BARCELONA: Delegates to the 14th International AIDS Conference departed for their 194 home countries this weekend with the first glimmers of belief that the world may finally be ready to take on the global AIDS pandemic, 21 years after the disease emerged seemingly out of nowhere.
Over the next few months, programmes that seemed inconceivable, and even foolhardy, a few years ago will commence. They will include efforts to massively increase AIDS prevention; to bring AIDS drugs to hundreds of thousands of people living in the world’s poorest countries; to create a global arbiter of AIDS spending; and to extract, year after year, billions of dollars from the wealthy nations of the world.
How much of this will work is the big question. But whether these things will be tried is no longer in doubt.
“This is the summer when everything will change,” Paul Farmer, an American physician treating AIDS patients in Haiti, told the delegates on Thursday. “A lot is going to happen this year.”
International AIDS conferences are unwieldy combinations of scientific conversation, transnational networking, political theatre, commercial promotion and, often, manufactured conflict and consensus. This one was the largest — about 15,000 people attended — and probably the most unwieldy ever. Nevertheless, these conferences sometimes become historic moments themselves in the unfolding narrative on AIDS, the worst epidemic in modern times.
If that proves to be the case with the Barcelona conference, it will be because, in some fundamental if unprovable sense, globalization came to AIDS this week.
No longer are the shocking tallies of infection and death, spelled out and released each year by World Health Organization epidemiologists, the only thing about AIDS that unites nations. Now, there’s a dawning realization that what has been done to fight the epidemic in the world’s wealthier nations can probably be done anyplace.
The seed of that realization was planted two years ago when the International AIDS Conference was held for the first time in a place being decimated by the epidemic — South Africa. There, the huge inequity in response to AIDS between rich countries and poor ones became intolerable in a way it hadn’t been previously. Since then, events have transpired and mechanisms have been put in place that — theoretically, at least — can start bridging that gap.
The list of those things is long. It includes a 90 per cent decline in the prices of antiretroviral drugs destined for use in the developing world. It includes greatly improved epidemiological information about the disease’s toll, and the toll of its toll, such as the number of children now orphaned, or expected to be over the next 20 years, by AIDS.
It includes the United Nations General Assembly Special Session on AIDS, held in June 2001, that set targets for increases in prevention services and decreases in disease transmission through 2015.
In the past two years, there has also been a huge addition to the body of knowledge about what AIDS prevention strategies work in high-prevalence areas. Guidelines for using three-drug combinations of antiretroviral medicines — the standard of care for the infection — have been simplified to a point where there is essentially no setting too deficient in resources to use them if they’re available.
Perhaps most important is the creation of the ‘Global Fund to Fight AIDS, Tuberculosis and Malaria’.
While many people privately share this feeling that much has been accomplished recently, few will say so openly. To do so risks sounding complacent, or even self-congratulatory, in the face of an epidemic that is proceeding essentially unimpeded by human intervention, with 40 million people now infected and 45 million new infections expected by the end of 2010.
Drugs for a year’s worth of triple therapy for one patient can now be bought from US and European pharmaceutical houses by the poorest countries for as little as $1,200 — a tenth of the price charged in industrialized nations. Generic manufacturers in India, however, can substantially undercut that, with the current cheapest combination from one company offered at $209 for a year of pills.
Health economists believe the price must fall to about $30 to $40 a year before the cost of drugs ceases to be an impediment to treatment in the poorest settings. Prices that low are not expected in the foreseeable future, if they’re even theoretically possible. —Dawn/The Washington Post News Service.