Costly campaign against AIDS looks past treatment to prevention

This article appeared in the International Herald Tribune UNITED NATIONS, New York - Having won big price cuts for AIDS drugs sold in poor countries, groups in the fight against the epidemic are now pressing for a far broader line of attack, one that would cost billions of dollars at a time when traditional sources of financial aid have been shrinking. Among institutions ranging from the United Nations and wealthy governments to public health groups and foundation researchers, the groundwork is being laid for a broad campaign against the epidemic in Africa and Asia. An estimated 36 million people worldwide are infected with HIV, 70 percent of them in Africa, and experts are looking beyond treatment drugs. Among emerging issues are more effective education and prevention programs, better clinics, larger numbers of trained health-care workers and imaginative development projects to put societies devastated by AIDS back on their feet. "Cheaper anti-retroviral drugs, however vital, will not, by themselves, provide the answer," the UN secretary-general, Kofi Annan, has said, summing up the new campaign and referring to the drugs now used to slow the spread of AIDS in the body and to combat its symptoms. "Without proper health care, they may even do more harm than good." AIDS experts in Africa and around the world insist that the epidemic's spread can be contained at the same time that treatment is made more accessible for those now infected. Senegal and Uganda have demonstrated this, with limited money but a decisive political commitment. They have brought the topic out into the open, reducing the stigma, and have encouraged many interests to get involved, from schools to clinics. But the costs are in the billions of dollars - some projections range as high as $15 billion annually for a decade or more - so advocates are stressing what they see as a need for creative solutions. Ideas from universities, research organizations, foundations, Congress and American business leaders spring from an underlying assumption that the epidemic goes beyond the possibilities of traditional foreign aid. That source has been declining, particularly in the United States. Large international organizations, including the United Nations and the World Bank, do not have money of their own to spend on the necessary scale, either. Instead, governments, in rich and poor countries alike, are being asked to consider a blend of public and private initiatives, with tax relief, larger subsidies and other economic incentives for corporations, not just for drug companies. On Monday, Mr. Annan took his appeal to a meeting in Philadelphia of representatives of 1,800 private foundations with assets totaling more than $300 billion. Several foundations have already been among the largest contributors to programs to fight AIDS in Africa. Unaids, the United Nations program on HIV/AIDS, which is based in Geneva, said that foundations gave $160 million to the cause last year. And next week in Istanbul, a meeting of international experts will struggle over how to close a widening gap between contraceptive supply and demand at a time when doctors are trying to stanch the infection of ever younger, more vulnerable people - many now girls in their teens. While experts welcome the lower prices on the anti-retroviral drugs to prolong the lives of people with HIV, they note that, in the poorest countries, even the reduced cost is still too high for most people. Moreover, these drugs - unlike condoms - do not stop the spread of the disease. A special General Assembly session on AIDS is planned for June, the first ever held to deal with a disease, and experts agree that it must conclude with concrete results on how to raise money. In a speech Thursday in Nigeria, Mr. Annan proposed the creation of a global fund dedicated to fighting AIDS and other infectious diseases. "The war on AIDS will not be won without a war chest, a size far beyond what is available so far," he said. His estimate was that $7 billion to $10 billion would be required each year. Quickly after that speech, the Group of Seven industrial nations, meeting in Washington, began to discuss a much bigger program to fight AIDS and other infectious diseases. James Wolfensohn, president of the World Bank, said $3 billion to $4 billion is needed annually for a reliable program for AIDS prevention and treatment in Africa. But the United States warned that spending had to be tailored to local conditions to succeed. Unaids officials say that the agency, the first at the United Nations created for a single disease, is just approaching the $1 billion mark in annual commitments now. That includes money from governments - including some of the poorest African governments, which are turning over money from debt relief - as well as from regional development banks and private organizations. About $500 million in loans from various sources is being made available to Africa over five years. In his speech in Nigeria, Mr. Annan listed his priority targets: prevention, a reduction in mother-to-child transmission, wider access to drugs and treatment, scientific advances and the care of orphans. His list reflects the thinking of many leading researchers. They say it is imperative to stop the rapid spread of the disease. Eric Friedman of the Lowenstein International Human Rights Clinic at Yale Law School and Paul Zeitz of the Global AIDS Alliance wrote in a paper last month: "AIDS is no longer only a disease of the individual; it is a societal malignancy." The Global AIDS Alliance is a group formed this year to advocate broader support for programs to fight the disease on many fronts.