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Analysis: AIDS science, politics mingle
By ED SUSMAN
TORONTO, Aug. 11 (UPI) -- More than 24,000 people began assembling in Toronto, Canada, Friday as the biannual International AIDS Conference convenes for the 16th time since 1985
-- a meeting often highlighted by promises of scientific advancement and government help in controlling the deadly viral epidemic that now infects 40 million people worldwide.
This year's theme, "Time to Deliver" reflects the hope that medications that can control the disease caused by human immunodeficiency virus (HIV) will finally be given to people in developing countries who bear the brunt of the epidemic, but who can't afford the expensive treatment.
"I think there will be an acknowledgement that governments, including the United States, have to do more than just make half-hearted pronouncements and actually begin funding programs that will impact this epidemic in the most needy areas," HIV/AIDS activist Julie Davids told United Press International.
Davids, the founder of the New York city -based Community HIV/AIDS Mobilization Project (CHAMP), said the meeting will also focus its attention on two things that world governments do badly -- issues that involve sex and drugs.
The main epidemics of HIV/AIDS are spread through sexual transmission or through use of contaminated needles by intravenous drug users. The disease is also spread through contaminated blood products, but that mode of transmission -- while devastating to populations of hemophiliacs in the 1980s -- has been controlled in the Western markets through blood donor testing.
"It's not only that when governments face crises involving sex and drugs that they don't do things right," Davids told UPI. "It's that they deliberately do things wrong."
For example, the United Nations AIDS Programme will highlight the fact that injectable drug users account for an estimated ten percent of all HIV cases and nearly one in three new cases outside Africa.
Yet even as many countries move to make HIV treatments more available, drug users remain disproportionately less likely to have access to antiretroviral therapy.
This gap leaves millions without care and potentially fuels the world's fastest-growing HIV/AIDS epidemics. Exclusion is particularly severe in countries of Asia, Eastern Europe, and Central Asia where the largest share of HIV cases are attributed to intravenous drug use.
Davids said she expects the conference will highlight that persecution of gays in some countries and a war against drug paraphernalia, instead of government-sponsored needle exchanges, fail to combat the epidemic and instead foster it.
When the series of AIDS conferences was begun in Atlanta, the focus was on scientific studies to find treatments and find ways to prevent spread of the disease. The meetings went biennial after several disappointing results of clinical trials were announced at the 1994 Yokohama, Japan, conference.
Yet, over the years, the sessions have featured more of the politics of HIV/ASIDS than its science.
That does not mean that research has been forgotten. In Toronto, researchers from Merck will present data on a new class of anti-HIV drugs, integrase inhibitors. These drugs -- which interrupt the ability of the virus to replicate in human cells -- are poised to join the four other classes of HIV drugs.
Robin Isaacs, executive director for infections disease research at Merck, told UPI, "We are encouraged by the results of our 24-week study with MK-0518. We will be presenting the data from those studies at the meeting. We believe that when this integrase inhibitor reaches the market it will give doctors and their patients a new weapon in battling HIV/AIDS."
However, Isaacs said that it is still unlikely that, even with the addition of the long-awaited integrase inhibitors, the combinations will cure the disease. Patients will have to continue to take their medications.
The existing classes of anti-HIV drugs are nucleoside and nucleotide reverse transcription inhibitors such as zidovudine, the first medicine used to fight the disease; non-nucleoside reverse transcription inhibitors such as efavirenz (Sustiva), the backbone of the most widely used combination therapy; protease inhibitors such as Kaletra which, in combination with other classes, almost overnight changed the course of the HIV/AIDS into a chronic disease state; and fusion inhibitors such as enfuvirtide (Fuzeon) which are the only injected anti-HIV drugs.
Other pharmaceutical attacks upon the life-cycle of the virus are also in clinical trials and further results from studies of those drugs will be announced.
The conference will also examine programs in Africa such as in Botswana where universal treatment has been promised and is being initiated by a combination of government and private groups, as well as other developments in microbicides and prevention policies.
Two years ago at the AIDS conference in Bangkok, the U.S. government -- the single biggest contributor in the war on AIDS -- was a virtual no-show. U.S. scientists stayed home to protest ill treatment of its official speakers, including then Health and Human Services Secretary Tommy Thompson, whose speech was drowned out by activists.
This year, more than 175 U.S. delegates will be in attendance to explain the government's policies, including the much criticized ABC standard of Abstinence, Being Faithful and use of Condoms in battling the disease.
Davids said that the conference will also focus on the role of stigma in exacerbating the epidemic. "Stigma comes from government. It is a top-down, not a bottom up phenomenon," she said. Davids said she hopes that the conference will demonstrate how governments can help remove stigma from HIV/AIDS so that the end result is that 2006 will truly be the time that aid for those with AIDS gets delivered.