AIDS Conference Draws Attention to Advances and Challenges

Returning from the recent International AIDS Conference in Toronto that drew 20,000 to 25,000 people, Iram Nadeem, MD, came back excited about the growing tide of concern focused on eradicating AIDS.

"The theme of the conference was 'Time to Deliver,' and now more than ever, it's time to hold accountable governments on the promises that have been made about curing global AIDS," said Dr. Nadeem, Medical College of Wisconsin Assistant Professor of Medicine (Infectious Diseases).

Dr. Nadeem heads up the new Women's AIDS Clinic at the AIDS Resource Center of Wisconsin (ARCW). In addition to her duties at the ARCW, Dr. Nadeem sees patients at the Froedtert & The Medical College of Wisconsin Infectious Disease Clinic.

Dr. Nadeem saw an increasingly unified focus arising from the conference. "It was heartening to hear people talking about prevention and treatment as two faces of the same coin," she states. "There was consensus about the need for access to care for all AIDS victims, getting into areas with high rates, prevention, and recognizing that outreach efforts haven't touched many people so far."

Former President Bill Clinton has contributed to the global effort against AIDS; he has been a particularly effective spokesman exerting influence worldwide to persuade governments to commit resources to fighting AIDS, says Dr. Nadeem. "Clinton's voice has really made a difference, and he has traveled to many countries," she observes. "He speaks so clearly on this issue, and it's made a lot of difference. It's good to see political leaders standing up."

Also encouraging was the support of organizations such as the Bill and Melinda Gates Foundation, which has invested heavily in distributing AIDS vaccines across the world.

"We're seeing AIDS rising among women, and you wonder why it is still happening," says Dr. Nadeem. "There are four million new infections a year, so we need to be getting prevention in the hands of women. Condom use is limited in effectiveness, and women are male-dependent in many cultures. Condom programs don't work by themselves."

An essay written by Melinda Gates, appearing on the Gates Foundation website and first published in the May 15, 2006 issue of Newsweek, elaborates on the problem: "Despite the array of breakthroughs we've seen for AIDS treatment, prevention efforts still rely on the three practices described by the abbreviation ABC ("abstain, be faithful, use condoms"). These approaches work, and we must encourage them, but they all depend on a man's cooperation. For millions of married women, abstinence is unrealistic, being faithful is insufficient and the use of condoms is not under their control."

Drug Prices Prohibitive
The high price of AIDS drugs set by major international pharmaceutical firms, backed up by patents and intellectual property rights, was also a key issue at the conference. "Two nations, Brazil and India, have been making generic drugs at low prices," notes Dr. Nadeem, but large drug companies appear to be unwilling to grant licenses to manufacture these drugs, for which they own the legal rights.

After wide-ranging appeals from non-governmental organizations and medical groups, US drug firms have begun to lower their prices for AIDS drugs from several thousand dollars to about $120 per year in poor nations. But even the new price is out of reach for many poor AIDS victims, says Dr. Nadeem. "We really are at a point in world history where medications should be available to those who need them for survival."

On the positive side, there have been hopeful new developments in the form of microbicides. "These new gels or creams function by not letting the virus through. They will be effective, safe, and affordable," Dr. Nadeem reports. "There are now many trials of microbicides in advanced stages."

In addition, nations such as Thailand and China, which had previously neglected the AIDS problem, are now starting to make serious attempts to address the spread of the disease.

Challenges in Africa
"But our biggest challenge is in Africa," where AIDS is spreading fastest, says Dr. Nadeem. Although South Africa is by far the most prosperous of sub-Saharan African nations, the government has downplayed the problem and its prevention.

When genuine AIDS cures are made available, there has been remarkable progress made in restoring the health of victims and slowing down the spread of the disease. "There was much speculation that poor countries and people would not be compliant in taking the medications," says Dr. Nadeem. These notions are all being proven wrong, she notes: "Studies actually show more compliance in poor countries."

More Testing Needed
Another myth challenged at the conference is the idea that testing is needed just for "high-risk" groups like gay men and intravenous drug users. "You can't define AIDS by high-risk groups. You don't just test certain populations," Dr. Nadeem maintains. "Yet you'll hear even doctors say, 'they didn't look like the kind of person who would be infected.'"

The newest approach promotes an "opt-out strategy" where AIDS testing is conducted among all patients, unless the patient asks to bypass the test. This strategy reflects the need for much broader testing. "Around the world, over 95% of AIDS victims do not know that they're infected. But some rapid tests are becoming available and making testing easier."

There are also positive developments on the treatment front, with many new medications being introduced and simpler treatment regimens being developed. Instead of taking multiple medicines at carefully-set time intervals, now three medications have been combined into one pill taken daily.

"Overall, we heard a lot of good news about new medication and expanded access," Dr. Nadeem says. "The conference was helpful in bringing the global picture back to us and reminding us of how fortunate we are here in the US. Our challenge is to make the US standard of care available across the world."

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.