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.
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MAP posted-by: Beth Wehrman