands, revealed that 10 per cent of all newly infected patients in Europe are infected with at least one drug-resistant strain of HIV.
Resistance is primarily brought on by a failure to adhere to often rigid treatment schedules, resulting in the development of resistant viruses. An earlier study in the US indicated that at least half of all Americans undergoing treatment for the virus are also carrying drug-resistant strains. These and the latest European findings have led some researchers to refer to the state of treatment as a kind of "therapeutic anarchy", with little concern for particular prescription combinations -- hence making the need for further treatment research even more critical.
The findings are particularly worrying for the developing world, where consideration of particular combination therapies may be the last among an impossibly long list of concerns. A more urgent priority is access to drugs, as most anti-retroviral therapies remain prohibitively expensive.
The result is that many doctors in the developing world prescribe regimens with little consideration for their appropriateness.
But no large-scale study on drug resistance has been carried out in the African context. According to the UN AIDS Programme, only about 50,000 patients in sub- Saharan Africa are on anti-retroviral drugs -- precious little considering that this continent claims a disproportionate 70 per cent of the global case-load.
Though the Paris conference was not without its heartening moments -- including news of the success of an aggressive sex-education programme in Brazil -- the bulk of the proceedings served as a stunning reminder that 20 years into the epidemic there remains an overwhelming amount of work to be done. The course of HIV/AIDS continues to be marked by rampant inequities in access to treatment, prevention outreach and general education, as well as significant scientific gaps in knowledge about the nature of the virus that causes AIDS.
