Vancouver conference brings good news on AIDS treatment

By Gwynne Dyer

LONDON (JP): "We can't claim victory until the fat lady really sings," said Dr. Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases, at the 11th international conference on AIDS in Vancouver. "She hasn't sung yet, but I think she is getting ready to sing."

The Vancouver conference, which opened on July 7, marks the first time that researchers think they are getting close to effective treatments for AIDS and its precursor, HIV infection. New combinations of drugs, particularly the class known as protease-inhibitors, are producing startling cases of remission from full-blown AIDS, and have reduced the HIV virus in the blood of HIV-positive people to undetectable levels for up to half a year.

If these early results are borne out by further tests, and if the new drugs continue to suppress the HIV virus over a period of years without severe side effects, then this is wonderful news for millions of HIV-positive people.

More precisely, it is wonderful news for those HIV-positive people who live in countries that can afford the US$15,000- $20,000 annual per capita cost of the treatment, and in social environments that let them follow a regimen of treatment involving up to 20 pills a day and strict dietary rules. It means nothing to the other 90 percent of HIV-infected people, who live in the Third World.

In the United States, an estimated one in 92 young men was HIV-positive in 1992. Until now, that was a delayed death sentence for the vast majority of those infected: HIV takes an average of ten years to develop into AIDS, but there was no cure.

In all, perhaps a million Americans carry the HIV virus, out of a population of 260 million. A million nightmares -- but the AIDS plague has never threatened the economic and social fabric of the United States or other developed countries. And maybe now medicine will provide an escape from the nightmare, for those who can afford it. Elsewhere, the situation is very different.

In Uganda, according to a 1994 report of the UN Food and Agriculture Organization, "it is estimated that half the population over 15 years of age is HIV positive." Uganda has no money to save these people even if a cure is found -- so half its adult population is destined to die in the next ten years.

This is a level of casualties normally associated only with scenarios for nuclear holocaust, but it is happening in Uganda now.

The U.S. Census Bureau estimated two years ago that life expectancy in Uganda, projected at 59 years before AIDS began decimating the population, will fall to only 32 years by 2010.

The rest of west, central and east Africa faces a catastrophe only slightly less dramatic: over half the hospital beds in several big cities in the region are now occupied by AIDS patients. Even South Africa, where health care and nutrition are well above the continental average, now has an HIV infection rate of 7.6 percent.

Infection rates are also so high in some non-African countries that they have drastic implications for population size. The same 1994 U.S. Census Bureau report estimated that in Brazil, Haiti and Thailand, plus the 13 worst-affected African countries, the cumulative AIDS toll by 2010 will be so great as to leave them with 121 million fewer people than was previously forecast.

New protease-inhibiting drugs will save almost none of these lives -- nor those of the tens of millions of people in Asian countries like India and the Philippines where HIV infections are spreading just as fast, but are less well reported. The hope dawning in Vancouver is only hope for the relatively rich. But there is hope of a less expensive variety dawning elsewhere.

Working with 1991 data, the U.S. Census Bureau predicted that AIDS deaths in Thailand would soar so fast that the average lifespan would fall from 75 to only 45 years -- and that the country's population would actually fall one percent by 2010.

The man most responsible for turning this situation around is Mechai Viravaidya, the director of the Population and Community Development Association, also known as the 'condom king'.

In 1991, when the Thais realized the size of their AIDS problem, Mechai was the obvious man to turn to. "We made a projection that if nothing were done from 1991 onwards to the year 2000, we would have between two million and four million HIV-positive cases," he told me late last year. "The situation is actually far worse in other Asian countries, but they don't know their exact problem, so they sit there and smile. They expect people to fall over in the streets. That's not what happens with AIDS."

"We knew that if we did nothing, these would be the numbers, these would be the economic and social consequences. As a result, we did a lot. Public education was available on television and radio, compulsory in fact. Every hour, there must be a half- minute of AIDS education on every radio and every television station."

"There is AIDS education in the last two years of all primary schools. AIDS education was done in offices and factories, and in the rural communities through the schools and the village committees. And we also cooperated with the movie and television industry: if they produce regular films and soap operas with an AIDS theme added in, the government subsidized them."

"As a result, 1991 was the year that new HIV cases peaked in Thailand. From 1991 to today, we have seen a 77 percent decline in sexually transmitted diseases, and we believe a very similar decline in new cases of HIV. The projections for the year 2000 are no longer relevant. Behavior change has occurred."

What Thailand has done, any other country can do. The heartening news out of Vancouver will give little solace to the millions of doomed HIV-positive people in poor countries, but there are ways to keep tens of millions more from joining them.