Pubdate: Fri, 01 Sep 2006 Source: Albany Democrat-Herald (OR) Copyright: 2006 Lee Enterprises Contact: http://www.mvonline.com/support/contact/DHedletters.php Website: http://www.democratherald.com/ Details: http://www.mapinc.org/media/7 Author: Tom Rafalski, MD Note: Dr. Rafalski is an internist in Albany specializing in HIV. For more information, go to www.aids2006.com. Bookmark: http://www.mapinc.org/women.htm (Women) Bookmark: http://www.mapinc.org/find?137 (Needle Exchange) Bookmark: http://www.mapinc.org/rehab.htm (Treatment) U.S. PLAN ON AIDS NEEDS A CHANGE The 16th International AIDS Conference in Toronto was held August 13-18. I was privileged to attend this, the largest gathering of HIV scientists and activists in the 25 years since AIDS was first described. I still remember, as a freshman medical student, the first case reports of healthy young men developing rare and fatal infections. Fear has given way to knowledge. No other disease has yielded so many discoveries in so short a time. The "cocktail" of HIV drugs became widely available 10 years ago in the developed world. The death sentence of AIDS has been transformed into a manageable chronic condition, as reflected in my own HIV practice. But, 10 percent of all people in the world with HIV, mostly Westerners, receive 90 percent of the treatment. In the developing world, lifesaving drugs were rarely available until three to four years ago. Since then, close to half a million patients annually have started treatment, with a goal of 10 million. But, almost 5 million new HIV infections occur globally each year, and new HIV cases in the USA remain steady. It will take $20 billion a year to deal with global AIDS. Global resources fall into three main categories: President's Emergency Plan for AIDS Relief (President Bush's PEPFAR), The Global Fund (other nations and various donors), and private charities (such as the Gates Foundation). These groups provide about $5 billion a year, roughly equivalent to three weeks of U.S. expenditures in Iraq. So, resources are clearly available, even if political will is lacking. Some say that HIV prevention is easy as ABC: Abstinence, Be faithful, and Condoms. It's so catchy that President Bush's PEPFAR mandates one-third of prevention dollars to go to abstinence-only programs. Data show that abstinence-only does delay the age of sexual activity, but in the long run increases HIV risk compared to programs that also provide a back-up plan. Some of the fastest rising rates of HIV (such as in India) occur in monogamous, faithful married women who were abstinent before marriage. It takes two (not) to tango for abstinence and faithfulness to succeed. PEPFAR ignores this. A huge theme at this conference was women, girls, and HIV. HIV is tied in with poverty, lack of education, and lack of power. Female-based prevention tools are needed now. The Gates Foundation is supporting research in Africa on microbicides for women, gels with anti-viral agents to prevent the spread of HIV. Abstinence-only ignores this option. The other epidemic, especially in Russia, is HIV spread through injection drug use. Plenty of that in Oregon, too! Increased criminalization of drug use is actually associated with increased HIV rates. Transmission is reduced with rehabilitation and needle exchange programs. The scientific debate is over, needle exchange programs work. Nevertheless, our leaders refuse to support this, and still erroneously believe that providing safe injection equipment increases drug use. Finally, data show that free access to HIV care may be the most important determinant of treatment success and prevention. Widespread HIV treatment reduces viral load so that transmission is reduced. Generic drugs can bring treatment cost down to 50 cents a day! President Bush has fought the use of generics and universal access. The USA has among the highest HIV rates in the developed world, an appalling fact. American policy calls for abstinence-only, no needle exchange, no universal access to care, faith-based restrictions on prevention, and drug company profits over human lives. This is not some liberal, partisan rhetoric. It is a plea for common sense and pragmatism to use proven tools to fight AIDS, save lives, and save money. Leadership from above is lacking, so please do what you can from the ground up: Contact your legislators, school board, do something. Clinging to ideology over evidence can kill. - --- MAP posted-by: Beth Wehrman