Despite AIDS Successes, HIV Prevention Efforts Falter

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At the international AIDS conference in Toronto, experts tell of successes in delivering treatments to the poorest corners of the world. But stresses are emerging: a weak health care system, a lack of drugs for children, and the high cost of therapies for those whose first-line treatment has failed. The most pressing problem is the failure of HIV prevention efforts to expand as fast as treatments have.

MELISSA BLOCK, host:

From NPR News, this is ALL THINGS CONSIDERED. I'm Melissa Block.

MICHELE NORRIS, host:

And I'm Michele Norris.

The AIDS pandemic has afflicted more than 60 million people worldwide and killed 25 million. As the 16th International Aids Conference gets into full swing today in Toronto, there is encouraging news about success in getting AIDS treatment to the poorest corners of the world.

But as NPR's Richard Knox reports, that's tempered by emerging problems in treatment and the need to do much better in preventing new infections.

RICHARD KNOX reporting:

Haiti is this hemisphere's poorest country and the one with the highest rate of HIV. So Dr. Bill Pop's assessment of AIDS in Haiti is pretty remarkable.

Dr. BILL POP (Treatment network, Haiti): I think that Haiti is doing quite well handling the HIV epidemic.

KNOX: Pop leads one of three treatment networks in Haiti. Together they have 8,000 Haitians under treatment to suppress the AIDS virus. He says anybody who comes to his clinics will get treated.

Dr. POP: It's no longer a drug problem. We have the drugs. We have the capacity to care for people who need the antivirals. So the major problem now is to identify those who really need them.

KNOX: That is testing many more people to find out if they're infected and how sick they are. Pop thinks there may be 150,000 Haitians with HIV. About 25,000 may need treatment. By 2008, he's confident they'll be getting it.

Dr. POP: I think that we can do it. We firmly believe that within two years we'll reach that magic number of 25,000 people and that we would have covered the entire country.

KNOX: And Pop says treatment outcomes are as good as anywhere. Haiti's not unique. A report from Zambia in south central Africa, where one in six adults has HIV, shows similar results. Zambia has a sever shortage of doctors, but 16,000 Zambians treated mostly by nurses and other clinic workers have survival rates just as good as in Los Angeles or London.

Dr. Kevin De Cock of the World Health Organization predicts rapid expansion of HIV treatment in Africa and around the world.

Dr. KEVIN DE COCK (World Health Organization): The attitude internationally towards the treatment of HIV/AIDS is radically different from what it was five years ago. I think today anybody anywhere has a legitimate aspiration to access to HIV treatment.

KNOX: But De Cock says stresses are amounting.

Dr. DE COCK: A major obstacle in developing countries, particularly in Africa, is the frailty of health systems, the whole gamut. Healthcare workers, physical infrastructure, laboratory capacity, procurement systems, fiscal management systems, the weakness of all of that is a formidable barrier.

KNOX: That's why fewer than 10 percent of pregnant women with HIV in sub-Saharan Africa are getting the drugs they need to prevent passing the virus to their babies.

Dr. DE COCK: This has been a very disappointing area and, frankly, kind of a shocking one.

KNOX: The 2 million children with HIV are also being left behind. Their care is more complicated and pediatric drugs just aren't available. And then there's the problem of treatment failures. Each year about 10 percent of people become resistant to first-line AIDS drugs and need second-line and third-line therapies that cost from two to 28 times more.

Dr. AMERTO SCHAFER(ph) (Doctors Without Borders): Eventually, they will fall sick just as they fell sick before they had access to the first-line treatment and will die over their immunosuppression if they don't have access to drugs.

KNOX: Dr. Amerto Schafer of Doctors Without Borders says these and other problems temper her outlook.

Dr. SCHAFER: It's too early for pessimism, but it's really not the right time for overwhelming optimism.

KNOX: The most compelling reason for that is the failure of HIV prevention efforts to expand as fast as treatment has. Addressing the conference's opening session, philanthropist Bill Gates pointed out that for each person who enters into HIV treatment, ten more become infected.

Mr. BILL GATES (Bill and Melinda Gates Foundation): When you extrapolate out to ten years you quickly see it's very difficult to do what morality requires -treat everyone with HIV - unless we dramatically reduce the number of new infections.

KNOX: Haiti has managed to do that. Aggressive prevention efforts have cut the number of HIV infections there in half. But that's a success story that has few equals.

Richard Knox, NPR News.

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AIDS Snapshot

OVERALL

— 65 million total HIV infections

— 25 million HIV deaths

— 38.6 million people currently living with HIV

2005

— 2.8 million people died of AIDS

— 4.1 million people were newly infected

AFRICA

— Southern Africa is the epicenter of the global epidemic

— 64 percent of the world's HIV population lives in sub-Sahara African

— Transmission is primarily through heterosexual contact

— More women are HIV infected than men

— More than 10 percent of the adult population (15 to 49 years) is infected in most Southern African countries

— In Botswana, Lesotho, Swaziland and Zimbabwe, more than 20 percent of the adult population is infected

— South Africa (along with India) has largest number of people, 5.5 million, living with HIV

— 17 percent of those in need of antiretroviral treatment receive it

UNITED STATES

— The U.S. has seen resurgence in HIV transmission in recent years, primarily among men

— An estimated 800,000 people are infected

— 25 percent of those infected don't know

— 44 percent of new infections are in gay men

— Blacks and Hispanics account for 69 percent of all reported HIV cases

— 55 percent of those in need of antiretroviral treatment receive it

Source: Centers for Disease Control and Prevention

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