There is a striking contrast between the countries where people are dying from AIDS and the countries where they are receiving effective therapy. In Western nations, there were 25,000 deaths from AIDS in 2001, and about 500,000 people were using antiretroviral drugs against human immunodeficiency virus (HIV) infection. In sub-Saharan Africa, however, there were 2.2 million deaths, and only about 25,000 people were receiving antiretroviral treatment.
If there was a single message from this summer's 14th International AIDS Conference in Barcelona, Spain, it was that this situation must change, and change quickly.
"Treatment is technically feasible in every part of the world," Dr. Peter Piot, the executive director of the Joint United Nations Program on HIV/AIDS (UNAIDS), said at the opening ceremony. "I don't know a single place in the world where the real reason AIDS treatment is unavailable is that the health infrastructure has exhausted its capacity to deliver it. It's not knowledge that's the barrier. It's political will."
The emphasis on improved access to antiretroviral drugs throughout the world has been catalyzed by the development of effective medications and by sharp price reductions. It also reflects a growing recognition of global interdependence and the devastating impact of the AIDS pandemic.
Of the 40 million adults and children living with HIV infection at the end of 2001, roughly 95 percent were in developing countries (see Table). HIV infection is spreading rapidly in many areas, including parts of China, eastern Europe, and central Asia. There are now seven African countries (Botswana, Lesotho, Namibia, South Africa, Swaziland, Zambia, and Zimbabwe) where more than 1 in 5 people between the ages of 15 and 49 years are infected with HIV, and another six countries where more than 1 in 10 are infected.
By 2010, orphans (children under the age of 15 whose mothers, fathers, or both have died) will account for 15 to 25 percent or more of all children in 12 sub-Saharan African countries; most of these children will have lost both their parents to AIDS. Also by 2010, the U.S. Census Bureau projects that life expectancy in some countries in sub-Saharan Africa will fall to near 30 years, levels not seen since the end of the 19th century. Without AIDS, life expectancy in Botswana would be 74 years in 2010; with AIDS it is projected to be 27 years.
The International AIDS Conference is a unique forum that brings together diverse groups, including researchers, practicing physicians, government officials, activists and the news media. While researchers presented their findings, Piot and other prominent leaders, such as Nelson Mandela and Bill Clinton, used the conference as a platform from which to galvanize support for more rapid and concerted action.
"We cannot lose the war on AIDS and win our battles to reduce poverty, promote stability, advance democracy, and increase peace and prosperity," Clinton said at the closing ceremony.
Ten billion dollars a year is required for a "minimum credible response to the epidemic," according to Piot. The $10 billion annual figure is more than three times the $2.8 billion that is currently available from governments, foundations, businesses, and other sources. Another $3 billion a year is required for treatment and prevention of malaria and tuberculosis.
"We cannot lose the war on AIDS and win our battles to reduce poverty, promote stability, advance democracy and increase peace and prosperity," former US president Clinton said at the closing ceremony.