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Asia on precipice of disaster
With smoldering epidemics in China and India, region at 'critical
juncture'
By Sabin Russell
July 11, 2004
Bangkok -- At least 12,000 delegates from around the globe are converging on
this Southeast Asian capital city for today's opening of the 15th International
AIDS Conference, a six-day event that organizers hope will strengthen world
resolve to combat a disease that has already claimed at least 20 million lives.
A blend of political theater, medical research and social science, these AIDS
conferences focus world attention on the gravity and scope of the epidemic and
help to set the course of future efforts to contain it.
"This is the biggest epidemic in human history, by any standard," said Dr.
Peter Piot, executive director of UNAIDS, the Joint United Nations Program on
HIV/AIDS in Geneva. He said it will take $12 billion a year to fight the
epidemic in 2005. This year's six-day meeting is likely to be dominated by
discussions -- and protests -- surrounding the question of how to bring the
costly combinations of antiretroviral drugs to millions of AIDS patients in
poor countries.
The theme of the Bangkok conference is "Access for All," posing a direct
challenge to wealthy nations to come up with strategies to provide AIDS drugs
to the poor. There are 38 million people infected with HIV, the virus that
causes AIDS, and nearly all of them eventually will need antiretroviral drugs
to survive.
Because of its setting in Bangkok, the conference also will highlight the
problem of AIDS in Asia. An estimated 7.4 million people across the giant
continent are living with HIV. There were 1.1 million new infections last year
in Asia alone, according to UNAIDS.
India and China, home to 2.2 billion people, are both coping with smoldering
epidemics that represent less than 1 percent of their populations but add up to
millions of infected people.
The conference is drawing important Asian political leaders. Chinese Premier
Wen Jiabao, Thai Prime Minister Thaksin Shinawatra and India's Congress Party
leader Sonia Gandhi -- who would have been named her country's prime minister
had she not turned the job down -- will address the delegates.
Newly released UNAIDS estimates put HIV infections in India at 5.1 million.
According to Dr. Richard Feachem, executive director of the Global Fund to
Fight AIDS, Tuberculosis and Malaria, India stands at a "critical juncture"
that could determine the course of the epidemic.
While most health experts doubt that HIV will explode in Asia as it did in
Africa -- in sub-Saharan Africa, it's estimated that 7.5 percent of adults
between the ages of 15 and 49 are HIV positive -- just a small increase in the
percentage of those infected in this most populous region on Earth would create
a vast human catastrophe.
Thailand itself has been a showcase for successful HIV prevention. Heavy
promotion of condom use in this country's commercial sex industry has reduced
annual infections to an estimated 21,000 from 140,000 in 1991. But a new report
by the United Nations Development Programme warns of "a possible new wave of
infections" due to growing complacency.
It found that only 20 percent of young sexually active Thais are now using
condoms consistently. Half of all injection drug users are now infected,
compared with 30 percent 10 years ago. Infection rates among gay men have risen
to 17 percent from 4 percent in the same time frame.
"I think we have lost the momentum," said former Thailand Prime Minister Anand
Panyarachun, in an interview published in the U.N. report.
That may not be the kind of attention Thailand was seeking when it agreed to
host the session, but it is an example of how the conference itself can
spotlight problems.
"The fact that the meeting is taking place in Asia will bring the focus once
again on the developing world," said Dr. Anthony Fauci, director of the
National Institute of Allergy and Infectious Diseases.
AIDS researchers no longer use the conferences to release their most important
findings. There has been enormous progress in scientific understanding of HIV,
but discoveries now tend to come in incremental steps, rather than major
breakthroughs. "We've been studying this disease for a long time, and the
low-hanging fruit has already been picked," Fauci said.
But he said the international conferences still provide a valuable opportunity
for the global AIDS community to take stock of its successes and failures in
fighting the epidemic.
Fauci will be leading a sharply curtailed U.S. government presence at this
year's conference. Citing budget constraints, the Bush administration decided
that only 50 scientists from the Department of Health and Human Services could
travel to the Bangkok session. That compares with 236 who were sent to the last
AIDS conference in Barcelona.
During the Barcelona conference, Health and Human Services Secretary Tommy
Thompson was famously booed off the stage by rowdy AIDS activists, and critics
of the Bush administration see the cutbacks as retaliation.
"It's outrageous that they would limit access to their scientific experts at
such an important meeting," said Dr. Paul Zeitz, executive director of the
Global AIDS Alliance in Washington, D.C. "They are undermining the whole global
response to the epidemic."
Bill Pierce, a spokesman for Thompson, acknowledged that many government
researchers were displeased with the decision. However, he said the
administration was in fact being flexible with a new policy that limits
delegations to 40 government scientists at international conferences.
"It's a perfectly human reaction, but I would even call it a bit of whining on
their part," Pierce said.
The United States spent $3.6 million on the Barcelona conference. The budget
for Bangkok has been trimmed to $500,000. Randall Tobias, a former Eli Lilly
executive who is heading President Bush's $15 billion overseas AIDS initiative,
will play a prominent role at the Bangkok conference, with numerous speaking
engagements to describe the U.S. program that will pay for AIDS drugs and
prevention programs in the focus countries.
Although Bush temporarily hushed critics of his AIDS policies when he announced
his plan during his State of the Union address in January 2003, the program is
now under attack because of the time taken to implement it.
Opponents of the president's approach also complain that Tobias has put up
barriers to purchasing the lowest-cost drugs made by Indian
pharmaceutical-makers in favor of more expensive, branded products made by
American and European firms.
Like a mountain that creates its own weather, the AIDS conferences, scheduled
every two years, tend to generate surges of publicity about AIDS, particularly
as it affects the developing world, and initiatives such as the Global Fund to
Fight AIDS, Tuberculosis and Malaria, and Bush's emergency plan, have often
followed.
Although the International AIDS Conference tends to break no ground in science,
the session has powerful symbolic importance, said Drew Altman, president of
the Kaiser Family Foundation in Menlo Park.
"The event has a catalytic impact on groups and government organizations
working in the field," he said. "Everyone gears up an initiative so they have
something to announce there."
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