$4.8 billion plan to fight global AIDS

News  San Francisco Chronicle, Page A1. Friday, 5 July 2002.

Sabin Russell

Circumcision not proven to prevent HIV/AIDS

The money would prevent 29 million cases, experts say

Barcelona, Spain -- Amid signs that the global epidemic is spiraling out of control, top AIDS experts rolled out a costly new prevention plan Thursday that they believe could avert 29 million new infections worldwide by the end of this decade.

The new plan, announced in advance of Sunday's opening of the 14th International AIDS Conference here, calls for a quadrupling of current annual spending on prevention programs to $4.8 billion, from $1.2 billion.

If the world responded with that level of funding, it would surpass the $3 billion spent worldwide on all AIDS programs. The money would be spent to scale up a dozen existing prevention strategies said to have already shown their worth in places where they have been adequately funded. They include condom distribution efforts; media programs that sell the concept of safer sex; HIV-testing programs; blood screening; treatment of sexually transmitted diseases; short courses of AIDS drugs for pregnant women and their newborns; education programs in schools and the workplace; counseling for prostitutes; and programs to reduce needle sharing among injection drug users.

This is a package of proven interventions, said  External link World Health Organization epidemiologist Dr. Bernhard Schwartlander. Schwartlander also warned that the higher spending called for by the plan, which was shepherded by the Bill and Melinda Gates Foundation of Seattle and the  External link Kaiser Family Foundation of Menlo Park, needs to be approved immediately.

If we delay implementation by one year, he told reporters in a telephone briefing, we would cause another 5 million infections. If we delay by three years, it cuts the estimated gains in half. There is no time to lose. Earlier this week, a separate United Nations report warned that the epidemic will kill at least 68 million people by 2020 unless drastic measures are taken to prevent and treat HIV, the virus that causes AIDS.

Schwartlander is the lead author of a complex mathematical analysis of the effect of increased prevention spending on targeted programs. The estimate that such an effort could prevent 29 million infections is drawn from that study, which is to be published in Saturday's edition of The Lancet, a British medical journal. Our blueprint is a response to the Lancet article, said Dr. Helene Gayle, director of AIDS programs for the Gates Foundation. The panel of 40 prevention experts that drew up the plan calls itself the Global HIV Prevention Working Group. It was drawn from around the globe, including United States and United Nations AIDS leaders, as well from African nations where the epidemic has hit hardest and where some of the most successful prevention efforts have been forged. We failed to act decisively in the early stages of the epidemic in sub-Saharan Africa, and now we are paying the price, said David Serwadda, of  External link Makerere University in Kampala, Uganda. But we still have an opportunity to save the next generation in Africa from AIDS, and to prevent runaway epidemics in India, Russia and China. Uganda's high-profile program of condom distribution and open discussion of AIDS and its causes is credited with rolling back infection rates there to 5 percent in 2001 compared with 30 percent in 1992.

Vaccines not included

Not included in the proposal are AIDS vaccines there aren't any that are proven to work yet or the use of antiretroviral drugs to knock down the level of virus in patients' blood plasma, rendering them less infectious. The report concludes that idea remains unproven and that if the costly drugs are made more widely available, they would likely be given to those well along in their disease, diminishing the public health impact.

Also left off the list as unproven is male circumcision. Although some 35 studies have shown that lack of circumcision is associated with a twofold to eight fold risk of getting HIV, definitive studies have yet to be completed. Experiments in Kenya and Uganda may yield an answer in two to five years.

Schwartlander told reporters that there does appear to be a protective effect from circumcision of newborns, there is absolutely no evidence that it would work for adults, and strong arguments that it might go in the opposite direction.

Some activists fear that a push for prevention would come at the expense of efforts to bring cheap AIDS drugs to those infected.

Schwartlander said the alleged conflict between prevention and treatment does not exist. It's a false discussion. It ought to be avoided, he said.


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